I've spent some time at the front of the classroom, but I've spent much more time in the lab studying…
Monday Morning Update 6/30/14
Top News
White House Deputy Chief of Staff Rob Nabors delivered his review of the VA to President Obama Friday. The report’s high points:
- The VA is the country’s largest health system with 1,700 sites and $150 billion per year in funding.
- The 14-day patient scheduling standard was unrealistic and encouraged inappropriate behavior.
- The Veterans Health Administration needs to be restructured because it has little accountability, isn’t responsive, and can’t communicate effectively.
- One-fourth of all federal government whistleblower complaints involve the VA.
- Individual VA facilities often ignore VHA’s directives and sometimes express their disagreement via the press.
- Employees know that the federal government rarely fires anyone, so they don’t try to solve problems.
- The VA’s VistA system is “cumbersome and outdated,” but is state of the art when it comes to capturing patient documentation to form an integrated health record. The real problem with scheduling patients is a lack of clinicians, support personnel, and space, not deficiencies in IT systems.
- The VA hasn’t planned well and hasn’t tied its budget requests to specific outcomes.
Reader Comments
From Mcklayoffs: “Re: McKesson layoffs. There were huge ones in April. I heard it happen again on Thursday. I heard even some of the Paragon folks were let go from services. You have to wonder if that’s their go-forward solution.” Unverified.
From Lt. Dan: “Re: cyberwarfare visualization. This real-time map of hacker attacks shows that the US is getting bombarded by pretty much everyone.” The extremely cool display from cybersecurity firm Norse, which looks like one of those 1960s US-Soviet World War III doomsday scenario illustrations, shows who’s being attacked and from where. Some of the information is surprising: at this moment, attacks are being launched from the domain of drug maker Merck in New Jersey as well as the University of Michigan and Cal Berkeley, quite a few attacks are originating from military domains, and the US is by far the most popular intended target with 10 times as many attacks as #2 Hong Kong.
HIStalk Announcements and Requests
Welcome to new HIStalk Gold Sponsor Ivenix. The Amesbury, MA-based company offers the Ivenix Infusion Management System, a smart IV pump that combines information technology with new smart pump design to reduce errors and improve patient safety. It measures and adjusts IV flow rate in real time and manages patient-specific infusion information via a secure, wireless, Web-based architecture that lets clinicians make decisions by viewing remote dashboards that display infusion information, alerts, alarms, and cross-pump drug alerts. Its analytics capability supports organization-wide quality and cost projects. IV orders are sent to the pump with nurse verification via open, pluggable EMR integration and drug library and software updates are delivered transparently. Thanks to Ivenix for supporting HIStalk.
Six percent of poll respondents said they participated in a video-based visit as a patient in the past year. New poll to your right: which EHR package should the DoD choose – Allscripts, Epic, or Cerner? Click the Comments link on the poll widget after voting to defend your decision – you never know, maybe the DoD is looking for your insight.
Listening: Austin-based Ume, who I saw live awhile back. Singer/guitarist Lauren Larson shreds it on stage with monstrous distorted guitar licks, passionate vocals, and a head-pounding mane of blonde hair, but I met her after the show and she’s a tiny, sweet Texas cheerleader type who decided to take a break from working on her PhD to focus on music along with her bass-wielding husband Eric. Ume is on tour with Circa Survive, which will play in Riot Fest in Chicago in September with some of my favorite bands: Jane’s Addiction, The Cure, Weezer, Metric, Failure, Superchunk, Dandy Warhols, and Mastodon.
Webinars
July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.
People
ONC’s Director of the Office of Consumer eHealth Lygeia Ricciardi announces on Twitter that she has resigned effective July 25.
Announcements and Implementations
ZirMed announces enhancements to its Analytics solution that include a customizable dashboard and drill-down interactive KPIs for key business metrics.
Cerner, not surprisingly, joins Epic and Allscripts in throwing its hat into the DoD’s EHR replacement ring. Cerner will bid along with partners Accenture and Leidos. Someone asked me on Twitter how I saw it playing out and I gave the odds at 80 percent Epic, 20 percent Cerner, and zero percent Allscripts. Epic has a big advantage in covering a huge chunk of the US population, having the only comparably sized implementation in Kaiser Permanente, winning just about every large-system bid, having implemented its system with the Coast Guard, having IBM as a partner, and having powerful members of Congress like Paul Ryan who have previously demonstrated willingness to use their clout to push Epic. Cerner’s advantages are the comfort level of being a large, publicly traded company with increasing healthcare reach outside of IT, strong government-savvy partners in Accenture and Leidos, good hosting experience, and a potential willingness to beat Epic on price in what will be the biggest deal in healthcare IT history. I don’t see Allscripts having a chance since large hospitals aren’t buying Sunrise, its biggest client North Shore-LIJ is keeping whatever enthusiasm it has quiet, its offerings are narrow compared to Epic and Cerner, and memories of its corporate stumbling haven’t faded yet, but it does have the strongest set of partners in CSC and HP, the latter being important since the much-touted $11 billion bid value is a 10-year cost including maintenance and infrastructure where HP shines.
Technology
3M announces ePrivacy Filter, $50 software that uses webcam-powered facial recognition to limit screen viewing to the authorized user, warn them if someone is looking over their shoulder, and blur their screen when they step away.
Other
Implementation of the C-CDA (Consolidated Clinical Document Architecture) semantic interoperability standard needs work, according to a JAMIA-published study by a group that found many errors in documents submitted from 21 systems. Meaningful Use Stage 2 requires using C-CDA, but the samples provided to the authors often included missing or incorrect information. The authors made four recommendations: (a) create a site with public C-CDA samples and scenarios since vendors say they don’t always know how to represent their data; (b) require EHR certification testing to include validating terminology such as SNOMED and RxNorm; (c) add a certification requirement that EHR vendors provide all of the data elements they capture instead of making many of them optional; and (d) electronically monitor the quality of real-world C-CDA documents being produced and report results. The authors conclude that further effort will determine whether C-CDA documents “can mature into efficient workhorses of interoperability.”
A study finds that patients discharged from hospitals that use an advanced EHR cost $731 less than those from non-EHR using hospitals. The methodology isn’t convincing: (a) the data is from 2009 and simply matched up a discharge database to what the article says is the HIMSS annual survey (which really means the HIMSS Analytics database); (b) the “cost” figures were the nearly worthless cost-to-charge ratios that everybody uses because hospitals don’t track individual unit costs well; (c) the analysis seems to have looked only at overall cost rather than for comparable diagnoses or treatments, but I’m not clear on that from the methodology provided; (d) correlation isn’t causation, so any jumping to conclusions that plugging in an advanced EHR will reduce hospital costs is ridiculous.
Here’s how disintermediated San Francisco cab drivers are competing with ride-sharing service Uber (valued at $18 billion): they’re using an app that lets people pay them for the public parking spots they intentionally occupy for that purpose. The city has ordered the app’s Italy-based developers to cease operations, saying its excuse of selling convenience rather than parking spots is “like a prostitute saying she’s not selling sex — she’s only selling information about her willingness to have sex with you.” The developer of a competing app is paying people $13 per hour to tie up high-demand evening spots in the Mission District and then resell them, give the company working inventory to promote its app.
Contacts
Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.
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While Epic may have a lock on the DOD project, I think if they win it, they will have to work very hard to not let the Feds destroy the implementation while working very hard to meet some of the unique needs of this install. Whomever gets it, I wish them well as our vets deserve to have the best care, with a good infrastructure supporting it. It wasn’t all that long ago some firms were trying to get the private sector to install Vista. Fortunately, nobody took that bait.
The sad truth is that he is actually right. But this only demonstrates the overall poor performance of all the enterprise EHR systems offered today. The rush into implementations over the last two years did not help to create better systems, knowledge or actionable analytics. At the most they just do the basic job ok – in today’s heavy data based businesses these still lag behind any equivalent industry – retail, banking etc… ok is just not good enough. And the multi-multi millions in the upfront investments here just push away the required improvements offered for a tiny fraction of these EHR projects. bottom line: way better than the current state of the art but we may be missing the opportunity to make a more drastic change. The next window of opportunity to make it may be in another 40 years…
TPD’s prediction is Epic will be the winner since past experiences with them by TPD showed that they can handle any install challenges that my come their way. Granted they have to deal we an archaic infrastructure and software but that will only mean that they have to employ their best and brightest workers. Cerner and Allscripts are publicly held which is a disadvantage to them since Epic is privately held. Lastly, it might be better for the DoD to go with EpicLite since it’s a lot easier to deploy across all the government facilities.
I think you are underestimating the chances of CSC/HP/Allscripts. CSC brings a much stronger credibility than IBM or Accenture in this space. And I believe Allscripts is the only one of the three EHR vendors that has apps that can operate standalone in a combat deployed fashion.
old army HIT guy
Since TPD comes from the vendor side of business dealings, and has worked with Epic, IBM, and CSC I can tell you from my experiences IBM is the one I would use since my experiences with CSC were not favorable. IBM went to full tilt to understand our operating system before proposing any solutions for better business results. On the other hand, the CSC Index division I worked with did not go that extra mile to improve our business but instead tried to impose their style operating of on our business and brought little new value for the money spent!
My experience with both CSC and Allscripts is negative so they may very well be a perfect match for each other. The real issue is Allscripts reputation in the marketplace. Allscripts isn’t growing in the hospital space because they continually fail to provide a reliable solution.
For our Veterans, I hope the DoD’s evaluation process is fair and honest. We owe it to the hard working men and women of our armed services to have a working, reliable, efficient, and safe EHR. Allscripts can’t provide that to its existing customers I hope the DoD is smart enough to realize they are not the right solution.
TPD doesn’t make any sense.
“Cerner and Allscripts are publicly held which is a disadvantage to them since Epic is privately held.”
Strong logic, pal.
Musical comment and perhaps a tad belated – totally thrilled that you mentioned “Eleventh Dream Day”. One of the most mesmerizing live bands ever and a shame it is that they never got the renown that they deserved. Thanks for giving them a shout-out.
“New poll to your right: which EHR package should the DoD choose – Allscripts, Epic, or Cerner? ”
Is “None of the above” an option?
The VA continues to lie to itself and continues to pay others to lie to itself and it’s leadership including congress, the Pentagon and the White House.
VA VistA is not commercially competitive in any sense of the word. It is a poor system that doesn’t reflect modern needs in healthcare. Plus, it’s miserable to try to interoperate with them.
No matter how many reports Edmond Billings (or others like him or in the VA) commission to claim that VistA is the best EHR available, all practical evidence points to the opposite.
MedSphere and Medscape and others would be actually be competitive if the claims were even half true. Remember, MedSphere dies if VistA dies. Of course they’ll say anything to survive.
Enough paying for more VA lies with tax payer funding.
Vendor_neutral
The reason I mentioned the publicly held status for Cerner and Allscripts is what might happen to the DoD contract during the ten year period if either of them are acquired by another company and the acquirer ends support for the solution they are on. That’s not likely if Epic is the winner.
@TPD
“Epic will be the winner since past experiences with them by TPD showed that they can handle any install challenges that my come their way. Granted they have to deal we an archaic infrastructure and software but that will only mean that they have to employ their best and brightest workers. Cerner and Allscripts are publicly held which is a disadvantage to them since Epic is privately held.”
1.) I’m fairly certain all HIT vendors have had experience with archaic infrastructure and software. It’s part of the business. It’s fairly ridiculous to assume that Epic is the only who has any experience in this area.
2.) Being publicly held is a disadvantage? Well I guess that makes sense. I mean, can anyone name a successful tech company listed on NASDAQ or NYSE that has scored a govt contract? Again a ridiculous comment.
@TPD
“Epic will be the winner since past experiences with them by TPD showed that they can handle any install challenges that my come their way. Granted they have to deal we an archaic infrastructure and software but that will only mean that they have to employ their best and brightest workers. Cerner and Allscripts are publicly held which is a disadvantage to them since Epic is privately held.”
1.) I’m fairly certain all HIT vendors have had experience with archaic infrastructure and software. It’s part of the business. It’s fairly ridiculous to assume that Epic is the only who has any experience in this area.
2.) Being publicly held is a disadvantage? Well I guess that makes sense. I mean, can anyone name a successful tech company listed on NASDAQ or NYSE that has scored a govt contract? Again a ridiculous comment.
As a US taxpayer, the VA best get the best deal possible. Cerner would be as good of a choice as epic IMO. If epic doesn’t want to step up and play ball price wise, I would drop them like a bad habit.
Dude, PACS desinger–with that logic please dont ever design my PACS!!!!!!!
I agree with the old Army HIT guy–Allscripts is the only vendor nimble enought to have customized apps for combat settings. More imptly, .CSC and HP are the best duo in this dogfight by far.
HAHAH epic will end up being a 50 Billion project, will be hard in integrate security and survaliance systems that DOD will require.
I put my money on HP and CSC (and Allscripts).
send in the clowns
PACS Desinger,
I definitely won’t design a PACS for you, but despite your negative comment the contrary exists as far as the DoD contracting goes for PACS as my PACS design resulted in the largest PACS contract awarded in its history recently after 15 years of use!
TPD!
For $11B why not pick 2 vendors, install at 2 sites and see who out preforms the other? It would be a cheap way to ensure that tax payer money isn’t wasted on vaporware or a bad partnership between an EMR vendor and an consulting partner that doesn’t work (i.e. can IBM and Epic work culturally on this?).
Picking 2 vendors could present a problem going forward from here because the lines between EHRs and PACS are starting to blur, having two different designs will certainly raise the possibility of interfacing problems which no one will want to experience.
My vote is to close down the VA hospital system, and let the vets go to the existing HC systems in place. The largest, best systems and academic medical centers have already spent the money for new EHR’s etc. and could use the money to sustain their very existence under Obamacare. It has been proven time and again that the government is not the best manager of any program, especially one that should put our Veterans at the highest level of care and attention.
This should be an option too that was never discussed.
The Norse Cyberwarfare graph/animation has now been sent to me many times. Mostly by C-levels and lawyers.
As a security officer I’d like to temper to many conclusions of these maps.
Nearly all well planned attacks are run though proxies or malware infected hosts. A companies name on the map could be major…or could be minor. Attribution on the internet is incredibly hard…
Given large companies’ foot print, not too surprising you’d see some big names. They could easily have a malware infection on a desktop that then is communicating with a command and control server that Norse is monitoring/has control over.
Is that an “attack”? On the map it will show as one… but not really.
That communication is to a known command and control server, if Norse knows it’s there… a few other security companies do as well (normally).
The source company “should” have more than one security solution/layer detecting the communication. Then stopping the desktop/infection and remediation b/c the next step.
Without seeing more detail on background data, it’s hard to say how serious different lines of attack on the Norse map actually are.
On the day we watched it, phone/VOIP traffic was listed as the major attack vector from France to some US destination.
Perhaps it was a VOIP denial of service attack… but just seemed odd.
Security today is crazy complex and these maps just add to the confusion, taking up cycles to explain what someone may see while watching it.
In our case we stopped putting geographical attack maps on our security posture reports.
Just didn’t make any sense as the attacker wasn’t from a university in Indiana or some Time Warner cable internet connection in New York.
But… it is fun to watch… I just expect to see Matthew Broderick at Norse typing at a mainframe console. 🙂
Interesting. Worked on multiple sides of the fence, and there are good/bad arguements for each company partnership. Leidos/SAIC is a joke. They can’t support their own defense contracts much less any heathcare deals. IBM Healthcare’s practice has been long since dead, and they are now trying bring it back to life. CSC has possibilities but they just want to farm it (no real skill sets in house to keep it.)
Just my own opinion having implemented EPIC and McKesson at several large hospitals but…It would be a mistake to put EPIC in the VA (too expensive and complicated to implement in the long run no matter what deal they try to cut).. Also… In the long run, the VA will need to deal with an investment in training long term to make it work. Once they chose to go down whatever path they select, it will be difficult to go back. The VA will need to get out of the military mindset that they can rip and replace if the deal goes bad.