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Monday Morning Update 8/1/11

July 30, 2011 News 5 Comments

7-30-2011 2-04-43 PM

From ACC_Champs: “Re: NCHICA’s response to Accounting of Disclosures. By getting input from all sides of the issue, they have drafted a great response.” Some of their concerns:

  1. Just because few people ask for Accountings of Disclosures now doesn’t mean they won’t in the future, requiring hospitals to do a lot of unpaid work.
  2. The scope needs to be better defined since not everything is stored permanently in the EMR (such EKG strips, as I read from their example).
  3. The definition of “access” should be clarified, such as if someone searches for “John Smith” in an EMR and is shown a long list of John Smiths, is that considered “access” of every one of them?
  4. It’s not as easy to generate an Access Report as you might think, with hospitals churning out tons of data from many systems (one hospital found that an average six-day inpatient stay generated 1,800 accesses).
  5. Access logs aren’t something the typical patient would be able to understand, meaning they may expect someone to spend time explaining them.
  6. Patients who don’t understand that hospitals have a lot of unseen people involved in their care are going to file unwarranted complaints to OCR.
  7. Employees aren’t protected from ambulance chasers or crazy patients who could easily obtain their full names by requesting an access report.

7-30-2011 8-22-22 AM

From Quaid: “Re: Siemens. Hawaii Health Systems Corporation just signed a $28.7 million deal for Soarian.” Verified.

7-30-2011 8-16-30 AM

From Anony: “Re: Piedmont Healthcare, Atlanta. Can’t believe I haven’t seen it here yet, but they’re moving from Allscripts to Epic.” As usual, the best way to verify is to check the hospital’s job postings since the Epic implementation method requires hiring a ton of people fast, including posting all jobs instead of just reassigning current staff. Piedmont listed several inpatient Epic positions on July 12, so I’d say that’s confirmation. I should also mention that Johns Hopkins signed its Epic contract this week. Both will apparently be Allscripts Sunrise losses.

7-30-2011 12-06-24 PM

From Anonymous: “Re: Allscripts. Continuing to reduce workforce in Raleigh as jobs are offshored, with 15-20 folks gone in the last week or two.” Unverified.

From Nasty Parts: “Re: Compugroup. Heard on the street that they’re buying the Sage Healthcare business. Folks at Compugroup USA HQ openly talking about it.” Unverified.

From KnowurCMIO: “Re: Cerner and Epic. Epic has indeed started expanding overseas — they have a satellite HQ in the Netherlands and have already installed there. I suspect they will begin seeing rapid growth once the implementations stateside slow down. Spaarne Hospital was the first EpicCare client in Europe in 2007.”

From Bob: “Re: shoe hoarder. I read this and thought of Inga.” A Philadelphia mom who happens to be a big-money poker champ owns 1,200 pairs of shoes (one pair worth $4,000) stored in four closets, one of them a converted sitting room. She’s profiled in a film about shoe nuts, which concludes that such compulsion is related to seduction and sex. I’ll let Inga to clarify her own motives.

Here’s the latest HIStory from Vince, this time covering Dynamic Control.

Listening: the new CD from teen rockers Jessica Prouty Band, sent over by her mom, who has a lot of history in HIT. Their sound has matured a lot over the years I’ve followed them, putting them right up there with Evanescence, Within Temptation, and some of the other female-led metal rockers. Big sound for a four-piece, with singer Jessica handling the bass very well. This is a really polished production – you would never suspect that the members are barely old enough to drive to their gigs. Video here.

My Time Capsule editorial from 2006 this week: When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In, snipped herein: “From my limited experience, I would say that CIOs overrule the concerns of nurse informatics people nearly 100 percent of the time and IT-based physicians at least 50 percent of the time.”

7-30-2011 10-12-19 AM

Most respondents believe that HITECH’s legacy will be increased EMR adoption, although the “waste of taxpayer money” camp was right on their heels. New poll to your right, spurred because I got a HIMSS member survey recently: how would you grade your satisfaction level with HIMSS? As always, you are able and encouraged to add your comments by clicking the Comments link on the poll, visible after you’ve either voted or clicked the View Results link.

HIMSS moved its Chicago headquarters this weekend.

Sage announces Intergy v7, which includes user enhancements, certification of all 44 ONC-ATCB clinical quality measures, and 5010 support for the PM/EMR system.  

NHS Scotland contracts with Imprivata for its OneSign single sign-on and password reset solution.

7-30-2011 12-13-21 PM

A reader sent over the full text EHR articles that were just published in the July issue Journal of Oncology Practice. Here’s a brief rundown of those I found interesting.

  • A US Oncology team, working with iKnowMed to standardize over 500 chemo regimen order sets, found that 10% of them needed to be eliminated, with changes required for all the rest (other than changes in title, the most common changes involved updating the cited references and changing doses and cycles). They mention that EMRs can help address drug safety issues.
  • NorthShore (IL) looked at the cultural impact of moving all inpatient and outpatient oncology ordering to Epic in 2005. The main benefit was data sharing among members of the multidisciplinary team (labs, rads, referrals, appointment information) and patient communication (secure communications, online test results). Chemo ordering in Beacon was found to be more complete and safer, with the percentage of complete documentation going from 67% to 93% and pharmacy interventions also increasing. They’re at 100% e-prescribing (other than for narcotics and oral chemo), outpatient med rec is over 90%, and AR days have dropped to 30. They’re using Epic’s data for research and quality monitoring.
  • A Vanderbilt group looked at improving compliance with nursing guidelines on chemo administration and documentation using their systems (WizOrder, Horizon Meds Manager, Horizon Expert Documentation, StarPanel). Pros: two-signature compliance improved, standardized MARs were easier for nurses to follow, alerts improved safety. Cons: systems could not track doses by relative day or dose number, could not document infusion stop time, stat and verbal orders required an override, and pharmacy had to adjust schedules frequently to avoid “wrong time” alerts.
  • Johns Hopkins pediatric oncologists wrote up their CPOE design process and creation of Eclipsys Sunrise MLMs to check height and weight, to force inclusion of hydration orders, and to provide the capability to adjust chemo doses by percentages. They also developed a fast-track process for creating and approving new order sets.
  • Memorial Sloan-Kettering described their Eclipsys CPOE chemo ordering implementation. They created 1,250 adult and 466 pediatric order sets and mandated CPOE-based ordering. They reported nearly universal use of the order sets. I didn’t see anything that documented clinical outcomes, but they did mention problems related to cumulative dose calculations and alerts.

From McKesson’s earnings call:

  1. They talked a lot about acquiring Portico Systems (surprising given that McKesson is a massive company acquiring a relatively tiny company for $38 million, which would be just a few weeks’ pay for CEO John Hammergren since he took home $151 million last year) and said little about their drug business.
  2. Technology Solutions  revenue was up 6%, but only because of revenue recognition timing – they expect growth to be a little better than last year’s 2%.
  3. Hammergren mentioned “significant progress” in the technology business, but basically said focus is on implementation rather than sales even though the company is “continuing to strategically position the business for continued growth.”
  4. He said that clinical systems are today’s opportunity, but a lot of McKesson’s customers are running 20-year-old financial systems that might be candidates for Horizon Enterprise Revenue Management.
  5. He thinks that big companies (“the anchor tenant”) will be the healthcare IT winners in the payer, hospital, and physician practice markets since smaller companies won’t be able to get to those prospects cost effectively.
  6. He mentioned some “consolidation in our overhead and our selling infrastructure last year.”
  7. An analyst asked directly about IT customer retention in calling 2010 “a tough year” for McKesson, with Hammergren’s response being that the company had spent a lot over the last two years to make its products better and he hopes the market share changes are a trailing rather than a leading indicator, with the potential of a slight rebound in market share this year with Paragon as the leader.

My sideline analysis of the MCK call (your comments are welcome):

  1. Most of the analysts’ questions involved the company’s challenges in the IT business, again surprising given its core business of drug distribution.
  2. McKesson seems to be acknowledging that it’s falling behind Epic and other vendors on the clinical systems side and is placing its only hope on a pendulum swing back to financial systems and its struggling HERM.
  3. The company hopes that product improvement will stop the market share slide.
  4. I inferred no commitment to innovation, acquisitions, or thought leadership, just that McKesson is banking on its huge size and customer touch points to keep selling all of its products.

 

The local paper covers the $36 million Epic system that will be in place when Orange Regional Medical Center (NY) moves to its new hospital next week. It says that stimulus money will cover half the cost.

In Canada, Nova Scotia will implement a $27 million system for sharing patient medication information, with all pharmacies expected to be linked by 2013.

7-30-2011 11-05-07 AM

Hawaii Governor Neil Abercrombie announces that Thomas Tsang, MD will join his healthcare transformation leadership team. He is ONC’s medical director over Meaningful Use, but it’s not clear from the announcement whether he’s resigning that post.

GE Healthcare Performance Solutions acquires Medical Event Reporting System, a Web-based system that helps hospitals collect and analyze patient safety events. It was developed by Columbia university with AHRQ support. The company, also called MERS, had been a GE Healthcare JV partner since 2008. A white paper on its use by Mount Sinai Hospital (NY) is here. GE says it’s working on rollouts to 16 hospitals.

From Cerner’s earnings call:

  1. The company talked up its physician practice sales, saying its improvements in the user interface and workflow positioned its products well as clients look for systems that integrate inpatient and outpatient.
  2. CERN says it is different from competitors in its willingness to connect to other systems.
  3. They are expecting Meaningful Use to keep driving sales for years.
  4. They suggest that 50% of US hospitals will reselect their core systems in the next 5-7 years as even those customers who are happy today will find their vendors falling short with regard to interoperability and reporting.
  5. The ProFit financial system is doing better.
  6. CERN says they expect to take on more outsourcing contracts since they are more able to hire scarce HIT employees than hospitals.
  7. Neal didn’t pop in for even his usual one-paragraph drive-by.

7-30-2011 11-23-57 AM

Shares in Omnicell touched off a 52-week-high Friday after turning in good numbers after the market close Thursday: revenue up 6.6%, EPS $0.08 vs $0.02. The one-year share price (blue) against the S&P 500 (green) is above. Market cap is $567 million.

Meditech filed its quarterly report Friday, with revenue up 25% and EPS up 33% ($0.86 vs. $0.64). The cost of acquiring the 78% of shares in ambulatory vendor LSS that it didn’t already own was given as $13.7 million in cash, with LSS’s first quarter performance being $0.8 million in net income on $5.4 million in revenue.

Strange: the former head of Alberta Health Services (Canada), who left his job in November after repeatedly telling reporters at an emergency meeting that he was too busy eating a cookie to answer their questions, gets $735K in severance. He seemed overly peeved, but made sense in pointing out that maybe the eager beaver talking heads should attend the scheduled press briefing that was being held in 30 minutes instead of chasing him down the street for their own personal on-camera moment.

E-mail Mr. H.

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Currently there are "5 comments" on this Article:

  1. Oh my goodness so much to talk about where to start?

    Don’t know if you got fired by McKesson at some point or maybe John Hammergren ran over your dog, but the McKesson hatred just has to stop man. It’s unhealthy. I read that earnings call transcript, and your analysis is 100% wrong. Its biased to the point of having a Fox News quality. Whatever grudge you hold against them, you gotta admit McKesson is really doing well, and Wall St likes it. Maybe you should just stop writing about McKesson altogether for a while and get it out of your system.

    On to Cerner. Read that call too, and it’s scary how desperate they are to catch up to Epic. If they think post-ARRA Epic hospitals are gonna be shopping around to make a new investment in a Cerner system, they’re a little deluded. Remote hosting is a good idea to maintain a services stream, but it reduces their margins on both sales and services. That’s the downside of remote hosting. It’ll probably serve them well in the short term until they can revamp their software to compete with Epic.

    Have to say, I’m impressed that you read those JOP articles – are you an oncologist? I had 2 key takeaways from reading the North Shore and Vanderbilt articles. North Shore went from bad processes around their cancer care to average. It’s scary that they were so poor on compliance, and it’s a little surprising the article was even published since there’s no science involved. The abstract of the article should just say “we installed an EMR and now we’re finally doing the things we were supposed to be doing all along.” Vanderbilt, on the other hand, went from average to good using their EMR, and have identified the gaps they need to fill to go from good to great. I wish there were more EMR-related journal articles like that one that are honest enough to identify and discuss both the pros and cons.

    Last but not least, sad to see a system like Piedmont spending that kind of money to swap out a pretty good Eclipsys system. They really can’t afford the change, but whatever, might as well jump on the bandwagon and do it anyway. Lookin at the Hopkins stats in their JOP article, gotta wonder what was so broken at Hopkins that they also had to make that multi-million dollar switch even when they’re gettin results like that.

  2. About North Shore, Il Oncology and EMR “The main benefit was data sharing among members of the multidisciplinary team (labs, rads, referrals, appointment information) and patient communication (secure communications, online test results).”

    Sounds great, but did this equate to improved survival? Chemo therapy regimens have been thought to be too complicated for CPOE. In the UK, there was a systemic dosing error afflicting several patients, one of whom died. The medmal lawyers will have a field day as more and more hospitals do CPOE chemotherapy.

  3. Mr. H – Don’t listen to Bob Johnson. I read the same transcripts on the McK call. Your analysis is correct. In fact, I think you were generous to them.

  4. Bob Johnson-Wall Street loves McKesson because of their supply chain business, not their technology business.

  5. Hey Bob,
    I agree that McKesson makes some very good products for hospitals. Unfortunately, McKesson has not been able to make these products integrate (not interface) with each other. Ask how well actions started in the ED carry over to an inpatient admit. Forget information transfer from their own physician practice systems to ED or inpatient or for hospital discharge meds. Their recent claim to fame is that allergies are now (finally) shared across their products. And don’t get me started on their antique physician documentation.
    When doing selections comparing them to other vendors, they usually do not make the first cut. They have a long way to go.







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