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Monday Morning Update 2/11/13

February 9, 2013 News 15 Comments

2-8-2013 9-24-20 PM 2-8-2013 9-25-14 PM

2-8-2013 9-22-56 PM

From Potsie: “Re: McKesson reorg. The customer announcement is attached. They’ve said they won’t force Horizon customers to convert to Paragon, but now with Pesce over both Paragon and Horizon, the writing is on the wall. I’ve also heard they’re encouraging Horizon employees to take jobs at Relay, which would seem to be scaling back by attrition rather than by layoff.” The customer e-mail from McKesson Technology Solutions EVP/Group President Pat Blake says RelayHealth will expand to over 1,000 employees, but more germane to Potsie’s comment, Paragon, Horizon Clinicals, Revenue Cycle, and Managed Services will be combined in a new organization called Enterprise Information Services, with Jim Pesce from the Paragon business (above left) serving as president. Rod O’Reilly (above right) will become SVP of strategy for MTS.  

From Ellingham: “Re: HIStalkapalooza. How can readers have missed the announcements? Presbyopia?” Beats me, but Inga and I get e-mails every day from people who swear they’ve study HIStalk intently each day without seeing the large HIStalkapalooza announcements I’ve run three times now. Maybe they’re not really HIStalk readers and just want an invitation, but I think they’re conditioned by the rags and other sites that trumpet non-newsworthy stories with a come-on headline and 10 paragraphs of padded prose that I would have summarized in one sentence without missing anything important. Skim HIStalk and you’ll miss stuff for sure. It takes me a lot of time to write in a way that wastes a lot less of yours. That’s why I guarantee that if you’ll give me 5-10 minutes of attentive reading each day, you’ll know more than almost everybody in the industry. 

An HIStalkapalooza menu update for readers who asked: Chef Brad confirms that he will have vegetarian and gluten-free items available.

2-9-2013 7-55-47 AM

The HIMSS conference will enjoy a net attendee gain this year compared to last if you believe that my poll is statistically reliable. Doing the math suggests an attendance of 33,450 based on last year’s count, but of course New Orleans can’t match Las Vegas as a draw. New poll to your right, from CHIME’s comments about ONC’s patient safety plan: should the federal government issue a national patient identifier?

2-9-2013 3-56-52 PM

Nuggets from the athenahealth earnings call Friday:

  • Jonathan Bush says the company reduced physician documentation per encounter to less than five minutes.
  • He acknowledges that athenahealth has low physician visibility and the Epocrates acquisition will be a way of promoting the company’s other businesses given its 90 percent awareness.
  • He said “athenaCoordinator had a rough year,” referring to the care coordination platform developed from the July 2011 Proxsys acquisition. He did not specifically reference the announced March 6 layoff of 36 employees from that group, but said the Proxsys system had to be rewritten from scratch, which hurt sales, and getting pre-certifications from payers is hard because each has different rules.
  • The company has integrated six products into athenaNet through its “More Disruption Please” program and plans to add another 25 in 2013, but is collecting no fees from those vendors.
  • They will launch athenaResearch next month to use the company’s database to provide insight back to clients.
  • While the company has developed turnkey rip-and-replace programs, they don’t push them because the data in the EMRs of clients isn’t reusable, or as Jonathan Bush said, “We’re going to get better at delivering it and develop the confidence to make promises that we’re good at delivering it more convincingly where we’re just going to have to get better at explaining to people why their Flock of Seagulls EMR is going to go to the same place that their Flock of Seagulls vinyl albums went.”
  • The company says they may dabble in the inpatient EMR business after reviewing a vendor’s implementation manuals and concluding, “That’s it? That’s what all the fuss is about?” and raised the possibility that athenahealth could replace the EpicCare ambulatory part of an Epic implementation and interface to Epic’s inpatient systems.

2-9-2013 2-09-27 PM

Medical facilities are necessarily extensive at Kumbh Mela, a Hindu pilgrimage held every 12 years in India that is drawing 30 million people as the largest human gathering in history. The military-like clinics were set up in two months and will be gone by the end of March. Medical records are basic and scrawled on paper. A team from Harvard School of Public Health created an iPad-based system for documenting the chief complaints and medications of the thousands of emergency patients seen each day. It also transfers data to a server to help detect public health outbreaks such as diarrhea. As stated by Logan Plaster, managing editor of Emergency Physicians Monthly:

So far the Harvard team has gathered more than 15,000 patient records, an impressive number by any research standards, and arguably the largest public health dataset ever gathered on a transient population. Their findings have been stable and predictable; most complaints are of cough and cold, and most prescriptions are for anti-inflammatory drugs, like ibuprofen. That’s good news to everyone’s ears as millions of new pilgrims enter Allahabad in preparation for February 10, the holiest bathing day on the calendar.

In China, a doctor’s social network warnings about a particular medication used in children causes shares of the drug’s manufacturer to drop 10 percent in a week, losing $160 million in value. It turned out that the doctor was wrong, having incorrectly recalled government literature. He has only 2,000 followers, but his message was reposted by a Chinese celebrity to his 26 million followers. The doctor apologized and clarified several times, but his original message continued to spread. Public relations analysis determined that a company’s response to publicly disseminated incorrect information must be issued within eight hours to be effective and must be distributed online rather than via traditional media.

The State of California fires SAP Public Services from its state employee payroll and medical benefits computer project after the new system was found to be making errors at 100 times the rate of the 1970s-era system it was supposed to replace. The project is years behind schedule and costs have piled up at triple the original estimate, with $371 million spent so far. SAP Public Services has been paid more than $50 million after the state fired BearingPoint three years ago.

An employee of Xerox/Affiliated Computer Services and an accomplice are indicted in Kentucky for using patient information collected in managing CVS’s Medicare Part D prescription plan to file fraudulent tax returns.

2-9-2013 4-17-39 PM

In England, the CEO of Royal Berkshire Hospital reports to the hospital’s board that implementation of its $47 million Cerner Millennium system need an extra $6 million to cover staff time required to navigate through patient scheduling screens that take up to 15 minutes per appointment. He warns that Millennium-related expenses will cause the hospital to move from a financial surplus to a loss for the year. According to the executive, Millennium crashes regularly, including this past Tuesday when it was down all day and the hospital had to revert to paper. The hospital’s 2013 implementation costs are projected at $10 million vs. its budget of $4 million due to unplanned manual data correction and extra staff time. The CEO said in a prepared statement to the Council of Governors, “The level of issues the trust faces having implemented Cerner Millennium is a significant drain on management capacity, despite robust risk mitigation plans. This has a significant impact on the trust’s financial performance and cash position, being the key driver between a surplus and forecasted deficit.”

Tennessee health department officials trying to manage a September meningitis outbreak were forced to develop an electronic workaround to their usual manual hospital data collection process due to the urgency of the situation. The agency had to convince hospitals to give it electronic access to their systems given restrictive federal privacy laws. Vanderbilt University Medical Center was identified as “becoming a substantial hindrance to our investigation” because its permission lagged that of all other area hospitals. The health department is considering proposing legislation to give it easier access in an emergency.

2-9-2013 3-07-00 PM

ORNGE, the air ambulance service of Ontario, is under fire for paying its physician CEO $4.6 million over two years. Taxpayers also paid questionable expenses that included European travel with $2,400 per night hotel rooms, a $1,200 dinner, limousines, minibar champagne, in-room movies, and trips with his girlfriend, who he had promoted to VP of the organization.

The CEO of the public healthcare system in Maricopa County, AZ defends her $125,000 salary increase, saying her $500,000 salary is “always the lowest of any hospital CEO in the entire state, even the little-bitty hospitals.” The board chair voted against the increase, saying the CEO has done a great job, but, “A $125,000 raise in a year when we give our janitors maybe a 1 percent raise or lay off people? It just doesn’t make sense.”

Beth Israel Deaconess Medical Center (MA) pays its former chief of anesthesia $7 million and will name its pain clinic after her to settle her charges of gender discrimination. Carol Warfield, MD says the former surgery chief, along with former hospital CEO Paul Levy, forced her out when she complained about being ignored in meetings. The Boston Globe says the hospital probably wanted to avoid reopening anything related to Levy since the woman’s attorneys had already claimed that the inappropriate relationship Levy had with a hospital employee was evidence that he ignored workplace rules.

A Truthout article says EMR adoption poses new challenges to lesbian, gay, bisexual, and transgender (LGBT) populations who will have to decide whether to share their status without knowing how that information will be handled digitally. One advocate says she doesn’t want to have to bring up her status in every medical encounter, saying, “I’m out to everyone, but I don’t want to have to come out to doctors over and over again.” Ares of EMR concern: (a) questions ask status like “gay” or “bisexual” instead of specifically identifying a patient’s relationships, since “sexual orientation is not useful medical information”; (b) EMRs should be able to identify same-sex partnerships instead of just checking “married”; (c) a label of “transgender” is not sufficient without more details; and (d) equal protection is not guaranteed in all states and an EMR-related outing can create problems. In an interesting twist on the tired HIE argument of “unconscious patient in the ED while on vacation” example, LGBTs say that their shared information could be a disaster in LGBT-hostile areas or facilities. An IOM study was mentioned whose conclusion was that the best course of action is to allow LGBTs to self-identify and opt out of answering related questions.

2-9-2013 2-15-19 PM

A hospital in Australia will discipline five employees, one of them a nurse, for posting in information to Facebook that it says violated patient confidentiality. The nurse posted the nursing home photo above, which she labeled as, “Randomly stripping for the oldies at work.” She also posted a patient’s pelvic x-ray showing an embedded object with the caption, “Take a guess what this is kids!”

2-9-2013 4-48-44 PM

Weird News Andy summarizes this story thusly: “I’ve heard of butt-dialing, but not answering.” A Sri Lankan prisoner who is startled by guards demanding to search his cell shoves a cell phone and two hands-free accessories into his rectum. The guards are surprised to hear a cell phone ring during the search, followed by the prisoner’s complaints of back pain. They take him to the prison hospital, where he tells doctors that his pain was caused by guards beating him. When the doctors reviewed x-rays and announced plans for surgery, he produced the contraband voluntarily.


Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

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Currently there are "15 comments" on this Article:

  1. “Jonathan Bush says the company reduced physician documentation per encounter to less than five minutes.”

    Interesting- and pertinent- statistic. Anyone know how they calculated this, or if any other EMR companies report their number? It would be important to define how they come up with the figure, so as to compare “apples to apples”.

    Would love to see a “note-off” where providers from several EMR’s are provided the same fictional patient and are asked to generate a note, allowing for a head-to-head comparison.

    Mr. H, Inga…..anyone care to set this up at HIMSS?

  2. RE: Numbers skeptic

    It would be great to see that number from a neutral source and let CFOs put the real number into the business case for that new EMR with the high up front cost.

  3. How is a crash defined in the world of hospitl HIT? Is anyone keeping records on the unavailability of EHRs in the USA? Our EHRs go down frequently and often run slow for reasons no one has been able to figure out. But most importantly, is there an organization who records these whether they be for 5 minutes or 5 hours?

    I feel bad for the chaps at the Royal Berks: “The system also regularly crashes, causing chaos, and was out of action again on Tuesday this week…” What a horlicks! Funny though, that they did not comment that the chaos interfered with patient care, but rather, just the budget.

    The other interesting point is that Cerner is booking record profits and revenues. That must rub it in to the Royal Berks, no?

    Thanks again for all you do for us IT geeks.

  4. I am sure Athena knows because they can actually “watch” from their Watertown center exactly how long it takes for any doc to complete an encounter.Which is one of the beauties of their cloud based EMR as opposed to a software based one , you cannot compare “apples” to “apples” because the software ,not cloud based ones, simply cannot do that. Kudos to JB again.

  5. Numbers skeptic,
    This used to be done at the TEPR conference. I wish someone would bring it back at a conference as well. Although, it’s still hard to compare apples to apples.

  6. RE: time er physician documentation encounter

    I am no software engineer, but isnt everything in an EMR time stamped and archived? Time one opens a new documentation note to time one saves it = documentation time.

  7. Truthout makes an excellent point. Considering the neglect of privacy in that patients have zero and no control over who sees their records when they are digitized, LGBT patients may lie, avoid care, or get screwed at work and elsewhere. They do not have any recourse.

    With paper records in the clinic, the doctor can protect the patient and the patient controls the reords destiny.

    I begin to wonder if this country is really the USA. I am thinking about demanding that none of my information is put on a computer when I go to the hospital and clinic.

    The doctors who use nothing but paper will become popular for privacy protection.

  8. Would Mr. Bush or someone from Athena please explain how they achieved doctors’ documentation time down to 5 minutes? What was it previously? Are the doctors now undercoding? Just wondering. The Athenas are giving out $100 gift cards to hear their pitch. I might just get my doctors to go.

    With an EMR that is so efficient, Mr. Bush should travel to the UK and meet with the Royal Berks team. Anything would be better than what they describe.

  9. I don’t think anyone who has used Cerner Millenium would be surprised by Royal Berkshire’s problems. I had the misfortune of supporting it in the early 2000’s and just keeping it running was a struggle (the Cerner server-side processes keep crashing and constantly have to be cycled–it’s a well known issue and some customers even resort to third-party monitoring tools). Even at it’s best it was clunky and slow (the database is very normalised). I assumed that they have improved somewhat but maybe not…

  10. Cut and paste, point and click – you can have a totally illegible, fully billable note in under 5 minutes. The wonders of modern medicine indeed!

  11. a) There are more than a few cloud-based EMRs out there, in fact most of them who were developed in the last few years.

    b) DZA MD is correct – almost every EMR has the ability to time stampt and archive functions, not just cloud-based solutions.

    c) No one else rolled thier eyers while reading JB’s comments that they might “may dabble in the inpatient EMR business after reviewing a vendor’s implementation manuals and concluding, “That’s it? That’s what all the fuss is about?” I would imagine we could build a list of 20+ CEO’s who have made similar statements and failed.

    All those shops who bought Epic on the premise of a single integrated solution are going to move away from EpicCare ambulatory….why?

    I know this guy is entertaining, but seriously would it hurt to ask some questions about the stuff he says?

  12. Re: QuietOne’

    Comparing your experience with a technology from the early 2000’s to today’s… it’s just not pertinent.







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