Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Epic Ponderings
By Cam O’Flage

Epic is a marvelous marketing machine, from initially establishing themselves as a boutique firm with a certain mystique since they were able to tell clients whether they were the right customer (rather than the customer telling Epic that they were the right vendor).  And it continues to be a superlative marketing machine.  They tell a good story, present a great vision, and manage customer expectations nonpareil.  They’re superb business people.

Epic doesn’t do everything right, but who does?

Epic makes many good decisions, but they make some bad ones.

Epic releases aren’t always so bug free.

Now, I know that I speak from a biased perspective since I currently am involved with provision of implementation consulting (staff augmentation) services.  But I’ve been around a long time and seen lots of successes and failures across multiple delivery systems using multiple vendor applications.

Epic’s current implementation methodology, however, is circumspect.  While it’s partially in response to ONC’s mandated MU timetable (another source of discussion), Epic does believe that it knows the best way to install its product.  But a tight timetable with little time to consider workflow needs or optimizations or deferral of vital function simply to make a deadline is so wrong.

We’re told time after time, plan and engineer correctly in advance to maximize return on investment and minimize production problems.  It’s in our business school case studies.  It’s in our re-engineering process improvement literature.  It’s in our quality theories.  Yet, Epic – and ONC – have embraced a slam dunk implementation methodology.  Get it in, optimize later.

There are so many choices.  So many informatics considerations (one of my biggest fears since so many of Epic’s designers and installers simply don’t have a good basis in understanding clinical informatics needs – or revenue cycle considerations, for that matter).  So many process issues.  So many opportunities to improve, to ensure that clinical documentation is complete, that patient safety is maximized, that budget is truly aligned with needs and expectations, that appropriate governance has been put into place, that risks are adequately mitigated, that expectations are properly established, that work/life balance is dealt with, etc.

There are too many customers that go apoplectic when there are budget overruns, even if scope has changed.  While that’s not an Epic problem per se, the perception that their plan is comprehensive and constitutes the safest way to attain MU is contributory.  CIOs and COOs and CFOs and VPs simply need to get real.  An EHR implementation is an immensely complex organizational change, fraught with unknowns and potential failure points.

There are too many customers who wish that they had done their implementation differently. There are too many times that customers realize that optimization entails rebuilding the foundation.  There are too many customers who find themselves a year later not where they wanted to be. HIStalk pages certainly document such things.

However, all of that said, I can’t say enough good things about Epic.  Epic truly focuses on improving the patient experience. Their culture is one of excellence, of passion, of dedication and commitment.  Their employees are smart and industrious.  And they continue to deliver what they promise.  I can’t say that about many IT vendors.

Why Are We Still Struggling with CPOE?
By Daniela Mahoney

I often ask CIOs a simple question: what keeps you awake at night? Over the years I have received many different answers. Lately I have been thinking about my work and my experiences from previous days and could not stop asking myself, “Why, after more than 30 years, are we still struggling with getting CPOE going?” What other industry has tried implementing technologies and three decades later they are still in their infancies with the results?

I was excited about the idea of writing an article each month for HIStalk to share some of my insights about what to do with this entire CPOE business and how to best prepare for its challenges. Then I was wondering about our colleagues in the industry, and who wants to keep reading about CPOE? Mine would be just one more article of something you read somewhere, else because “theoretically,” we know what we need to do and there is already a lot of information about it. And that is the exactly the key — we know the “whats” but we oftentimes miss the “hows”.

But, one would ask, why should anyone listen to Daniela? Well, you don’t have to. I am only going to share what I have learned by doing CPOE for over 20 years. I am going to keep it simple because I find that we can achieve much more when we present information in a way that we can relate to and it makes sense to most of us. It is like baking a molten chocolate cake –  it has only six basic ingredients, but the outcome is divine! You can add the raspberries on top if you wish. Simple is good, and we can achieve exceptional results.

Did you know that CPOE has been talked about since the 70s? In June 1971, the National Center for Health Services selected El Camino Hospital, CA, to evaluate and implement the Technicon Medical Information Management System (TDS) to be used by nurses, physicians, and others. The main goal was to expedite the overall patient care processes.

By 1974, 45% of all orders were entered directly by physicians into their CPOE system. Yes, we had it then, and unfortunately at that time in the 70s and 80s, some of the institutions and vendors who attempted had varying degrees of failures, with some limited successes. It was not until the late 80s and early 90s that we experienced a renewed effort and interest in CPOE. I started my journey on this path in 1990, so I can say that we have learned a lot. Or did we?

I am going to begin with the end in mind, assuming that we are not just doing CPOE to meet the political timelines, but also to do the right thing for the patients and give our clinicians a tool they can appreciate and incorporate into their everyday workflow. Based on this assumption, we will work backwards and talk about the right things to do as we prepare for this CPOE journey. Almost three decades later, it is about time that we get it right the first time around! Here is the roadmap we will talk about in the next 12 months:

1. Is it only CPOE, or there is more? We have to think about what is ahead of us more holistically because CPOE is no longer a standalone project.
2. What support we need from our leaders to pave the road for us and why?
3. Why should I (physician) use it? What’s in it for me? How do we create a value proposition?
4. How much will it cost?
5. How do we create the teams (who steers the wheel vs. who shifts the gears)?
6. Don’t let perfection get in the way of good. Setting the scope of what CPOE is and what it is not.
7. Clinical process transformation. How to manage and not get crushed by the magnitude of change.
8. How about the vendor? Where do they fit into this?
9. Did we get it right? How do you know? (aka, success factors).
10. What is going to make us fail? If 30% of CPOE installs have historically failed, how do we rise above this? (aka, risk factors).
11. Large or small hospital, we need to roll out somehow. What are the options and their respective pros and cons?
12. No, I did not forget about training and support. I will address this as well.

And if there are any other readers who enjoy cooking as much as I do, here is the link to the molten chocolate cake. 30 minutes to prepare, six minutes to cook, and 10 minutes to savor your work of art. And while you are enjoying this superbly rich chocolate delicacy, please try not to think of CPOE!

Daniela Mahoney RN is president and CEO of Healthcare Innovative Solutions of Seville, OH.

Thoughts on Lazar Greenfield Stepping Down
By Tiffany Carroca

On Sunday April 17, renowned surgeon Lazar Greenfield MD resigned from his position as president-elect of the American College of Surgeons (ACS). The resignation came just over two months after he had written a controversial article that caught the attention of nearly everyone in the healthcare community, including those in medical coding, and has achieved a level of infamy nationwide as the Valentine’s Day editorial. The controversy of the article stems from a statement made in which Dr. Greenfield suggests giving women semen for Valentine’s Day instead of chocolates.

The editorial was originally published in the February 2011 issue of the American College of Surgeons affiliated newspaper, Surgery News. The paper, made available free to the public online, was pulled from the Web site when the controversy erupted soon after the story ran. Interestingly, Dr. Greenfield was also editor-in-chief of the publication, but was subsequently removed from the position due to the content of his article.

Although Dr. Greenfield apologized for the editorial and reaffirmed his belief in the rights of women in health care, these actions did not end the controversy. Besides offending many female surgeons who have had to put up with sexual harassment for decades in this male-dominated field, Dr. Greenfield managed to dig himself in deeper when he sent an e-mail to several media outlets defending his claims. However, Dr. Greenfield did ultimately determine that resigning would be the best way to put an end to the uproar over his article. In a statement given to ABC News, Dr. Greenfield said, “My personal and written apologies were ignored, and my suggestion to use my experience to educate others rejected. Therefore, rather than have this remain a disruptive issue, I resigned.”

The comments made by Dr. Greenfield on Valentine’s Day seemed like a joke to some and the crass opinion of a womanizer to others. However, the statement does have a basis in scientific and medical fact. Dr. Greenfield was referring to a study published in the Archives of Sexual Behavior in 2002. The study was performed by psychologist Gordon G. Gallup, PhD at the State University of New York in Albany, and gained widespread attention when it was reported in the article Crying Over Spilled Semen by Tiffany Kary for Psychology Today.

The study was conducted on 293 college women who were sexually active. The results showed that women experienced less depression after having unprotected sex, and the depression slowly returned as the time progressed after their last sexual encounter. Women who used condoms did not experience any reduced or heightened rates of depression.

The conclusion reached by Dr. Gallup was that the hormones contained in semen are absorbed through the walls of the vagina and elevate the mood of the woman after intercourse. Other variables that could have caused the reduced depression, such as birth control and behavior patterns, were also taken into account.

The group most outraged by the editorial was women in the healthcare field, most notably women surgeons. Colleen Brophy MD, a prominent professor of surgery at Vanderbilt University School of Medicine and chairwoman of the ACS’s surgical research, explained to Pauline W. Chen MD who reported on the story that she was “aghast” at the editorial. However, when the ACS refused to stand by her response, Brophy resigned from the College in response, claiming, “The editorial was just a symptom of a much larger problem. The way the College is set up right now is for the sake of the leadership instead of the patients.”

Many women in the healthcare field voiced their outrage over Dr. Greenfield’s editorial, but he was not without his supporters. Dr. Greenfield, a professor emeritus at the University of Michigan, had always been highly regarded and was presented with the Jacobson Innovation Award just last year, according to NPR’s Health blog.

A colleague at the University of Michigan, Diane M. Simeone MD, came out in his defense, saying that she has witnessed several accounts of gender bias among surgeons, but never from Dr. Greenfield. Similarly, Dr. Gallup, who conducted the initial study, also came to the defense of Greenfield, noting that what he said may not have been tasteful, but does have “some basis in available science.”

Undoubtedly, Dr. Greenfield’s remarks caused a public outrage even though they were based on science. However, a lewd and womanizing comment based on science is no less offensive that one based on fiction. If Dr. Greenfield was trying to be humorous or otherwise non-offensive with his comments, he failed miserably, as public opinion has shown. Even an esteemed doctor and scientist can fall from grace when injecting personal opinions into the science. As most scientists will agree, it is best to keep the science pure.

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Top News

The VA awards The Informatics Application Group a $5 million contract to serve as the custodial agent that will manage a proposed open-source development program for VistA.

Reader Comments

From Anon: “Re: ONC. Recently cancelled a number of print and Web ad contracts. They have instructed their ad agency to work with 10% of their original million-dollar budget.” Unverified.

HIStalk Announcements and Requests

Vince Ciotti is loving all the comments, stories, and even corrections he’s getting to his HIStory series. He gave the OK to run his e-mail address for anyone who wants to get in touch. 

Thanks to the following sponsors (new and renewing) and long-term advertisers that supported HIStalk, HIStalk Practice, and HIStalk Mobile in May. We appreciate their support.

Acquisitions, Funding, Business, and Stock

PwC acquires Implementation Specialists (ISH).

athenahealth’s Jonathan Bush and Ed Park are among a group of angel investors and VC firms investing in HIT start-up Kyruus. The company’s software platform compiles data from public and private sources to create predictive analytics and professional profiles on physicians. Sound big brother-ish.

Misys doesn’t have much healthcare presence these days, but for those who still follow the company, it confirms that a potential buyer is interested in acquiring the company at a valuation of $1.4 billion.

Sales

North Idaho Health Network picks MobileMD to provide HIE services for five hospitals and 305 physicians.

People

PatientKeeper president and CEO Paul Brient wins the Ernst & Young Entrepreneur of the Year award for New England and is now eligible for consideration for the national award.

Former Ingenix VP Tom MacDougall joins Curaspan Health Group as the company’s first CTO.

Prognosis Health Information Systems appoints William M. Conroy to its board. He was CEO and president of Initiate Systems until IBM acquired the company in March 2010.

University Health Care System (GA) names Leslie Clonch as VP/CIO. He was previously with Doctors Hospital at Renaissance (TX).

Announcements and Implementations

The University of Kansas Hospital goes live with 240 evidence-based order sets using Zynx Health’s clinical decision support solutions. The ZynxCare tools are deployed via KUMD’s Epic EHR.

Accenture and MOH Holdings announce that the first phase of Singapore’s National EHR system is now live.

The data warehouse appliance product of Health Care DataWorks earns EHR Modular certification for calculating and submitting inpatient and ambulatory clinical quality measures.

Yuma Regional Medical Center (AZ) gets a mention in the local paper for its $70 million Epic implementation.

Cooper University Hospital (NJ) says it’s the first in the country to transmit real-time clinical information for dialysis patients in the ICU. iSirona’s  medical device connectivity software sends the information to the hospital’s Epic system, allowing doctors to monitor the effectiveness of dialysis treatments from any location. They’re planning something similar for vent patients.

Government and Politics

CMS will use predictive modeling to fight Medicare fraud. It’s the same sort of risk-scoring technology that credit card companies use, but modified to analyze Medicare claims. That reminds me of the time VISA called me to see if I really did purchase several hundred dollars worth of goods and services at a strip club (the answer was no.) I wonder if Medicare will start calling up 70-year-old men to verify whether they indeed had procedures performed to sever their vasa deferentia?

The National Library of Medicine launches MedlinePlus Connect, a free service that allows health organizations and providers to link patient portals and EHRs to MedlinePlus.gov for consumer health information. Providers can meet one of the 10 menu set criteria for Meaningful Use by linking to it.

An India-born weight loss doctor who took in $25 million from billing insurance companies for questionable weight loss treatments makes the FBI’s Most Wanted list. The complaint says the doctor’s five clinic locations billed for tests not needed or not performed, allowed employees to hand out controlled substances without asking a doctor, and dressed up unlicensed personnel and passed them off as nurses. He got in trouble a couple of years ago for insider trading.

Technology

SAP is apparently offering an EMR.

Other

Several health systems and a few HIT vendors earn spots on ComputerWorld’s 100 Best Places to Work in IT 2011. Top health systems include Kaiser Permanente (16), Texas Health Resources (19), and Lehigh Valley Health Network (20). Recognized vendors include Cerner (27), Quest Diagnostics (70), and Compuware (86).

NextGen will host a webinar this Thursday called Tips from a Physician on Transforming Your Practice Through Meaningful Use. The physician presenter has already led 29 doctors achieve Medicare Meaningful Use.

Weird News Andy proclaims himself Sad News Andy because  of this tragic story from the UK: a top orthopedic surgeon hangs himself in the garage of his estate, reportedly after making a relatively minor surgical error.

Fallon Clinic (MA) joins Atrius Health. Both are Epic users.

Odd: a man gives a bank teller a robbery note demanding $1, then sits quietly waiting for police to arrest him. The reason: he’s unemployed, ill, and has been turned down for disability and Social Security. He’s hoping the court puts him away for several years (and says he’ll do it again if not) so he can receive medical care, after which he plans to collect Social Security and move to the beach.

Ohio Public Radio covers electronic medical records, with Dr. Gregg as one of the guests along with folks from ONC and Ohio Health Information Partnership.

Sponsor Updates

• CynergiskTek and its partner Diebold will exhibit their enterprise security solutions at next week’s HFMA ANI 2011 conference in Orlando.
• ADP AdvancedMD is sponsoring at this week’s Utah Promontory HIE and Technology Connectivity Conference in West Valley City, UT.
• Emdeon expands its services portfolio with the acquisition of Chapin Revenue Cycle Management, a provider of hospital-based revenue cycle services.
• GetWellNetwork’s chief outcomes officer David W. Wright is appointed to the board of directors for the American Nurse Credentialing Center.
• TeleTracking Technologies will host a free conference on automating transfer center operations August 17-18 in Nashville.
• HMS Direct, a subsidiary of Healthcare Management Systems, will expand its data center capacity by utilizing hosting services from Peak 10 Inc.
• Thomson Reuters’ Pharmacy Xpert  and Clinical Xpert CareFocus earn ONC-ATCB modular certification.
• Medicity announces that its ProAccess technology has received ONC-ATCB modular certification.
• Benefis Health System (MT) selects NextGen Ambulatory EHR, PM, and HIE technology for more than 80 physicians at its hospital-owned practice.
• Access releases a new version of its on-demand forms applcation.
• QuadraMed and Elsevier align to combine Elsevier/MC Strategies ICD-10 e-learning suite with QuadraMed’s ICD-10 Countdown Program.
• Elsevier also signs an exclusive partnership with The Quality Group (TQG) to market TQG’s Health Care Series, a customized process improvement training solution for healthcare professionals.
• McGraw-Hill Higher Education and Greenway Medical Technologies announce an online HIT course for colleges and universities. Integrated Electronic Health Records: An Online Course and Worktext for Greenway Medical Technologies’ PrimeSUITE will be offered through McGraw-Hill’s Connect Plus teaching solution.
• OptumInsight (Ingenix) collaborates with InstaMed to offer CareTracker Payment Connect, an electronic bill payment service for patients.
• Billian’s HealthDATA will exhibit at HFMA ANI 2011 in Orlando next week. Check in on Foursquare and show it to the booth reps and they’ll give you a Starbucks gift card.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

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Well, it seems Dr. Jayne has a new not-so-secret crush. His name is Ricky Roma. Seriously, I almost swooned reading his response to my recent Curbside Consult. 

Why, you ask? Because 90% of the time, I sit on that wall right beside the fearless IT warriors at my hospital, defending security policies and standards as well as truth, justice, and the Enterprise Way.

I’m the one who has the fun of giving the smack-down to whiny end users (frequently Department Chief types or high-profile surgeons) who don’t understand why giving their passwords to their students and staff is a bad idea. I get to explain why each department can’t have their own customized software when we’ve got a large health system to run. I’m a huge fan of that speech in A Few Good Men and I’ve used a variation of it more than a few times.

One of the things I enjoy most about writing for HIStalk is for Dr. Jayne to be able to represent viewpoints that are not necessarily mine. I’ve been an “IT guy” long enough to know that we do play a somewhat parental role. Like those who celebrated Father’s Day yesterday, giving in to everything that’s asked of us isn’t a good idea.

Another aspect I enjoy is the ability to throw topics out and see what’s hot and what’s not. And this is clearly hot. I’d like to share some of the responses I received. Regarding my comment about an orthopedic colleague who had the wide-aspect laptop, one reader pointed out:

The hardware issue is really a software issue. Your point about software working on 4:3 vs. 16:9 screen displays is valid to a point. However, I find that my Web apps can adjust to my display, especially if the display is a phone. It seems to me that with the growth of HD capable monitors and gaming- and video-optimized laptops that software vendors would let go of their control of each pixel and allow folks to optimize their software for the aspect ratio of their system.

One of the coolest things I ever saw was a technical writer would could take his massive 16:9 monitor and pivot it from landscape to portrait orientation and his application (Word in this case) reoriented the display to take advantage of the orientation. He went from side-by-side book layout of two pages to one page over the other. Very, very cool.

HIT should demand that kind of separation of display from the underlying application. I know it can add to support costs, but is the goal here to reduce support costs or make medical practitioners more efficient and comfortable in their work.

I don’t disagree. More vendors need to make their user interface dynamic. However, when the vendor clearly states in the documentation that there is a specific aspect ratio and resolution required for the product but the IT staff purchases something different, it’s a hardware/people issue. Agreeing on that point, the reader added:

Having started in healthcare at a startup years ago then moved on to other fields, including mobile, and then back into healthcare and EMRs, I felt as if the industry had not changed in my absence. What I see is that there just has not been enough money in the market for anyone to actually maintain apps the way they should be, which is managing the infrastructure as well as just shoveling on more features.

In the ambulatory EMR market, I just see a race to add functionality without investment in redesign so you get these incredibly long series of tabs with very difficult discovery of how to do what you want to do next. In this world of Google, it is crazy that many searches are still bound to a particular field rather than being ‘softer’ and allowing for searches across multiple fields with a list sorted by relevance.

There is this huge disconnect for healthcare workers between the systems they use at work and those they use in their private pursuits.

This last statement is incredibly profound. It supports why so many physicians want to use the technologies available to them in other arenas when they are caring for patients.

Trust me, I understand security. I understand encryption. I understand HIPAA, OCR penalties, and the perils of letting users slap any old device on the network. I also understand load balancing, network and server performance metrics, and a host of other things that, when spoken about in mixed company, render other physicians clueless.

Having had not only my physician data breached (including SSN) but also my own PHI, I really do get it. What I have difficulty understanding though, is an IT department that runs Windows XP across the board and will allow Fujitsu tablets on the network but not HP devices.

Some savvy readers noticed that although many reader comments were of the “no Apple, no way” variety, other than citing the project at Albany Medical Center, I never suggested that IT departments should allow users to put personal devices on the network at their every whim, or that Apple products didn’t have potential security issues. In speaking of the variety of hardware in the market today, I used the word “nightmare” to describe the consequences of lack of standardization. I didn’t suggest that IT departments throw the baby out with the bathwater, but noted that those who are able to temper their requirements have an advantage over those who don’t.

Not every IT department is understaffed, underfunded, or abused. One correspondent cited a hospital where the IT department has more employees than any other business unit, as well as a level of funding that is many times that of the top clinical divisions combined. (word of advice – if you don’t want to “out” your employer, don’t message on Facebook because I can see who you work for. And BTW, I am not surprised!)

What’s extremely hard for CMIOs to do, even those of us who sit in solidarity with our IT brothers and sisters, is to explain to the physician who is working with the ergonomics team because of a visual disability that the IT department does not have any devices to offer her other than a fixed-location PC with a large monitor (even though they’re readily available from the vendor) because they’re not “standard.” As Shipes commented, maybe it’s an IT governance problem.

How should we respond to the colleague who has read about competitors using different technology, or the one who is on staff at a competitor hospital who allows iPads for patient care? HIStalk and other media are full of articles about healthcare organizations embracing the iPad. Clearly some organizations have figured out ways around the security issues, or are able to limit use to certain applications. Clinicians are looking for facts, not fear. As I was thinking that I’d like to hear from those groups how they do it, my inbox made its happy little ‘ding’ sound, and a fellow CMIO hit the nail on the head:

Security and productivity can’t be mutually exclusive, or healthcare is doomed. It is imperative that everyone in IT from the CIO and CMIO down to PC support realize we all share a common mission: (1) patient safety and satisfaction (often forgotten); (2) organizational productivity (no margin, no mission); and (3) physician satisfaction (we like happy docs). If this means devoting resources to figure out how we can provide secure access from physician devices, we should plan on that investment. I often hear from my colleagues that we care little about their practice, we have no consideration for patient care, and we have no interest in helping them with daily activities of being a physician. IT has become integral in the care of patients and needs to act that way.

We are in the process of provisioning the Epic Haiku (iPhone) and Canto (iPad) app to probably close to 1,000 physicians. We did an internal survey and discovered 90% of our physicians use smart mobile devices, greater than 75% the Apple platform. The Epic mobile app allows them to have deep access to the patient’s current chart and past history in real time, and with AT&T, they can be speaking with a nurse or colleague while reviewing the chart simultaneously. Please tell me how that sort of convenience isn’t worth the extra steps to ensure secure PHI. The app is set up as a remote viewer, no PHI is stored on the phone, and it requires three-factor authentication (user ID, password, and unique device ID). That’s much more secure than random papers floating around in hallways and cars.

As a CMIO, it’s my job to represent the physician perspective and help bridge the gaps between the needs of IT, the needs of clinicians, and the almighty budget. When I’m not drowning my end of day sorrows in a nice scotch, I’m hoping for the miracle that allows me to deliver the impossible with solutions that are simultaneously fast, safe, and physician friendly. In the meantime, though, I’m right next to you on that wall, Ricky Roma.

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From Cheesy Politics: “Re: Epic. At least one Wisconsin political blogger sees it as evil. She does have a point: isn’t HITECH about government getting more control over health information to be able to push out mandates?” I read that post when it was published, but like most partisan blogs, it was a bit too hysterical for me to mention here. Not to mention factually incorrect, saying HITECH has set aside “almost $100 million in total” for EHR incentives (oh, if only) and that the Health IT Policy Committee that Judy Faulkner sits on is “the federal Health IT board.” I agree that the government runs healthcare and will continue to expand its influence over it, but that’s to be expected – they’re paying for most of it in the form of redistributed taxpayer money.

From The PACS Designer: “Re: Prezi. In a recent blog post on HIStalk, Will Weider mentioned that he used Prezi as his online presentation software which he preferred over other possible choices. Prezi seems to be more user friendly with its zooming whiteboard concept, and is gaining more popularity because this feature.” It can “Prezify” your PowerPoint slides, I note. Price ranges from free to $159 per year. PC Magazine gave it 3.5 stars in October, mostly because of limited design choices, but said presentations are “an animated visual feast.” I’m not sure that’s enough reason to switch, especially if you aren’t already using PowerPoint’s animation tools (and let’s face it, for most in-person presentations, those “animated visual feasts” would be super annoying, so I’d save them for making videos).

From Former CIO: “Re: corporate proxy reports. Not healthcare related, but amazing.” A corporate governance group highlights corporate proxy disclosures that are bizarre:  one company’s CEO agrees to spend 80% of his “business time” on the company’s affairs, up from the previously agreed on 60%. I have to say I was disappointed – the proxy disclosures are nothing compared to the perks executives get that aren’t disclosed. Even non-profit hospitals and groups are quite generous with the executive bennies: cars, private club dues, travel, and big bonuses. Clueless VPs get fashionable technologies to screw up, meaning they’ll make impatient calls to the CIO to demand that the on-call field support tech be sent over to their summer home to fix the hospital-provided, state-of-the-art laptop that the VP’s teenage son messed up while torrenting porn.

Several readers have e-mailed over the years saying that they would like to support HIStalk’s sponsors, but can’t easily figure out who offers what products and services from the ads. They suggested an online guide similar to the one that HIMSS puts together for conference exhibitors, where you can look up companies by category. Great idea, so we’re doing an HIStalk Resource Center that does exactly that. You can navigate by company name or category and jump between companies by breadcrumb links. You can also request information by clicking a “send RFI” link that will let you contact a company directly without having to fool around with composing an e-mail or finding the contact form on their site. It’s a work in progress. I’ve added a tiny clickable banner right below the Founding Sponsor ads that will take you there.

When Ricky Roma left his A Few Good Men parody rebuttal to Dr. Jayne’s complaints about IT, I knew it was too good to not promote to the main page of HIStalk instead of leaving it as a comment. Your reactions proved me correct – it’s darned funny and, for those of us who have worked the IT side of the house, a good description of why IT shops don’t always have the budget or labor to support Apple’s latest gizmo. In case you weren’t around or paying attention back in 2009, check out Ricky’s excellent Tales of the Dark Side (a  snip: “Remember, the demo is an illusion. A lunch demo, doubly so. ”) I’ve been pestering him to write more for HIStalk ever since. If I thought an outpouring of support would convince him, I’d start a petition.

Not good news if you compete with Epic: while survey respondents give differing reasons for its success, combining answers 3, 5, and 6 together suggest that more than 60% believe it’s because Epic’s product is better. New poll to your right: is it OK that an electronic medical record contains scanned documents along with discrete data fields?

Watching: In Plain Sight, my new favorite Netflix series. You could neatly categorize most people by the character they find most attractive: federal marshal Mary Shannon of the Witness Protection Program, her sister Brandi, or her partner Marshall (who I guess would be Marshal Marshall). Brilliant acting and writing, like this quote: “The second revelation came as I sat at the bar in morose solitude, pondering the cantilevered relationship between bartender’s gut and lower extremities. And this is important, so pay attention. Before the big bang, before time itself, before matter, energy, velocity, there existed a single, immeasurable state called yearning. This is the special force that, on a day before there were days, obliterated nothing into everything. It is the unseen strings tying planets to stars. It’s the maddening want we feel from first breath to last light.” And Listening: Yes, The BBC Recordings 1969-70. Truly amazing and polished, complex music played live by guys in their early 20s, one of my favorite bands (through Relayer, anyway). Stupendously good.

Cerner forms a joint venture in Saudi Arabia to offer Millennium to hospitals there, working with a government-owned investment firm and a business development group.

Dr. Jayne is interested in learning more about IBM’s Medical Record Text Analytics solution (a spinoff of Watson), so if you’re an in-the-know IBMer, feel free to contact her. She missed last week’s Webinar on the topic, I assume.

I see from his Facebook updates that Ed Marx has reached the top of Mount Kilimanjaro, Africa’s tallest peak at over 19,000 feet (that’s an earlier training pic above, just in case you were thinking that it doesn’t really look all that tall). Ed’s an ardent HIStalk supporter: he voluntarily writes for us (very well, I should add); he Likes all of our Facebook posts; and he graciously took time out of his HIMSS schedule to speak at our sponsor lunch in Orlando. Therefore, I quite reasonably conclude that Ed is the man.

My Time Capsule editorial this week from 2006: Before You Buy, Look at the Impact on User Productivity.

ONC is using some of its tsunami of taxpayer money for publicity: ghost-written blogs, contests, and now advertising. The one above has a new “campaign” that I’m guessing came from an expensive PR firm: "Putting the I in Health IT.”

Weird News Andy summarizes this story as “The government paying more than necessary and offering less than effective options? I’m shocked, shocked to find that is going on here! </casablanca>” UCSF researchers say Medicaid could save a lot of money by paying for drugs that are on WHO’s Essential Medicines List, which is used by 131 of 151 countries surveyed, instead of letting each state make up their own inconsistent lists. If you’re a fan of creeping socialism, you’ll be happy to note that 20% of the country is on Medicaid. Sometimes I get the feeling that those of us who pay taxes to support everyone else are getting to be a tiny minority.

Speaking of Medicaid’s wasting of money (was that redundant?), North Carolina’s project to replace its Medicaid claims processing system is now two years behind schedule and more than $200 million over budget, not to mention that the state will also pay EDS another $110 million to process claims over two years since the new system isn’t ready. The contractor is CSC, the company that’s even more behind and over budget in Britain’s NPfIT boondoggle, also responsible for Medicaid system problems in other states. The state isn’t blaming CSC, though – they say it’s the federal government’s constant Medicaid tinkering that keeps changing the specs. The state is offering to change the five-year, $287 million contract to a seven-year, $495 million one with Uncle Sam picking up 90% of the tab. I have several reactions: (a) never hire CSC to do anything; (b) North Carolina is obviously ignoring my advice since CSC’s punishment for missing budget and deadline is to get more money; (c) as everybody who knows billing is well aware, the government may talk efficiency and modernization, but its arcane Medicare and Medicaid payment requirements ensure that providers can adopt neither; and (d) it’s pathetic that a mid-sized state has to spend $500 million just to manage Medicaid payments (small compared to Medicare) and none of that money does anything to improve population health or patient care – it’s just an administrivia management system created by an unholy alliance of contactors, lobbyists, and government employees (many of those in the latter category planning an eventually profitable exodus to one of the first two.)

Minnesota Public Radio runs a surprisingly comprehensive and balanced article on electronic medical records in rural hospitals, covering (a) the benefits; (b) the penalties; (c) the shortage of HIT labor for both providers and vendors; and (d) the likelihood that EMR pressures along with healthcare reform will force rural hospitals to sell out to bigger and better-funded organizations or shut down completely. A quote from the CEO of a 14-bed hospital (above): “I’m not sure that even God’s bank has enough money for electronic medical records. Are we working on it? We’re working ourselves crazy. Eighty percent of our capital budget every year goes toward implementing another aspect of EMR.” The article talks a lot about Duluth-based SISU, a non-profit hospital consortium that offers Meditech systems, hosting services, group purchasing, and IT expertise.

Clueless Internetters who probably couldn’t name the Secretary of State or point out Canada on a map focus their limited intellectual capacity on tracking down Haynes Management, a 21-employee real estate company that supposedly fired an employee whose wife was diagnosed with cancer. In their haste to become part of a viral mob reacting emotionally to the one side of the story they read, the nitwits Google over to Hayes Management Consulting (apparently deciding that the N in Haynes is insignificant) and start sending hate e-mail. Hayes issues a press release denying that it’s them. When Inga e-mailed me the press release, I gave an instant reply: “Hayes is brilliant for using this to promote themselves. It’s fun to write about, so I bet it will get picked up.” Which it has. 

Lehigh Valley Hospital-Cedar Crest (PA) kills a kidney transplant patient, a 51-year-old nun, with insulin when defective blood glucose testing strips erroneously show her as hyperglycemic. Communication problems were also involved: a nurse from the hospital’s remote ICU monitoring station noticed the difference between results from the test strips and from blood draws, but didn’t tell anyone.

Chuck Friedman, ONC’s chief science officer and one-time #2 guy there, is leaving to run an informatics program at University of Michigan. We told you on June 8, courtesy of rumor reporter Roman DeBeers, that he was quitting, although Chuck ignored my e-mail asking for confirmation. ONC’ers sure like those academic appointments.

Here’s Vince’s latest HIStory, for which he credits the help of Bob Haist of SMS/ISD and Bob Pagnotta of MDS/Tymshare.

Dell will spend $80 million on an ad campaign pitching its capabilities beyond selling commodity PC hardware, with one of the four TV ads showing a doctor. 

Strange: the medical school dean of the University of Alberta is demoted to professor after parts of the graduation speech he delivered were found to have been taken verbatim from a similar speech Atul Gawande gave at Stanford last year. Graduates claim they Googled a particular phrase, “velluvial matrix,” on their smart phones as the dean spoke, allowing them to follow along from Gawande’s original speech. It was a giveaway since Gawande made the phrase up, as he explains later in his own speech: “OK, I made that last one up. But the velluvial matrix sounds like something you should know about, doesn’t it? And that’s the problem. I will let you in on a little secret. You never stop wondering if there is a velluvial matrix you should know about.”

University of Florida gets a $500K NIH grant to create EHR alerts using genetic information, which will influence treatment decisions involving an unnamed drug to prevent heart attack and stroke (which I assume is clopidogrel). 

A Maryland infrastructure company gets a $45 million contract to work with a China-based counterpart in developing a cloud computing center to host electronic medical records in that country.

Utah announces Clinical Health Information Exchange (cHIE), a statewide HIE (part of the Utah Health Information Network) with participation from Intermountain, MountainStar, IASIS, and University of Utah. It’s actually been around for a year or so as I recall, so maybe the announcement was related to broader participation.

Just in case you need something to run on your iPad: Big Fish Games releases the free Hospital Haste, where you “help Nurse Sally work quickly to diagnose, treat, and cure all of her patients.” (obviously they aren’t intimately familiar with what nurses are legally allowed to do).

E-mail Mr H.

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I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in April 2006.

Before You Buy, Look at The Impact on User Productivity
By Mr. HIStalk

A story often repeated: a big organization executes a high-profile rollout of a clinical system, but caregivers say it takes longer to use. They deliver an ultimatum — either you accept a reduction in productivity or you ditch the system.

The latest subject is the Department of Defense, whose new $1.2 billion AHLTA system (which is actually the renamed old system, CHCS II) is claimed by users to be so slow that they have to reduce their patient schedules by one-third. Patients are being diverted to emergency departments and routine checkups aren’t being done.

Maybe this is telling us that we don’t look hard enough at a system’s impact on user productivity. I don’t recall ever having heard of a health care organization that measured how long it takes to write an order, document care, or write a prescription, comparing times before a system install and after. I’ve never heard of someone choosing a particular system because it’s faster for the caregiver, or in many cases, even giving the caregivers a peek at it before the decision to buy is made.

I’ve also not heard of an organization budgeting additional staff to offset reduced productivity with automation. The reason is there’s not supposed to be any slowdown. Everybody knows that computers improve productivity, right?

If that was the case, all those PCs that hospitals have deployed would have caused huge staff reductions. I haven’t heard of that either. Sales prospects are easily impressed with unrealistic projected staff reductions that never seem to materialize.

It gets worse when users are hard-to-find licensed staff, such as nurses or pharmacists. A system that takes up more of their time, no matter what benefits it provides to someone else, may create a staffing dilemma that directly impacts patient care.

This is a customer problem, not a vendor problem. If customers demanded productivity gains for their users, vendors would respond (or lose business). This goes back to a generally casual regard for usability testing — never a priority in the mainframe days and not improved very much since in health care.

Local configuration options make it hard to evaluate an off-the-shelf vendor system upfront to determine workflow impact. You could ask the vendor’s customers, though. Arrange to time how long it takes to chart a med as given, to create a progress note, or to enter an order set as a physician. Then, compare that with the time required by your current process.

You don’t need the vendor’s help to do this. You might want a management engineer to look over your shoulder for consistency in measurement. Otherwise, all it takes is for hospitals to talk to each other, which they’re usually pretty good about doing.

I don’t know about you, but I’d rather not be in the hot seat to answer this question from clinicians — do you want us to take care of patients or to use your system?

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