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Monday Morning Update 4/6/15

April 5, 2015 News 7 Comments

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Allscripts will pay $10 million to settle a 2012 class action lawsuit in which investors accused the company of hiding problems after its 2010 acquisition of Eclipsys. Allscripts unsuccessfully filed to dismiss the case, saying that its executives didn’t intend to deceive shareholders with their “unspecific puffery,” “immaterial optimism,” and “vague aspiration.” I didn’t realize until just now that the lawsuit extensively quoted parts of my 2010 interview with former Allscripts CEO Glen Tullman and former Eclipsys CEO Phil Pead right before the announcement.

The lawsuit accuses the company of painting an overly rosy picture of how Allscripts would absorb the Eclipsys people and integrate its products, pointing out the extensive head-rolling that followed (head of sales, CTO, COO, board chair, three directors, the CFO, the president, Pead, and finally Tullman) and revenue projections that required tripling Sunrise sales even as prospects held back because of a bad 5.5 release and uncertain integration progress. The suit also quoted internal company witnesses who said Allscripts canceled its reseller agreement with Medicity and chose instead what the witness said was the inferior product of dbMotion (which Allscripts acquired in March 2013 for $235 million) and laid out an ugly story of Tullman steamrolling those who questioned him, executives who believed the incorrect information being fed to them by subordinates, salespeople unable to make quotas because of product deficiencies, hospitals with increasing ambulatory needs either replacing their Allscripts practice EHRs or moving to Epic, Pead losing his job after failing to get Tullman fired, and customer unhappiness with product releases and integration. It’s a pretty fascinating read even allowing for the fact that it’s just one side of the story. It’s probably reflective of that tumultuous time in the company’s history that it won the HISsies “Smartest Vendor Action Taken” category in both 2013 and 2014 for taking the same action in both preceding years – firing its executive team.


Reader Comments

From Sturges: “Re: Epic-Mayo deal. Epic supposedly bought Mayo’s data center for $45 million and is leasing it back to them at an infinitesimal cost. Buying Mayo’s business?” Unverified.

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From Pickle Loaf: “Re: IBM’s new provider apps. I heard they developed these for Tenet originally. They look nice, but came out of nowhere and IBM didn’t commit to integration or ongoing maintenance. Companies, especially those new to healthcare, often jump to mobility as just another interface without considering the app itself.”


HIStalk Announcements and Requests

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Poll respondents say the most important reason they would avoid doing business with a startup is the fear that the company isn’t financially viable. That might be a surprise to startups that think they are failing mostly because they don’t have reference sites. New poll to your right or here: what should happen to ONC’s certification program after MU Stage 3?

Welcome to new HIStalk Gold Sponsor Burwood Group. The Chicago-based consulting firm’s healthcare business offers help with clinical collaboration, adoption, regulatory compliance, medical device strategy and integration, and strategic planning. The company’s client roster includes Palomar Health (which hired the company to develop the infrastructure strategy for its new 740,000 square foot hospital of the future) and North Shore-LIJ Health (for which the company created a far-reaching clinical collaboration and communications strategy). The company’s healthcare leadership team is available for meetings at the HIMSS conference. Thanks to Burwood Group for supporting HIStalk.

Interesting people will be meeting and greeting in our tiny HIMSS booth (it’s as small and sparsely furnished as my 11-year-old econobox car) including authors, CIOs, and other characters that I think are interesting. I’ll consider giving you an hour to meet your fans if you email me describing why you in fact have fans (or if you don’t have them, why you think you should). We don’t have anything to sell or business to conduct, so we’re just hanging out there as I try to forget how much it’s costing. I’ll run a schedule of who’s dropping by later this week. I know the Walking Gallery folks are meeting there.

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Find out what HIStalk sponsors are doing at the HIMSS conference by checking out our guide.

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Join Jenn and our patient advocate HIMSS conference scholarship winners for an #HIStalking tweet chat Tuesday at 11 a.m. ET. @LAlupuslady, @woodymatters, @leffet_papillon, @carlyRM and @bostonheartmom will talk about patient engagement, advocacy, and healthcare IT. You can brush up on their backgrounds here. They’ll be wearing their Walking Gallery tee shirts at the conference as they follow a busy schedule of interviews, meetings, and exhibit hall cruising.

I saw a restaurant menu the other day that had sections labeled “nibbles” and “drinkies.” I like to think it was intentionally self-ironic, but I passed anyway since maybe they’re just clueless. I’m not eating anywhere that leans hard on grammatical cutesiness, like writing “veggies,” “sammies,” or anything in the form of “Get your _____ on.” 


Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIstalk Practice, and HIStalk Connect. Click a logo for more information.

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Last Week’s Most Interesting News

  • IBM releases four iPhone apps for healthcare providers, although the company offered no details about integration or validation testing.
  • Two visible CIOs, Chuck Christian and Ed Marx, resigned their jobs, as did HHS CTO Bryan Sivak.
  • CommonWell announced several new vendor members.
  • In Australia, 30 doctors resigned over patient safety concerns with its new Department of Defence EHR.
  • The Senate deferred its deliberation of the SGR doc fix bill, which so far is free of ICD-10 delay language, until after its two-week vacation.

Webinars

April 8 (Wednesday) noon ET. “Leveraging Evidence and Mobile Collaboration to Improve Patient Care Transitions.” Sponsored by Zynx Health. Presenter: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health. With mounting regulatory requirements focused on readmission prevention and the growing complexity of care delivery, ACOs, hospitals, and community-based organizations are under pressure to effectively and efficiently manage patient transitions. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.

April 22 (Wednesday) 1:00 ET. “Microsoft: The Waking Giant in Healthcare Analytics and Big Data.” Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Microsoft has been quietly reengineering its culture and products to offer the best value and most visionary platform for cloud services, big data, and analytics in healthcare. This webinar will cover the Healthcare Analytics Adoption Model, the ongoing transition from relational databases, the role of new Microsoft products such as Azure and Analytic Platform System, the PowerX product line, and geospatial and machine learning visualization tools. Attendees will learn how to incorporate cloud-based analytics services into their healthcare analytics strategies.


Acquisitions, Funding, Business, and Stock

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Chicago Mayor Rahm Emanuel helps ZirMed celebrate the opening of its Chicago office, for which the company plans to hire 200 employees for its predictive analytics business.

Vince Ciotti covers mid-range vendors in his new series on 2014 company revenue.

Aetna SEVP Joe Zubretsky, who is in charge of the company’s Healthagen business, sells $22 million worth of stock and still holds shares worth $23 million.


People

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Pharmacy automation vendor Parata Systems promotes D.J. Dougherty to CEO. He replaces Tom Rhoads, who will become CEO of HAP Innovations, a Parata spinoff that is developing consumer medication adherence technologies.


Announcements and Implementations

Sacred Heart Hospital (FL) goes live on GetWellNetwork’s interactive patient care system.


Government and Politics

Premier’s comments on ONC’s interoperability roadmap suggest that ONC develop interoperability standards and add them to its EHR certification criteria, require EHR vendors to publish APIs, and prohibit EHR vendors from “data blocking” by charging fees to access standard information or by not providing adequate interoperability documentation. 


Privacy and Security

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Indian River Medical Center (FL) blames an unnamed software vendor for a mistake that exposed the records of 30 of its patient portal users to other patients. Their patient portal appears to be from RelayHealth, but the hospital’s broad description suggests that the problem was exporting information from another system rather than the portal itself. On the EHR side, I think they used to run McKesson Horizon but migrated fairly quickly to Paragon.


Technology

Walmart’s head of payments says chip-based credit cards won’t help much with fraud and says the US banking industry’s failure to adopt a PIN-based system for credit cards (as has already been done for debit cards) is “such a joke.” Experts blame the cost of adding PINs and the fear of banks that the extra user step might reduce the use of their high-interest credit cards.

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Microsoft co-founder Paul Allen tweeted this photo of the cover page of the source code from the company’s first product, BASIC, that was created 40 years ago. Microsoft was formed April 4, 1975. Allen is on the lower right in the 1978 company photo, with Bill Gates at the lower left. While you’re pondering just how long ago that was, recall that Meditech was formed six years before Microsoft in 1969.


Other

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I asked readers to send screenshots of how their system configuration would have handled the error that Bob Wachter, MD writes about in his book aimed at consumers, in which he mostly blames a ridiculous medication error on the IT systems his employer (UCSF) bought and configured rather than the people UCSF turned loose on patients with minimal experience and questionably effective training  (I wrote about the error, in which a nurse gave a peds patient 38.5 adult tablets, last week). Above is UCFS’s Epic screen, which forces the prescriber to order every drug by weight in mg/kg, a requirement they imposed along with their Epic implementation just over a year before the error. The resident was trying to enter a patient’s home med of one Septra DS tablet daily, which in UCSF’s laborious setup would require her to divide the home dose of 160 mg by the patient’s weight of 38.5 kg on a separate calculator, then enter the dose into Epic as 4.15 mg/kg to allow it to calculate the already-known dose. She screwed it up by entering the dose as 160, which as the screen plainly showed (and warned her about) would be a massive overdose (160 mg/kg x 38.5 kg, or 6,160 mg instead of the intended 160 mg). The resident and the pharmacist ignored Epic’s dose warning and the brand new nurse working on an unfamiliar unit was afraid to speak up, so she gave the patient 38.5 tablets, luckily without harm. Bob pretty much blames Epic specifically and EHR vendors generally for allowing people to make mistakes.

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A CMIO reader from a children’s hospital provided this screenshot, which shows the mistake-proof way his hospital configured Epic. Prescribers can click the most common doses in either mg/kg or the overall dose, so the UCSF resident would have simply needed to click the 160 mg button and everything would have been fine. This screen makes it easy for doctors to to the right (and most common) things (note that they put the preferred dosing method first on the screen, but didn’t prevent use of the other method). This CMIO says this is the way most Epic sites do it – UCSF created a cumbersome, error-prone screen just to force doctors to order in mg/kg even when it doesn’t make sense and they could have killed their patient as a result.

The UCSF error made me recall errors I’ve seen that were caused by faulty configuration assumptions, all of which mortified the application analysts who had failed to consider the oddball exceptions or the possibility of irrational prescriber behavior:

  • Invoking peds dosing pathways as deduced from patient location. Sometimes adults get moved to a peds bed and are inadvertently dosed using pediatric formulas.
  • Invoking a particular dosing pathway as deduced by age, which caused a problem in my hospital’s 14-year-old, 300-pound patient.
  • Assuming that only adults are assigned to a particular service, such as when our 12-year-old patient was overdosed on oxytocin while in labor.
  • Complex IV order entry screens that led some doctors to simply give up and enter plain IV fluids with their desired additives entered as free-text comments.
  • Accidentally moving acetaminophen liquid to the top of the pick list, driving its usage through the roof as doctors failed to notice that tablets no longer came up first.

As the CMIO commented, you have to be very careful with the assumptions you use in creating forcing functions that limit the doctor’s options.

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Forbes Hospital (PA) finally replaces paper charts and fax machines by implementing its first EHR. They’re the first Allegheny Health Network hospital to go live on Epic.The 350-bed hospital was supposed to implement Allscripts several years ago, but scrapped that plan when insurance company Highmark acquired the struggling West Penn Allegheny Health System in 2013 after an ugly ongoing fight with cross-town competitor UPMC.

A psychiatrist says patients sometimes show up for their first appointment with a folder full of Google search results about her that contain scarily personal details, also adding that ED psychiatrists often Google new patients before seeing them to make sure they aren’t dangerous or famous. She also says patients threaten doctors who refuse to give them drugs or special treatment by vowing to write negative online reviews. She adds a positive example of how overhearing patients on phone calls lets her see how they behave outside her office::

My patients arrive in my office and, like gunslingers in a saloon, unload their various electronic devices, laying them on the sofa, often two or even three, before turning them off. But there are times when the phones have to stay on: There’s a sick child at home or the boss may call. Hearing in real time patients’ responses to important figures in their lives gives me an unfiltered glimpse into those relationships. A man who sarcastically belittles his girlfriend to me is surprisingly tender speaking with her on his cellphone. An unhappy, self-deprecating executive is suddenly a confident and even commanding figure speaking with one of his subordinates. An aggressive lawyer becomes shy and awkward when speaking with his mother.

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An interesting New York Times article cleverly titled “When ‘Moneyball’ Meets Medicine” describes how health economists are measuring personal, public, and global health using a sports-like measure called disability-adjusted life years (DALYs), which count not only premature deaths but also the detractive effect that chronic conditions have on good health (example: being paralyzed is half-healthy). It sounds geeky, but it isn’t — car accidents, for example, are 2.5 times worse for humanity than lung cancer, which mostly affects older people and leaves few of its sufferers with lingering disabilities. Mexico used the calculation to prioritize medical treatments that reduced DALYs the most, while Australia allocated public health spending using the method. US figures highlight several high-impact, low-fatality conditions that don’t get the research and awareness money spent on less-impactful conditions such as stroke and breast cancer — low back pain, depression, neck pain, and anxiety disorders. I’m interested in the new book called “Epic Measures: One Doctor. Seven Billion Patients” about economist, physician, and public health professor Christopher Murray, MD, DPhil, whose “Global Burden of Disease” work was funded for $100 million by Bill Gates.


Sponsor Updates

  • Sunquest hosts its Point of Care Summit April 7 in San Francisco.
  • Versus Technology offers a blog on how wireless technology works to track the spread of infection.
  • NVoq describes “The Link Between the Simple Checklist and Improved Patient Safety.”
  • Zynx Health posts “Zynx Carebook: Real People, Real Impact.”
  • MBA HealthGroup offers “5 Ways to Optimize Your Revenue Cycle on Allscripts PM.”
  • MedData offers a sneak peek at its ICD-11 conversion tool.
  • New York eHealth Collaborative will exhibit at the Health 2.0 Mental Health Digital Innovation Challenge April 8 in New York City.
  • Perceptive Software offers the third of its series on “Tips for Sustainability Progress in 2015.”
  • NTT Data posts its top five takeaways from Mobile World Congress.
  • Oneview Healthcare offers “Eight Steps to Improved Patient Experience and Outcomes.”
  • Orion Health posts “Improving Patient Care, One eReferral at a Time.”
  • Patientco offers “The Future of Patient Engagement: Going Beyond the Clinical.”
  • PMD shares “On the Cutting Edge in Anchorage.”
  • Dodge Communications interviews Porter Research President Cynthia Porter.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
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Currently there are "7 comments" on this Article:

  1. Small vendor poll.
    Not financially viable is the biggest concern by a wide margin? As one who was a ‘small vendor’ for over a decade I’d like the voters to explian how financially viable was: SMS, IDX, Siemens, Allscripts, HBO, etc. Get the picture?

    Financially viable is not a hurdle or concern for just small vendors, it should apply to all vendors of all sizes. What system buyers do not appreciate is that doing financial due diligence on a small vendor is easy and straight forward, but on a Siemens EMR is virtually impossible. How many providers signed extension contracts with Siemens the 12 months before it gave up the ghost (or other acquired vendor)? Now there’s an interesting survey for ya!

  2. Forbes CMO regarding Epic: “at the end of the day, it will improve care and provide patients a better clinical experience”

    Evidence please…or is this simply hype, similar to that of Allscripts as described in the lawsuit reported above?

  3. “…gave the patient 38.5 tablets, luckily without harm.” A code blue, stopped breathing & grand mal seizure are not quite what I’d call ‘without harm’, but fortunately the patient did recover.

    All of us in the vendor community need to take near misses seriously. The process my company uses for reviewing and reporting incidents and accidents is deadly serious. Every employee in certain roles gets training. It’s a process that culminates in voluntary reporting to the FDA of any incident, including near misses.

  4. “Bob pretty much blames Epic specifically and EHR vendors generally for allowing people to make mistakes”

    I take issue with this statement. Bob is failing to realize that the end-users and the hospital’s leadership share just as much in the blame and it is not always on the Vendor. Blaming the Vendor is an easy cop-out for taking no responsibility.

    I have been on both sides (Hospital and Vendor) and while the vendor’s like Cerner, EPIC, McKesson, etc provide the hospitals with Best Practices and recommended design decisions, at the end of the day, its the Hospital’s decision on how the system works and functions. Many of the mistakes that occur in our EHR’s are actually a result of poor design decisions made by the hospital itself, not the vendor. Bob’s says that Nurse was new and not familiar with the system, is that really the fault of the Vendor? No, its the fault of the hospital for not properly training their nurse and make sure they were system competent to be on the floor.

    Yes, Vendor’s make mistakes and have flaws in their systems. I am not relieving them of responsibility when then issue is their’s to own and resolve, but in this case, it seems clear to me the issue is not the Vendor’s but rather the Hospital’s. As you can see from the CMIO of the Children’s hospital, “They” decided to design their system differently. This means that the Hospital took an active part on owned responsibility for how their system would function for their users.

  5. Technical note:

    Vince Ciotti’s slide decks don’t appear to work in Internet Explorer 8. The buttons are active and respond, but nothing happens, leaving the presentations stuck on page 1. None of the other controls work either (full screen, etc.).

    IE 11 runs the slide decks correctly.







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Reader Comments

  • Classic Jonathan: Dissing on Epic to dismiss athena's failures. If your fundamental premise in business is that every one of your compe...
  • meltoots: Anyone else think that it screams excessive for athenahealth to OWN a Challenger 300 private plane? EHR vendors have a n...
  • HHC...: Not that this should come as a surprise, but the amount of corruption and “side deals” involved with the HHC Epic im...
  • HIT Girl: That's quite a bloodbath....
  • Where's Kyle: Nevermind. Obviously, Kyle's been busy....

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