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Monday Morning Update 10/24/11

October 22, 2011 News 25 Comments
10-22-2011 1-49-39 PM

From Mintonw: “Re: NorthCrest Medical Center (TN). It’s the first hospital to receive a Medicaid EHR incentive payment by just using ED patients and an EDIS, in their case Allscripts ED 7.0, the only EDIS certified as a Complete EHR.” The hospital’s press release is here. SVP/CIO Randy Davis says the 109-bed hospital was already in the high 90s percentile and didn’t need to change much. The hospital says it will meet Medicare’s MU requirements later this year.

From Tommy Tune: “Re: Jim Fitzgerald. Definitely no longer at Dell. My source says it was his choice.” Unverified.

10-22-2011 4-20-34 PM

From Rigoletto: “Re: GE Healthcare. Says Centricity Practice and EMR can’t generate accurate Meaningful Use reports. See link here to its letter to customers.” It sounds like basic technical stuff, made interesting only because the company admits that there could be problems for clients who have already attested – the corrected reports may show that they didn’t hit the required thresholds after all . GE says they will provide “further instruction on how to work with CMS related to any changes related to attestation.” The recommend changes in practice are: (a) choose specific race/ethnicity codes instead of free text and don’t choose “multi-racial,” “Hispanic,” or “other;” (b) use specific options for describing smoking status; and (c) us prescribing to measure patient medication education since issuing handouts that the EMR did not suggest doesn’t count toward Meaningful use. I don’t see any of this as a slam on GEHC other than they are awfully late in identifying the problems, which seem pretty obvious. Let’s hope the triggering event wasn’t an eligible provider getting in trouble with CMS.

10-22-2011 5-39-17 PM

From Dr. Nurse: “Re: McKesson CEO John Hammergen’s $131 million one-year compensation. Their products are a patchwork of jury-rigged acquired code which has never been upgraded and they clearly have no idea what a usability standard is (the joke is, ‘just keep scrolling down and to the right and you’ll eventually find the right checkbox.’) They perform paper-based billing for specialty practices (Fedexing boxes of paper forms to Pittsburgh – really?) and use antiquated reporting systems that cannot be altered (you can’t add columns due to system limitations). His compensation package is obscene considering McKesson’s ongoing loss of market share, discernible lack of innovation, and adherence to outdated methodologies and business practices. He’s not alone – the CEO salaries of third-party payers are off the grid, too.” Above is the five-year performance of MCK (blue), the Dow (red), the Nasdaq (green), and the S&P 500 (yellow). A big chunk ($112 million) of that compensation was from stock options that he won’t get to exercise every year. At least shareholders (including employees) got to make money along with him. Not to mention that IT isn’t the company’s bread-and-butter business, although that product line is still profitable.

From Por Favor: “Re: WNA. I totally love Weird News Andy, but as a Canadian, I’m appalled by the actions of the clinicians at the hospital. There once was a time where it didn’t matter how you came to be in the ER. I was in the ER several years ago when a young man of about 17 was brought in with a terrible leg break. He was from England on a rugby tour with his school. I remember him crying and trying to tell the doc he had insurance and hoped the doc would take care of him even though he couldn’t produce the documents right there. I’ll never forget what the doc said: ‘Son, I don’t care if you have insurance or not. I’m going to take care of you. Rest easy, try to relax, and do not worry. You’re in Canada and under my care.’ That demonstrates why doctors became doctors in the first place – to heal the sick. It is so sad that somewhere along the way, we have lost this. Please tell Andy to keep the weird news coming – it’s always fun!” The example was from Canada, but I’m certain we have at least as many such cases on this side of the border.

10-22-2011 5-43-14 PM

From Neil Louwrens, MD FACP: “Re: physician’s malpractice award as a patient at Northwestern. I’m vehemently opposed to the current tort system, but passionately for justified litigation, including substantial earnings to injured patients. I’m equally and passionately against trivial pestering from the legal profession, claiming wrongdoing and pain-and-suffering that runs up ridiculous tabs at this nation’s expense. The physician in this case is a patient and the case must rest on that. When we fight for tort reform, we are asking for some sense of sanity to be infused back into the system. Nowadays, even the best doctors doing the right thing are still sued. It’s a lottery mentality and the nation picks up the tab. Most physicians who have wronged someone are remorseful and wish they could compensate the patient for their wrongdoing, but to watch the lawyers walk away with 50-60% of the winnings is a travesty. Give patients their money back! Wall Street’s wrongdoings pale in comparison with what the Association of Trial Lawyers of America has managed to carve out for themselves in the current system, backed and perpetuated by the preponderance of lawyers in Congress. Tort reform will reform this inequity, but will not touch the earnings to the injured for their costs, such as justified pain and suffering. We need tort reform – not ‘we’ as physicians, but ‘we’ as patients.”

Thanks to Jacob Reider, ONC’s new usability guy, for taking the time to interview. A reader had tipped me off that he’d taken the job, I e-mailed him, and he asked me to hold off for a couple of days (the details weren’t quite finalized, I surmise.) He not only gave me the first interview, but didn’t tell anyone about his new job until I could get back from vacation so we could do the interview and have the scoop here. Above is another interview he did on usability before he took the ONC job. ONC is interested in reaction to NIST’s usability paper, which I’ll be providing once I’ve had a chance to read it over. Hopefully those readers who constantly gripe about poor EMR usability will channel some of their energies into reviewing the NIST document since it’s the best hope so far (short of some super-secret vendor development project that nobody’s seen yet) to improve the healthcare IT usability landscape.

Listening: reader-recommended Elizabeth Cook, who sounds a good bit like Dolly Parton. The youngest of 11 children, moonshiner dad in prison, took dual degrees in accounting and computer information systems, and worked as an auditor for PWC.  She writes most of the songs, which have brilliant lyrics and range from the good old boy rowdy (“Say Yes to Booty”, “Sometimes It Takes Balls to Be a Woman”) to the starkly moving (“Heroin Addict Sister”).  Modern country is one of my least-favorite genres because it’s been taken over by industry-groomed, overproduced pretty faces faking credibility in the pain and loss department while fronting pop music that has the absolute barest minimum of mandolin or steel guitar, but this is the real deal.

My Time Capsule editorial this week, squinting its eyes upon seeing its first daylight since October 2006: GM and Intel are Right: Healthcare Is Too Expensive, but Technology Alone Can’t Fix It. A taste: “Most US job growth since 2001 was in healthcare, and that’s not something to be proud of. We’re leaving an expensive mess for our children to clean up just as Baby Boomers suck the system dry with healthcare demands. If GM doesn’t like it today, they’ll hate it tomorrow, unless they’re watching from China or India.”

Good stuff on HIStalk Mobile, where Dr. Travis Good covers How to Make Money on Consumer Health Tools and Enterprise Provider Apps. He started out covering straight news, but now that he’s comfortable, he’s putting together some really good analysis and opinion posts that I appreciate since I’m learning from them. Sign up for the e-mail update over there if you like what you see. Thanks to our sponsors there, too: founding sponsors AT&T and Vocera and platinum sponsors Voalte, 3M, Thomson Reuters, Patientkeeper, Kony, and Access.

I’ve said before how much I like using speech recognition for certain tasks (composing e-mails and sometimes writing HIStalk, for example). I was about to upgrade my Dragon Naturally Speaking when I found about Windows Speech Recognition. Like DNS, it’s great for dictation and controlling Windows by voice. Advantages: its system performance seems to be better, its accuracy is almost as good (96% vs. 99%), and it’s included free in Windows 7 (you’ll find it in Control Panel.) Well worth experimenting with since everybody can talk faster than they can type and sometimes your fingers just get tired.

Here’s the latest HIS-tory from Vince, this time with Part II of JS/Data, with lots of info about its eventual (many-named) acquirer.

10-22-2011 1-52-54 PM

Most respondents (some of them with considerable skin in the game) think HITECH should pay providers for starting their EHR use even before HITECH started. New poll to your right: should HHS require doctors to generate personalized, unique documentation (i.e., no boilerplate or macros) in order to be paid?

Dr. Jayne brought up an interesting point in her latest post: the government seems to want everybody to be fooled into thinking that Medicaid is insurance rather than a social program that takes money away from taxpayers and gives it to non-taxpayers (all warm-and-cuddly positives aside, that’s what it is.) We’ve already taken the shame out of being on the dole courtesy of the ever-fewer working Americans (Social Security and Medicare being the big drains among many), so unless you have a lot more faith than I do that either politicians or voters will start exercising responsibility instead of acting in their own self-interest, keep an eye on what’s happening in Greece because we’re getting close to that point of non-sustainability. Politicians won’t stop handing out financial lollipops and the taxpayer/non-taxpayer ratio keeps shrinking, so something has to give regardless of the indignation and injustices involved. Our lavishly funded healthcare system isn’t exactly helping as it sucks up an ever-increasing chunk of GDP.

10-22-2011 2-53-57 PM

ProHealth Care (WI) finishes its implementation of Epic.

GE announces Q3 numbers: revenue flat, EPS $0.31 vs. $0.28, meeting expectations.

10-22-2011 5-46-17 PM

Interesting revelations from the Steve Jobs biography, hitting stores Monday: (a) he apparently lied about the extent of his medical problems; (b) he initially resisted having surgery for his pancreatic tumor, so he tried diets, acupuncture, a psychic, and remedies he found online, to his apparent eventual regret; (c) he claimed Google stole iPhone features in creating its Android phone, saying he would “spend every penny of Apple’s $40 billion in the bank to right this wrong.”; (d) his last ambitions, possibly involving Apple products yet to be released, involved developing an integrated TV and taking on the textbook monopoly. He also told President Obama that he was destined to be a one-termer because he is business-unfriendly; described Microsoft as “mostly irrelevant” and struggling like most other companies that put salespeople in charge; and said HP is being “dismembered and destroyed” by poor leadership. Nobody quoted him all that much while he was alive and he stayed out of the limelight for the most part, but now every scrap of writing and video is being assembled into the Gospel According to the Recently Canonized Steve (and I admit being just as fascinated by it as everybody else.)

Speaking of Apple, here’s the first commercial for the iPhone 4S and its Siri voice command system.

Kaiser needs to dig into its Epic database to evaluate this study from Canada. Overweight people (BMI of 25 to 29.9) were found to have the same risk of health problems as normal-weight patients. The study found that the big health problems start with a BMI of 35 (defined as “obese.”) Hopefully the study looked longitudinally at patients rather than just current weight. You can calculate your BMI here.

Washington Hospital Center (DC) and AT&T develop CodeHeart, a mobile collaboration app that provides real-time audio and video contact in critical care situations, such as for ambulances in transit.

A lawsuit against Abbott Northwestern by a kidney stone patient alleges that a drug-addicted nurse stole his ordered narcotics for herself, leaving him to suffer excruciating pain through the procedure. The patient says the nurse told him she couldn’t give him very much medication and that he should just “man up.” During the procedure, he says the nurse was unsteady and slurring her words as she coached him for his pain, telling him, “Go to your happy place, Larry. Go to your beach.”

E-mail Mr. H.

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Currently there are "25 comments" on this Article:

  1. re Hammergren Pay Package-it is beyond obscene what he was paid this past year. No CEO is worth this amount, particularly when you look at the numbers of people who lost jobs while Hammergren was raking in his largest earning year since he has been with MCK. Hammergren is the poster child of what is wrong with American business and the excuse is always-“well investors made money too”. Far too many lost jobs while HAmmergren was getting rich.

    It must be tough for John to continue to talk about his iCARE principles. Maybe should change iCARE to iRICH!

  2. Unusable HIT is unlikely to help ” Our lavishly funded healthcare system isn’t exactly helping as it sucks up an ever-increasing chunk of GDP.”

    NIST has done what the FDA would have done a decade ago if the Federal Food Drug and Cosmetic Act was uniformly and dutifully enforced.

    The matters raised by NIST must be required of and retrofitted to the systems that are currently in use. I was just asked by a doctor who I called about a diet order for the patient’s blood pressure.

    Honest to god, I did not know what it was. It is sort of out of sight and out of mind. I told the doctor it was ok cause I was too busy to change screens and click several times to get to the BP.

    Thank god, the doctor did not accept it “was ok” as satisfactory, and demanded to know what it was. Two hours earlier, it was 205/78 mmhg.

    We nurses have all become too complacent and do not know our patients, since the computer knows them. There is a direct correlation between the degree of user unfriendliness and the degree that the nurses and doctors are not fully aware of the patient’s disease state and physiology.

    Sad and pathetic, I must say. Please take this back to the ONC as “hearing from the users”.

  3. Jefe-first of all comments are opinions, and you’ve read mine. Please justify Hammergren getting paid $131million this past year.

    He was the highest paid CEO in the US. Did McKesson deliver the highest shareholder value this past year?

    And do you have any idea how many people lost jobs at McKesson last year?

  4. @Lou – I think Mr. H already solved the mystery on Hammergren’s paycheck: $112 million of it is one-time stock options, earned by providing a huge return to shareholders. It’s sad when anyone loses a job, but there weren’t that many people that lost their jobs at McKesson outside of the sales force of one product. It’s odd how many people don’t seem to realize that McKesson is much more than a single product line in HIT.

  5. Well aware of that. Look at what he’s earned yearly for the past 10 years and you’ll still see what is in my opinion, excessive pay. I am familiar with McKesson and realize they are mainly a distribution company, less than 10% of their revenue comes from technology. That being said look at their peer group, Cardinal and Amerisource and see what their CEO’s make for comparison.

    Or look at their peers in the technology world.

  6. Well, you know then but, can meaningful use be achieved with EHRs, CPOE, and CDS systems that are meaninfully unusable which is what the NIST Draft Document states, you know?

    And then, so what! Who will listen to NIST; but they will listen to FDA with enforcement powers.

    You know then, the NIST says to vendor so make these things usable but what will the NIST do to the vendor if their products remain unusable which then make the users make more mistakes?

    This you know, should have been accomplishment many years ago before these systems cause doctors and nurses to make new mistakes than before, because of the problem NIST writes on.

    Read this, and print this ONC, you know, for it has ignored these unsable things issues since the Brailer leader who also was an HIT vendor executive. I shake my head, you then, how pathetic this all is.

    This document form the NIST is too little too late, you know then but, as the expresion goes.

  7. I am fairly new to the forum and i have a question for your readers. Soon I will graduate with my Associates Degree in Health Information Technology, the problem, as I see it, is I have no healthcare experience. I am a 46 year old male who is retraining due to a lack of work in my former field.
    The question is, Are there jobs out there for me?
    Any response is appreciated.

  8. Speaking of Mckesson, any update on the 10/10 news of “Horizon Clinicals is going maintenance-only”? Is this the EMR with Paragon?

  9. Lou Lou Lou,

    The justification is we live in a (somewhat) capitalistic society. McK BOD can pay Hammer whatever they want. Besides, his income is mostly at risk.

    No company operates based on an obligation to hire or employ anyone. It’s fx is to generate profit for it’s owners. If you spent more time as a contributor to that end rather than a consumer you wouldn’t be so focused on other people’s income.

    You sure you’re not camped out at the park by Wallstreet?

  10. Dear Por Favor,

    Any country that is the source of Tim Hortons, Nanaimo bars, Great Big Sea, and Mrs. WNA will always have a very warm place in my heart.

  11. Hammergren is far overpaid while his employees get little or no raises or bonus. You are also forgetting his private plane, the millions spent on his bodyguards, etc. McK has layoffs all year long so jobs are being lost. Buy another company and someone else gets laid off. No one is worth that kind of money.

  12. Jefe-I must chuckle at your contributor comment. I’ve contributed plenty over my years to a variety of organization’s bottom line and been compensated fairly well. And although we live in a capitalistic society, the things happening on Wall Street and around the world are a sign of the times-the middle class is becoming extinct. That’s another discussion. You have not justified Hammergren’s compensation with your comment about a capitalistic society and your generalizations about McKesson’s board. Cardinal’s CEO made about $14million last year with financial results similar to McKesson. Hammergren has made roughly $35-$50million per year over the past 10 years. Although McKesson’s gross revenue is well over $100billion, their profitability, because they are a distribution company and run on thin margins, is small. And I am a stockholder and incensed about his pay.

    As Hammergren made his $131million, he was laying off piles of people, and not all from sales. And this happens yearly at McKesson.

    Get your facts straight, or get some period!

  13. @Lou – if you are so incensed with Hammergren’s compensation, do not support any McKesson products. If the little people at McKesson are not being compensated fairly, then they should find a different place to work. However, who are you to say what is appropriate compensation for anyone? Instead of whining about someone getting a bigger slice of pie than you, maybe you should work harder so that you deserve a bigger slice of pie. Life isn’t about “fair”, life is about choices and action.

    And as for the Occupy Wall Street movement, I don’t see the middle class protesting, I see a bunch of hipsters with nothing else to do, movie stars who make as much as Hammergren does, and of course, the Unions who stand to lose a great deal if the anti-Union sentiment continues to spread.

  14. Louie Louie,

    Start a company of your own, or become a CEO of a publicly traded, make your millions and you’ll soon change your tune.

    I think you’re just jealous.

    As for the “protesters”… All 6000 of em, I don’t see them protesting the politicians who started and benefit from their campaign contributions or vacations w lobbyists.

    C’mon maan!

  15. @John Galt – @Lou didn’t say he wanted more – he offered the opinion that Hammergen was getting paid too much. As an investor, it’s his right (even obligation) to do so. You also failed to address his question.

    On the topic of “more $ => better performance”, I find the studies referenced in this talk (and the presentation of the talk itself) to be absolutely fascinating:
    http://www.youtube.com/watch?v=u6XAPnuFjJc

  16. NewBee, I’m concerned you are asking this question now. Only upon completing your studies… You will find difficulty as in any industry without experience in the field it is you wish to work. I can only recommend, pursue a position with passion – research who you plan to interview with, research their product, their market and “wow” the employer with how you plan to aid their company and how you could assist. No magic answer, just outshine your 100+ competitors looking for the same position you are. Good luck.

  17. Jefe-what publicly traded company do you run? If you do, I’m surprised your spending time on HISTalk. (No offense Mr. H)

    I’m beginning to think you might be Hammergren’s butler!

  18. Newbee, generally the larger vendors will consider new grads for entry level Implementation or customer service roles, this is a common entey point into the HIT world. I would look at Meditech, Epic, Cerner, etc. Good luck!

  19. Whenever I hear someone say ‘Well don’t buy company x products’ or ‘Don’t buy any of company x shares’ as some form of protest against a particular company I have to kind of chuckle. Yeah your voice as individual investor or customers means anything in isolation or has any kind of impact. If anything, it mean less than nothing bordering on irrelevant.

  20. Ah, yes, Great Big Sea, great band, and a great BIG treat, and all Canadian…..AND 100% genuine Newfoundland!! Extra special!! Love it.

  21. Retort – If you really think so but I would call that blinding naivety and ignorance. One common person acting in isolation and not banding together to act cohesively to form a group that actually has enough clout to affect has no effect.







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