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Monday Morning Update 3/7/11

March 6, 2011 News 25 Comments

3-6-2011 8-50-14 AM

From Harvey: “Re: Mediware. Shares of MEDW popped 15% after hours Friday on no news.” That is interesting, especially on a down market day and for a stock that trades in a fairly narrow range. Maybe a deal is in the works and word leaked out. Or, maybe someone is buying up shares after the company’s recent good performance. I haven’t heard anything, but if you have, let me know. The two-year share price chart is above. Shares nearly tripled in a steady run despite poor market conditions.

3-6-2011 8-41-33 AM

From ClinicalWonk: “Re: Wayne Smith, CEO of for-profit hospital operator Community Health Systems, quoted from a Wednesday investor conference.” Here’s what Wayne, who holds $37 million worth of CHS stock and makes $10 million a year, had to say.

We’re all working on Meaningful Use. We’re working on it in terms of IT piece of this, which I absolutely think is a black hole when it’s all said and done. Everybody is talking about they have a zillion dollars worth of expense here or cost here, and the government is going to give them back a half a zillion. I don’t know how that works for other people, but it leaves you half a zillion short as far as I’m concerned, when it’s all said and done. And return on investment here is not all that great. We are very careful about how we think about how we deploy our capital, so the return is not all that great, either. So, that’s one piece.

3-6-2011 8-54-00 AM

From Dave Magadan: “Re: VITL chooses Medicity for Vermont’s HIE. That means GE Healthcare lost their contract in a state where they have a big footing. This wasn’t just a new contract – it was a complete replacement.” GE Healthcare was announced as the technology provider for the RHIO (as HIEs were known back then before they gave themselves a bad name that needed changing) back in 2006. GE is strong in Vermont because of its IDX acquisition.

From CMIOFlorida: “Re: AT&T. Looking for a CMIO to run its healthcare solutions division.”

Dilbert.com

From Luke O’Cyte: “Re: Dilbert. Today’s strip sums up many of the booth babe comments about HIMSS.” Nice! Maybe Scott Adams was writing from experience – those few folks who stuck around until Thursday of HIMSS 2005 in Dallas saw his keynote presentation that year (the other keynotes were John Chambers of Cisco, Barbara Bush, David Brailer, and the no-show Scott McNealy of Sun).

From Peter Groen: “Re: COSI Open Health site. It provides information on open source or public domain health IT solutions and might be of use to some of your readers.” I’m not big on giving sites free PR, but I’ll allow it in this case.

From Punxsutawney Phil: “Re: Pennsylvania Health Information Exchange (PHIX). Medicity won the contract. AT&T protested like they did when they lost the Florida bid to Harris. PA state procurement turned them down so AT&T sued the state. They cancelled the contract and will re-bid it, but project work has stopped and PHIX’s ONC money is threatened because the state hasn’t finished its selection.” Unverified.

Listening: the not-yet-released new album from R.E.M., streaming free on NPR until its Tuesday release. They had a dull spell in their 30+ years, but they’re sounding good again. Watching: a depressing commercial featuring Jamie Lee Curtis, who went seemingly overnight from a scream movie hottie to a gray-haired, Activia-swilling AARP cover girl.

I’ve posted the hot-off-the-press results of my reader survey. It’s a fun read, with some interesting stats (my favorite being that 87% of readers say reading HIStalk helps them perform their jobs better), some great suggestions for changes (improving the mobile device format and giving Dr. Jayne her own post, both of which I’ve already done as a result), and comments (“I’ve always wondered if you had a deal set-up where your identity will be revealed after your death. Similar to Deep Throat of Watergate fame.”). Thanks to all who responded, except for that last comment which forces me to contemplate my own mortality, especially since Inga just innocently asked me, “What happens if you get hit by a bus?” Bloggers don’t usually have succession plans, so I have no idea.

Here’s a to-do from the survey. If you want to help, let me know. The real value in this suggestion is requiring a new company looking for exposure to provide at least one happy client’s testimonial, which goes a long way in separating the wheat from the chaff:

Open a channel for "new" companies to provide a brief description of what they do. Kind of a "what’s hot or what’s new" type section. Companies would have to be small (five or less clients?), have proven success (one client testimonial), and be ready to expand. Might give the company and your audience a chance to connect. Would also allow the rest of us to learn about new things and maybe push us all to be better. I would offer to help edit/review submissions and I bet others would as well.

3-5-2011 10-07-23 AM

Lots of people went to HIMSS without attending any educational sessions, which is easy to do since the schedule encourages heading off the exhibit hall profit center. Few of those who did found the education sessions excellent, but most said they were at least OK. New poll to your right: of the booth features people have complained about, which (if any) should HIMSS ban? You can choose multiple answers and the poll will accept your comment.

Here’s a virtual tour of the Nashville Medical Trade Center, where HIMSS is the big signed tenant on the fourth floor, right next to the vendor showrooms (in a seamless and slightly uncomfortable blending of a supposedly patient-centered non-profit flanked by its purely commercial members). From the video: “Visitors for hospitals, clinics, professional practices, and other provider organizations move swiftly toward activities and informed purchasing decisions.” Sounds like a cross between the HIMSS conference exhibit hall and Cerner’s hard-selling Vision Center. Somehow as a HIMSS dues-paying provider member, I keep feeling more and more like a fresh meat prospect for its higher-paying vendor members in the business model that I always call Ladies Drink Free.

DrLyle wraps up HIMSS with a list of innovative companies to watch (congratulations to the several HIStalk sponsors who made his list) and a wrap-up of the HIT X.0 sub-conference, including winners of the HIT Geeks Got Talent competition.

3-6-2011 8-45-38 AM

Speaking of HIMSS wrap-ups, several people e-mailed to say that I needed to read that of the PACSman, a friend of HIStalk and master of radiology (a Black Sabbath pun that just popped into my head) trying to find his place in the IT-centric world of HIMSS. Pretty funny stuff.

Also funny: a high-ranking exec of a big vendor that was the subject of a unverified rumor I ran awhile back chastised me by e-mail, saying that “tabloid-type rumors” threatened the integrity of HIStalk. I responded nicely, saying (a) at least 80% of the rumors I’ve been running for eight years now turn out to be true to some degree; (b) if I’m hearing the rumors, chances are everyone else is, too; (c) rumors are, from the reader survey, the #2 most-liked HIStalk feature, barely behind the news; and (d) quite a few big industry news items came to light only because I’d run a rumor that turned out to be true. I liked the exec’s follow-up admission: “I am truly a fan of the service (and yes, I follow the rumors). It just sucks when it’s about us :-).” That’s an honest answer – every company loves reading rumors as long as they’re about someone else.

3-6-2011 7-25-53 AM

In a remarkably bold marketing campaign, the vendor of a system that transmits ECG readings from ambulance to hospital boasts that its product actually makes heart attack patients wait longer for treatment. That or the headline writer for the San Antonio paper isn’t very good.

3-6-2011 8-08-25 AM

Amcom Software, which provides paging and messaging software for a large number of hospitals, is acquired for $163 million by USA Mobility, the largest wireless medical paging operator.

Image Stream Medical raises $2 million in funding. The Massachusetts company sells OR video solutions that include a server-based video repository and broadcasting. Other than the new money, it must be pretty quiet there since their latest news release is from 2006. I’m not sure I’d trust a technology company that can’t keep its Web site updated.

3-6-2011 8-21-59 AM

Medical waste handler Stericycle apparently acquires NotifyMD for $50 million. The company provides call center services and automated calling applications for physician practices.

E-mail me.


3-5-2011 7-25-49 AM

From Aussie: “Re: Jon Patrick’s article. Mr. HIStalk, I have never seen a dissection (without anesthesia) of Cerner going to this depth. Unbelievable, although in the USA, one would be professionally dead in the HIT industry if even contemplating talking about these long known issues. Hope you will have the courage to publish something about it.” Professor Jon Patrick of the Health Information Technologies Research Laboratory of University of Sydney expands his writeup (currently in draft) about problems with the implementation of Cerner FirstNet in emergency departments in New South Wales.

You’ll love it if you sell against Cerner because everybody from doctors to software validation experts tears into FirstNet (and, by implication, Millennium in general) from every angle — usability, software and database design, and implementation methods. FirstNet competitors could create a fat anti-Cerner prospect piece just by excerpting from it.

On the other hand, I wouldn’t say it’s necessarily unbiased, it focuses on implementation of a single department application that didn’t go well for a variety of reasons (despite many successful FirstNet implementations elsewhere), it uses the unchallenged anecdotal comments of unhappy users who make it clear they liked their previous EDIS better, and it nitpicks (I wasn’t moved to find a pitchfork when I learned that the primary keys in the Millennium database aren’t named consistently).

But it is interesting when it tries to associate user-reported problems with observed technical deficiencies, such as why information known to have been entered sometimes disappears (problems with non-unique primary keys and referential integrity are mentioned – certainly the latter is a problem with many systems). 

In other words, it’s not just about Cerner or some ED project in Australia. The real message is that design and support patient care software is the Wild West at this point since we’re arguably still in the first generation of systems claiming to be clinical (even though they often are really business systems masquerading as such).

Products have long-uncorrected design flaws that were created in an urgency to get product to market regardless of the required compromises, all known to clinicians who work for those vendors (clinicians are often the booth babes of the vendor world — hired to attract prospects but given no real authority). There’s no oversight or accountability beyond what vendors choose to provide and that decision is often made based on vendor staffing, budget, or individual managerial prerogative. 

Here’s my conclusion. Start with Part 7, which is definitely worth a read. Forget Cerner specifically and focus on sloppy software design practices and poor usability. We know it exists throughout the industry and this is a good primer on what can go wrong. Examples:

  • Using time values as unique database keys, such as the assumption that a single patient could not have multiple lab orders with the same timestamp
  • The problem whereby even integrated systems build modules in silos, which can make them as inconsistent and fragile as interfaced systems
  • Free text entries are allowed for problem lists, allowing staff to create entries that nobody will be able to find
  • Mandatory terminology selection doesn’t match common usage, such as staff looking for “CTPA” when Cerner calls it “CT chest PE”
  • Entered information is lost when users get pulled away and the system times out for security reasons
  • The application shows only the clinical notes of the current episode, giving clinicians no longitudinal feel for the patient
  • Trainers advise that users never use available functions because they will cause problems (happens all the time at our non-Cerner place — “don’t do that even though the system allows you to”)
  • Staff found they can change some information and re-save under the original doctor’s name

The takeaway is that patient care software is far from perfect, but we already knew that. What’s more interesting is how vendors respond to well-documented reports of specific software problems that impact patient care.

I see it every day. My hospital’s vendor has a huge list of problems we’ve reported that don’t get addressed for a variety of reasons: the problems are limited to sites that use a system in a particular way (i.e., the vendor doesn’t think it’s worth fixing since few clients are complaining), they don’t want to tackle the issue because doing so would require an expensive rewrite of a badly designed system, or they don’t have the resources. All of these are logical answers unless you are one of our patients harmed as a result.

I spend a lot of my time on looking at patient safety related to IT and it’s not pretty. Much of it relates to user error, but that, too is a reflection of software design. If IT systems were drugs, you’d see quite a few black box warnings and probably some recalls. The resulting negative publicity would push the vendor in ways no single hospital can do.

I’d like to see mandatory public disclosure of known patient-impacting software defects using a standardized classification system, whether vendors do it themselves or someone else (FDA) has to step in. We customers and our patients often find out about known problems the hard way, and we don’t have much clout to get problems addressed since we’ve already signed on the line which is dotted. This article, if nothing else, is a good reminder of where the industry stands and a reminder that we have the opportunity to make it safer.

Like clinicians, vendors don’t harm patients intentionally, however, and nothing is ever as easy as it looks from the cheap seats outside of vendor-land. The same naysayers who predictably and monotonically chant the “HIT is evil” mantra at every opportunity haven’t been all that effective because their only implied solutions are naive: every software vendor should just drop everything (including profits) and rewrite systems with the involvement of self-proclaimed experts such as themselves, thereby fixing everything (they obviously haven’t seen the horrors of newly written software or applications designed by ivory tower informatics experts).

Somewhere between “we vendors are doing the best we can given a fiercely competitive market, economic realities, and slow and often illogical provide procurement processes that don’t reflect what those providers claim they really want” and “we armchair quarterbacks critics think vendors are evil and the answer is free, open source applications written by non-experts willing to work for free under the direct supervision of the FDA” is the best compromise. Obviously we’re not there yet.

That’s why I advocate transparency before anything else. Let the industry know the extent of the problem and let that information drive the solution. This article (and others) are building a case for that level of openness about patient-impacting systems.

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Currently there are "25 comments" on this Article:

  1. Patrick reveals sobering information, information and evidence that supports prior comments which have stated the need for FDA regulation.

    Mr. HIStalk, Inga, and Dr. Jayne: How can doctors and nurses trust these systems when errors are random and caused by the systems themselves, not withstanding the errors that are facilitated by the systems’ poor usability?

  2. Kudos to Mr. HIStalk and his wonderful cast for the epiphany!:

    “I spend a lot of my time on looking at patient safety related to IT and it’s not pretty. Much of it relates to user error, but that, too is a reflection of software design. If IT systems were drugs, you’d see quite a few black box warnings and probably some recalls. The resulting negative publicity would push the vendor in ways no single hospital can do.”

    AND

    “I’d like to see mandatory public disclosure of known patient-impacting software defects using a standardized classification system, whether vendors do it themselves or someone else (FDA) has to step in. We customers and our patients often find out about known problems the hard way, and we don’t have much clout to get problems addressed since we’ve already signed on the line which is dotted. This article, if nothing else, is a good reminder of where the industry stands and a reminder that we have the opportunity to make it safer.”

    BUT

    This is patently false and a gross exaggeration, an ad hominem attack:

    “The same naysayers who predictably and monotonically chant the “HIT is evil” mantra at every opportunity haven’t been all that effective because their only implied solutions are naive”

    From my read, these so called “HIT is evil” naysayers never stated what you claim.

    Might it be that your own perception was colored, or filtered, but not by a “mammary filter”? Ha Ha!

    And now you are agreeing (at least partially) with the likes of Suzy.

  3. Re: Cerner report analysis

    Absolutely fantastically said, Mr.H!!

    And here is another rather new hurdle for vendors: everybody is busy adding buttons and checkboxes to allow for all that CQM data collection, which in and of itself is a deterrent to usability, which translates to even less time & resources to fix bugs and address customer concerns.
    The pressure to build new, and largely useless, shiny things is leaving very little time to fix and fine tune the existing code base.

  4. Good stuff on the clinical system design weaknesses H. And it isn’t just Cerner. Even the much exalted Epic products have serious holes when it comes to addressing the clinical needs of specific clinicians (Hospitalists, Obstetrics, Ophthalmology,etc). And last but not least are reasonably well designed products (still pinging at Epic) that are badly implemented despite the much vaunted Kid Genius install approach of that particular vendor (thinking of monkeyed up DX and CPT lists for encounter generation – what is up with always putting the NOS DX’s first??). Keep at it and someday this may all work out.

  5. I wonder if David Blumenthal (and Kathleen Sebelius) have read Professor Jon Patrick’s report.

    Thanks for sharing with us, and kudos for also adding your own comments Mr. H! This is just the tip of the iceberg in the rush to implement. There will be no time to fix, only to install products as quickly as possible. And with no time left to train new employees, hospitals will be stuck, realizing they are left to figure out their own solutions for their problems.

    Many small physician practices were right not to implement. It is better to pay the penalty fee (if there really will be one in the end, perhaps another extension), and “wait and see” if the EHR industry makes good on their promises and fixes the bugs in their own products.

  6. Very disappointed Mr. H!
    Jamie Lee Curtis faced her own reality several years ago. I found it refreshing that she publicly announced (People Magazine: 09/03/03) that she was finished with the needs and surgical demands of being a ‘Hottie’!
    From People:
    JAMIE LEE CURTIS
    “I’ve done it all and it doesn’t work.”

    “People think there’s a fix for everything, and there’s not.”
    Signed,
    Non-Activia-swilling AARP qualified HISTalk subscriber.

  7. Thank you for extending my work into a more general sphere of applicability and I’m grateful for those observations. I would like to tune a couple of comments slightly if I may.
    You state
    “Using time values as unique database keys, such as the assumption that a single patient could not have multiple lab orders with the same timestamp’
    The problem was slightly different to your statement. Different tests for the same sample have to be lodged at exactly the same time ( an obvious impossibility) to be accepted by the system. If not recorded in that way you had to draw another sample. The workaround was to go into the order write down the time stamp for the first order and then write that value into the second and subsequent orders. So the processing problem might be that using a timestamp as a primary key for two tests is needed for them to be synchronised on the one sample. Not a very elegant solution.

    Your Comment “it uses the unchallenged anecdotal comments of unhappy users ” is not only unfair but unreasonably inaccurate. The comments made by the users are the Directors of 7 EDs and so they have a right to carry authority by virtue of the experience but also the number of 6 out 7 presenting a view of Firstnet as unfit for purpose has numeric validity, which they justify with about 20+ pages of their comments – see Part 2 Appendix 2.
    I would also point readers to my editorial about the role of personal experiences being the most useful information to understand the nature of socio-technical failures. http://aci.schattauer.de/en/contents/archive/issue/1124/manuscript/15463/show.html

  8. Prof. Patrick’s analysis brings up the question of: how to approach health IT in the future?

    I think the answer is to consider it an experimental technology once again, a view that has been in dormancy for far too long, and respond accordingly.

    Medicine has ample experience with how to conduct experiments soundly and ethically.

    — SS

  9. Re: “hit by a bus” — there’s a sad precedent — from 1995 to 1998, a couple of nurses published a very funny magazne called “The Journal of Nursing Jocularity” (it pre-dated blogs), some of it really classic healthcare humor…they developed a road show that included a musical comedy extravaganza called “Who’s Got the Keys?”. The entire 5-member editorial staff was wiped out in a car accident driving to one of the shows. It was a sad day in an era when originality and impertinence was beginning to disappear, at least from the world of print.

  10. In the few days I have been following this site, I have really enjoyed the content and style of writing. Thanks for your work.

  11. Great post on the John Patrick article, Mr. H.

    I think HIT safety is at a point much like patient safety was 15-20 years ago. We know there may be issues, but we don’t know where the biggest problems lie. It might be that the most “obvious” problems (clear-cut bugs, e.g. losing data) may contribute less to errors and adverse outcomes than subtler problems (e.g. the system responding to a user command in a way different from what the user anticipates). We probably don’t know all that we need to know in order to make HIT systems maximally safe.

    I believe that whatever is done regulation-wise, we need a way for issues around HIT safety to be studied systematically. An “Institute for HIT safety” could be established as a public-private partnership (e.g. under the auspices of an agency like AHRQ). It could receive reports (anonymous or otherwise) from anyone who cares to submit them, and researchers could study these and attempt to identify previously unrecognized, or under-recognized, sources of potential hazard. If it were established with liability and IP “firewalls” around it (this would likely have to be done under statute) that could loosen some of the current logjam amongst the various stakeholders that block such an effort today. The output could be used to make HIT systems more usable and safer, and also to establish strongly evidence-based standards for these systems.

    Who’s with me?

  12. @ Dr. Herzenstube

    I somehow don’t think this is so simple. Voluntary reporting is not really going to work judging by the voluntary reporting occurring today (see MAUDE database). Also if everybody is not reporting everything, the research would be skewed.

    On the other hand, mandatory reporting is also problematic, since reporting an adverse event would automatically create evidence available for discovery in a malpractice case. Public reporting will probably actually create malpractice activity where none was contemplated.

    Not sure what the solution should be…..

  13. “The output could be used to make HIT systems more usable and safer, and also to establish strongly evidence-based standards for these systems.”

    Outputs interesting, well, you know then but, not very many medical doctor or informations people know what the gentleman said above with no one ever checking whether bad events outnumber any goods from these systems.

    Everyones has waited many many years more than should have to know answers from using systems of dangers reperted by Jonny Patricks. The output could be used to make HIT systems more usable and safer, and also to establish strongly evidence-based standards for these systems.

    It is nevers too later to know in experimentsation bad things making patients sicker even whens not easy. Margulete, the commenter, says like you know, and states too difficults, do not try. Bad attitudes and well, makes these sytems worser.

    Thank yous for excellent bloggers here.

  14. Dr. Herzenstube,

    Re: “I believe that whatever is done regulation-wise, we need a way for issues around HIT safety to be studied systematically“, I think there’s too much industry resistance for that to ever occur voluntarily.

    We study issues around drug safety/car safety/safety/aircraft safety etc. systematically. I think we need to apply the lessons from those domains to IT used in healthcare.

  15. I want to learn more about the mcKesson layoffs. 80% of sales force?? Please tell me more or refer me to a site where I can learn more.

  16. I think the anonymous comment issue is really important and Jon’s response bothers me.

    When his shorter paper was first published in 2009, I read the following:

    “The following section is a representative sample of the positive and
    negative opinions of clinicians each with many years of experience working with
    Clinical Information Systems…

    Other critical comments (made in writing) about the frustrations at using Firstnet
    include:
    “I prefer looking at a paper result than the counter‐intuitive waste of my time trolling through
    the system.
    I keep forgetting how the damn thing is supposed to work and find it more a time waster than a help.”
    Similarly,
    ” every single user *hates* it with a passion…ENTERING the data is a pure nightmare”
    And another
    “it is exclusively used by the nurses and entirely ignored by the doctors”
    and another,
    “Clumsy, complicated (not complex), user hostile, and above all slow at any task I tried”. (p6-7)

    Then via our friend Mr Google, I discovered all of these comments word for word in some correspondence that was printed on the web – and found that they came from only two users. But as you can see that is hardly how the comments are presented in the paper. It reads as if dozens of users separately said these things…

    I am not going to embarrass anyone by identifying the individuals, but I will also note that one of the two doctors quoted has in the past developed their own open source EMR and one might reasonably assume him to be in the same pro-open source, anti-Cerner camp as the Professor. Nothing wrong of course with holding those views – it’s just a rather startling omission that this is not mentioned in the paper.

    In the same correspondence this same doctor offers to put up a notice in his hospital seeking more criticisms to send to Patrick. One way of conducting unbiased research I guess…

    It has now all mysteriously disappeared from the Web, however happily I still have screenshots of all the correspondence which I would be delighted to provide to Mr HIStalk if challenged….

    I don’t think anyone objects to balanced and focused criticism. However, unbalanced opinions presented as facts by interest groups tick me off! When I went to University there were higher standards of academic integrity.

  17. Tired of Patrick PhD Says:

    (see above)

    Except none of the comments address the technical issues such as regarding the conceptual and logical data models and deviations from accepted programming standards creating risk of malfunction and complications on upgrades, raised in Prof. Patrick’s new paper.

    Could this actually happen?

    We’ve already seen at a past HISTalk story a medical center where Cerner system upgrades led to orders going to the wrong patient’s charts (Trinity).

    Perhaps future comments could address those technical issues, not Prof. Patrick.

    Thank you.

  18. Patrick published a report that contains a patient name in his screen shots. Because of him some poor woman’s information has been blasted all across the internet. A simple google search will even get you a photo. Horrible.

  19. This report is not correct and entirely mischievous. The screen shots have been taken from a training database and so do not represent the clinical records of actual patients and can only reference real people by accident. Secondly the person who you have identified is from North America and so is unlikely to have visited a suburban hospital in Sydney. Thirdly the names given in the screenshot do not give an exact match to the North American individual and anyone with one days experience in record linking knows that one needs more than names to associate two records together as belonging to the one person. We will nevertheless remove the name to avoid confusing other dim people like yourself.

  20. Sloppy Patrick Says:

    Patrick published a report that contains a patient name in his screen shots. Because of him some poor woman’s information has been blasted all across the internet.Because of him some poor woman’s information has been blasted all across the internet.

    How petty.

    It looks like this comment is without merit; however, clearly the writer does not know how to recognize what’s important.

    This kind of comment on such a serious matter as international EHR defects is like complaining about polluting Florida with little bits of tank insulation material after the Space Shuttle Columbia launch.

  21. The commentator Tired of Patrick PhD Says “But as you can see that is hardly how the comments are presented in the paper. It reads as if dozens of users separately said these things…” This is a distortion of your own making. You give 5 quotations which makes the number of respondents at most 5 which is somewhat less than your dozens. Contrary to your distortion I give no indication whatsoever of the number of contributors but do give attention to the many years of experience which is absolutely correct.

    You say of the 2009 paper “In the same correspondence this same doctor offers to put up a notice in his hospital seeking more criticisms to send to Patrick. ” and this is correct and represents the level of frustration the community at large have had with Firstnet to the point that many of them were ropable.

    You go on the say “One way of conducting unbiased research I guess…”. I never made any claims as to the sampling of the contributors in the first survey, just a reference to the general level of disaffection. That disaffection remains despite the authorities knowing of it from their own internal mechanisms and the publication of my first report. The second report PArt 2 gives a description of its methodology and canvasses the opinions of a range of ED Directors in the SYdney basin and its environs. It includes hospitals of variable sizes and because I only interviewed Directors the opinions expressed are that of very experienced staff.

    Your comments strike me as hollow and are only designed to distract. It would be useful if you addressed the contents of the reports Parts 2-8 and let us know what tangible defects you have found.

  22. It has been confirmed to me by several different sources in NSW Health that the patient details printed in the Patrick document were definitely the real thing.

    In the normal course of events this would be merely unfortunate but given Jon’s comments above that this claim was a fabrication and the people reporting it were “dim”, perhaps he would now care to let us know whether:

    1. His comment above was a deliberate untruth; or
    2. His sources have given him incorrect information which he has again repeated without any verification

    Surely it must be one or the other?

  23. Occam’s Razor (OR) tells us that they have been told by NSW Health staff about a patient which is clearly a violation of their responsibilities to protect privacy. As I have stated in my case I was using data from a training database and never sought nor believe I have used real patient data.
    OR is either an employee of NSWHealth and has accessed or persuaded others to access records they are not entitled to access which I would have thought made them open to disciplinary action. Alternatively they could be plausibly be an employee of Cerner and have used their access to the records to take this position, in which case many customers would be concerned that they might take such action to attack a valid critical observations about their technology, or a third option is that OR is lying about having inappropriately gained access to someone else’s health records.
    I’m not prepared to engage in this discourse which is clearly dishonest and malevolent. If you want to reveal who you really are we can discuss the actual contents of my reports, the details of which I notice no-one anywhere in world has risen to challenge, yet.

  24. Occam’s Razor Says:

    patient details printed in the Patrick document were definitely the real thing.

    And the “real thing” implications of the research are that this ED EHR product line can main and kill patients. Do you perhaps think that’s important?

    Meanwhile, data breaches due to corporate negligence affecting tens of thousands or millions continue unabated:

    Health Net Delays Notification of Data Breach Involving 2 Million People

    http://www.eweek.com/c/a/Health-Care-IT/Health-Net-Delays-Notification-of-Data-Breach-Involving-2-Million-People-830137/

    True to my observed lack of patient concern and critical thinking skills among our IT “experts”, here’s Scott Adams on:

    FAILURE TO RECOGNIZE WHAT’S IMPORTANT

    My house is on fire! Quick, call the post office and
    tell them to hold my mail!

    — SS

  25. Scot – I think it depends on who is saying the house is on fire. If a fireman was outside my house yelling, I would be inclined to get out quick. If it was an insurance salesman I would probably have a good look around first before I left the building; and if a thief, I would stay inside and bolt the doors.

    So when someone with a limited background in healthcare who also happens to be developing their own system produces a report that claims “everyone” hates a system – without actually naming ANYONE who has actually said this… well no-one should be surprised if some are skeptical!







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Reader Comments

  • : Spot on analysis for how consumerism in healthcare is so critical for future health system success. Thank you for sharin...
  • FLPoggio: I seem to recall that Jeff Immelt, GE CEO resigned from one of Trumps special business committees about a month ago, may...
  • TomInStPaul: AHCP 1. Ryan's proposed law was awful. (How could it not be; it was all about politics and not healthcare financing. ...
  • Clustered: Re. GE investment of $500 million into 5000 software developers over the next 3 yrs There is no way this amount would...
  • printgeek: I am a huge fan of Vince's industry information, so don't take this the wrong way. Regarding the ranking by revenue, how...

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