From Ryan Nichols: “Re: CIO salaries. In 2004, you posted salary data for a number of CIOs, including some fairly high ones like Shands. How accurate was that data? Was there some other reason for some salaries to be off the scale, >$500K?” The salaries came directly from IRS reports, so they show exactly what a CIO was paid in one year, skewed only if that person quit and got lump sum benefits. Not true in most cases, including Shands — 2008 tax records show they paid Joan Hovhanesian $708K, more than everybody except the CFO (who made barely more) and the CEO, who got $1.26 million. Sweet, although not up there with what they pay Urban Meyer to coach football ($24 million over six years).
From Jerry Seinfeld: “Re: Tampa General. Heard a rumor that they will move to Epic from Siemens. Going to the board for final approval.” Unverified.
Listening: Travis, alternative rock from Scotland that sounds like an upbeat, pop-tinged Radiohead.
Eclipsys announces Q3 results: revenue down 5%, EPS $0.07 vs. $1.58, although most of the Q3 2008 earnings came from a one-time tax treatment. Without that, earnings were down 47%. The company also announced that North Mississippi Medical Center has chosen Sunrise.
QuadraMed announces its Q3 numbers: revenue down 7%, EPS $0.02 vs. $0.12.
Cleveland’s MetroHealth has had Epic for ten years, so Judy was there Thursday for the celebration.
An undercover journalist in England buys detailed medical records of British patients from two chat room “salesmen”, apparently provided by India-based transcription center employees. One said, “We can do really good business with these leads. These leads will give you diagnose, entire diagnose of all the customers, what the customer is facing … The floor managers, they are working as freelancers for me.” The records came from London Clinic, which doesn’t outsource transcription, but some of its doctors hired a local firm and may not have been aware that their information was being sent to India. In a quick marketing reaction, Atlanta-based Webmedx assures customers that all of its employees are US-based and therefore aren’t out of the reach of US laws.
HuffPo covers EMR stimulus money and the vendor marketing techniques being employed to go after it: “cash for clunker” rebates, interest-free loans, Walmart sales, and the Stimulus Tour. John Glaser is quoted as saying that ONCHIT will start tracking EMR prices and marketing claims, looking for any stimulus-related misstatements like the ones Siemens claimed Cerner user to steal its customers (and sued them over it, although it has settled, which I’m not sure I know until I read it in this story). HIMSS was invited to comment but, not surprisingly declined, knowing it might step on some diamond toes. I was amused that John Halamka was identifed as “John D. Halambra” in the article.
USA Mobility announces GA of I-LAND, a two-way emergency messaging system for hospital and government campuses that gets through in emergencies because it doesn’t use public networks.
Over 97% of healthcare organizations say they have behavior problems with doctors and nurses, according to an ACPE survey. Examples: yelling, cursing, insulting, refusing to work with each other, throwing objects, trying to get someone fired or disciplined unjustly, and harassing sexually. Many of the problems happen in public or in front of patients. Here’s an interesting one from the respondent comments: male surgeon says to female nurse, “You must be deliberately screwing up. No one could be so stupid as to be this incompetent.” Nurse replies, “If you don’t stop insulting me, I am going to drag you out into the parking lot and kick your ass.” Surgeon reports nurse to administration, nurse gets fired. Only 22% of respondents said doctors had been terminated over incidents, while 61% said nurses had.
Maybe this is related: a couple of readers Googling for the doctor road rage story may have uncovered an important trend — there are a lot of those stories in the news. Doctors have beaten motorists with Thermos bottles, punched women drivers in the face, and pinned a pregnant woman against a wall with an SUV. Do they teach anger management in medical school?
Dann from RelWare says the Fall Technology Conference of Midwest HIMSS in Grand Rapids this week drew over 400 registrants. He took a picture of someone reading HIStalk during the sessions, which creeps me out the couple of times I’ve seen that at HIMSS (I write it entirely alone with only e-mail contact, so seeing someone read it in person makes me feel exposed).
I missed a couple of graphics from Mark Moffitt’s Web services article (you code geeks will love it because it shows a little bit of programming and some XML). I also ran across this video in which doctors talk about it and give a quick glimpse or two.
NHS is threatening its suppliers CSC and BT with termination if they don’t hit the November dates that were set earlier this year for bringing patient systems live. Sounds great, other than the previous suppliers it tried to hardball walked away. I tried to suppress the sophomoric cackling as I read the name of the hospital that went live this morning on Lorenzo, but I couldn’t — NHS Bury.
My UCSF sources told me in August that it was stopping its Centricity project (finally verified by UCSF in mid-October). They also said that Epic would be brought in as soon as the lawyers killed the GE contract. Right again, apparently, as negotiations with Epic are underway and, if all goes well, implementation will start in the first quarter. I snooped around and found a copy of the e-mail online (warning: PDF). The GE experience must have been ugly: “I understand the frustration in our prior efforts over the past several years, and the concern that we are facing another two years of this work. However, because we are going with an established, proven system, we can have much greater confidence that in two years we will have the tools that our clinicians need to improve the quality and safety of the care they provide.” Wonder what that Strike 1 cost them?
Speaking of Epic, I got a nice note from Dr. Lucy, aka #1 Dinosaur, who was surprised to find that people assumed her EPIC FAIL line in her anti-EMR blog post that I mentioned referred to that Epic (she’s a fan of FailBlog and was riffing on that about EMRs in general). She does, however, stick to her guns in not buying an EMR for her practice, with her reasons listed in this post:
A man in the back spoke of the new EMR he had just purchased for $30,000. Once all the numbers were crunched, though, it turned out he was only going to see about $3,000 in P4P bonuses. The response, delivered somewhat more softly than the stentorian tones of the main presentation, was that his return was more likely to be in the areas of quality and lifestyle. I imagined presenting a proposal to an insurance company — actually to any kind of business — and saying, "Now, you’ll only make back about 10% of your initial investment, but you’re likely to see improvement the areas of quality and lifestyle."
And speaking of EMRs, cost is a big concern for doctors, but 58% of them know nothing about ARRA.
Philips and the biggest insurance company in the Netherlands start a pilot project to develop home monitoring programs there.
This strikes me as bizarre: the MyMedicalRecords people engage a clinical trials company to help bring its monoclonal antibodies assets to market. An earlier announcement says it acquired the technology when it did a reverse merger with Favrille, Inc. in January 2009, although all the Phase III trials results I could find indicated that all of Favrille’s products were flops. The news didn’t seem to help the parent company’s share price, now down to less than eight cents, about a quarter of what it was worth in May.
Pharmacy OneSource acquires the MedBoard in-hospital drug delivery tracking system from MedKeeper.
Strange: a Phoenix doctor’s office gets 1,000 hang-up calls a day from a man angry at a former practice employee with whom he had a relationship. He’s done it for months and says he will keep it up for 25 years. They can’t block the calls because he’s in Jordan.
eHealth Ontario’s $236 million contract, signed quietly a few weeks after its CEO and board chair quit after a bidding scandal, will give 5,700 doctors a connected EMR – less than a fourth of those practicing in the province. The backlash over Ontario’s problems has stalled approval of a request from Canada Health Infoway for $500 million of what is basically stimulus money, although its audit was clean. That non-profit has spent $1.5 billion so far.
State government in India, annoyed that private hospitals obligated to treat poor patients are turning them away, directs them to post a count of empty beds daily on the Web page of the Director of Health Services. The newspaper article concludes that “If this works as planned, it will mean that patients will no longer have to share beds, limiting cases of infections.”
David Grant USAF Medical Center (CA) goes live in six weeks on ClinicComp Essentris CPOE, repository, and alerts.
Seton Family of Hospitals (TX) says its Sychron desktop virtualization saves caregivers 30 minutes each per day since the “roam button” allows them to save a session, leave, and then pick up where they left off on another PC without logging in again.
IMS, the big seller of patient and prescription data, sells itself for $5.2 billion, the largest buyout of the year. Thank them if you believe drugs are too expensive since they specialize in telling drug companies how to wring the most profit out of their products.
The SEC settles with imaging vendor Merge Healthcare and its former CEO and CFO for improper revenue recognition that overstated net income by 230% for three years, resulting in a $500 million hit in market cap when it was discovered. The former suits will pay a combined $870K. I read the original complaint and it said Merge did what an insider told me that HBOC did in the 90s — shipped empty boxes to customers when products weren’t ready so the revenue could be recognized anyway.
The whistleblower who turned in a Texas hospital group for paying doctors kickbacks for referrals gets a 20% share of the settlement amount — $5.5 million. Anybody know a really crooked hospital that’s hiring?
Q3 results for AMICAS: revenue up 121%, EPS $0.05 vs. -$0.02, handily beating estimates of $0.01 and guiding up. The one-year share price graph is above (they’ve nearly tripled).
Odd lawsuit you’ve already seen: the woman mauled by another woman’s pet chimpanzee has already sued its owner for $50 million, but now her family wants to sue the state of Connecticut for another $150 million because it didn’t prevent the attack.
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From The PACS Designer: “Re: Windows 7. Microsoft has released a 90-day trial copy of Windows 7 for IT professionals to use in testing Windows 7.”
From Charles Chips: “Re: road rage story. The doctor was found guilty on all counts.” Thanks for the link. After some soul-searching, I’m going to pass on running specifics even though I said I would once the jury had reached a verdict. The person’s in enough trouble already (looking at up to 10 years in jail) without having the details trumpeted to the industry just because their employer is an HIT vendor and just because I happen to know that. I’m a Golden Rule kind of guy, so I’ll sleep better knowing that, right or wrong, I didn’t go against my conscience. You can probably Google it.
This moment brought to you by Weird News Andy: “Snoring less improves your golf game. Yes, a bit late except for those in Florida, but remember it for the spring.” Another reason to seek treatment for sleep apnea — the handicap of golfers studied improved by three strokes. I like that the UK newspaper, obviously scratching their heads at not having a photo of a CPAP-wearing golfer on the links, stuck in an unrelated picture of Barack Obama holding a golf club.
Ingenix Consulting names John Nackel as CEO, replacing Ted Chien.
Thanks to the reader who sent over the six best practices for medication administration from CALNOC, which dramatically reduced errors in several large hospitals. They are simple: (a) check the medical record against the med; (b) don’t get distracted; (c) leave the label on the med until it’s given; (d) use to methods of patient identification and explain the med to the patient; (e) chart the med immediately after giving it; and (f) check the Five Rights. Bedside bar code verification isn’t on the list. I supposed you have to assume that if these steps reduced errors, they weren’t doing them before, but it’s not much of a magic bullet for those looking for one.
eHealthOntario issued another $236 million in contacts after CEO Sarah Kramer resigned in July over excessive consulting expenses. A political opponent is outraged that the government made no announcement about the new agreements, saying “It’s very ominous that at the height of the controversy around the billion-dollar boondoggle at eHealth, the government slipped another $236 million out the door.”
MD Buyline jumps on the ARRA EHR bandwagon, offering an odd lot of services (a glossary, a list of Web links, customer survey results, etc.) Maybe their services have improved since I was pressured to subscribe to them years ago.
The Advisory Board Company reports Q2 results: revenue up 1.2%, EPS -$0.14 vs. $0.32, but a lot of that loss was one-time write-offs. Shares that were in the high 60s three years ago are at $25.45 now, dropping the market cap to around $400 million. None of the executives are big holders, with even the president holding only around $350K worth.
A guest editorial in a Toronto newspaper says the Canadian government’s H1N1 vaccination rollout “looks like rush hour at a Mexican bus terminal” (I’m a bit uncomfortable with that choice of words). It lauds, however, a clinic that used its scheduling system to book vaccinations and its EMR to verify that recipients were high risk, resulting in no patient waiting. It summarizes, “If there were a Group Health Centre in every Canadian community, the H1N1 vaccination campaign wouldn’t make us look like a Third World country. We need more effective primary health care in Canada and we need to seamlessly link primary health care to public health.” Don’t we all.
London hospitals are testing a “digital patch” that allows wireless patient monitoring, with information being downloadable into a smart phone or integrated directly into EMRs. Toumaz Technology, which makes the Toumaz Sensium, says its on-board chip extracts critical information and not just raw data, working over low-power radio.
Here’s a fun blog post complaining about EMRs from the perspective of a family practice doc who can’t get information about his or her ED patients. What’s notable: the gripes (“The Emergency Department EMR from Hell”) apparently involve Epic (it’s too detailed to summarize). I really liked this comment from an anonymous reader of that site, though:
“Medicine is often compared unfavorably to the airline industry in its failure to use checklists to avoid mistakes. Well, I’m pretty sure there’s no checklist that requires a pilot during take-off to go into the cabin and ask who ordered the fruit plate. But the forces that run modern medicine (including our professional societies) feel that there is no administrative task too trivial that it should not be allowed to interfere with the doctor’s interaction with his patients. This trend is only exacerbated by making an EMR the focus of the physician’s concentration. Basic point: anything that reduces the time and mental energy a physician has to bring to direct, one-on-one patient contact is BAD.”
From accidental Googling, I see that Sharon Howard, formerly of Sage, is now VP of marketing at RelayHealth.
I editorialize on PR-fueled H1N1 data reporting in my guest editorial at Inside Healthcare Computing this week. I must have had too much soda since I sound manic: “Just be aware that people exaggerate their own illness for maximal sympathy or as justification for skipping work, so any kind of sniffles or tiredness will convince people to say they have H1N1 because they heard about it on Oprah (‘headaches’ become ‘migraines’, ‘a cold’ becomes ‘the flu’, and ‘getting sick from too much Super Bowl beer, wings, and guacamole’ becomes ‘food poisoning’).”
I see HHS got a few EMR comments on its site, some of which are good. Here’s a snip of one I agreed with as a contrarian: “The fictional scenario of showing up unconscious at some distant medical center, alone and without ID and contact information, and needing instant treatment that solely depends on an EHR (not on physician judgment) is so rare as to be nil.” Most medical care is delivered near the homes of patients, so it would be a stretch to justify spending a lot of interoperability money to avoid the oft-told “unconscious in a Florida ED on vacation alone and avoided a penicillin allergic reaction” fable that happens, but rarely.
In England, three thumb drives are lost that contained information on 76 cancer patients, stored in unsecured Word documents.
Odd lawsuit: a woman sues her former lover, the married head of the OB-GYN department of Greenwich Hospital, claiming the doctor used the OR for their trysts, told her to get Hepatitis C vaccine afterward, and illegally injected her with Botox. He says she’s out to get him after he dumped her at his wife’s insistence, saying the former mistress posted Internet comments under his wife’s name that called him “a pervert”.
John Fontanetta MD, CMO of ED systems vendor EDIMS and a practicing ED physician, is named a Top Emergency Doc in a survey by New Jersey Monthly Magazine.
A psychiatry magazine says stimulus dollars won’t encourage psychiatrists to buy EMRs because the Meaningful Use criteria will be aimed at generalists controlling chronic physical disease. A New York state mental health official says quality indicators exist for psychiatry if HHS really wanted to use them to define Meaningful Use for that specialty. He also pointed out that hospitals look harder for physical conditions whose treatment generates revenue, which has encouraged vendors to focus on the broader market.
Fletcher-Flora announces GA of its lab outreach portal.
Jeff Arnold, a founder of WebMD, launches Sharecare.com, which features expert advice from “celebrity physicians”, big-name hospitals, and “Knowledge Partners”, advertisers who provide answers marked as sponsored comments. Oprah is a backer.
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HERtalk by Inga
From DragonGuy: “Re: conversations meeting. Had a great Dragon conference in Vegas last week. Dragon 10.5 will (we all hope) partially solve the ‘Citrix issue’. The room was mostly filled with Epic-based hospital IT people wanting to improve the experience for their docs: Kaiser, Cleveland Clinic, and similar.”
Drummond Group, which provides interoperability/performance testing and certification, announces that it will apply to become an EHR certifying body once ONC releases its requirements. I think mixing things up a bit and giving CCHIT some competition isn’t a bad thing. Of course the introduction of choice is bound to lead to strife, with certifying bodies and their constituents each claiming superiority. Perhaps competition will reduce certification fees, which would be especially appealing to smaller vendors. Now that Drummond has announced its intentions, will other entities step forward as well? Could be fun to see what unfolds.
Perot Systems is now Dell Services Global Business Unit, following Dell’s purchase of 90% of Perot’s outstanding shares. Perot CEO Peter Altabef was named president of the division.
Hospital have had a total of 126 mass layoffs (50 or more employees) through the end of September, which exceeds the 112 layoffs for all of 2008.
dbMotion opens a regional office in Singapore to address the growing demand for EHR solutions in Asia-Pacific.
Mediware reports a 184% increase in earnings over last year, and a 9% jump in revenue. Shares climbed 15% based on its better-than-expected numbers.
West Penn Allegheny Health (PA) makes plans for a new medical school, as well as an overhaul of its 700 member physician practice group. Despite a $34.6 million loss for the nine-month period ending March 31, West Penn is investing big money in EMRs for its physician offices.
McAllen, Texas once again makes healthcare headlines. The area’s largest hospital system agrees to pay the federal government $27.5 million to settle allegations that it paid doctors illegal kickbacks to refer patients to its facilities. The government claims that South Texas Health Systems disguised payments to doctors in a series of sham contracts that included medical directorships and lease agreements.
St. Rose Hospital (CA) deploys Horizon Cardiology CVIS from McKesson. Meanwhile, Crittenton Hospital (MI) selects McKesson’s Horizon Enterprise Revenue Management solution.
The seven-physician Toledo Orthopaedic Surgeons group selects SRS EMR.
HHS says it’s taking HIPAA violations seriously, imposing significantly stiffer penalties for HIPAA breaches. The maximum penalty for a civil violation jumps from a mere $100 to a hefty $25,000 fine. The penalty cap was also raised from $25,000 to a whopping $1.5 million.
Following what seems to be low-tech techniques, VHA helps 28 hospitals in Oklahoma and Arkansas improve ER traffic. Most of the EDs made significant reductions in wait times and LWBS rates, despite increases in patient volumes. I was surprised that VHA did not attribute the improvements to some new HIT tool. Instead, old-fashioned internal competition and communication were the main forces at work. One VHA official says, “The real driver for improvement for these hospitals is not comparing themselves to national standards, but with each other. Once a hospital administrator sees that another hospital has achieved success, he or she picks up the phone and asks how.” Now that’s innovative.
Bermuda’s primary hospital and urgent care center are getting rid of paper processes and installing MEDHOST’s EDIS.
CareTech Solutions reaches an agreement to acquire IGCN, which helps hospitals build and manage Web sites.
Moses Taylor Hospital selects ClaimTrust’s InSight Denials to track and analyze claims.
Cortland Regional Medical Center (NY) contracts for ProVation Order Sets to automate evidence-based order sets.
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Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!
Web Services, A Real-World Example
By Mark Moffitt and Kevin Hornberger
In this article, we will give an example of the use of a “transactional” Web service to request and return clinical data.
GSMC processes about 90,000 patients per year, 1,700 per week, or 250 per day in our Emergency Department (ED). ED physicians at GSMC use MEDHOST to record each patient visit. MEDHOST is a “best-of-breed” ED application. MEDHOST is interfaced to our hospital information system (HIS), Meditech Magic, using HL-7. Meditech and MEDHOST stay in sync by way of HL-7 data transfers. In this example, think of Meditech as our HIS and clinical data repository (CDR).
GSMC developed an iPhone web application that physicians use to view clinical data. GSMC ED physicians wanted to use this application to pull up a list of patients assigned to them. Then, they can access clinical data like lab and radiology (audio dictation) on the iPhone. This information (list of patients) is not included in the HL-7 messages sent from MEDHOST to Meditech.
We could modify the HL-7 transaction from MEDHOST to Meditech to include this field. The GSMC iPhone app would then query Meditech (CDR) to get a list or patients associated with an ED physician. This effort would require modifications to MEDHOST and Meditech to process and store this data. See Figure 1.
An alternative approach is to keep the data in MEDHOST (source) and get it using a Web service when needed. See Figure 2. The advantage to this approach is:
- Only one copy of data exists.
- Implementing a Web service is easier than having multiple vendors modify an HL-7 message.
- It is easier to maintain – the Web service only needs updating when changes are made to the underlying MEDHOST database.
GSMC uses a Web service developed internally using XML over HTTP. The Web service receives a physician identifier, constructs an SQL message and queries the MEDHOST database, and returns the result in a Web service. See Figure 3. The return message contains a list of patients assigned to a specific ED physician. Figure 4 is a return message (with patient identification altered to keep confidential).
Most CDRs in operation today perform two functions: 1) provide easy access to data spread across multiple systems, and 2) serve as a data store for analytics and decision support.
It is fairly easy to construct a Web service to get data from different systems. Web services with direct access to data sources eliminate the need for a CDR with respect to providing easy access to data spread across multiple systems.
New technologies in the business intelligence (BI) space may eliminate the need for a CDR for analytics and decision support. I will be writing about this topic in my next article.
I acknowledge that this is a simple example of the power of Web services. To take Web services to the next level, aka a Service-Oriented Architecture (SOA), you need interoperability and other features. Interoperability, unlike the example above, requires cooperation and coordination from vendors, something not always easy to obtain. MEDHOST is working further on its web services to provide a full SOA.
Figure 1
Figure 2
Figure 3
Figure 4
Mark Moffitt is CIO and Kevin Hornberger is a senior software developer at Good Shepherd Medical Center in Longview, TX.
Strategic IT Investments in the Operating Room: Why Now is The Time
By Kermit Randa, FACHE, CPHIMS
By now it’s obvious that the current economic downturn has not spared hospital organizations. With capital markets inaccessible to many hospitals, the financing for major investments and physical plant expansion is suddenly unavailable. Additionally, income from hospital endowments, which is often dependent on equity investments, has been dramatically reduced. The recently passed economic stimulus for healthcare and especially the $19 billion for adoption of an electronic health record may offer hospitals some funding relief in the long term, but initial funding for hospitals will not begin until 4th quarter 2010. In addition, the regulations for determining funding and eligibility are still being debated and finalized.
Long-term assistance may be on the way, yet demands on hospitals remain high for now and the foreseeable future. These demands include the need to maintain a high level of quality, operate ever more efficiently, continue with patient safety initiatives, comply with regulatory requirements and attract and retain talented clinicians. Certainly, this is not a time for “business as usual” and it offers a real opportunity for renewed leadership, strategic vision and action.
The traditional response to tough economic conditions is to put current project expenditures on hold or to implement an “across-the-board” belt-tightening budget process (“Every department needs to reduce their expenditures by 10%”). This latter approach, while appearing straight forward and fair, may have unintended consequences. But where can an organization begin to effectively navigate through these unprecedented times?
One sound approach involves a back-to-basics look at the economic underpinnings of hospital organizations and the importance of the hospital operating room (OR). According to recent HFMA studies, today’s OR is the economic engine of most hospitals – accounting for up to 60% of a hospital’s revenue and some 35%-40% of the hospital’s expense. Over 60% of the hospital’s margin typically comes from surgical patients. Based on data from DJ Sullivan Healthcare Consulting’s database of 700+ ORs, each empty but open OR suite costs a hospital an estimated average of $1,000 per hour (including pre/post op staffing and anesthesiology costs). The OR is also a primary source of up to 50% of hospital-based errors. The impact of the OR is felt well beyond the perioperative department, according to the AHA’s Quality Center, “Because the OR is a primary source of admissions, it is virtually impossible to streamline hospital-wide flow without first streamlining patient flow through the OR”.
Optimizing the performance of the perioperative department can significantly improve performance of both the perioperative department and the hospital. Through the use of new perioperative information systems coupled with improved work flow processes, hospitals can expect the following improvements in their OR:
- More accurate scheduling resulting in a more rational schedule
- Increased on-time case starts due to an effective pre-surgical screening and documentation process
- Improved quality of care and patient experience by reducing redundant data collection through an integrated digital record
- Reduced supply costs by using preference cards automatically maintained on actual usage, not “what was used last time”
- Documented cost-per-case averages to offer greater access to surgeons with higher margin case mixes
- Generated comparable metrics showing cost-per-case by surgeon by procedure so that standardization decisions can be made based on full information and not just purchasing data
- Published empirical performance outcomes to demonstrate quality and efficiency to other surgeons and the community using analytics and business intelligence tools
- Web access to create a path of least resistance for surgeons and their offices
- Consistent and predictable surgical days for which everyone can plan
- Integrated Anesthesia record driving increased efficiency, charge capture, and safety
To enable hospitals to make a perioperative IT investments now, some healthcare IT vendors have already announced special subscription pricing models that enable hospitals to fund such initiatives from operating budgets rather than capital budgets that may be currently on hold. Hospitals can begin these projects now, spreading payments over a longer time horizon, realizing a positive ROI more quickly.
Surgeon and OR Staff Recruitment and Retention
Another strategic consideration for moving forward with an investment in perioperative IT is that it can be a powerful motivator in attracting talented surgeons, residents, and OR clinicians.
According to James Pennington, Chief Information Officer, JPS Health Network, located in Ft. Worth, Texas, “Our hospital has long been a preferred institution for incoming residents due to its diverse levels of patient acuity, service lines and our use of advanced technology. We recognize that top new residents understand the benefits of advanced IT solutions in the provision of care and expect them to be available”.
One way to increase OR revenue is to attract surgeons with high volume practices from competing hospitals.
The Centers for Medicare and Medicaid Services (CMS) reports that the average surgeon reimbursement from Medicare has decreased by some 7% over the last three years, resulting in surgeons seeking hospitals that can demonstrate efficiencies that will enable them to maximize volume and revenue for themselves and consequently the hospital. I believe that if the following key considerations are met, surgeons will be willing to consider moving their OR schedule to a different provider if:
- Surgeons’ referral patterns are not disrupted
- Surgeons can perform at least one more procedure daily
- They see an improvement in lifestyle (earlier leave times, reduced extended hours)
- They have regular access to OR time using an easy, repeatable process (e.g. guaranteed block times)
- The OR documents high satisfaction ratings from patients and staff
The use of a robust information system that is well integrated into the workflow of a perioperative department can be a key underpinning in recruiting (and retaining) talented surgeons and other perioperative staff.
Conclusion
This is a time for leadership. Recognizing the perioperative department as the economic engine of the hospital offers many opportunities for change that can result in quick economic wins. Prioritizing this area to ensure the ability to gain and maintain economic advantage is a critical step. A robust perioperative system is one of many improvements that can be made relatively quickly with significant and early ROI payback. The strategic long-term benefits can be even more significant. While such investments may seem counterintuitive in challenging economic times, they can in fact result in both tactical and strategic advantages that will lead to financial success for the organization.
To take on this initiative, support from senior management is essential. It requires focus, team work, leadership, and the final key ingredient – courage.
Kermit Randa is Senior Vice President, Surgical Information Systems.
From HISJunkie: “Re: InfoLogix. Looks like they are on their last breath. Never did think this outfit would make it. They always seemed kind of shifty to me — did the Wall Street dance, pumped it up, took it public, made a killing on stock sales … then puff!” The company, which sells an odd lot of healthcare systems ranging from RFID to ERP, defaults on loan covenants requiring it to keep $1.5 million of cash. They were supposed to either raise $12 million or sell themselves by July 31, but missed the deadline. Share price has dropped steadily over the last couple of years, from over $5 to the current $0.18 and a market cap of less than $5 million.
From CK: “Re: Lindsey Jarrell, CIO of BayCare. He was awarded the CHIME-AHA Transformational Leadership Award on Thursday at CHIME’s Fall Conference.”
Jonathan Bush in the athenahealth earnings call, acknowledging that the company is at capacity in its EMR implementations: “.. our Clinicals implementation process still has some vestiges of the early EMR thought that went into building it. EMR is a shitty way to get a practice online. It’s just garbage, and we still have that stock inside of some of our thinking. It’s almost gone … we are getting much more of our thinking oriented towards, ‘This is a clinical information network.’” He answered a question about enterprise deals with a little jab at the big HIT vendors: “We don’t have massive professional golfers on the ground ready to be buddies with these people the way some of our giant competitors do. The athena jet doesn’t fly people into the experience center to have a day of visualizing the software of the future.”
Interpreters at UNC Hospitals (NC) replace their pagers and cell phones with the iPod Touch at half the cost, also rolling out a customized version of their ServiceHub dispatching software to work over WiFi.
British parliament member Richard Bacon gets his answer on how many people actually use NHS’s Lorenzo system in the five early adopter trusts: 174 total, with a peak concurrent user count of 19, according to NPfIT. Bacon’s cost estimate of up to a million pounds per user may not be far off.
Data analysis vendor Initiate Systems (I challenge you to concisely describe what they sell after a quick glance at their Web site, but they’ll always be an EMPI vendor to me) acquires interoperability vendor Accenx. You may recall that Initiate was initially an investment and also a vendor of the CIA (identity intelligence stuff, which was big during the previous administration) and also pulled its $75 million IPO last year.
Weird News Andy, straying from his core competency of weird news, recommends this healthcare series by noted thinker Dr. Thomas Sowell. I like it that Sowell is not only brilliant, but actually writes so you can understand it (unlike the 99% of academics who lapse into obfuscatory journo-babble). “In reality, an injured, deformed, or brain-damaged baby and an eloquent lawyer can lead to jury awards in the millions of dollars, even when it is by no means clear that the doctor who delivered that baby was in any way at fault … It costs a jury nothing to ‘send a message’ warning doctors to be more careful, and the particular doctor in the case at hand probably has insurance from a company that can pay a few million dollars easily out of its billions of dollars in assets.”
The HIT Standards Committee wants to hear about your EHR experiences, good or bad. You can also vote on the submissions of others. “Today, the Health IT Standards Committee within the Department of Health and Human Services will begin an unprecedented effort to get the public’s view on how our work might ‘pull forward’ the benefits of healthcare information technology (IT). Specifically, we’re interested in uncovering new strategies to accelerate the adoption of health IT standards.” Your comments are welcome by November 19, the date on which they will be presented to the committee.
Results of my CPHIMS poll are above. Apparently, the credential doesn’t hurt but also doesn’t usually help, which is what I would have said. New poll to your right: should clinical software be treated as a medical device under FDA guidelines?
Border unrest escalates between Missouri and Kansas, bitter combatants fighting for the right to pay Cerner hundreds of millions of dollars in incentives to lure its office complex and the pro soccer team that Neal and Cliff own chunks of to their apparently economically desperate states. Right as Cerner was choosing its new BFF state, Missouri hires the commerce secretary of Kansas who was instrumental in putting the Kansas package together. Kansas officials, sustaining mortal wounds in the civic pride area, said that’s was like a baseball player switching teams during the World Series, with one adding, “We thought (Kerr’s) Number 1 goal was to bring jobs to Kansas, but find out now he was working to take his own job to Missouri.”
Doctor complaints about patient safety and an increasing backlog of delinquent charts lead Jefferson Regional Medical Center (PA) to go back to paper for some reports. They’re using Siemens, as evidenced by this cheery article about how swell it was going in 2007. You wouldn’t think chart completion would be such a big deal.
TPD has updated his list of iPhone applications.
A quiz question for you non-newbies, spawned from some random Googling: in what year did these companies first make the Healthcare Informatics Top 100: Per-Se, Applied Healthcare Informatics, Object Products, and Triple G? (hint: it was the same year that these companies were acquired and therefore fell off the list: Phamis, Amisys, Medicode, Medicus, HPR, Bukstel & Halfpenny, SDK, Rothenberg, and HCI).
The Teamsters put out an angry press release against McKesson, which sided with the minority of shareholders in continuing to allow “golden coffin” provisions to be offered without shareholder approval. Those provisions pay a lump sump to heirs when a senior executive dies, $25 to $39 million when John Hammergren meets his maker (in addition to the $80 million his family would get from his retirement plan). “Mr. Hammergren took home $29 million in total realized pay last year alone and has ample opportunities to provide for his estate. We believe shareholders should have a say in whether they’re saddled with payments made without receiving any services in return, and clearly our fellow McKesson shareholders agree.” For the first time ever, I agree with the Teamsters. Hammergren is always in the top ten lists of executives salaries, benefits, and security costs. You would think he founded the company instead of just coming on board eight years ago. Maybe Senator Grassley should look there if he wonders why healthcare is so expensive. But, if MCK shareholders would rather he get the money than them, so be it.
A hospital in Ireland reduces appointment no-shows by 44% by sending patients text message reminders.
Speaking of text messaging, StaffKnex, a nurse scheduling vendor whose product sends text messages about open shifts and schedule changes, raises $1.3 million in funding. The product originally sent only text messages, but it now converts them into voice messages for recipients who don’t like texting. Interesting: recipients can respond to the message (“I’ll work that shift”), the scheduler is alerted to the overtime cost involved, and the request is routed to the supervisor for approval.
A group of California hospitals that includes Stanford, San Francisco General, and two Kaiser facilities says it reduced medication administration errors by 88% by following best practices from the California Nursing Outcomes Coalition. I was hoping to find a list of those practices but struck out.
Patrick Soon-Shiong, the billionaire drug company founder with a keen interest in healthcare technology, offers to back $100 million in loans to reopen MLK-Harbor in LA. He’s on the board of Dossia. I tried to line up an interview awhile back, but he passed.
Charlie McCall’s attorney says he’ll call former HBOC president and CFO Al Bergonzi to the stand. He says Bergonzi, convicted years ago, will back Charlie’s story that all the phony accounting happened without Charlie’s knowledge.
Merge Healthcare’s Q3 numbers: revenue up 16%, EPS -$0.02 vs. $0.01.
Confidential records of House ethics investigators are made public when a junior staff member working on documents from home accidentally makes them available to his peer-to-peer file sharing application.
Quality Systems’ Q2 numbers: revenue up 22%, EPS $0.41 vs. $0.37, meeting expectations on earnings and exceeding on revenue. ARRA is accelerating PM/EMR sales, the company says. Market cap for the company, including its QSI and NextGen divisions, is at $1.74 billion, of which founder and chairman Sheldon Razin holds over $300 million worth.
Odd lawsuit: drug company Amgen is sued by 14 states for offering doctors kickbacks for using the anemia drug Aranesp. The suit claims that Amgen intentionally added extra overfill to the drug vial as a “free sample” that could be billed to insurers.
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From HITGhost: “Re: Aspyra. It voluntarily delists itself from NYSE Amex.” The market cap of the LIS/PACS vendor is down to $1.4 million, so obviously it’s not worth the administrative cost to stay publicly traded.
From UKnowMe: “Re: Accenture. I hear that Accenture is eliminating its healthcare practice over the next 2-3 months and will be releasing 300-400 people. Can anyone confirm?” I haven’t heard that, but Accenture just launched the Center for Health. I never know what a company or university means when it announces a “center” that doesn’t seem to involve new people, new facilities, or anything more than a new marketing campaign and maybe a new suit or two, but it happens all the time. Here’s another one: IBM is opening a Health Analytics Solution Center in Dallas, which one of its people says is related to Dell’s Perot acquisition.
From Weird News Andy: “Re: brain surgery. Being in Britain, the patients did not have to pay through the nose for this procedure.” Surgeons are removing skull base tumors through the nose, with one patient leaving the hospital just to days later. Just in case this doesn’t impress, the newspaper article gives a graphic description of the alternative: “Previously, neurosurgeons would have had to split the facial skeleton or peel back the scalp and remove the skull on the forehead to complete the same operation.”
Athenahealth reports Q3 numbers: revenue up 37% to $49 million, EPS $0.14 vs. $0.14, missing expectations of $0.16.
In Britain, a member of Parliament wants to know the cost of iSoft Lorenzo at early adopter sites, saying the number could run anywhere from hundreds of thousands to even millions of pounds per concurrent user. Richard Bacon says Lorenzo isn’t providing value and Cerner Millennium “has caused absolute havoc.” On the other hand, the arguments seems largely political.
HIMSS continues its acquisition of other member groups, this time taking over the Medical Banking Project (HIMSS always calls it “unification with” the group it takes over). Its membership is a bit company-heavy with 163 individuals and 42 corporate members. The only employee mentioned is its founder, from whose home in Franklin, TN it is apparently run. I could find only one reference that called it a non-profit, with its own materials describing it as “a self-funded policy research firm.”
CHIME awards Ivo Nelson, chairman of Encore Health Resources, its Lifetime Achievement Award. I couldn’t find a link for the press release that someone sent me.
A radiation oncologist says Varian’s linear accelerator sales should increase in an economic recovery, but its clunky ARIA oncology EMR is a dog that might hold it back. In his words, “ARIA is far too complex and does none of the simple everyday tasks well. Obviously written by an engineer with little clinical input from the end users, ARIA is a major physician dissatisfier, as they find daily tasks much more time consuming.” Just what you want your doctor to be struggling with as they’re treating you for cancer. If you agree with his opinion, that is.
In all the Charlie McCall talk, I shamefully neglected to observe the October 18 11-year anniversary of the announcement that McKesson was buying HBOC. I editorialized about his first trial back in 2006, with this shout-out to the neglected McKesson shareholders who got burned the worst: “Among those involved were certainly some crooks and some fools, but let’s not forget those who suffered most, those McKesson lifers who had stashed away years’ worth of shares of their unexciting company’s stock instead of risking it on flaky enterprises like Microsoft and Dell. When lonely old conservative widower Dad McKesson brought home a sexy young step-mom named HBOC, she stole the kids’ piggybank.”
Cerner announces Q3 numbers: revenue down 3%, EPS $0.57 vs. $0.54, falling short of revenue estimates. System sales were down 14% and global revenue was down 23%. CERN also guided down on Q4 revenue. Neal actually chimed in at the end of the conference call.
A little recognition for HIStalk’s Founding Sponsors: Medicity and Nuance. Medicity has started a rather cool HIE Blog, I notice, that unlike the usually crappy corporate “blogs” that have “posts” written by chipper marketing types that don’t even claim to be written by executives, Medicity’s is the real deal. Included are posts from one of the smartest people I know in the biz, Robert Connely. Both companies (eScription, in the case of Nuance) were among the sponsors of HIStalk back when I was writing it with a chisel on stone, so I ought to thank them a little more often.
Allscripts used to own the domain escripts.com but let it lapse, so it went up for auction this week. There were no takers at the expected range of $10-25K. On the other hand, medicalpractice.com went for $9,000, conciergedoctor.com fetched $1,250, and h1n1fluvaccines.com was bought for $1,000.
I e-mailed the Canadian medical device licensing people about classifying EMRs as regulated devices. I appreciate this response:
In general, but not necessarily inclusive, patient management software is any software that is intended to be used to diagnose, treat, mitigate or prevent a disease, disorder or abnormal physical state, or its symptoms, in a human being. Please be advised that the classification of patient management software as a medical device and the requirement for licensing is not a new approach taken by Health Canada. Manufacturers have always been responsible to undertake their own due diligence to determine regulatory requirements. Health Canada has considered software of this nature a medical device for several years. Health Canada did not create the notice regarding patient management software with specific ‘information systems’ in mind. It has always been Health Canada’s role to review medical devices to assess their safety, effectiveness and quality before being authorized for sale in Canada.
According to the US FDA’s interpretation, a medical device is “intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals.” It almost sounds like software vendors in Canada recognized their own products as medical devices and had them evaluated as such, but US vendors have staunchly argued that their products aren’t covered. Software that displays or manipulates lab results, provides diagnostic suggestions, or manages drug therapy seems to fall into the broad category as laid out by FDA.
Ten software developers in Rwanda who work on the OpenMRS EMR graduate from an 11-month course called e-Health Software Development and Implementation, part of the country’s effort to transform itself into an IT hub.
The Center for Connected Health and Mass General buy a Tandberg telepresence videoconferencing system for telemedicine. I thought they dealt more with home medical sensors and monitoring, but maybe the mission has changed.
A med student and his programming partner (isn’t that who always creates medical apps?) develop iMurmur, an iPhone-based learning tool for heart murmur. It has sold 15,000 copies to users in 35 countries, pushing its price from 99 cents to $2.99 and leading to its acquisition by a digital stethoscope company.
The King of Jordan hosts hosts a public demo of its VistA system, implemented by Perot and the non-profit Electronic Health Solutions. Jordan is creating a VistA educational program to make itself self-sustainable.
Jobs: Director of Business Development, Clinical Application Educators, Cerner Remote PathNet Support.
Half of the doctors responding to a British survey say they are too busy typing into the computer to look patients in the eye. One doctor said, “The demands of the patient’s agenda, the Government’s agenda and the requirement that everything I hear, say and do must be meticulously recorded make for an extremely crowded consultation.”
John at Chilmark Research finds interesting facts about the Dossia PHR. After they parted ways with Omnimedix and hooked up with the Indivo platform from Children’s Boston, they found that Indivo wouldn’t scale, so they had to rewrite it. John outlines other problems they’re having. One I’ll add is that PHRs aren’t exactly lighting up the skies and Google and Microsoft are formidable competitors for what little interest there is.
Odd lawsuit: welfare recipients in Michigan file a class action lawsuit against the state for not paying for adult dental benefits. The state is broke, of course.
Also going broke: California, which paid $2.1 billion in overtime to state employees last year. One state hospital nurse made $733K in overtime in a five-year period, while two other nurses at the same hospital made $132K each per year, twice their annual salary.
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HERtalk by Inga
The US Postal Service finds CalOptima’s missing CDs that contained unencrypted personal data on 68,000 members. The package landed in a secure postal facility in Atlanta and the disks appear to be intact.
GE Healthcare’s Medical Quality Improvement Consortium (MQIC) is submitting anonymous clinical data to the CDC to provide H1N1 tracking information. MQIC is a repository of de-identified clinical data captured from GE’s Centricity EMR users. Every 24 hours, MQIC is forwarding updated data that’s been collected from 14 million record patient records. Great use of EMR data, though I wonder if the patients (and/or providers) are aware their de-identified clinical data is being used for this purpose. Or if they need to know.
Would you be more willing to travel to Thailand for surgery if you knew the hospital was using Microsoft HealthVault to document your treatment? Me neither. Hospital officials at the Bumrungrad International Hospital in Bangkok seem to think it will add to their appeal. I believe the $5,000 knee replacement that would cost $50,000 at home is still the bigger draw.
St. Paul Eye Clinic (MN) selects SRS EMR for its 15-provider group.
API Healthcare announces that seven new hospitals have signed on for its human capital management solutions.
El Camino Hospital (CA) deploys Web performance monitoring solutions from Gomez, Inc. The performance and availability monitoring applications will concentrate on El Camino’s recently launched public Web site and its physician application site.
Ingenious Med reports that nine new organizations have added its inpatient practice management system over the last three months.
I love my iPhone, so I was not surprised to learn that 99% of all iPhone users are happy with their smart phones. In fact, we are two times more likely than BlackBerry users to say we are very satisfied. I’m not sure I can think of any other consumer product with a 99% satisfaction rating.
Speaking of iPhones, Harvard Medical School launches an application to update consumers with the latest H1N1 flu virus news, including tips for shaking hands or other body parts to avoid the spread of virus. (Do people seriously do this?)
One last iPhone comment: here’s a nice list of healthcare applications, complete with product summaries and pricing.
GE expands its healthymagination campaign, launching a new e-health business unit that is focused on connectivity among providers, hospitals, and patients. While the announcement suggests that GE is jumping into a brand new world, the core products sound familiar: LifeSensor PHR, Centricity HIE, a clinical portal, and master patient index technology. I guess GE wasn’t too concerned over the use of “eHealth”, even though the folks in Ontario sort of sleazed up the name.
Allina Hospitals collaborates with CVS’s MinuteClinics to align clinical care operations and medical oversight. Allina and MinuteClinic will also develop interfaces between their two EMR systems.
Regional Medical Center Anniston (AL) selects ProVation MD software for cardiology procedure documentation and coding.
A Florida man opens his mailbox and finds an envelope containing medical records of over 70 people. The full chain of events is unclear, though a postal employee or two seem partly at fault. Just a reminder that while we might one day have fully secure EMRs, we’ll never rid the world of stupid (lazy?) people.
Send Inga a scary note
