From Bobby Orr: “Re: the new Allscripts. They rang the Nasdaq bell. Hopefully it’s not too late to have a real challenger to the mighty Epic.” Glen has rung that bell a few times, I found by Googling. Since I couldn’t find a picture from this week and their Web site seems to be down, the one above is from one of the several previous “new Allscripts”, this one from 2008. I’d like to think it’s not too late to compete with Epic either, but I think it is, at least if the goal is to match up head to head. The Eclipsys clinical apps are better in some ways, but prospects are eating up Epic’s “one record” pitch and looking that the avalanche of new Epic business compared to long, slow decline of the Eclipsys Sunrise customer base. On the other hand, those Eclipsys apps have never been in better management hands than they are today now that the acquisition is finished, so maybe Glen can turn it around. When I asked him about that, he was pretty confident that Epic is vulnerable, but then again, former Eclipsys SVP (now Allscripts president) John Gomez said the same thing right before a stunning string of Eclipsys showcase accounts announced plans to displace Sunrise with Epic.

Speaking of Allscripts, here’s an insightful comment from quadwatch on the Yahoo stock board: “We are seeing what drove this merger — Eclipsys’ inability to compete with a weak ambulatory product and Allscripts’ lack of a hospital system. Given MU requirements for hospitals (in particular, CPOE adoption) the reality is you have only three products with proven adoption rates that don’t make a new purchase a crap shoot for the CIO: Epic, Cerner, and Eclipsys. It becomes a Epic-Cerner race if the facility has employed MDs or is looking to establish a community model. This one of the most logical mergers that I have seen in this segment.”

And while I’m quoting from stock boards, here’s another excellent one from my favorite industry analyst, sonomaca, on Glen’s bell-ringing: “Not surprised he decided to go and ring the bell. This is his triumphant return to control of MDRX. He’s proven himself to be a master of the game, starting with the secondary offering back in 2000 which ultimately saved the company. You’ve got to marvel at how he took a near-bankrupt MDRX in 2002/2003 to the top of the heap in 2010. Amazing. My guess is that, in the end, ECLP will be integrated without too much trouble. In the next couple of years, US market share will be pretty well divvied up between Epic, Cerner, Allscripts, and some of the lumbering giants like McKesson. No doubt, GT is already thinking ahead. And, what’s ahead are myriad tuck-in acquisitions and, most importantly, overseas.” Above is the ten-year share price, peaking at something like $80 in 2000 and bottoming out at less than $2 just three years later, now back to $17. Glen was CEO that whole time and before. He’s got $19 million worth.

From Price Checker: “Re: UPMC. I love this creative, airline-like a la carte approach to paying for the EHR at this paperless hospital.” UPMC, like other hospitals, is charging patients a “facility fee” for being seen in a physician practice it owns, even though patients may not even know that UPMC is involved. The patient profiled in the article noted that the reception area bears a plaque thanking the donor who paid for it, making her wonder why she has to pay again. She had no choice since UPMC threatened to turn her account over to a collection agency, but she vows to steer clear of that doctor and building for her future medical needs.

From The PACS Designer: “Re: Apple TV. Apple has announced their latest Apple TV configuration containing a faster custom built processor called the ARM A4. With a hookup to an HDTV, could medical image viewing find a place in the home viewing schedule? Only time will tell if it catches on with practitioners! This iTV device also has an Ethernet port and 802.11B/G/N Wi-Fi for streaming.” I’ll say that my Roku box was a game-changer for me. I haven’t watched a minute of DirecTV or even DVRed stuff since I got it – everything else seems so primitive compared to free, on-demand Netflix streaming. I’ve discovered great TV shows and movies I would never have found otherwise. I think I saw there’s some kind of medical channel on there.

From Mya: “Re: weird medical news stories. Did you hear about this one?” Sad: a female doctor, apparently drunk, tries to break into her former boyfriend’s house while he is there. He leaves out the back door to avoid a big fight, but in the meantime, she climbs on his roof and tries to slide down his chimney. Three days later, someone checking on the man’s fish notices a smell coming from the fireplace and finds her dead a couple of feet up the chimney, where she had died of asphyxia.

From Irving R. Levine: “Re: EHR vendor. We’re converting from [vendor name omitted]. They don’t understand why an IT shop needs access to clinical data in the SQL tables, so we can’t access our clinical data on our servers on our network without using their UI. They also don’t understand why we want to do our own backups instead of using their service.” This kind of issue is going to pick up steam as people starting switching out EMRs. Small practice vendors don’t usually understand clients with real IT people on board, so they distrust their intentions in a rather parochial manner. Like Bill O’Toole said in his HITlaw, if it’s important to you, get it into the contract.

The proposed Healthcare IT site on Area 51 (geeks know what that means) needs reader commitment to move ahead, being 15% of the way there so far. If you’d like to see an place to have HIT-related questions answered by experts (or to answer questions if you’re the expert), then sign up.

Marty Larson is named executive director of the Greater Dayton (OH) HIE.

GetWellNetwork will announce that it has developed the first digital care plan for reducing admissions for pediatric asthma, including multimedia patient and family education covering triggers, medications, and equipment.

Jobs on the sponsor job page: Technology Account Executive, Epic Certified Consultants, Account Manager, Eclipsys Orders/Results Analyst. On Healthcare IT Jobs: Cerner SurgiNet and Power Orders PMs, McKesson HEO I-forms Consultants, Development Manager, Epic Report Writer/Programmer Analyst.

Listening: reader-recommended The Sensational Alex Harvey Band, 70s glam rockers from Scotland. The namesake died 28 years ago, but even though he hasn’t been reincarnated, the band has. He was quite a showman.

HIStalk stats for August: 102,047 visits, 145,694 page views, and 6,114 verified subscribers. All are new highs. Thank you for reading.

Metropolitan Health Networks and Senior Bridge start a year-long pilot project to evaluate the use of telephone-based telemedicine and specially trained staff to manage 100 Medicare Advantage patients who require frequent hospitalization. Each individual is assigned a nurse and a social worker to work with the patient’s physician to develop a care plan and to conduct in-home assessments for safety and patient evaluation.

This is ingenious: Kerry from Network Management Solutions of Garner, NC e-mailed to tell me he’s figured out a cool way to use his iPad. He downloaded the free Remote Desktop Lite app (which also works with the iPhone) and remotes into his home PC, meaning he can run all of his Windows apps on an iPad from anywhere. That sounds like it might have some possibilities for small-scale hospital or practice apps, as long as each iPad user has a dedicated PC to remote into (it’s like a poor man’s Citrix farm, although the non-poor man might run Citrix Receiver to run apps directly from a Citrix server). I bet the wheels are spinning in the heads of some readers even as we speak.

Why haven’t EHR vendors done this? A chiropractic software vendor partners with the creator of the Facebook Fan Page Generator to get its customers into social networking and promotion, or as the press release says, to create “an automatic new patient referral generating machine.”

The Community College of Allegheny County (PA) will offer free, non-credit HIT classes to qualified applicants, courtesy of $16 million of federal taxpayer money.

The presentation was from an Australian HIT executive, but the message is familiar when it comes to IT challenges in hospitals: IT gets heat to finish projects even with insufficient resources, they patch old systems together instead of buying new ones, and the IT people don’t have the clinical knowledge to run the systems used by clinicians. But it was an audience member who got big applause for describing health department IT procurement practices: “[It’s like] taking a 17-year-old and letting them buy any car they want, with any sized engine. We get clinicians to dream up what they want, then they go and buy it without even thinking about whether it will or won’t work. We have people who don’t know what should and shouldn’t be used, who have the power to make the decisions on buying".”

Odd lawsuit: a surfer hospitalized in Hawaii after a shark bite claims the hospital posted his picture of his leg wound on the Internet. He’s filed a suit alleging HIPAA violations and several more potentially lucrative charges.

More iSoft struggles: the company’s major shareholder says it will decide in April 2011 whether to unload its shares.

I haven’t quite decided whether to do a Monday Morning Update. If I don’t, or if you won’t be around to read it even if I do, have a wonderful end-of-summer holiday (just my US readers, I keep having to remind myself since that’s not all of them). I will be laboring on Labor Day in any case since I am extremely behind, so as Inga suggests below, you can always send us a Facebook or e-mail message if you are feeling lonely, unappreciated, or unfulfilled. 

E-mail me.

HERtalk by Inga

From KP Duty: “Re: Sutter’s iTriage app. Looks like a great tool for consumers, except for one thing (disclosure: I’m with Kaiser Permanente). When I clicked on the Find Emergency Department link to see the EDs closest to my house, is it a coincidence that the largest Kaiser Medical Center in Northern California is absent? I would have to drive by this large and well-established facility with its gigantic emergency department to get to the one listed. To be fair, I put in the address of one of the other Kaiser hospitals and it came up in the right order.” Is it a conspiracy or a bug? I’ll go with bug since I did a spot check on a couple addresses and KP sites definitely popped up prominently.

In what may be the first of similar announcements, ChartLogic reports it has applied for EMR certification with Drummond Group. I reached out to ChartLogic and asked them why Drummond was selected over CCHIT. Here’s the reply from Eric Sorenson, ChartLogic’s VP of marketing:

Our choice for Drummond over CCHIT came down to timing. We believe we are ready to be certified today. CCHIT has indicated that they will launch their program on September 20, and begin receiving applications then. Additionally, they’ve previously indicated that they will give certification priority to their CCHIT 2011 and their “Preliminary ARRA” certified products. We believe this would push our testing date and certification to a date much later than desired. Conversely, Drummond has indicated that they are taking applications immediately, and can begin testing within a few weeks. They have no backlog. We believe this will give us the best opportunity to be certified immediately. CCHIT has a 5 year head start on marketing their products and services, so we weighed the value of a certification with CCHIT vs. Drummond and felt we could overcome any of possible difference in marketing value by being one of the first companies certified, if not THE FIRST. Additionally, Drummond has been certifying other software for a longer time than CCHIT, so we agree with ONC and don’t believe their lack of EHR certification experience is likely to cause us problems in the certification process.

Southwestern Vermont Medical Center says it spent $1 million on its Picis periop system.

Valley View Hospital (CO) goes live on Meditech 6.0.

Actor Michael J. Fox will provide a keynote at HIMSS11, sharing his experiences as a patient and telling healthcare IT experts how IT impacts healthcare. Sadly, he’s got the dreaded Thursday a.m. slot, which means only 200 people will be in the audience. What I want to know is whether Jonathan Bush will try to schedule a meet-and-greet with his look-alike.

Memorial Hermann (TX) selects FairWarning to monitor patient privacy.

Former Streamline Health and Misys VP Scott Boyden takes over as VP of new client sales at TSI Healthcare. Kermit Copley also joins the company as CFO.

Hoag Hospital (CA) opens its new $84 million, 154-bed facility in Irvine. That’s $545,000 a bed if you are the calculating type.

HHS names its final two Beacon Communities: Greater Cincinnati HealthBridge and Southeastern Michigan Health Association. HealthBridge will focus on pediatric asthma and adult diabetic care, while Southeastern Michigan will concentrate on diabetes care and prevention.

UnitedHealth Group is loaning $10 million and donating another $1 million to help rural hospitals improve their HIT and add EHRs. Between this program and the recent Ingenix acquisitions, it sounds like UnitedHealth is trying to unload some cash.

This week on HIStalk Practice: Dr. Gregg Alexander shares the EHR-laced lyrics of some of his soon-to-be-hit tunes; Jonathan Bush tames an octopus; and an Iowa REC shares the cost of their consulting services (between $300 and $2,000 for two years’ worth.)

Stanford Hospital and Clinics commits to a seven-year agreement with Accenture to take over some  of Stanford’s IT functions. Accenture will manage applications and infrastructure and provide data centers, network, help desk, and device support. We said this was happening a couple of weeks ago, courtesy of a reader rumor from Scatman Crothers.

Memorial Hospital at Gulfport (MS) lays off 47 workers, including 10 nurses. The staff reductions are part of cost-cutting measures to offset an $11 million budget shortfall.

The Massachusetts attorney general recommends that the board of Beth Israel Deaconess Medical Center do “some soul-searching” about CEO Paul Levy’s ability to lead the hospital.This follows her office’s conclusion that his long-time personal relationship with a female employee “clearly endangered the reputation of the institution and its management.” Board chair Stephen Kay responded by saying, “We are having a great year. We have more patients than we’ve ever had before. He’s made some wonderful alliances with some quality places. He has great credibility. He’s a national leader.” I’ll bite my tongue as it relates to this toxic topic.

Sponsor News

• Enterprise Software Deployment (ESD) ranks #561 on Inc.’s list of the 5,000 fastest-growing companies. ESD, by the way, just hired former maxIT director David Tucker as its national VP of sales.
• MetroSouth Medical Center (IL) goes live with iSirona’s medical device integration solution, transmitting data from over 100 GE Unity Network devices.

If you have a three-day weekend, I hope you are not in Earl’s way and are able to enjoy the fruits of your labor.  And if you are laboring, remember you can always sneak into Facebook and drop us a note.

E-mail Inga.

Care must be taken by the provider customers. Some will be investing capital based solely on the prospects for reimbursement. Protection of their interests is important. This is by no means a complete list.

Certification

The best situation would be for the vendor to warrant that its EHR technology has been certified by the appropriate authority and is installed and live at more than XX (vendor to fill in the number) sites. The fallback position today would be a warranty that the product will be certified in the appropriate timeframe for full reimbursement eligibility.

Further, they must warrant that certification will be maintained throughout the reimbursement periods (note that the timelines for provider reimbursement differ for Medicare and Medicaid participants). It is technically possible for a provider to lose a year or more of reimbursement if the vendor’s EHR product was initially certified, but then misses certification during the reimbursement period. The year of ineligibility still “counts” for the provider, but they will not receive associated funding.

Be wary of “best efforts” clauses. Some vendors will take care and be uncomfortable warranting that a product will be certified, and for that they should be applauded. Others will take the “we have no choice” approach and provide the warranty. Their gamble is weighing a potential breach of warranty against lost business today when the customer selects an EHR vendor that provides the warranty. The customer has little practical choice. The warranty is essential.

Delivery and Live Status

The delivery date for certified EHR product, together with the implementation timeframe for the product, must result in the EHR in use in live environment so as to enable customer to achieve Meaningful Use. Keep in mind, though, that for long projects with work to be done on both sides, a vendor should not be expected to warrant that something will be live when considerable work must be done by the customer. That work which is completely out of the vendor’s control.

This one factor is greatly reduced as a consideration when dealing with an EHR provided in the SaaS model since time from delivery to live is in some cases negligible.

What you should look for is guaranteed timelines that, if all is accomplished on time by both vendor and customer, will allow for live use by a certain date. This is very reasonable.

Payment Terms

Assuming a certified product is delivered on time, payment should flow accordingly over the implementation timeline. That is fair.

However, some implementations will be quick and some will not. Delaying payments until reimbursement occurs would be outstanding for the small providers, if you can find a vendor that will take those terms.

Undoubtedly the primary concern for some providers is laying out capital on a project and counting on reimbursement when the possibility exists that reimbursement may not occur. If the circumstances are solely the fault of the vendor (failing to maintain certification, for example) then the customer should be protected and monies should be refunded. The requirement to make payments on a product that ultimately does not qualify the provider for reimbursement is patently unfair to the provider customer.

Some accommodation must be made for the hopefully never-to-occur failure of the project. Keep in mind that some of these contracts will be executed with the full intent and purpose of obtaining reimbursement, otherwise the investment would not be made at this time. That one major factor cannot be ignored.

Finally, Meaningful Use

The items above are tailored toward protection of the customer provider, while hopefully acknowledging the fairness factor to the vendor. Meaningful Use is another situation entirely.

In my opinion vendors cannot guarantee or warrant that any customer will achieve Meaningful Use. Vendors only provide the tools needed for that process. The customers are responsible for the work on their side, using the certified EHR tool acquired from the vendor in their operations necessary to achieve Meaningful Use.

The best I could do if writing the warranty for the vendor would be to warrant that the certified product, delivered in the appropriate timeframe, will enable the provider customer, through its efforts and implementation, to achieve Meaningful Use, but that the vendor cannot ultimately warrant that the customer shall achieve that goal. Achieving that goal is the responsibility of the customer providers that will receive the reimbursement if all goes well.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

Nancy Brown, formerly senior vice president of business development and government affairs for athenahealth until July 1 of this year, has been named chief growth officer of MedVentive, where she will head up the company’s sales, marketing, and business development efforts.

Tell me what MedVentive does.

Nancy Ham: MedVentive provides a physician performance management solution for whoever is clinically at risk. Traditionally in our industry, health plans have been at risk, but there’s a huge trend towards providers taking risk and becoming more directly responsible and accountable for both the quality and cost of care.

One thing that we think is interesting about our company is that we support providers and health plans, and in fact are trying to bring them together into a more collaborative environment around managing populations and managing the cost on top of those populations.

Our passion around this springs from our history. In the mid-90s, here in Boston, we started as a mega at-risk provider organization affiliated with CareGroup, which is an integrated health system with eight hospitals and 3,500 physicians. At the time, it was the leading marketplace around providers assuming risk. We were bearing full global capitated risk for about half a million patients, managing about a billion dollars.

Everything that we have today, that we believe today, was really forged in that real-world environment managing our own patients, managing our own data, engaging our own physicians, and trying to learn how to do that successfully in a provider-oriented environment. The challenge was that model was really prevalent only here in Massachusetts and in California.

What’s so exciting about today for us is that we see the whole market opening up and moving away from payer-side risk, fee-for-service risk — which hasn’t served our industry well — and into these new risk models. We’re here with 15 years of experience and a very mature product to bring to that problem.

It seems like that whole assumption of risk idea has come and gone for practices. Do you think this time they’re ready, both organizationally and technologically?

Nancy Brown: No, not generally. There have been a number of organizations who have grown up in this model. The one that Nancy Ham has just described. I grew up professionally at a staff model HMO called Harvard Community Health Plan, which is very similar to Kaiser, where we were totally at risk for a population of patients and everything about our work, our DNA, was all around thinking about populations — how to keep them well and how to deal with their illnesses in the most efficient and effective way.

The vast majority of organizations are not incented that way, are not aligned that way, and don’t have that DNA naturally. This is a major shift, meaning a shift in the industry, where more and more risk is being pushed back down to providers.

I would say the answer to your question is no, they are not generally prepared for this. Just imagine doing work the way you do it every single day being more and more oriented towards seeing the patient who’s sitting in front of you, getting paid for each encounter, and then going to a model that is really completely different. That is exactly why tools and services need to be brought out to these provider organizations to ensure that they won’t hurt themselves in the process of converting over.

Nancy Brown, let’s talk about the announcement that you are joining MedVentive. What discussion did you have with Nancy Ham about her long-term plans for the company and your contribution to them?

Nancy Brown: It’s been a really exciting couple of months, to say the least. I’ll answer that question directly, but let me start by saying that what really motivated me to go back out into the market and to leave athena was this trend towards what has really been established by all the work being done through Obamacare or the Healthcare Reform Act, which is to really think about how healthcare is delivered and to really think about how to change incentives in order to get people to think about cost and quality.

Having grown up, as I said, in a staff model HMO, it was a little bit counterintuitive to me that the management of patients was being carved out and handed to payers and third-party organizations when in fact, there’s no one better than the physicians who are in front of the patients, who really know what care should be delivered, to be the ones that think about the approach to patient care and to think about quality and cost.

I am absolutely thrilled that the country is moving away from fee-for-service and moving back towards accountable care or sharing risk and putting risk and quality back into physician hands.

I was approached by a number of people who knew my background who wanted me to either join large companies who are thinking about establishing toolsets to serve this market, or venture capitalists who were thinking about starting brand new companies that would serve this market. Honestly, the entire time I was going through that process, I thought, well, there is actually an absolutely fantastic company that has been around for over a decade that not only has come up with tools, but has lived and walked in the shoes of at-risk providers, and who has been through many, many cycles of the product. We all know, those of us in healthcare IT, that products all need to go through at least three or four life cycles before you get it right.

The conversation I had with Nancy and with Dr. Jonathan Niloff, the founder, was perfectly aligned with what I thought the market needed. I thought, here’s a company that has existed, that has had terrific tools. The market has not been huge, quite honestly. They’ve taken care of probably a lot of West Coast and East Coast clients, and now they’re perfectly positioned to fully take advantage and really educate clients as to what the needs are to take on risk.

What lessons would you say you learned from your time at athena that will be useful to you at MedVentive?

Nancy Brown: I was at athena for six years and it was a wonderful experience. I consider them to be the closest of friends. I learned about a service model. I think a lot of what we talked about in my conversations with Nancy Ham and others is that you cannot just hand a toolset to an organization — in this case, an analytics toolset — and expect them to do everything that they need to do perfectly.

What I hope to bring to MedVentive that I’ve learned — and actually, it’s really part of my DNA now, based on my time at athena — is two things. One is that we’re going to have to get even more involved with our clients to really help them through these significant transitions.

A specific example of what I mean is when you give them dashboards and toolsets, which MedVentive does now, and you point them in the direction of where they are in terms of a red zone around a particular business problem, I think we hope in the future to be able to actually be in there with them, almost as a virtual chief medical officer, to be able to get them through the ongoing change or the overall change; and then the day-to-day work that they need to get done.

Nancy Ham: Nancy’s experience — her whole career — is of incredible relevance and resonance, as you’ve been hearing. We’re very excited about the service model coming into greater use among our customers because we are very focused about real results in the real world.

We don’t build software for theoretical purposes. We’re not an IT company who’s just building something because we want to sell it for revenue. We’re a healthcare company that forged everything we do in the crucible of the real world. That meant moving the needle on cost and quality. Whether it’s pretty dashboards or beautiful analytics was really irrelevant unless we accomplished the business goals.

We have a very strong ROI story for our customers today. Along the way, for example, we were profiled by the US Department of Health and Human Services as one of the five best national practices in pharmacy cost control. Last year, we were honored to win the Microsoft Healthcare User Group Award with a lovely customer of ours, Northeast PHO, for driving breakthrough levels of quality while reducing costs.

So to Nancy’s point, we have customers today who are independently very capable-mature in their ability to take risk and to execute on risk. But as that model broadens across the country, marrying that proven experience in that ability to drive an ROI with more supportive service capabilities, I think, is going to be key.

Nancy Brown mentioned that venture capital wants to get into this and other companies want to start something up. Who would you say is the competition now and what are the barriers to entry going to be for someone who wants to be in the position you’re in?

Nancy Ham: The barrier to entry is the relevant domain expertise. Not from reading about it, not from going to conferences about it, but from living it. There is no substitute for the fact that for ten years, we were the customer. We were in the real world bearing risk for almost half a million patients and driving positive changes against our budget and our risk and our quality and our population.

There is just no substitute for that. So in one sense, unless you’ve come from that environment, it’s really hard to say you have the same relevant experience and DNA that we bring to the opportunity.

That’s what differentiates us with our customers. They come and they see and they listen to it and say, “You guys really get it. You understand what we need to do, and we take comfort in the fact, frankly, that you’ve traveled this path ahead of us and you can share with us the lessons learned — good and bad. And you can share with us how you engaged your physicians in a way that they found appropriate and relevant and caused them to change behavior in a positive direction.”

Nancy Brown: I would just add to that what I observed is this practical-tactical way of thinking about how to deliver information to physicians. But this is all about helping physicians understand what’s going on with their population and guiding them toward the right decision. That’s not easy to do. A lot of the information that comes out of these analytic tools, generally, can create a lot of noise that they tune out.

I’ve been very impressed in the exposure I’ve had from MedVentive to see what Jonathan Niloff and the team here have done to really make sure that they’re getting the most important information to the physicians and making sure that the feedback loop is staying intact. And, that it’s a practical tool that can be used versus just one of these things that the administration has bought, but that in no way, shape, or form will ever be useful at the point of service.

When you talk about the business model as a service, is there any contemplation of selling service as a percentage as athena does?

Nancy Ham: I think it’s a great question. Historically, we have been focused on wrapping services inside of our software subscription fee. Lately, we’ve been really dialing up our capabilities around clinical consulting. We just hired a new senior director to lead our practice. In there, we are starting to go at risk for the actual results that we’re able to drive.

How that evolves towards a different model or towards the athena model, I think, is something that Nancy Brown and I will be working on and thinking about over the upcoming months and quarters.

Everybody wants to talk about Accountable Care Organizations. What technologies do organizations that want to go in that direction need?

Nancy Ham: To start on the journey of taking risk, organizations need a lot of things. They need a culture of quality. They need a transformational ability. They need to think through physician alignment and reimbursement. There’s a lot they need to think through from a services and strategy perspective.

When it comes to technology, there’s really two ways that an organization can begin to assume risk. One is if they’re already financially integrated, they can jump into becoming an Accountable Care Organization. There you need a suite of tools to manage for cost and utilization and quality from a whole new perspective because it’s not about fee-for-service now, it’s around episodes of care. This was a heart attack, not a series of disconnected claims. This is a population of diabetics and I need to be able to look at them as a population — cost utilization, quality, and engagement — because I’m going to be reimbursed on it as a bundle.

If you’re going into true global capitation, you need to be able to look across the entire spectrum of care no matter where delivered, no matter whether it’s in your network or out of your network, ambulatory or inpatient, and budget it and predict it and price it and manage it very differently than what you’re doing today.

If you’re not already financially integrated, then you actually have a step before that, which is to become clinically integrated, which gives you a safe harbor, if you will, from the Federal Trade Commission. There, you really need an intelligent, patient-centered disease registry that can be distributed across the community to promulgate your quality program and to engage physicians in an interconnected network focused on driving guideline-compliant care.

We’re fortunate at MedVentive that we offer them a spectrum of solutions no matter where you are on your journey to risk. We have a technology and a capability that matches up to where you are and what you need to do next to move forward.

Who helps organizations are assess their capabilities to enter into these agreements? Are they going to become standalone at some point, or are they always going to need some sort of support — technology or otherwise — to have ongoing success in being part of an ACO?

Nancy Brown: What I’ve observed in my journey over the last few months in looking at a lot of organizations focused on this market — there’s an equal number of consulting firms that are spitting up new practices to focus on all of the human capital issues. So if you parse apart everything Nancy Ham just said, underlying it is that technology is important. MedVentive has done fabulous things, but I’m sure if Jonathan Niloff was sitting here, he would tell you that it was the people side of it. Once you get the information in front of you, it’s really getting the teams built and the mindset in place to do the right thing.

So to answer your question, I think hand-in-hand with the technology will be folks who come in — and I already see it happening — that will work a lot on everything from organizational design to organizational behavior and the creation of probably all-new incentive plans beyond the medical incentives. I think it will be ongoing, absolutely.

I also think, as I talked a lot about during my days at athena, that there will be an ongoing evolution of these reimbursement plans over time. This is yet another set of ideas that people have, from Medical Homes to P4P to accountable care. Somewhere in all of this there will be a model that begins to effect really positive change. What I mean by that is it will incent providers to actually go in and make changes to workflows and to their approach, which is what Jonathan Niloff probably observed at CareGroup and I observed at Harvard Community Health Plan.

That it is an ongoing journey of give me the data, let me observe. Then, what’s going wrong? Let me improve my processes. Give me the data, let me observe what’s wrong … it’s an ongoing effort that never ends.

The HITECH Act has stolen everybody’s attention, so everybody’s focusing on EMRs or HIEs or whatever it is. How do you expect the vendor landscape and organizational strategic priorities to change as we get past that first total focus on just EMRs?

Nancy Brown: You couldn’t have asked me a better question. I won’t get on my soapbox for too long, but I often said in Washington and other places that I felt like the HITECH Act was a little bit of a distraction. While people were busy looking at it and going out after their $44,000 and had their backs turned, they’re going to get hit by a train and the train was going to be changes in reimbursement, as well as other major changes to how people are dealing with the administrative side, such as ICD-10.

It’s very interesting because it’s very hard right now to quantify how much business is shifting from fee-for-service to these quality contracts. What I say to anyone who will listen is don’t worry so much about the percentages because right now it’s definitely a very, very high percentage still in fee-for-service.

But let’s look at the reality. You can’t bring all of these uninsured into that coverage to have insurance coverage, and then also — simultaneous to bringing this new population of patients in that will now have insurance coverage — mandate that the insurance companies cannot increase premiums and then not expect that the costs are going to go somewhere. Those are going to be really put onto the backs of the providers. The insurance companies really don’t have any other way to get the money other than to assert change reimbursement.

The accountable care concept is owned by Medicare, but I think we’re already seeing a rapid acceleration of a risk shifting by commercial payers. As that risk shifts, people are going to have to be prepared. Compared to taking on an EMR, that’s child’s play in my opinion. This is very, very serious. Meaning you have to have a lot of information, a lot of guidance, and a lot of change in behaviors to be successful.

The other thing I’ll add about the EMR side, which was a big focus at athena, is that the EMRs need to be prepared to take the information that comes out of systems like MedVentive. These are things, to be specific, like gaps in care, for instance. When they tell you that Nancy Brown has not had a particular test or is at risk for a particular disease state, that information needs to be showing up at the point of service, ideally.

Many of the systems, most I would say, the majority of them do not have the capability to take that in and haven’t even reformed themselves in a way to think about population.

I think it’s going to be a very exciting time for those EMR vendors who really step up and think about themselves as being in a continuum that starts with taking risks, managing populations, and then intervening at the point of service.

You’re right, it’s an EMR-centric world out there, and those vendors typically don’t like to acknowledge that there may be contributions from other systems or other vendors. How do you intend to work around that, from the MedVentive standpoint, to convince them that it’s in their own best interest to collaborate?

Nancy Ham: We see, in our current client base, a very interesting spectrum of organizations. We have clients today who are 95% deployed on single EMR, so they’ve already climbed that mountain. But what they have found, to Nancy Brown’s point, is that the EMR does not provide them this horizontal capability to look across their population, to manage populations in an episodic or disease-centric way. It does not allow them to look at their cost in a capitated fashion; to look in-network and out-of-network to control all the levers they need to control to be financially successful.

We have in-the-middle organizations, those who are building broad-based networks in which their physicians are on many EMRs. So there, you have a bit of a Tower of Babel approach where there’s no source of truth, no central view, no view that goes across the continuum of care and across the community.

And then we have customers who have said that $44,000, frankly, is not compelling. We’re looking for tools that we can acquire and implement rapidly to allow us to step into risk because what we hear is forward-thinking organizations know fee-for-service is dying. So whether it dies tomorrow or dies two years from now or four years from now doesn’t matter.

They know now they need to get control of their data. They need to start measuring themselves. They need to get ready so that whatever form risk takes in their market — it could be heavy pay-for-performance, it could be episodic or population, it could be true global cap — that they can’t be ready overnight to spring into that environment.

They have an urgency about that to get started now, and that’s very exciting for us as a company because as we said, we started — Nancy and her path, and MedVentive in ours — in provider risk organizations more than a decade ago. It’s exciting to us to see that model, which we know works in improving quality and reducing costs, spread across the country. We couldn’t be more excited about the possibilities in front of us to help organizations learn how to do that and to be successful.

What are the long-term plans for the company?

Nancy Ham: With Nancy coming on board as chief growth officer, our plan is clearly to execute on our growth strategy and to leverage the fact that we think we have a very unusual capability born on the provider side, but ambidextrous, if you will, because we can serve whoever’s at risk — the self-insured employer, the health plan, the provider — and bring them together on a collaboration platform, a much-overused term that rarely exists in the real world. We think it’s the right model, which is we need to be sharing and looking at the same data with a focus on changing what is a societal ill at this point.

Our collective failure to create a universal model that reduces the healthcare costs in this country is impinging our growth as a society. Really, the ability to bring that all together, we think, is unbounded in terms of size. Our focus is just on getting the word out about what we’re able to do and to do it for more people. And with Nancy Brown on board, I’m sure that that’s what we’re going to be able to do.

From Redzenskyca: “Re: Allscripts/Eclipsys merger. New company name: Allscripts. New color: green.” The announcement is coming tomorrow, reliable sources tell us (nobody official, but people who should know). Green is my favorite color, though. Here I was criticizing the sea of orange at ACE and now it’s going to be a collector’s item or something (or sold on eBay just in time for hunting season). UPDATE: the Allscripts site has been updated with the logo above and a welcome to the merged companies.

UPDATE 2: The company’s leadership team is listed as Glen Tullman as CEO (Allscripts), Lee Shapiro as president (Allscripts), Bill Davis as CFO (Allscripts), Eileen McPartland as COO (Allscripts), John Gomez as president of product strategy and development (Eclipsys), Jeff Surges as president of sales (Allscripts), Diane Adams as EVP of culture and talent (Allscripts), Laurie McGraw as chief client officer (Allscripts), Dan Michelson as EVP and chief marketing officer (Allscripts), Kent Alexander as EVP and general counsel (Allscripts), and Joe Cary as chief of staff (Allscripts).

From Curious in Texas: “Re: MD Anderson in Houston. I’ve heard they will be installing Soarian Financials. This surprises me because I thought the UT hospitals were all converting to Epic. Can you verify this rumor?” Verified. MD Anderson hasn’t signed the contract yet, but they are planning to migrate from Invision to Soarian patient accounting, ADT, and scheduling. Their primary motivation is its service-oriented architecture.

From Boomer Later: “Re: Maine Medical Center. I heard its board will meet Wednesday on a proposal to migrate from Eclipsys to Epic on a 20-month timetable. Approval is expected. It’s a blow for Eclipsys since MMC is one of their most progressive and active customers and was customer #6 on the old TDS product.” Verified. They were already using Epic on the MaineHealth ambulatory side, so this will be the next step toward their “One Patient, One Record” philosophy. Epic Enterprise will be implemented in their six member facilities in addition to Maine Med.

From Lizard King: “Re: HITECH. AAOS average member salary: $$$$. GP in private practice: $. Meaningful use is the gateway to federal $$$ to pay for HIT that providers might not otherwise be able to justify as an ordinary practice investment. Generalizing, specialists have more profitable operations and seem to have much better ROIs on HIT than GPs, so it is no surprise that MU is headed this direction. Which seems about right to this taxpayer and consultant.”

If you’ve been following the current poll and comments on Ed Marx’s Blessing of the Hands post, you may wonder why the comments suddenly turned ugly. An atheist blogger linked to it and his followers dropped by to vote and opine. Since the point was to find out what industry people think, here’s the stat that counts: the poll was running 50-50 when it was just real readers voting.

Inga interviewed Chet Speed of AMGA about Accountable Care Organizations on HIStalk Practice. It’s a hot topic, so we’ll have more soon from the hospital point of view. Hats off to her for drawing readers to HIStalk Practice, with visits up 50% or so compared to a year ago.

A Member of Parliament in England wants to know if BT was paid hundreds of millions of pounds to persuade it to stick around with NPfIT instead of bailing out like other companies did.

In the News of the Obvious, a small study finds that Facebook is a big draw for narcissists prone to encouraging shallow relationships by carefully controlling their image, bragging on themselves in their Info section, and in the case of females, posting revealing and/or doctored photos (not that there’s anything wrong with that). The conclusion is somewhat profound: “As we abandon the fake avatars and cryptic usernames of years past and begin associating our online identities with our real-world lives, our online activities begin to have more relevance to our true personality traits.”

Mike Cannavo, the one and only PACSman, cranks up a blog: The PACSman Pontificates. He was darned funny, irreverent, abrasive, and always informative when he wrote for a rag-sponsored blog, but says he got tired of being forced to change his posts every time an advertiser complained. I can only imagine what he’ll say unmuzzled. Also in the PACS and radiology world, Mike’s occasional partner in crime Doctor Dalai celebrates 200,000 blog visits. I like those guys.

Newly named EHR certifying body Drummond Group releases testing guidelines and cost (warning: PDF): $19,500 for inpatient or ambulatory remote testing, $23,500 plus travel for on-site testing.

In Australia, iSoft CEO Gary Cohen will resign after the company posts a $383 million fiscal year loss and a 20% drop in revenue. Shares are down 83% year to date to around 12 cents. I interviewed Gary in April.

WellStar Health (GA) will pay $2.7 million to settle Medicaid fraud claims, admitting no wrongdoing and blaming its claims processing software.

Ambulatory EMR vendor iSALUS names (warning: PDF) Richard Noe as president and CEO. I don’t see any mention of previous healthcare-related employment. He says he’ll double headcount there.

Retired Army General Hugh Shelton, the former chair of the Joint Chiefs of Staff and a Special Forces veteran of the Vietnam War, is named chairman of the board of Red Hat.

Detroit Medical Center says its EMR saved it $5 million last year, $4.5 million of it coming from reduced length of stay related to pressure ulcers. That’s not a great ROI for a $50 million system, but it’s a good start.

I don’t look at LinkedIn often except to verify where someone works since it’s kind of junky looking and always trying to upsell additional features. Still, I was happy to hear from Dann that the HIStalk Fan Club he started there has 1,088 members, some of them spamming my hard-won audience with their own pitches, I notice, which seems kind of tacky but common for LinkedIn. Anyway, since I seldom mention LinkedIn, feel free to add Inga or me to your network (just search for HIStalk). I even added a spiffy new photo since they removed my old one. We’re more Facebookers these days (there’s that narcissism thing), so ditto: just search for HIStalk and you’ll see individual profiles for Inga and me plus our HIStalk page. I’m feeling loserly since I have only 89 friends (although I appreciate every one) vs. Inga’s 112.

The CEO of Naples Community Hospital (FL) writes an editorial bragging on the hospital’s use of its Cerner EMR. Actually he mostly seems to be bragging on the possibility of getting taxpayer money for using it, saying the hospital will be an “early applicant” for money and hopes to get nearly $12 million continuing to do what it was already doing. He says Cerner told him Naples is the second most MU-ready Cerner site.

Markle Foundation assembles (warning: PDF) 45 organizations who advocate that HIT vendors offer the “simple, but rarely offered” ability for people to download their own health records, the so-called Blue Button.

The SVP/CFO of Danbury Health Systems (CT) is charged with defrauding his employer of more than $140,000 by directing health systems payments to a software company he ran out of his house.

IBM and Dell chase the Chinese equivalent of HITECH money. Interesting: one hospital has more than 10,000 patient visits per day.

Bizarre: an auto accident patient says he awoke in Prince George’s Hospital (MD) and asked for food, only to be told by a nurse that he was NPO for cancer surgery, which was news to him. As he was being prepped, he noticed that another patient’s wristband had been placed on him. His wife helped him pack up with intentions of getting out fast AMA, but he claims two hospital security guards beat him and advised him that “Hell, no, he don’t come up in here and be telling us what the f*** to do.” He says a hospital manager acknowledged the incorrect wristband and invited him to have “any type of drug he wanted, just to name the painkiller.” He was diagnosed with broken ribs, a sprained shoulder, a ruptured spleen, and a concussion. He’s suing for $12 million.

E-mail me.

HERtalk by Inga

From Roger Sterling: “Re: DocSite. News has it that Covisint is buying DocSite. Covisint wants to add it to the AMA portal project being rolled out in Michigan.” Unverified. I have a message out to the Covisint folks.

HealthInfoNet, the HIE for Maine, partners with Health Language to provide clinical content integration.

EDIMS licenses First DataBank’s National Drug File Plus database to integrate into its emergency department EHR.

Quincy Valley Medical Center (WA) commits $200,000 for computer hardware in advance of selecting a an EMR application. Software finalists include Meditech 6.0 and CPSI.

Sisters of Mercy Health System launches a $60 million data center in Washington, Mo. The 42,500 square-foot center will host EHR and other applications for all of Mercy’s sites. The regional business journal also points out that the medical information is secure, as it relates to “HIPPA.”

The 16-hospital system IASIS Healthcare selects QuadraMed’s coding, compliance, and reporting tools in preparation for the transition to ICD-10 code sets.

St. Mary’s Medical Center (WV) contracts with Wolters Kluwer Health for its ProVation Order Sets.

Matt Grill, Sunquest’s former manager of technical training and publications, takes over as VP of Global Client Support for MRI Software, a developer of real estate management software.

Patient education material from Thomson Reuters and its Micromedex CareNotes system is available in 15 languages, including Arabic, Chinese, Russian, and Turkish.

On HIStalk Practice: an interview with 20-year-old Greg Waldstreicher, founder of DoseSpot. Everyone who was running a viable business at age 20 while going to school full time, please raise your hand.

Sutter Health (CA) activates iTriage, giving consumers the ability to check systems and find out detailed information about doctors, hospitals, clinics, and ERs via a free mobile application.

The average American hospital barely breaks even, but some have operating margins of 25% or more, according to a Forbes survey of the country’s most profitable hospitals. HCA owns 11 of the top 25 hospitals; two of Mayo’s main facilities make the list as well. Flowers Medical Center (AL) topped the list with its 53% operating margin. Fifteen of the 25 hospitals were for-profit.

Baptist Medical Center (MS) lays off 186 workers, including 14 in management. Laid off workers are being offered a chance to apply for the 136 current openings.

Sponsor updates

• Greenway Medical Technologies says four additional HIEs, IPAs, and regional medical centers have selected its PrimeSuite EHR/PM solution.
• Cumberland Consulting Group has been named one of the 2010 Best Small Firms to Work For by Consulting magazine, having made their list every year since it was started.
• For the second year in a row, the Central Penn Business Journal names MEDecision to its 100 Best Places to Work in Pennsylvania.
• Sierra View District Hospital (CA) hires MEDSEEK to develop and deploy its Web site and clinical portal.
• Access has a new Web site at accessefm.com.
• MaxIT Healthcare makes the Inc. 5000 list, as well as being named #56 on the HCI 2010 Top 100. The company has over 430 consultants.

A baby in Italy suffers heart problems and possible brain damage after two doctors involved in his birth get into a fist fight in the operating room over the appropriateness of doing a C-section. The mother had to have her uterus removed. The region has a 60% C-section rate.

E-mail Inga.

Meaningful Use:  Specialists Still Not a Priority
By Evan Steele

The HIT Policy Committee’s creation of a new Quality Measures Workgroup last week is the most recent in a string of actions confirming that meaningful use has not been defined meaningfully for specialists — and that it is not likely to be. Despite the fact that this new workgroup is charged with prioritizing Stage 2 quality measures and analyzing gaps in Stage 1 criteria, the 18 physicians selected for the 24-member group are primary care providers* — a fact that surely raises concerns among specialists.

The appointment of this workgroup comes on the heels of a growing response to the Stage 1 definition of Meaningful Use from specialists and their professional organizations, commenting on the lack of fit with the way specialists routinely practice. Every one of the six core clinical quality measures are primary care-related, and many specialists will be hard-pressed to identify three of the 38 additional clinical quality measures that are relevant to their practices.

At last month’s HIT Policy Committee meeting, committee member Gayle Harrell commented that much of the input gathered from the specialist panels convened last October seems to have been ignored, She contended that in the final rule, CMS made it more — rather than less — difficult for many specialists to comply with Meaningful Use.

This position was echoed by Thomas C. Barber MD, EMR project team leader of the American Academy of Orthopaedic Surgeons (AAOS) in discussing the Academy’s EMR position statement in the most recent issue of AAOS Now:

Orthopaedic surgeons will have great difficulty in meeting the current 25 Meaningful Use standards. Orthopaedics would derive greater benefits from standards promulgated by our medical specialty society rather than a set of generic requirements that mostly do not apply to musculoskeletal patient care.

This is not a new issue. The primary care focus of the legislation and regulations has been intentional from the outset. President Obama appointed an internist, David Blumenthal MD, to spearhead the program. There was only one private-practicing specialist among the committee members that crafted the recommendations to CMS.

It is not surprising that the Meaningful Use criteria do not reflect the practice patterns of specialists. Federal funding to assist physicians with EMR adoption has been directed towards primary care. The $357 million allocated for Regional Extension Centers, for example, was earmarked to “provide outreach and support services to at least 100,000 primary care providers and hospitals.”

The definition of Meaningful Use is not the only obstacle for specialists. The EMR products themselves are not tailored to the needs of specialists. The AAOS EMR Position Statement correctly suggests that in developing certification standards, it is essential that “the different needs and uses of EHR by disparate medical specialties should be recognized. In particular, the differences between surgical specialties and primary care specialties should be acknowledged.“

Unfortunately, because the certification criteria are linked to the Meaningful Use requirements, they are similarly primary care-driven. The EMRs most likely to be certified for Meaningful Use are predominantly those that were created and developed for primary care physicians — those of vendors that, from 2004 until recently, have devoted their development resources to meeting CCHIT’s 467 largely primary care-focused criteria. The AAOS statement continues: “Many systems are geared toward primary care medical practice, which can limit the utility of EHRs for specialty surgical practice.”

Specialists are no different from other physicians in their desire to participate actively in the evolution of the country’s medical care delivery system. But until Meaningful Use is defined in a way that is applicable to the way they deliver that care, they will participate on their own terms — adopting specialist-focused EMR technology that increases their productivity and enables them to provide the highest quality care and service to their patients.

* Includes internists, family practitioners, pediatricians, preventive medicine, an internist/hematologist, and a psychiatrist.

Evan Steele is CEO of SRSsoft of Montvale, NJ.

Safeguarding EMRs Against System Failure or Downtime
By Arthur Young

Using time-saving information technology and automated patient records management ensures clinicians have faster access to the most up-to-date patient information, enabling timely diagnoses and treatment and maintaining a high quality of care. However, if the network goes down, the system fails, or a planned or unplanned system downtime occurs, clinicians are unable to access critical patient information.

Whether they are planned or unplanned, system downtimes can occur for any length of time — from a few minutes to a few days. Downtimes can also be very costly if there is no system for preserving and accessing up-to-date patient information and maintaining uninterrupted patient care. Healthcare organizations have implemented systems for recovering from disasters, but not for protecting data and continuing operations during downtime. Without such a system, downtime can become more than an annoyance — it can be a life-threatening event.

Distinct from disaster recovery — which helps get systems back up when they go down due to a power outage or property damage — business continuance keeps vital business operations running at or near normal capacities in the event of any network or system downtime. That includes the downtime that occurs while disaster recovery mechanisms are being executed.

There are various solutions available that can help healthcare organizations remain functional during downtimes. However, they have drawbacks. Redundant or fault-tolerant systems can keep computers running and available during a system failure or power outage, but if they are the only system being used for business continuance and the network also goes down, clinicians will not be able to access patient data. Printing patient reports periodically allows clinicians to have the current data on hand, however it is a time-consuming and cumbersome task that diminishes data security, not to mention a waste of paper, ink, and other resources.

To maintain access to patient information from the location its needed, healthcare organizations need to select a business continuance approach that will provide the most protection in the most circumstances. Ideally, a business continuance solution should enable healthcare organizations to do the following:

• Identify critical information and automatically distribute it to areas it will be needed in the event the HCIS is unreachable;
• Ensure the information is secured but available on local machines;
• Maintain seamless operation in the background, notifying administrators of any interruptions; and
• Eliminate the storage of data in paper form, saving paper, ink, and printers.

Intelligent report generation and distribution decentralizes data in the event of downtime by sending the latest reports from the HCIS to its system and creating secure databases in multiple locations. The information is indexed in the database so clinicians can search and find the data they need whenever they need it.

With access to critical data during periods of system failure or extended downtime, clinicians can provide uninterrupted care and healthcare organizations mitigate risks to patient safety. Patients can be assured their health records are up-to-date and secure and confident they are receiving the best possible care.

Arthur Young is the president of Interbit Data of Natick, MA.

Ode to the Dumbwaiter and Robo-Butt
By Frustrated Farmacist (Female)

I saw your blurb about the Aethon TUG delivery robots installed at El Camino Hospital. The old ECH had an awesome dumbwaiter delivery system in place.

It is rumored that the Aethon TUG delivery robot solution was something of an afterthought that came six agonizing months after the grand opening of the $470 million hospital. Apparently earlier plans to integrate a delivery system may have been (ahem) overlooked. You can see from ECH documents that the robot contract was drafted in January 2010, several months after the new hospital opened. Early reports said the robots didn’t work for all departments and some ended up using volunteers, auxiliary staff, temporary workers, and other solutions to get medications and lab materials delivered.

$470 million and NOBODY initially planned an integrated medication delivery and lab transport system for a brand new, ultimate-in-high-tech 400-bed hospital! It doesn’t take too much imagination to extrapolate how important timely medication delivery is in the patient care scheme of things and why it’s the top complaint and employee satisfaction issue for nurses.

ECH’s competitor down the road has been using a similar robot system from Pyxis for the PAST 22 YEARS. It’s on its third generation, fondly named Robo-Butt. He travels in elevators and down halls to six floors and 15 departments. He is guided by sensors in the walls and speaks aloud to nurses to alert them when he arrives and when he commandeers the elevator. He steers around obstacles. His compartments are locked and secure, requiring a numbered password to open. He’s powered by six car batteries that are recharged and swapped for backups 2-3 times daily.

He breaks down every now and then. The elevators break down more often, grounding him on the first floor. Pyxis no longer supports these robots, so parts were scrounged from the basements of other hospitals and from a hospital supply house in Hawaii. But Robo-Butt WORKS. Here’s a picture of this bad boy:

The average hospital pharmacy department dispenses at least 40% more meds than were ordered because of late deliveries or items that are misplaced. The overhead and amount of wasted labor and supplies is unacceptable and frustrating for everyone involved, including the patient, nurse, doctor, pharmacy, and departments like lab and surgery that are held up because of medication delays.

With pneumatic tubes, you place meds in padded bullets and shoot them to the receiving department. Fragile ampules and vials can be broken — think about Epogen, a blood booster whose fragile proteins are destroyed by a violent trip in the tube system. It used to cost $6,000/vial and is still in the $600-900 range. Can I tell you how many bullets have exploded inside the pneumatic tube tunnels? Can I tell you what I think about the ER department tubing patient urine and blood samples to the lab inside this system?

We still have bullets that wind up in the basement due to malfunctioning suction or drivers. It’s hilarious when it’s a $45,000 rattlesnake venom antidote. But the bad part is that sometimes meds lie in piled up bullets in the tube receiving bin. Worse, the staff goes to send an “empty” tube to lab or ER and accidentally send a bullet filled with meds. The worst part is there is no “track-ability” or accountability — we can never tell whether someone received a bullet. If they “say” it never arrived, we have to send it again.

Here’s why I think dumbwaiters may be the ultimate smart medication delivery system with the fastest turnaround times, the least amount of waste, and minimal lost meds and lost charges. The pharmacy staff places labeled / bagged medications into little sectioned trays (like your silverware drawer’s insert) and leave them in the little locked elevator. The nurse that needs meds comes to her department’s locked elevator door, calls up the tray, and REMOVES ONLY HER PATIENT’S MEDS. She leaves the other meds in their little slots.

Think about this. You don’t have one nurse removing meds for her entire department and then misplacing them, storing them improperly (oops, that expensive IVIG that cost $20,000 belonged in the refrigerator?) or just putting them in her POCKET and forgetting to put them in the med room altogether. Then the Pharmacy can call the dumbwaiter down later and retrieve unused meds, credit them back, and recycle them. 

You can imagine that the number of missing med phone calls drops in half. Anyone in the pharmacy can check the dumbwaiter and see if missing meds are there before re-making them. Can I tell you how much time I waste every day re-doing the same missing med that simply gets misplaced or misdelivered and there’s no way to track it? It’s cheaper to bag up another blood pressure pill with the patient’s name and send it again sometimes. And then we get to retrieve all the duplicates, sort them, and restock them in the pharmacy bins…

I have nightmares about this.

A reliable well-planned medication delivery system is worth $$$ millions and makes up 80% of the nursing / customer satisfaction basis. I swear this is true! Any healthcare organization that builds a state-of-the-art facility without planning a delivery system is completely ignorant.

Done with my rant.