Monday Morning Update 9/26/11

From My Little Pony: “Re: Epic. They’re recruiting programmers from Hong Kong.” The job posting says Epic is looking for Hong Kong software developers, with paid relocation to Verona. Epic will have a recruiting team in Hong Kong in November. I found the list of solutions the noobs might be working on interesting: genomics and proteomics, telemedicine, creating software that adapts to the individual user, developing next-generation user interfaces, and adding gesture recognition. Epic always resists the idea of outsiders setting usability standards that vendors would be required to follow, but it sounds as though the company has something potentially big in the works. Another version of the same ad is aimed at developers from Singapore.

From Gluteus Max: “Re: Epic being perceived as ACO ready. Epic is good at storing and presenting data, but it’s not good at doing useful things with it. If the ‘Epic Octopus’ business model theory is correct, that’s very much by design. Analytics and data sharing are two of the most important features ACOs will need, so it’s difficult to believe Epic is ‘close to ACO-ready.’” Unverified.

From Verona Notes: “Re: Epic. Now has 266 customers, up from 224 last year and 190 two years ago. Future vision shows Epic is listening to usability criticism, such as software that understands the physician-patient conversation and readies documentation and orders. Unsurprising stock tip: IBM servers dominate competition in internal Epic tests. Amazing logistics for so many people, but starting late=disrespect.” Unverified. There’s that usability thing cropping up again.

From Bea Fragilis: “Re: Epic. To what extent are Epic-certified people allowed to make changes to local hospital code? My sense is that those changes must be minor, documented, and controlled from Verona.” I’ve heard that Epic will let responsible customers change source code and will even provide them with programming standards and documentation to help, although they don’t encourage everybody to start hacking around. I’m interested in that answer as well, not to mention how the customer gets access to the source code (or the extent to which application behavior can be controlled through external hooks).

From MT Hammer: “Re: front-end speech recognition. A new study finds that it results in 800% more errors in patient reports compared to transcribed dictation.” The study, published in the American Journal of Roentgenology, finds that 23% of reports created with front-end speech recognition (i.e., you dictate into a microphone and your words immediately appear on the computer screen) contained at least one major error vs. only 4% of those created from standard dictation and human transcription. Overall, the error rate with speech recognition was eight times higher than with human transcription. Interestingly, speaker accents didn’t make much difference, but imaging modality was a predictor of error rates. I don’t have access to the full text of the article, so I would be interested in radiologist’s analysis (such as the significance of issues defined as errors, why the radiologist didn’t catch the mistakes on the screen when using speech recognition, etc.) Also keep in mind that this compared only two transcription options, with the third being back-end speech recognition like that of the former eScription (now Nuance), which I believe has much higher accuracy since it can consider context and history rather than just pronunciation (similar to what transcriptionists do).

From The PACS Designer: “Re: Windows 8 tour. Microsoft has revealed aspects of its new Windows 8 platform for developers to peruse. Windows 8 will be tightly integrated with a new Internet Explorer 10 using a next generation internet platform called HTML5.”  The problem with pre-iPhone cell phones is that they worked like tiny, underpowered PCs with crappy keyboards. I’m not sure we need the opposite problem – PCs that work like huge iPhones – especially since touch screens are extremely rare in PC-land and the point is lost anyway since you’re either sitting in front of a desktop keyboard or a laptop. My understanding is that Win 8 will have two user interfaces, one for mobile use and one for desktop. MSFT had better make sure not to screw up the latter in trying to pander to those who yearn for an iPhone clone as their primary device.

From King Coal: “Re: HIStalkapalooza. Which night? Looking forward to it with bated breath.” Don’t count on it just yet. The potential sponsor had some venue contracting issues and won’t have enough space  to handle the historically large turnout (and waitlist.) I may end up cancelling it for Las Vegas, leaving you to read your HISsies winners online instead of seeing Jonathan Bush’s one-man show crafted around them (and that I really will miss).

My Time Capsule this week from 2006: The VA Outperforms Private Hospitals in IT Vision and Resolve. An aliquot: “Like a tailor-made suit, VistA was developed to meet the VA’s needs, not those of a vendor’s ‘average’ hospital customer. Just as hospitals talked themselves into buying instead of building (helped along by vendors and risk-averse CIOs,) the industry’s darling turns out to be a homebrew job.”

Reporters and TV stations have gone crazy with their lazy, press release-sourced coverage of the prospect of turning healthcare encounters over to the Jeopardy-winning IBM Watson (most common lame headline: “The computer will see you now”) but readers here weren’t equally impressed with its announced use by WellPoint, with most saying IBM and WellPoint will get the benefit instead of patients and providers. New poll to your right: now that Sage Software has announced plans to sell its healthcare division to Vista Equity Partners, who will benefit most from that transaction?

I’ve enjoyed Vince’s HIStory series immensely, to the point that I suggested that the pre-1980 industry pioneers get together at the HIMSS conference to reminisce (and knowing some of those folks, perhaps tipple a tad). Shelly Dorenfest, Bob Pagnotta, John DiPierro, and David Pomerance are a few of those who have said they’ll be there. If you know them, you should be there, too. Drop your e-mail info on this form and Vince will be in touch. Think of it as a 30+ year class reunion of the College of HIT Hard Knocks.

This week’s e-mail from Kaiser boss George Halvorson talks up the company’s newly won Davies Award win, also mentioning that Kaiser hospitals make up 35 of the 60 HIMSS EMRAM Stage 7 hospitals and that the remaining KP hospitals are all Stage 6. And despite early reports of HealthConnect availability problems, he says KP has won six awards from the Uptime Institute, the only healthcare organization to ever win (although as a counterpoint, that’s data center uptime, and plenty of ways exist to knock users off systems even though the server is chugging along). He also mentions some employee-recommended technology projects that have been funded by KP’s internal innovation fund: an automatic glycemic calculator, a hospital capacity prediction tool, and an SMS appointment reminder system.

Weird News Andy finds this story about hospital drug shortages and the resultant third-party profiteering scary. I’ll elaborate from experience to scare him more. Even if you ignore the possibility of obtaining counterfeit or impure drugs when forced to buy from secondary channels, the patient safety risks with drug shortages are considerable. Product packaging and sometimes concentrations differ from what nurses and doctors are used to, greatly increasing the chance of wrong drug / wrong dose errors. Sometimes the backup drug is therapeutically similar but chemically inequivalent, meaning doctors are forced to use a drug that wasn’t their first choice and one they may not be all that familiar with, making it more likely that something will go wrong. Shortages come and go all the time, so information systems can’t be kept current to steer prescribers to the one currently being used, sometimes requiring IT workarounds that neuter electronic protections such as dose and allergy checking. Those drugs may have similar active ingredients that are still different enough to trigger unexpected drug allergies and drug-drug interactions. My analogy is always this: suppose you’re about to have open heart surgery, but the drugs your surgeon always uses are on shortage, meaning the surgeon will have to compromise with a less-desirable drug that they’ve rarely or never used. You’d be mad at someone for letting that situation occur. The problem here is that everyone involved claims to be innocent and powerless.

On WNA’s slightly lighter side (it involves death, so it’s still not all that light), he captions this story as “Spinal Tap’s drummer?” Coroners in Ireland review the death of a man whose body was found burned in his sitting room, with no damage to the floor on which it rested, no evidence of foul play, and no signs of the source of the flame.  They conclude that he died of spontaneous combustion. A retired pathology professor ruled out divine intervention, saying, “I think if the heavens were striking in cases of spontaneous combustion, then there would be a lot more cases.”

A good article covers the high cost of children’s hospitals, with the Nemours Children’s Hospital (opening next year) in Orlando leading it off. The 95-bed hospital, being built in a city that already has two large and notable children’s hospitals, will cost $400 million ($4.2 million per bed) and was approved by the state only after the well-funded Nemours called in some political favors. Mentioned about high-profile children’s hospitals in general: lack of financial transparency, fast-rising costs accompanied by big executive paychecks and impressive construction projects, big financial war chests, and only tiny amounts of charity care provided. I can say from experience that those multi-million dollar children’s hospital CEOs have the ultimate weapon to keep the donor and political largesse flowing – feel-good happy ending stories of miraculous medical work accompanied by fuzzy-focus, intentionally heart-tugging pictures of adorable babies and toddlers. Your hospital will lose every time if your particular medical miracles involve less Hollywood-like episodic interventions on behalf of elderly patients, the chronically and incurably ill, psychiatric patients, and that particularly colorful stratum of society that shows up in the ED full of street drugs, hostile microbes, and intentionally inflicted wounds.

Don Berwick says CMS administrator is the best job he’s ever had, but he’ll lose it on December 31 unless the Senate confirms him by then. No confirmation hearings have been scheduled.

The New York Times covers telepsychiatry, where patients receive counseling sessions via Skype or specialized Web apps like Breakthrough.com. Says a psychologist, “In three years, this will take off like a rocket. Everyone will have real-time audiovisual availability. There will be a group of true believers who will think that being in a room with a client is special and you can’t replicate that by remote involvement. But a lot of people, especially younger clinicians, will feel there is no basis for thinking this.”

An OB-GYN subpoenas Bellevue Medical Center (NY), demanding a list of every person who accessed the Internet from the hospital on a particular day in 1999. The doctor is trying to find the person who posted defamatory comments about her on a physician review site, claiming she has reason to believe it came from a particular NYU doctor. The hospital says it keeps access logs for only 30 days, but the doctor’s legal team found a computer forensics expert who claims he knows a sophisticated (and undoubtedly expensive) way to bring back 12-year-old records.

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