From California Dreaming: “Re: privacy statement on Amazing Charts Web site. Funny stuff!” It is funny. “ … USE COMMON SENSE WHEN USING THIS SITE AND THE AMAZING CHARTS SOFTWARE, AS WE ARE NOT RESPONSIBLE FOR YOUR LIFE AND DECISIONS … USE COMMON SENSE WHEN GETTING INFORMATION FROM THE INTERNET, SOFTWARE, LIBRARY, ENCYCLOPEDIA, DOCTORS, OR ANYBODY ELSE. WEAR SUNSCREEN, USE SEATBELTS & CONDOMS WHEN APPROPRIATE, AND PROTECT YOUR EYES WHEN USING POWER TOOLS.”

From Ex-Concerro!: “Re: layoffs. Concerro laid off all but one of its QA department and demoted the VP of engineering. They have been unable to stabilize the product since 5.0, which was an attempt to turn a shift-bidding product into a scheduling product.” Unverified.

From Personal Problem: “Re: palm biometrics for patient ID. I would refuse to use it since those can be intercepted or hacked. Then what — get a new palm?”

From Nancydoll: “Re: GE Healthcare IT Enterprise Solutions. Laurent Rotival ousted – there on Monday, gone on Tuesday.” Unverified. GE doesn’t comment on personnel issues. His LinkedIn profile is unchanged.

From Aldonza: “Re: PKI security. Have solo practitioners or small groups tried it? Some technologists say its simple to implement, others are skeptical.” Your comments are welcome.

The Dubai government talks up HIMSS Middle East 2010, expecting 300 people at the November 8-10 conference.

A new report by HIT research and advisory firm CapSite covers the HIM market: vendor penetration, mind share, buying plans, etc. based on information gleaned from 500 hospitals. They sent over the full report for me to check out and it was interesting – hospitals are considering lots of new HIM vendors for buying opportunities of an extremely short time frame (less than a year). The table of contents is here (warning: PDF).

The eClinicalWorks user conference started Sunday in Orlando, with over 2,500 attendees.

Weird News Andy rises to the “beer bottle in the colon” challenge, saying, “I raise you some precious gems. I suppose this guy wanted to be the King of Diamonds. what a card!” Police in India arrest an airline passenger on the rumor that he is carrying diamonds. His bags were found to be empty, but he fidgeted suspiciously during questioning, claiming his hemorrhoids were acting up. The hospital X-rayed him and found 42 condoms’ worth of precious stones that he had swallowed. The diamonds were re-mined with the help of laxatives and bananas.

From the last poll, it’s an even split whether “best places to work” companies are really all that great to work for. New poll to your right: will you be participating in the upcoming HIMSS Virtual Conference?

Epic put up a fun Halloween-inspired home page for the weekend, including some bats randomly flying around (since they’re in the Midwest, that made me think of John Candy and Dan Aykroyd in The Great Outdoors, if you’ve seen that scene).

Quality Systems (NextGen) reports Q2 numbers: revenue up 14% to $81.5 million, EPS $0.46 vs. $0.41, with both revenue and earnings falling short of expectations. The Street was looking for $85.7 million and $0.49.

Meditech’s quarterly numbers: revenue up 23%, EPS $0.89 vs. $0.57.

CPSI’s Q3 numbers: revenue up 24%, EPS $0.45 vs. $0.37.

Memorial Healthcare System (FL) signs up for ExactCost’s Cardiovascular Service Line software, allowing it to support activity-based costing.

Chubb Group adds an insurance program for the healthcare IT industry, covering defective software that causes patient harm, liability for data breaches, and the cost of notifying consumers of a data breach.

States don’t have the expertise or money to develop the Health Insurance Exchanges, consumer insurance marketplaces that are mandatory by 2014. HHS announces Early Innovator grants that will be available to up to five states who develop systems that other states can use. HHS announces said that it will announce financial help for all states in February.

A Massachusetts court gives the OK for a private equity firm to take over Caritas Christi, Boston’s Catholic hospital system, for $895 million. Cerberus Capital Management will turn it into a for-profit entity. Closing is expected within a month. The company can cleave ties with the Catholic Church for a $25 million payment.

Microsoft’s HealthVault personal health platform will enter the Chinese market as the company signs an agreement with iSoftStone Information Technology. The announcement says that a total of 150 hospitals are connected to its platform worldwide, which seems pretty skimpy.

St. Joseph’s Hospital (CA) devotes its annual gala to raising money for its EHR, raising $160K from 600 guests who got to play around with iPads and the Microsoft Surface coffee table thingy.

West Penn Allegheny Health System (PA) will lay off 400 employees, most of them from West Penn Hospital, in a restructuring plan.

I really like this idea: a team from Norwood Hospital (MA) and its community health partners use a $200,000 grant to create a LifeBox within their EMR. Hospitalists interview patients about their backgrounds and record the wishes, values, and goals of those patients in their LifeBox so that other caregivers can understand what’s important to them. I think Norwood is one of the Caritas Christi hospitals that will soon be going for-profit.

Sponsor Updates

• Three hospitals in Sweden will implement iMDsoft’s MetaVision for their ICUs, ORs, and PACUs.
• eClinicalWorks announces its Version 9.0 and a new site, 100millionpatients.com, as a patient portal with PHR access.
• RelayHealth’s RelayClinical EHR receives ONC-ATCB certification from Drummond Group.
• Allscripts was a joint presenting sponsor of the Walk to Cure Diabetes held October 30 in Raleigh, NC.

E-mail me.

Article Review
Health information technology: fallacies and sober realities

 

A reader asked me to review this paper, which just appeared in the October issue of JAMIA.

The first thing I noticed is that it was published as a “viewpoint paper.” Rightly so: it’s a lot of footnoted opinion. The problem with opinion papers is that those who agree with their conclusions laud the work as pivotal, long-overdue, and seminal. Those with different points of view say that fancying up personal opinions in a published article, by grant-funded academics, is no more credible than watercooler chatter.

It’s a mildly interesting piece, but the only folks likely to proclaim it as a work of great insight are those who have already convinced themselves that electronic health records, the companies that sell them, and the providers use them successfully are clueless and/or evil (I should mention that the authors use the broad term health information technology, but are writing specifically about clinical information systems from what I can tell).

My red flag went up immediately with this sentence in the abstract: The twin issues of the failure of HIT adoption and of HIT efficacy stem primarily from a series of fallacies about HIT. An article that can definitively state the reason that providers don’t use EMRs or that they underperform would indeed be useful, right? Only if the statement is backed by proof, which I don’t see here.

The authors come up with a Letterman-like list of 12 "misguided beliefs about HIT.” Who holds these beliefs is not documented, but the implication is that the authors observed them in some capacity. Maybe they are right and these exact 12 misguided beliefs mean that HIT is in need of a reboot. Or, maybe they worked back from the conclusion that HIT needs a shake-up and selectively chose the ones that made their case.

Here are the 12, reworded to make the opinions of the authors clear:

IT risks are not as minor or easily manageable as IT people think.

The article says that “many designers and policymakers believe that the risks of HIT are minor and easily manageable” (without referencing how they know that). They correctly observe that it’s hard to develop and implement systems as planned, that humans are fallible, and that software problems are hard to prevent and can have widespread impact. Everybody reading that paper or this post probably already knows that.

Being an opinion piece, the authors recommend as a solution: regulation and/or independent, external validation. I agree that some degree of oversight is needed for specific types of HIT. That’s still just an opinion (that of the authors and me). I’d like to have seen citations of articles researching the outcomes of getting the government involved in product regulation.

HIT is a medical device.

This is stated as a fallacy: “the belief that HIT can be created and deployed without the same level of oversight as medical devices.” That’s not really a fallacy since that’s the current state. It’s just another way for the authors to opine that the government should start regulating clinical software.

The article makes a good (but obvious) point: humans can’t be relied on to catch computer mistakes. It doesn’t make another equally good and obvious point: computers catch a lot of human mistakes. Based on the conclusion that HIT can’t be trusted unless it’s regulated, hospitals should immediately stop using bar code scanning, CPOE, clinical decision support, etc. because they might mislead gullible but otherwise error-free clinicians.

The following unreferenced conclusion about lack of FDA oversight would have been struck out of any article not labeled as an opinion piece: “The current approach can no longer be justified.” Says who?

Humans are not the problem when software fails to improve outcomes or efficiency.

This is another obvious point. Outcomes are system-related (people, processes, oversight, etc.) Bad users acting individually aren’t usually the problem. I also don’t know anyone who would say that — is this really a common fallacy that required debunking?

Just because clinicians use a system doesn’t mean it works.

The conclusion seems to be that “meaningful use” is situational, which is absolutely true. Sometimes users don’t get a choice in the decision to use or not use a system. Still, we’re talking about highly educated and licensed professionals who still bear the responsibility to speak up if a system is unsafe.

It’s also true that the same problem happens with paper. Individual providers don’t necessarily get to decide for themselves whether to complete certain kinds of paper documentation, regardless of whether they see value in that activity.

Clinical work is messy and can’t be rationalized into something linear.

It is true that programmers think linearly and logically, so IT systems are designed that way. But it’s also true that software often organizes and standardizes, which is the only hope to improve medical care beyond individual decision-making with whatever information is at hand.

This is the “medicine is an art” argument, which has some merit. But the argument that primitive clinical decision support systems interrupt clinician workflow (true) means we need “new paradigms for effective HIT design” is a leap. I don’t really know what they mean by that. I suspect the authors don’t, either – it’s easy to say that today’s systems don’t always perfectly match the work clinicians do, but hard to say exactly what they should be doing differently. Today’s systems continue to evolve, albeit a lot more slowly than I’d like.

Rightly or wrongly, clinical practice — within the same organization, on the same medical service, and by individual practitioners — is inconsistent, situational, and often illogical. Paper couldn’t fix that problem and neither can technology. I’m all for taking shots at the HIT industry where it’s warranted. However, if the argument is being made that clinical work is admirably illogical, then turning programmers loose to somehow pave that particular cow path doesn’t seem like a great idea.

Front-line users are stuck with poorly designed and inefficient IT systems because people above them incorrectly think they will solve problems.

I’ll buy that. End users often get a few productivity aids, but are stuck with awful features otherwise. Hospital executives make decisions for employees whose work they can’t begin to understand.

I found this statement a bit of a lark even though I agree with it in a pie-in-the-sky kind of way: “Healthcare does not exist to create documentation or generate revenue, it exists to promote good health, prevent illness, and help the sick and injured.” If the authors have figured out a way to improve healthcare by eliminating documentation or working for free, then I’d like to hear it. If not, then they should not blame software for reflecting reality.

Providers drive the design and adoption of HIT by voting with their dollars. If products aren’t meeting their specifications, they presumably wouldn’t be buying them. Software reflects the way things are, not the way we wish they could be. Vendors would go broke fast trying to sell systems that don’t reflect reality.

Software designers assume that their software is perfect and any problems must be due to bad users. Computer consistency is not the same as intelligence.

I’ve worked in the industry for a long time and I’ve never heard this belief expressed. Software designers (among which are often the users themselves) know the limits of what they can envision and deliver. They expect bugs, reworking unforeseen design flaws, and improvement by iteration.

Software is designed to do things that humans are not good at: keeping lists, calculating, and reminding. There’s no doubt that sometimes user interfaces (like the Three Mile Island example cited) are misleading or allow important information to be missed.

The conclusion is that “HIT must support and extend the work of users,” which sounds nice but is hard to define. It also seems to presume that none of today’s HIT systems do that, which I would say is just plain wrong.

HIT systems are designed for a single user working on a single patient doing individual discrete tasks.

That’s often true. Systems don’t always optimally facilitate collaboration, but that doesn’t mean they are worthless. It’s early in the HIT adoption game, so today’s systems are actually yesterday’s systems, designed in the 1980s and 1990s with simple functionality: record, calculate, display. Customers are buying those systems, though, and deriving benefit. You don’t see many hospitals going back to paper.

I agree with this argument. We need better systems that go beyond today’s 1980s paradigms of simply automating repetitive tasks. However, as long as customers keep buying available systems instead of working to demand and design these new ones, this kind of innovation probably won’t happen.

Computerizing paper processes doesn’t help much. Paper will persist.

The article says that paper forms are more than data repositories –  they are artifacts that support situational awareness and coordination. Suggesting that “HIT designers and administrators” are unaware of that fact is insulting.

Hospital executives and HIT vendors may toss around the “paperless” buzzword, but nobody’s paperless and that’s not necessarily bad. I don’t see either providers or vendors who are so enamored with the “paperless” concept that they fully believe that paper is bad and computers are good.

Frankly, I don’t get why this is a “fallacy” and a bad one at that. It seems too obvious to be a fallacy.

Putting clinicians together with programmers won’t necessary create usable systems.

That is undeniably true. Asking users what they want and then turning programmers loose to deliver it is not exactly IT leadership. Users are way too limited in their perceptions and preferences. Their world view is often limited to a single facility, profession, and specialty. That makes it hard to design a one-size-fits-all application that vendors can sell to hospitals of all sizes (which should have been on the fallacy list – that no product meets the needs of all sizes and types of hospitals, no matter who else has implemented it).

The article suggests involving a lot of people who aren’t working in the industry (like the authors). That sounds great on paper, but software designed by committee is usually terrible, a Frankenstein of pet ideas that make the cut only because the most aggressive and outspoken committee members convinced the silent majority to agree.

Conclusions

The authors of this paper are academics. I like their objectivity, but I’m left with the feeling that they are disillusioned about this fact that is distasteful to them: both healthcare and healthcare IT are businesses that, rightly or wrongly, make decisions based on their own self-preservation, not high-minded academic ideals. 

If HIT is as bad as the authors say, why are customers buying it? Nobody’s putting a gun to their heads (although HITECH is a step in that direction).

The authors conclude that the right HIT metric should be not be adoption or usage, but population health. They are correct. I’ve been saying that for years. We’re still in the primitive stage of HIT, automating simple care delivery tasks that may or may not have profound health impact. People are paying millions of dollars for systems that sometimes behave like 1980s database programs: they accept data entry, store it, and regurgitate it in ways that are useful, but hardly revolutionary. I agree that in many cases, providers should be spending the money elsewhere. But it’s their money.

It’s easy to criticize any industry for doing the wrong things or not doing the right things. It’s also mostly irrelevant. MBA 101 tells you that business aren’t good or bad, they simply meet the needs of their customers. Otherwise, they would cease to exist. If you don’t like vendor products, blame the customers who are buying them (and who in many cases, directly influenced their design). As an analogy, it’s too easy to blame the fast food industry for obesity than to fault their customers for creating the demand in the first place.

The track record of vendors who rewrote systems from scratch certainly doesn’t encourage more of the same. The development of Millennium nearly took Cerner down. Soarian turned Siemens into a punch line. A vendor thinking about rewriting a major clinical suite will need to be willing to live without 5-7 years of sales (since prospects don’t want to buy an orphan product) and had better not have impatient shareholders or investors. Not many vendors are strong enough to sit on the sidelines for that time, much less to amass the resources and expertise needed to undertake such a project.

I have less confidence than the authors that adding government oversight and a bunch of non-industry academics to the mix will make things better. That’s how the government does things, and government systems reflect all the bad characteristics the authors decry: they are user-unfriendly, task-oriented, outdated, and massively expensive.

I agree with two major themes from this article: (a) independent oversight of clinical information systems would be a good thing, and (b) the state of healthcare software is as disappointing as the state of healthcare itself. I didn’t need this article to tell me that, though.

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Japan-based IT provider NTT DATA corporation announced this morning that it will acquire IT services firm Keane, Inc. as part of its plans to expand to the US market. Terms were not disclosed, although sources indicate a price of $1.2 billion.  

The president and CEO of NTT DATA, a quoted subsidiary of Nippon Telegraph and Telephone Corporation, said in the announcement, ““This transaction with Keane will allow us to provide comprehensive IT services including system development and management of mission critical systems in North America. Keane has a superior reputation in the area of application and infrastructure services, as well as deep industry expertise. I believe that this, combined with their unique global delivery model and our global scale, offers more cost-effective and higher value solutions to our customers.”

Keane’s healthcare offerings include IT services, revenue cycle, the Keane Optimum application suite, and the NetSolutions suite for long term care facilities.

Keane was sold three years ago for $854 million to a California outsourcing firm backed by a Citicorp private equity investment. 

Rumor of the acquisition was posted on HIStalk last Friday after a tip from Broadway Joe.

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From Domestic or Import?: "Re: this NEJM case study. Has Weird News Andy found this yet?” He has not. I’m sure there’s a fascinating story about how a full bottle of beer found its way into this inebriated man’s rectosigmoid colon, but I’m equally sure I’d rather not hear it.

From Man Up, MCK: “Re: most outrageous comment EVER. From the McKesson earnings call transcript, McKesson CFO Jeff Campbell claimed that nearly non-existent revenues for Horizon Enterprise Revenue Management were due to customers who aren’t buying anything except clinicals and are also pushing back their implementations (it’s the customers’ fault, in other words). He also mentions ‘new and latest requirements’ for HERM. What new requirements are causing them to basically stop all installs? The requirement that it work? I think you should ask the customers if it was really their choice to stop the installs. He said it was going to take ‘a number of quarters’ to meet those requirements — is it two, or three, or four? But the most outrageous comment ever is this: ‘… our customers are saying to us, we’re happy running that 20-year-old to 30-year-old software we bought from you 20 or 30 years ago.’ Are you kidding me? Their customers are happy to be on Star and Series, with no embedded contract engines, no professional charge billing capability, bolted-on claims scrubbing, no online bill pay, and no online registration? Customers just called up in the last few weeks to stop installs of a next-gen system that’s been touted for years and said, ‘That’s OK, we’re really happy running this old software, no rush from us?’” I actually do believe that to a certain extent – customers probably aren’t thrilled, but are used to McKesson’s deferred promises and have Meaningful Use to keep them busy short term (which will quite likely bite them long term when reform comes knocking). Also, the CFO’s reality is filtered through layers of corporate underlings like the president of the revenue cycle business they just fired, so maybe he really believed what he was told about how happy the customers are to wait and how impressive HERM will be … someday.

Listening: Atomic Tom, sounding great in the above video playing live on iPhones on the B-train of the New York subway (the video claims their instruments had been stolen, but they now admit that didn’t happen). A cool link sent by a reader, even if it does smack of an intentional viral campaign (multiple camera coverage, carefully mixed audio, and a convenient Apple tie-in).

Microsoft announces Q1 earnings after Thursday’s market close: revenue up 25%, EPS $0.62 vs. $0.40, beating estimates. The Windows, Office, and server software groups put up good numbers, while $527 million in ad revenue from the Bing search engine wasn’t much consolation for its $560 million loss. Still, these are good results and a nice bellwether for a hopefully-recovering economy.

Zynx Health announces a five-site pilot of its software and services solution that prepares hospitals for being involved in accountable care organizations. It will address clinical decision support in improving mortality rates, readmission rates, length of stay, and total costs.

Shore Memorial Hospital NJ) promotes Fred Banner from CIO to vice president, having worked his way up from PC specialist in his 20 years there.

A reader asked me if I knew of any possible candidates for a big health system corporate CIO job that requires CIO experience, but also a strong IT vision for healthcare’s future state (person-centric and involving wellness and not just care delivery). Send me your recommendations if you have any and I’ll pass them along.

University of Michigan Health System and 570 West Michigan doctors form Physicians Organization of Michigan, what they hope will be a statewide network of independent physicians. Benefits mentioned include EMRs and telemedicine.

To-dos for you: (a) drop your e-mail in the spam-proof Subscribe to Updates box to your right to get instant alerts when I post something new, allowing you to feel smug as you sprint down the hall like Paul Revere alerting everyone of some big HIT development, not because you want them to know, but because you want them to know that you knew first; (b) support HIStalk’s sponsors by checking out the ads to your left and clicking those that catch your eye as interesting; (c) Friend Inga and me or Like HIStalk on Facebook so that we can have the illusion of being BFFs; (d) make Inga happy by reading HIStalk Practice and signing up for the e-mail updates there (when Mama ain’t happy, ain’t nobody happy); (e) send me your rumors, news, and guest articles; and (f) tell people you know about HIStalk and the other sites since the ad budget is … well, zero. Thank you for reading.

Cerner just announced $65 million in quarterly profit, but it wants Kansas City to buy the computers for its new $63 million data center without charging it taxes, then lease them back to the company. That would save Cerner at least $3.7 million over 10 years even though it would create no new jobs, just the transfer of 11 existing positions from North Kansas City.

North Carolina public health agencies, free clinics, and community health centers will get broadband services from the initial phase of the NC Telehealth Network, with the $7.2 million cost paid out of a $12.1 million FCC Rural Healthcare pilot program. I couldn’t follow the confusing list of organizations, offices, and grants that were involved, so if you are really interested (I wasn’t), then you should probably read the announcement instead of relying on my impatient summary.

PinnacleHealth System (PA) chooses (warning: PDF) electronic documentation and charge capture solutions from Salar, Inc. I interviewed Todd Johnson, president of Salar, this past February. Sometimes my interviews are lame (usually because the person I’m interviewing is just not interesting or can’t quit pitching their product or themselves, so I rationalize) but this one’s good.

An investigative article from The Center for Public Integrity questions the effectiveness of having a 29-doctor AMA group recommend to CMS how much their profession should be paid for performing individual procedures. CMS accepts more than 94% of those recommendations, leading to “rubber stamp” criticism. Part of the group’s job is to deflate the times specialist groups claim it takes to the procedures they’re paid to perform. A former member of the group says specialists scratch each other’s back in the meetings, but everybody fights with the primary care docs (which the article says nearly always lose to the specialists who successfully get big payments for performing procedures). It was also noted that, even with major technology and efficiency breakthroughs, the group almost never recommends that work units be reduced.

Palomar Pomerado Health (CA) is chosen as a Pyxis development partner by CareFusion.

Sponsor jobs: HIE Team Lead, Clinical Executive Physician, Clinical Executive Nurse. On Healthcare IT Jobs: Clinical Pharmacist, Metadata Administrator, Senior Manager Healthcare Solutions Marketing, Senior Data Specialist.

Curaspan says 354 hospitals and over 2,500 nursing homes use its Web-based discharge planning, referral, ride sharing, and transportation applications.

Ingenix forms an independent physician advisory board to guide its healthcare technology direction. Among them are Joseph Heyman (who was on some Health IT Policy Committee work groups), Salvatore Volpe (president of the New York State chapter of HIMSS), Martin Harris (his ubiquity precedes him), Gregory Reicks (an osteopath who is board president of an HIE), and Alice Loveys (a CMIO).

Charleston Area Medical Center (WV) cuts $40 million from its budget due to low reimbursement, high drug costs, and $16 million worth of software upgrades. They didn’t say which systems were being upgraded, although I seem to remember that they’re a Siemens shop.

The fired CEO of 15-employee, Indianapolis-based EMR vendor iSalus Healthcare sues the company for breach of contract. Mark Day says he was fired after telling the board chair that he was suspicious that employees were stealing software. The board’s termination letter said he was let go for telling a prospect that iSalus was in trouble and warning the customer of some of the company’s untrustworthy executives, also asking the prospect for a job if things went south there (I’ll hazard a guess that they didn’t sign on the line which was dotted). Day says that conversation was misinterpreted.

Boston-based MedNetworks is developing software based on Harvard-licensed technology that maps the social networks of people and clinicians. The startup plans to sell the information to drug companies, insurance companies, hospitals, and the government. It says that the influence of friends and colleagues may be more important than formal experts when it comes to changing healthcare behaviors or getting doctors to prescribe specific drugs. One of the founders is Harvard professor Nicholas Christakis, whose social network book landed him on Time’s 2009 list of the most influential people in the world. I might have to get a copy.

E-mail me.

HERtalk by Inga

From Za: “Re: my McKesson rep. Said that while it has not been verified, Horizon is on life support. Pretty sure this is not news other than I am gloating a bit because when I got to my current hospital, they were looking at McKesson Horizon and I told them there is no way that mess would ever work. I like being right!” Unverified and purely conjecture, we’ll quickly disclaim, but it’s coming from a hospital CIO who’s usually right.

From Trinketeer: “Re: MGMA goodies. I know you like evaluating all the vendor freebies at trade shows. I brought home a bunch of stuff for my kids. My 10-year-old remarked that it was ‘the same old stuff’ and nothing very good.” Kids say the darnedest things. I have to agree with the 10-year old, except for my souvenir photo with the alligator (redacted for anonymity, of course). It supported alligator conservation, but as I said on HIStalk Practice, all I could think of was how nice his skin would look on a pair of pumps.

I  am back from New Orleans and trying to find the bottom of my e-mail inbox. If you care to know what practice administrators are talking about and what vendors and pundits are telling them, we have three days of highlights on HIStalk Practice.

While at MGMA, I had a long conversation with an Allscripts executive. One of the topics discussed was the company’s decision to discontinue upgrades to the Peak Practice EHR. While I can understand how this decision is disturbing for end users, I must admit that Allscripts seems to be trying pretty hard to reduce the pain. A bit of background if you haven’t been following the story:  Peak Practice is an EHR that Allscripts acquired in the Eclipsys purchase, which Eclipsys had acquired from developer Bond Medical. Apparently the Peak product has a number of functionality gaps and only 300 users. Allscripts has applied to have it ONC certified and won’t sunset it per se, but they won’t be releasing enhancements to it, either. They’ll offer Peak users free like-for-like MyWay licenses and perform the data conversion at no charge. Change is difficult, but I can’t fault Allscripts for making what is probably a good business decision and I commend the company for trying to make things as right as possible for the Peak Practice clients. An interesting side note: Bond Medical founder Travis Bond is now a MyWay reseller.

Another MGMA reflection: I asked several of the smaller vendors if they were going to obtain ONC-ACTB certification, and if so, through which certifying body. Those going the CCHIT route said it was easier since they were already CCHIT certified and/or they thought the CCHIT label was more prestigious. No one specifically named InfoGard as their certifying body. Those going with Drummond noted it was less expensive and faster. One vendor, interestingly, said they were “negotiating” with the certifying bodies to find the best price and suggested that more certifying bodies would soon be announced. And, I don’t recall a single EHR vendor saying they would not seek certification of their products.

HIMSS is hosting another virtual conference November 3-4. I “attended” the first one two or three years ago, mostly because I was curious about the virtual format. The conference is free for “qualified” participants and $99 for “non-qualified” HIMSS members. I can’t find anywhere on the HIMSS site that clarifies what it takes to be qualified, but I can say that when I tried to sign up for a conference a year ago, I didn’t have the secret requirements. I am mildly amused because my status must have recently changed, having received two separate invites from HIMSS this week. I should clarify that neither invite was for “Inga,” but for her counterpart in the “real” world. Since not much has changed on my end, I have to assume HIMSS is under pressure to boost attendance, probably to please its 25+ sponsors. If I have time, I’ll probably accept an invite and lurk around a bit.

Rush University Medical Center (IL) awards a five-year, $25 million contract to Siemens Medical Solutions for medical equipment and HIT consulting services. The press release does not provide a breakdown on equipment versus consulting services, but it does specify a whole bunch of hardware for its new facility opening January 2012. The HIT consulting services will focus on providing “a more efficient electronic infrastructure for managing patient information and services.” Rush, by the way,  is in the process of implementing Epic.

GE Healthcare and UPMC announce that their imaging joint venture, Omnyx, is working to digitize the pathology process and eliminate the practice of pathologists using glass slides and microscopes. If glass slides and microscopes disappear, I wonder what schools will teach in seventh grade science class? So far GE and the non-profit UPMC have invested $40 million in the project.

Trustees for New Hanover Regional Medical Center (NC) approve a $56 million move to Epic (that will be another McKesson Horizon de-install). The investment in software, hardware, and implementation is only $15 million more than the $41 million than upgrades to their existing systems were going to cost.

Cerner announces third quarter results, which were up from last year. Revenue was up 13% to $462.7 million and earnings per share were $0.71 vs. $0.57, beating estimates excluding special items.

Northeast Hospital Corporation (MA) will deploy Merge Healthcare’s PACS and ECM systems.

Sponsor updates:

• Advanced Pain Management (MD) selects the SRS Hybrid EMR. Which reminds me: while at MGMA, the SRSsoft folks told me they are working on an app store to be released early next year. It will give users a quick way to add innovative extras to the core application.
• RelayHealth aligns with TransforMED to provide a communication tools that aids primary care providers by establishing patient-centered medical home models of cares.
• EDIMS earns ONC-ATCB certification through CCHIT for its ED EHR product.
• St. Paul Radiology (MN) says its accounts receivable days has decreased 35 to 40 percent since implementing ZirMed RCM tools.
• CareTech Solutions and nine of its healthcare clients are recognized for excellence by the Web Marketing Association.
• SCI Solutions, a provider of access management solutions, completes its fiscal year with 42 new customer contracts representing 86 hospitals.
• Voalte is named a Mobile Health Expo 2010 award winner in the category of outstanding contribution to the growth and success of nursing and mobile health communications.
• Mobile Health Expo also awards PatientKeeper for the best innovation in mobile health technology for patient safety.
• Eastern Connecticut Health Network chooses Access Intelligent Forms Suite to auto-index patient forms in Meditech Scanning and Archiving.

E-mail Inga.

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The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Innovation is Leadership

After 30 years of procrastination, I finally did it. I got braces. Yes, the shiny stainless steel that contributes to the bane of fragile teenage egos.

Sadly, the technology related to braces has not changed. Take, for instance, the cosmic gap between my two front teeth. The doc glued the brackets to my teeth and pulled wire through them. He will now tighten them — a slow torture lasting 2-3 years.

After the recent painful, nanometer adjustments, I lamented the fact this technology has experienced little innovation in the past fifty years. While there are magical products to make the appliance less visible, nothing has actually evolved in the clinical efficacy — a gap I liken to the size of the one between my teeth.

Best practices is a regression to the mean. Wouldn’t you agree? Our love affair with the term “best practices” is really another way of embracing the average. We are desperate for improved and enhanced ways of doing things, yet the best most of us can manage is copy someone else — a slide towards shared mediocrity.

Either innovate or perish.

Plenty of scholarly evidence exists to substantiate my critique. You cannot pick up business literature, electronic or otherwise, without reading about the dearth of innovation in our country. And I think healthcare is as fertile a ground for a good outpouring of innovation as any other vertical.

Innovation takes on many forms, from technical to transactional to cultural. Most readers should already be familiar with Christensen’s works, the Innovators Dilemma, and Innovators Solution. More recently, Christensen applied his innovation concepts to healthcare with a landmark piece, The Innovators Prescription. It’s a mandatory read for my leaders.

What can you and I do to spark innovation in healthcare and in our organizations? First, we start with our own lives; and second, our span of control.

Career mimics persona. If you are innovative, it will reflect in everything you do — work, play, relationships, etc. To stay or to become innovative, you must embrace a matching lifestyle. I don’t mean the old pat-on-the-back hug, but an embrace of lovers reunited. Do you select hobbies that wreak creativity and imagination?

One reason I’ve immersed myself in the Argentine Tango is because there are no right or wrong moves. Instead, I can take the 2-4 count patterns learned and arrange them according to the feel of the music or mood. That means I have to think afresh for every song, yet maneuver in a way that allows my partner the space to be equally artistic. Triathlon is credited for its many transformational improvements in cycling, clothing, and accessories that other sports have adopted. The sport itself continues to evolve.

The above hobbies work for me. Clearly, there are thousands of choices that can cater to your personality and ambition. The point is to pick something that stretches you. If I ever grow comfortable, I know I’ve hit stagnation. My career will imitate my life.

At work, you must be boldly intentional. While I do a fair amount of speaking on a variety of leadership-related topics, the most common request I receive is on innovation. After speaking as a keynote at the recent Computerworld’s SNW Fall Conference , the audience enthusiastically embraced the innovation message.

Innovation doesn’t just happen. You have to promote it with sound processes to help those yet uninitiated. You can have innovation portals that showcase processes and how to get involved. Set up reward systems as encouragement. Hold contests where all submissions have to be done via video, which is a creative process in itself. Recruit judges from your C-suite to ensure high visibility.

Host a Tedx event. This is a new program that enables local communities such as schools, businesses, libraries, neighborhoods, or just groups of friends to organize, design, and host their own independent TED-like events. Or pick a technology that you think has potential and invite a wide variety of participants to brainstorm. This mash-up could lead to some amazing outcomes that transform clinical care.

The most pioneering ideas will come from people who are closest to the action and who are given a forum for their voice. The leaders’ function is to act as the catalyst and create an environment suitable for originality.

No single idea will transform your culture into one of innovation. Nevertheless, as you begin to mix in such ideas, processes, and events, you will have an impact, and transformation will begin to take hold. Anticipate resistance — and view it as positive feedback. If you don’t encounter resistance, double your efforts.

Live in such a way that no person could look back at your career or your life and say, “Not much changed.” Kind of like the battle between my teeth and stainless steel.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

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From Southern Belle: “Re: Epic. I hear they’re thinking about changing their consultant non-compete agreement from one year to two.” Unverified.

From Blame the Dog: “Re: BlackBerry tablet. Here’s some video up of a demo of the eUnity PACS virtual workstation running quite seamlessly on the BlackBerry PlayBook through their fancy new QNX-based Tablet OS. I’m a big fan of the trend Apple has started with (finally) user friendly tablets, and there’s been a lot of interest in healthcare for the iPad so far because of the cost and usability factors, but I have a feeling there are more than a few healthcare CIOs out there collectively holding their breath for the PlayBook. Apple has some management tools for the iPad and I think they’re starting the realize the potential there, but they’re still nowhere near RIM on the enterprise, information security, and compliance management front. The PlayBook is going to be a BES-compliant device, meaning all those hospitals out there with existing BlackBerry infrastructure don’t have to do much to start putting the PlayBook into lab coat pockets early next year. No matter what, RIM, Google, and Apple are finally giving hospitals and practices simple and cost-effective devices that can integrate more comfortably into existing workflows. No more bulky notebooks posing as tablets, no more clumsy laptop carts, no more silly workstations in every exam room. Finally.”

From BCS Luv: “Re: Epic. Who’s implementing it in Boise?” I’d have to guess St. Luke’s since Saint Alphonsus just went up last week on an unnamed system (Cerner, I assume, since St. Al’s is a Trinity hospital and their Genesis Project runs Cerner, if I remember correctly).

Inga is posting live from MGMA on HIStalk Practice with our patented blend of news, rumors, booth critiques, and observations (she says she got hit in the head by a lady’s tossed beads, which I hope doesn’t mean that she flashed her, French Quarter-style). Check out her posts from today and yesterday.

Core Health Technologies releases its HL7 survey results (warning: PDF). Demand for HL7 expertise will increase, said 85% of CIOs. Respondents predicted that Cloverleaf will lead the integration engine market.

Cardinal Health signs a marketing agreement with Swisslog that will allow Cardinal to offer that company’s drug packaging and distribution technologies.

New York eHealth Collaborative plans to spend $129 million in state and federal money to create a statewide electronic medical records network.

UW Health (WI) is using palm scanning to positively identify patients and to reduce identity theft and insurance fraud. They spent $70,000 for 200 of the scanners.

McKesson announces Q2 numbers: revenue up 1%, EPS $1.25 vs. $1.11, missing on both revenue and earnings excluding a one-time asset sale. Revenue for Technology Solutions was down 3% (with some one-time adjustments), with the press release saying the reduced operating margin “was impacted by continued investment in our clinical and enterprise revenue management solutions.” The company also wrote off $72 million because of Horizon Enterprise Revenue Management, which readers have told us is in big trouble with high development costs and rumored missed deliverables. I looked up their term asset impairment charge and it means (in my non-accountant interpretation, anyway) that an asset’s value has declined even faster than it’s being depreciated and amortized, requiring  one-time adjustment in value.

Disappointing perfomance in McKesson’s Technology Solutions business was surely the cause of Monday’s big McKesson reorg, which I mentioned on Facebook (actually the performance would have been great without the HERM charge). Clinical and revenue cycle groups will be combined to form Health Systems Enterprise Solutions (seems odd). The president of Revenue Cycle Solutions was let go. Several other products (workforce management, surgery, performance, analytics, HR, etc.) are being combined under Health Systems Performance Management. Enterprise Imaging will be made part of Medical Imaging. Sales teams will be integrated with their business lines. They seem to be focusing on differentiating Horizon vs. Paragon prospects.

Healthland promotes sales VP Angie Franks to CEO. Former Interim CEO John Trzeciak of Francisco Partners will keep his board seat.

Surescripts expands (warning: PDF) its e-prescribing network to become a “national backbone” that will allow exchange of clinical messages, expanding on its work with CVS’s MinuteClinic. The company is marketing itself as a trusted network, using messaging tools made possible by its investment in secure messaging vendor Kryptiq. Surescripts says it will follow standards for NHIN, HL7, CCD, CCR, etc. VA CIO Roger Baker was quoted as saying that the Surescripts network would help his organization connect with community providers. John Halamka was also quoted, although in a non-committal way (he doesn’t generally shill products, just ideas). This is a big announcement, both in length and in impact. Implementation dates: Net2Net connect to allow providers and vendors to connect outside their networks (December), Message Stream secure messaging (December), and Clinical Message Portal for providers who don’t have an EHR (January). I had to refresh my memory about who owns Surescripts: the founders, the National Association of Chain Drug Stores, the National Community Pharmacists Association, CVS Caremark, Express Scripts, and Medco.

Even Weird News Andy is speechless at this article (well, almost – he only said “wow”). In England, a quadriplegic home care patient, convinced that he was not receiving good nursing care, puts a bedside camera in his room. It caught an NHS agency nurse panicking after incorrectly adjusting his ventilator’s controls and setting off its alarm. The nurse, who says she was given no training on the ventilator, couldn’t get it restarted and didn’t know how to resuscitate him. It took paramedics 21 minutes to arrive and give him oxygen, but by then he had suffered major brain damage, reducing his mental capacity to that of a child. NHS says it’s sorry.

Panasonic invests in Houston-based CardioNexus, announcing its intention to become a global leader in personalized preventive medicine. CardioNexus, formed last year, is a product of Baylor College of Medicine’s commercialization organization and works with Texas Medical Center, which was already working with Panasonic. The company focuses on early detection of heart disease, which I assume means imaging.

Sage Intergy Meaningful Use Edition is ONC-ATCB certified by Drummond Group. Also earning certification, but from CCHIT: GE Centricity Practice Solution version 9.5.

AirStrip Technologies provided some clarification about its agreement with Sprint that I mentioned recently. Users can choose any mobile device (including Android-powered ones in the next couple of weeks, but 80% of their users are on iPhones so far). Those users generally use AirStrip on their personal smart phones (makes sense – they wouldn’t want to have to carry two). Sprint helps the hospital pay for AirStrip to encourage them to use more Sprint devices, but they help subsidize the cost for all users, not just those who choose Sprint smart phones. AirStrip gets what it says is better 4G performance from Sprint, which will allow it to eventually expanding its offerings to real-time video collaboration, imaging, and extended historical waveform data. Thanks to AirStrip for the clarification. I usually steer clear of proclaiming a company or technology as “hot” since I’m just a cheap seat observer, but I’m pretty sure they are.

Folks I know at Cedars-Sinai tell me that they’re up on Epic’s nurse documentation and care plans. They’ve also shut down CareVue now that they’re live on device integration and doing some physician documentation in the ICUs.

Our Lady of Lourdes (NY) chooses Allscripts EHR for its 16 employed medical groups. They’ll also implement Allscripts Remote, which allows physicians to access the system via the iPhone, iPod Touch, iPad, BlackBerry, Android, and Windows Mobile smart phones.

Martin Memorial Medical Center (FL) borrows $25 million for equipment they say is EMR and HITECH related, including smart pumps and patient monitors.

A prospective sponsor e-mailed me a question I’ve not been asked and couldn’t answer without digging through some stats. How many unique people read HIStalk each month? The answer: just over 19,000. I also noticed the countries they’re from: the US, of course (over 93%), then Canada, Australia, UK, India, Israel, Ukraine, UAE, China, and so on. All I see from this end is a blank screen that I have to fill each day while sitting in my inner sanctum and playing music at excessive volume levels, so it’s fun to occasionally be reminded that real people are on the other end.

Healthcare futurist Jeff Goldsmith says HIT adoption is lagging because there’s no return on investment. He says the payment system is largely at fault for piling tedious documentation requirements on doctors, made worse by new quality measures (I assume those prescribed by Meaningful Use are among them). He says he would have done Meaningful Use differently, offering providers an immediate malpractice shelter for following guidelines instead of a payoff down the road. He also thinks that hospitals buying practices will drive more HIT usage than Meaningful Use since the new owners will want them to communicate with each other (and will want to monitor and control their performance, which Jeff didn’t say but I will). His estimate of consumer influence on EHR adoption by doctors: “nearly zero” since people have stayed away from PHRs in droves and the improved communication that patients really want doesn’t require IT. Jeff’s an investor in some startups, which I’d love to do if I had the money (although I probably therefore wouldn’t have it for long since those rarely pay off).

Francisco Partners takes a majority stake in Quantros, which sells quality and risk applications. The private equity firm is no stranger to HIT, with investments in AdvancedMD, API Healthcare, Healthland, QuadraMed, and T-System. I interviewed Quantros CEO Sanjaya Kumar this past April. Worth a read (or re-read). I have to say that if your vendor is bought by someone, you should hope that it’s Francisco Partners since they appear to be the most patient, most HIT-savvy, least change-demanding acquirer out there. They seem to help the companies they invest in succeed instead of slashing and burning their way to a fast payoff.

A Modern Healthcare article says that the AMA is getting into the EMR business with its Amagine project, which will go live in 2011 after the current pilot in Michigan is finished. It will charge vendors to list their wares on a portal, then take a cut of the action. AMA will actually providing technical support and possibly implementation services. I’m having a rather strong reaction to this, but leave a comment at the bottom of this post and let’s hear what you think first.

Ever wonder how those frequent flier patients get to your ED? By ambulance, of course. One health commissioner said, “The misuse of ambulances speaks to our health system. If we had a place as user-friendly as an emergency room, people would likely use it. The fix is to have more primary care and a better way to get to it.” One New York patient called for a ride to the hospital 313 times in one year. Like the rest of healthcare and the country in general, relying on personal responsibility is a bad idea, especially with a government willing to subsidize stupid decisions by taking money away from those too responsible to make them.

HealthPartners launches virtuwell (annoying all lower case besides being a pun), an online MinuteClinic-type alternative to office visits that offers online nurse practitioners around the clock. Online users (only in Minnesota for now) get a diagnosis, treatment plan, and prescriptions for $40 or less, depending on insurance.

The Wisconsin State Health Information Network is named as the overseer of the statewide HIE, set to launch next year.The group is a non-profit with members Wisconsin Hospital Association, the Wisconsin Health Information Organization, the Wisconsin Collaborative for Health Care Quality and the Wisconsin Medical Society.

Sponsor Updates

• All Children’s Hospital (FL) will use GetWell Town from GetWellNetwork as its interactive bedside TV system offering Internet browsing, games, movies, and behind-the-scenes clinical applications.
• RelayHealth beats the mandatory 2012 date for complying with Version D.0 of the NCPDP pharmacy claim standard. The company’s prescription transaction solutions are compliant now.
• RelayHealth also announces at MGMA its RelayAnalytics Financial Diagnostics, a visibility dashboard into claims and remittance information.
• Revenue cycle vendor ZirMed announces that it has processed 750 million healthcare transactions and is doing 20 million per month. The company says its 39% annual growth rate required adding two executives: former Allscripts sales VP Kevin Weinstein as VP of marketing and Kraig Brown as sales VP.
• MEDSEEK announces its Sprint to Meaningful Use solution, which will help organizations meet the MU goals involving patients and families.

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