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Monday Morning Update 4/9/12

April 8, 2012 News 8 Comments

From N2InformaticsRN: “Re: UCI Medical Center. Developed a program to bring staff nurses into the field of nursing informatics in support of their EMR implementation. It uses ONC’s Health IT Workforce Curriculum as its core.” Above is the video explaining the program.  

From El Pescador: “Re: HITECH incentives. I don’t disagree with you often, but I do this time. We are one of the systems that is going to get a ‘windfall’ in MU money without significant investment. Where I take issue with your response is that when the looming reductions in reimbursement are taken into account – surprise – it’s almost dollar for dollar. Zero sum game for our organization. Perhaps others don’t find themselves in the same boat. Enjoy your website immensely … best source of info in the industry.” I think my point is still valid. CMS may indeed take your money elsewhere, but that was not related to your unrestricted HITECH “grant.” Without it you would be in the hole rather than even. It’s like winning $2,000 on a scratch-off lottery ticket but blowing your car’s transmission at a repair cost of $2,000 on the way to cash it in. You still won the lottery, and the repair was going to cost you $2,000 in any case. WildcatWell’s original question was: is it fraud when providers use a free EHR to earn HITECH money? Answer: no, there is no requirement to spend anything to earn an MU check. Most providers will indeed spend money (and sweat) to earn their payout, but that’s between them and their vendor … Uncle Sam doesn’t care when he writes the check.

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From WildcatWell: “Re: Jason Dufner. Would a Masters win bolster his sponsor’s footing? Doubt it. At Augusta, a Greenway label comes across like a landscaping company. Wasted marketing dollars.” Above is an Associated Press photo of him after the second round with the Greenway logo on his shirt. Like NASCAR drivers and football coaches, life is good when you get big paychecks just for wearing logo apparel in public. I don’t know how you’d calculate the ROI on wearing a PM/EMR logo in front of a golfing audience, but I assume there’s leverage opportunities with prospects who enjoy watching someone else play golf.

From Fish: “Re: Epic’s 2006 ambulatory sale to Capital Health in Edmonton, Alberta. Whatever happened to it?” Beats me. Readers?

Imprivata provided a response to 1Sign’s unverified rumor about Dell having discussions with the company about an acquisition. Here it is: “Not true.”

4-6-2012 8-13-52 PM

Our judicial handicappers expect the Supreme Court to strike down just the insurance part of the Affordable Care Act, with equal minorities saying it will be all or none. New poll to your right: how much impact will the JOBS Act have on healthcare IT startups and innovation?

In case you don’t know what the JOBS Act is, here’s a CliffsNotes version. The JOBS Act, signed into law last week, makes it easier for small business startups to raise investment capital. Anybody can offer the general public shares in their venture, which was previously illegal (investors had to be accredited, i.e. wealthy and vetted, before being allowed to buy their way in.) The new law lets anyone invest and allows early-stage and tiny companies to solicit investors, even via Web-based “crowdfunding.” On the downside, amateur investors are on their own to perform due diligence, some shaky companies are now going to be free to pitch to investors, and lawyers will probably make a fortune as would-be CEOs and their unsophisticated investors butt heads. The hope is that small businesses can grow faster with easier access to unrestricted capital, allowing them to hire employees earlier than they would have otherwise.

4-6-2012 7-50-44 PM

An article in Clinical Pharmacology & Therapeutics called Electronic Health Records: The New Vehicle for Drug Labeling, Safety, and Efficacy by Ed Fotsch MD, CEO of PDR Network, proposes that services like those offered by his company could increase safety and decrease liability by delivering up-to-date drug labeling, REMS, and adverse event reporting right to individual provider EMRs. It finds from its own database that 25% of brand name drugs have clinically significant changes in their professional labeling each year, meaning that paper-based literature used to make clinical decisions is often obsolete. The problem: most EHRs don’t have the capability to electronically receive these alerts and confirm receipt. The article also says that EHRs could be used to file adverse drug event reports with the FDA and improve patient adherence.

Note: I come home straight from work on Tuesdays and Thursdays and jump right in to spend an unbroken 4-5 hours writing HIStalk and I’m up pre-dawn the next day to go to work. Therefore, I will rarely be able to reply to any Tuesday or Thursday e-mail until the next evening at the earliest. Re-sending the e-mail doesn’t do anything except clog my inbox even further. I always catch up, but it takes time.

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Law firms are using California’s Confidential Medical Information Act of 1981 to file profitable class action lawsuits against providers, who are required by that law to pay $1,000 for each person whose information is exposed. The article says McKesson lobbied to have the damages clause removed retroactively about a year ago, but failed. Courts will need to decide whether the law is appropriate since when it was written in 1981, breaches were both rare and small, but today a single breach could result in millions of dollars in payments, which the lawyers find irresistible. 

E-mail Mr. H.


The Healthcare IT Week in Review

1. Newt’s Think Tank Tanks

Facts and Background

The Gingrich Group LLC, doing business as the Center for Health Transformation, filed for Chapter 7 liquidation after struggling to maintain relevance once founder and former Congressman Newt Gingrich resigned last spring to run for the presidency. The for-profit group offered its strategic services to healthcare companies whose products and services addressed Gingrich’s big ideas themes, including healthcare IT. The company had pulled in $55 million by charging companies such as Blue Cross Blue Shield, Allscripts, HealthTrio, and VISICU up to $200K per year to gain access to Gingrich and his contacts.

Opinion

CHT was not illegal, just distasteful. It’s satisfying that it went down in flames, but unfortunately Pilot Newt had already done a DB Cooper and bailed out with the money. It’s too bad that the smoking wreckage still had employees who lost their livelihoods because Newt decided to run an unsuccessful political campaign, not to mention surprising that he didn’t just end his presidential run and go back to the one thing he’s been really successful at — selling his influence. It’s too bad that he presumably had at least some hand in  getting the $19 billion HITECH package inserted into the stimulus bill.

Musings

  • CHT was like William Shatner signing autographs at Star Trek conventions. If you wanted Newt’s attention, it was going to cost you.
  • Unlike Shatner, CHT claims it wouldn’t accept money from anyone whose agendas didn’t align with Newt’s, but offered no proof that Newt’s rich man’s club had standards that exceeded passing a mandatory checkbook inspection.
  • Newt’s loyalties were apparently available even when for issues that would not typically enjoy widespread Republican support, such as pushing federally subsidized EMRs and mandatory health insurance.
  • One of CHT’s most controversial clients was Freddie Mac, which paid CHT $1.6 million to advise it on potentially troublesome new Congressional regulation. He claimed he was hired as a historian, which probably encouraged historians everywhere to offer their services as a slight discount. Freddie Mac’s bailout will cost taxpayers up to $360 billion.
  • Newt was adamant that CHT did no lobbying, which was critical to preserve his presidential run. That’s probably legally correct, but the average citizen would find it hard to believe that paying a former Speaker of the House to make introductions to his political pals and and to pitch client offerings in Washington isn’t pretty much the same thing.
  • In a fit of stimulus schizophrenia, Newt called the stimulus package a “big politician, big bureaucracy, pork-laden bill” that should be stopped, but lauded the HITECH part of it that benefitted his clients as “a key part of the stimulus package.”
  • After the stimulus bill passed, CHT set up regional meetings called the “EHR Stimulus Tour” with Allscripts and Microsoft, urging doctors to implement EHRs to get their taxpayer payouts.
  • While running CHT, Newt kept popping up like Where’s Waldo at Washington events and even on the Capitol floor, but his former colleagues never questioned why he was entitled to have that access. Some said later they didn’t realize CHT was a for-profit organization, assuming from its name that it was a non-profit think tank with purely altruistic interests.

2. CSC: Pardon the $30 Billion UK Black Hole –What US Healthcare Needs is Lorenzo

Facts and Background

Government consulting CSC, a key player in the massive NPfIT failure in the UK, says it will use the lessons learned there to launch its Lorenzo product in the US.


Opinion

Choose your site visits carefully.


Musings

  • CSC bought iSoft a year ago when that company, which was also the key supplier in CSC’s NPfIT contract, was about to go belly up after huge losses and government financial investigations.
  • iSoft had a long record of missing its NPfIT dates, although it was an awkward arrangement between CSC as the contractor and iSoft as its most important provider.
  • Once NPfIT was shut down, individual trusts could decide whether they still wanted the previously mandated Lorenzo. Many didn’t.
  • When the UK government talked about the money that could be saved shutting down NPfIT, CSC said it would sue the government since it had spent $1.5 billion trying to get Lorenzo running in England and was planning to make an extra $3 billion for the planned one-year extension.
  • The company’s UK problems triggered layoffs and investor lawsuits.
  • CSC joins every other NPfIT contractor and supplier in nearly going under after winning what seemed like a windfall NPfIT business, but accepting such hardball contract terms that they couldn’t deliver.
  • CSC named former Misys PLC CEO Mike Lawrie as president and CEO in February.
  • Shares are worth half what they were five years ago.
  • A key CSC healthcare acquisition was First Consulting Group in 2007 for $365 million.
  • Much of the reason US vendors such as Cerner have struggled in the UK is because of localization issues, trying to get software designed around US healthcare processes to work elsewhere. Lorenzo will have the same challenge in reverse here.
  • All that said, it will be fun to see if Lorenzo is competitive with the usual suspects (Cerner, Meditech, Epic, etc.) and whether CSC will offer a wide range of department and financial systems instead of just clinical systems. The market could use another choice.

3. Data Entry Error Kills Baby, Costs Hospital $8 Million

Facts and Background

Advocate Lutheran General Hospital (IL), which admitted that a pharmacy technician’s IV machine data entry error in 2010 killed a baby, settled the family’s lawsuit for $8.25 million last week.

Opinion

Many hospitals have electronic interfaces that connect their pharmacy system to their IV manufacturing systems. Why didn’t Advocate? Hospital system vendors often consider such interoperability only begrudgingly since there’s no benefit to them other than keeping clients happy, so it would be interesting to know whether that option was available.

Musings

  • IV room automation is perhaps the least-understood, yet most patient-impacting technology a hospital owns. The final product is a clear solution that may or may not contain the intended contents in their correct amounts, and mistakes are often deadly and undetectable.
  • IV compounder data entry errors are not uncommon, just not commonly reported and not always fatal. Any time you have people keying highly critical numbers into a machine there’s a good chance that they will eventually mess up. Allowing this work to be performed by unlicensed personnel is not a good idea, but the reality is that anyone – licensed or not – could have made the same mistake.
  • IT departments are usually at least slightly involved in IV compounders because they require a server, but often they stop there and assume the pharmacy department knows what it’s doing.
  • Potentially life-saving alerts on the compounder were turned off, but activated after the fatality.
  • A lab tech sealed the baby’s fate by assuming that his high serum sodium level was a mistake, rather than what it really was – the last chance to catch the IV error before it was too late.
  • Some clueless critics blamed CPOE for this error. That had nothing to do with it – the order was entered correctly by the prescriber and the pharmacist in the CPOE and pharmacy systems, respectively. It was the sometimes forgotten but most important step of actually preparing the ordered dose for the patient where things went horribly wrong.
  • CIO lesson learned: don’t assume the world revolves around big-iron IT systems. Go to the sharp end of the stick (on the nursing stations, ED, and particularly high-acuity areas like the OR and ICU) and see what gets put into patients. Then track it backward to see where it comes from. Technology could be increasing the chance of mistakes, or it could offer opportunities to reduce them. Serious patient drug harm is rarely caused by drug ordering (which is where IT systems focus), sometimes caused by drug preparation, and often caused by drug administration.
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Currently there are "8 comments" on this Article:

  1. Capital Health went live on some of Epic’s modules, branding the project “eCLINICIAN”. The organization became part of Alberta Health Services when that health authority formed. eCLINICIAN continues to be used and rolled out in and around Edmonton.

  2. Healthcare PR Maven Chimes In: Well, you might just have to live in the ATL to see the value in Greenway’s Masters sponsorship. First,my guess is that a bus-load of ATL physicians attend the Masters every year in nearby Augusta. And mos to them know Greenway isn’t a landscaping company. Second, a Greenway competitor just hosted a MU breakfast for physicians in ATL. It was advertised repeatedly on our local NPR station the week prior to the Masters. So from this marketing pro’s perspective, it was a good investment focused strategically on the ATL market.

  3. Re: “UCI Medical Center. Developed a program to bring staff nurses into the field of nursing informatics in support of their EMR implementation.” There are pros and cons to using in-house vs. outside clinical staff to support EMR implementation. Best practice for any organization is to determine “soft” and hard costs of losing in-house staff for hours of training, vendor/management cost of training, staff burn-out, etc., then compare cost and benefits of outside staff support. There is an ever-growing population of EMR-expreienced nurses and allied staffing available and interested in such assignments.

  4. Re: “I don’t know how you’d calculate the ROI on wearing a PM/EMR logo in front of a golfing audience, but I assume there’s leverage opportunities with prospects who enjoy watching someone else play golf. ”

    Does anyone else remember when Misys sponsored a rookie golferat the US Open one year? See how well that paid off…

  5. Quite a tragedy on the IV piece. At least the systems being used made the error traceable to a particular technician. Easier than a lot of finger pointing and no proof.

  6. Re: Epic modules

    Wow. Let’s see how long that link stays active as I’m sure Alberta Health is in violation of Epic’s policy/contract by making e-learning videos containing Epic content available to the public.

  7. Although Greenway didn’t sponsor the winner, Dufner has contended in each of the past (2) majors (PGA and Masters). I’d be curious to know how much activity they get on their website. In addition, as he gets more exposure, I would imagine the cost of the sponsorship will increase as well. At the end of the day, the company does get increased exposure.







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