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News 12/12/07

December 11, 2007 News 6 Comments

From Todd Taylor, MD: “Re: Azyxxi. Yes, Microsoft Azyxxi is for real and supported by 700 members of Microsoft’s health Solutions Group. There is an e-mail link on the www.azyxxi.com website above the tabs at the top right of the page (‘Contact us’).” Todd’s a Microsoft doc, so he might want to cover his ears while I slam his employer on behalf of the prospect who tried to explain nicely how clunky the site is instead of just taking his business elsewhere. Clicking the “Contact Us” link on the site takes you to a page for signing up for updates (what if I just want to e-mail a human being, not sign up for an autoresponder?) Click that link to get to a signup page. But, here’s the kicker: you can’t sign up without having a Windows Live ID! OK, let’s review: I’m a customer with an RFP, hot to send Microsoft some money. I nose around the Azyxxi site looking for a telephone number or e-mail address and finally notice the microsopic “contact us” link as my only option. I click it, and now I have to click again (after reading that I’m about to sign up for spam). Then, three clicks deep, I find that Microsoft doesn’t want to hear from a prospective customer who doesn’t have their crappy Windows Live ID. You’d think of those 700 people, somebody would recognize this as utterly arrogant and clueless. No wonder Google rules the world.

From Dana Moore: “Re: Centura. Since you have mentioned us on your site, I thought you would like to know that Centura Health has implemented MEDITECH at all 12 hospitals, effective December 1. We brought 11 hospitals live in 5 months.” Nice. Congratulations on a rapid-fire rollout. Big-hospital CIOs sniff at MEDITECH, but it works, it’s cheap, and it’s integrated. If it wasn’t for MEDITECH, the penetration of IT in hospitals probably wouldn’t be much better than it is in physician practices. And speaking of which, I’ll have a CIO interview soon that talks about bolting on more sophisticated specialty apps on top of MEDITECH to get the best of both worlds.

From Phineas Tutwiler: “Re: selling patient data. I’m surprised that you all are having this discussion about selling de-identified patient data. Somebody — the vendors or the hospitals — is currently selling identified patient data. My wife got dozens of catalogs from wig and breast prosthetic companies after breast cancer treatments/surgery. Any parent is inundated by hundreds of advertisements for baby formula, baby magazines, etc.” I thought most hospitals stopped that with HIPAA, although some felt there was a loophole based on the level of opt-in from the patient.

From Mr. Whipple: “Re: selling patient data. I am surprised that no one has brought up the fact that CMS licenses MEDPAR data back to vendors for various reasons, including distribution as part of the vendor’s application suite.”

From DrCool: “Re: selling patient data. Long time listener, first time caller. I remember signing a contract with Cerner years ago and seeing the language allowing them free access to sell de-identified data. We said no. They laughed and said most people don’t read the fine print and notice it, so they agreed to remove it. But, this should be no surprise. The HIT vendors want to figure out how to leverage things and this could be reasonable with appropriate safeguards (true de-identification), agreement from the customers, and compensation (either we get access to all de-identified data for our own research or we get a percentage of whatever money they make). If the privacy advocates want to focus on the issue of ensuring data is truly de-identified, that is great. However, Paul Tang and others are simply being fear-mongers when they claim they ‘know of’ companies selling identified data or have contracts allowing them to do so. If Paul actually has evidence, then he is an embarrassment to the HIT community if he does not share it. That goes for any of the privacy advocates. If they have evidence, let’s see it. If not, then focus on the real issues.

From Kanye Diggett: “Re: barcoding. Given your past support of barcode solutions to improve patient safety, I thought you might find this article interesting. I was surprised to see that they quoted a past error rate. Not something hospitals typically volunteer to the public.” Link. Hopkins facility Howard County General Hospital resolves specimen labeling mistakes with barcoding, reducing errors to zero from 11 in the month before they started. A little Googling turns up the fact that the vendor was Iatric Systems and its MobiLab handheld phlebotomy system.

From Merriweather Tishman: “Re: demo data. The story of a customer recognizing their data in a demo smells strongly of urban legend. The companies I’ve worked for use strictly fictional patients created by their clinical staff for demos.”

Speaking of barcoding: why isn’t there outrage that drug manufacturers don’t follow any format when putting NDC numbers on their packages? They whined forever about having to comply, but suddenly became overachievers by inserting other junk within the bar code (because FDA wimped out on specifying a format, I suspect). Result: scan a drug’s bar code and the NDC is in there somewhere, but not predictably. Thank goodness the FDA and drug companies didn’t design UPCs or you’d never get through a grocery store checkout.

The folks DB Technology sent over information on their RAS and RASi products, which collect, aggregate, and distribute information from existing systems. A quote: “Today Siemens Invision automatically forwards the 35 Siemens reports to RAS. Once there, the RAS Data Extraction Module exports specific data elements from the reports to individual spreadsheets. Excel Macros, that automatically launch at the time of report capture, update the Master Daily Monitor spreadsheet.” Now I admit that I’m a sucker for tools like this that can solve many kinds of problems, but I still think this is pretty cool. I don’t know much about the company and I don’t usually give plug about stuff I haven’t used, but I see my bud Rod Neaveill is there (he used to be at Picis and was very nice about volunteering to hand out the “I Am Mr. HIStalk” buttons at HIMSS) so they deserve a little shout-out.

Computerworld’s 100 Premier IT Leaders 2008 includes Asif Ahmad (CIO, Duke University Health System), Eric Cowperthwaite (CISO, Providence Health & Services), David Dillehunt (CIO, FirstHealth of the Carolinas), Michael LeRoy (CIO, Detroit Medical Center), Michael Long (SVP, Siemens Medical Solutions), Marc Probst (CIO, Intermountain Healthcare), and Rick Warren (CIO, Foote Health System).

Lots of jobs at HealthcareITJobs.com: VP Client Services, IT Director, VP/CIO, Millennium analysts, and sales executives, to name a few.

Chris Perkins, former COO of Per-Se, will replace Grady Floyd as COO of Emageon.

Noobs: to your right is a Google search box that will scan 4.5 years’ worth of HIStalk for your desired keywords. Sign up for site updates and the Brev+IT newsletter over there, too. Check out HIStech Report for interviews about vendors and products (lots of those coming right before HIMSS). If you want sponsorship info, e-mail me, and if you want to tip me off to news or rumors, use the secure Rumor Report button to your right (which can hold an attachment if you’ve got super-secret documents of some kind). Lastly, please click the sponsor ads to your left and support the companies that support HIStalk since paying the bills out of my day job paycheck kind of sucked, making me crankier when I wrote.

WSJ runs a story on mobile VPN software that can maintain a connection under adverse circumstances that would kill a traditional VPN connection. St. Luke’s Episcopal is mentioned for its use of NetMotion‘s mobile VPN software to keeep laptop apps from crashing between access points.

MedAssets will IPO this week.

Dairyland Healthcare, fresh off its sale to Francisco Partners, brings in an executive team to work with new CEO James Burgess: Kevin Fahey as CFO (from Premise), Paul O’Toole as SVP of operations (from Mediware), Angela Franks as SVP of market development (from Lawson), and Mark Middendorf as SVP of sales (internal promotion).

Dell will ship its first tablet PC within the next few weeks, but will continue to sell slates from Motion Computing.

E-mail me.

Inga’s Update

Frost & Sullivan announces their Healthcare Opportunities industry excellence awards. There is a lot of excellence out there, so check out the link if you want to see the winners in about 30 different categories.

The CEO of a Connecticut nursing home chain is accused of taking $15 million in assets to purchase a yacht, three apartment buildings, a record label, and a lakefront home. The Haven Healthcare chain now finds itself in financial trouble and may be unable to recover.

MacPractice announces the availability of an EMR solution that is fully integrated with their practice management and runs on Mac OS X. I have never understood the Mac mystique, but know that there are a bunch of Mac fanatics out there. I thought it was interesting they included pricing information in their press release ($2500 though the end of the year plus $500 for annual support and updates.)

The Health Affairs folks release findings from a study on RHIO’s. The news is pretty bleak. Of 145 RHIO’s surveyed earlier in the year, 25% are now defunct. Only 20 were at least of moderate size and exchanging clinical data (mostly test results). Thirteen of the RHIOs received regular fees from participating organizations in order to support themselves and another eight relied heavily on grants.Their conclusion: It is unclear whether or not the current approach of offering small grants and waiting to see if they survive will work. My conclusion: Time for a different model if we ever want to see wide-scale HIEs.

Maybe Lee Barrett simply views the state of the RHIO world differently. He was just named to the board of directors for HTP, a company specializing in connecting healthcare communities.

eClinicalWorks is selected by the Mount Auburn Cambridge IPA in Massachusetts for their 230 physician members. They already have 18 sites and 70 doctors live.

Picis names Melissa Cruz as its new executive vice president and CFO. She replaces R. Scott Lentz, who will become senior vice president of business development.

Bright Medical, a 55-physician multispecialty group in Los Angeles, selects MED3000’s InteGreat EHR.

E-mail Inga.

Constance Gervais, RN on Nursing Information Systems

Constance (not her real name) followed up after writing this to observe that she had probably misunderstood one of my editorials, in which I argued that today’s systems weren’t designed to benefit nurses directly. She did, but I liked her response anyway.

I am a nurse who has been involved with clinical information systems for 25 years. I was very surprised at the commentary regarding HIS systems and their alleged negative impact on nursing. The reason I changed my career to information systems in the first place was that as an ICU nurse, I saw what information systems ‘could’ do to save nurses time, provide needed information to physicians in a timely manner, and reduce medical errors. I can remember at least three times when I administered the wrong medication dose to patients, nearly causing a fatality. Twice in my ICU, nurses made medication errors that actually ‘did’ cause patients to die; one was an overdose of insulin, the other an overdose of potassium.

Information systems at the bedside could have prevented ‘all’ of these errors. In one hospital in Virginia last year alone, eight patients had to be removed from the operating table after being anesthetized because information was not provided when and where it was needed prior to surgery. That issue was resolved with technology. I’m just one nurse. If you talk to any nurse, they can tell you about similar stories.

Not only can information systems save patients lives, they can also help standardize clinical practice and save cost for the healthcare organizations. Some nursing professionals may think that cost is not their problem, but I believe it is. After all, we are in the ‘business’ of delivering patient care, and that begins at the bedside. As a nurse, it always amazed me that we spent so many years developing financial systems, yet never controlled cost at the bedside where the decisions were being made. Unnecessary treatments, supply costs, and the cost of clinical errors significantly impact the profitability of a healthcare organization. Perhaps if we could save money by standardizing patient care practice, capturing supply usage, and preventing clinical errors, healthcare organizations would be able to afford more practitioners and support personnel at the bedside, thus making nursing a more attractive career path. I know from my experience as a recruiter that nurses and physicians prefer an organization with advanced clinical technology in place.

I walk into ORs in so many hospitals and see rooms stacked with supplies that are not being tracked or charged for appropriately, empty OR rooms during prime hours due to poor scheduling practices, nurses working overtime because rooms are not being utilized appropriately during the day, and surgeons not conscious of hospital cost using the most expensive implants designed to last 60 years on a 90-year-old person. You must understand that we cannot improve processes that we cannot measure. Management reporting without information systems is time-consuming and ineffective. Evidence-based analysis of clinical practice cannot be accomplished and improvements cannot be measured without information systems.

The problems arise when hospitals attempt to implement clinical systems without changing process. Many simply automate old processes, and yes, when that happens, it takes more time. Technology changes the way we practice, and processes have to be examined and re-engineered to take advantage of the new technology. Many hospitals do not take the time prior to implementing a system to examine current processes, understand what the issues are, and what define what they want to accomplish with the new technology.

Healthcare is a business. A significant factor in helping hospitals keep the doors open and afford staff is the ability to control cost. As a nurse and as an information systems professional, I take issue with this article and would challenge anyone who believes that it is a waste of time and money to use information systems technology to help manage patient care where patient care happens (at the bedside), prevent medical errors, and provide information when and where it is needed to support physicians clinical decision making process.  The biggest complaint I hear from physicians is “I don’t know what I need to know”.  I find that very disturbing.

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Currently there are "6 comments" on this Article:

  1. A key reason as to why barcodes have not been more widely adopted is the confusion in Standards. Pharmacy has three or four industry groups, none of which can agree…and the same holds true for Hospitals.

  2. re: selling patient data – first, I am not a vendor selling or buying data… no offense but why not let them sell your data as long as it is patient de-identified propoerly? it benefits targeting, messaging, product development and more. plus, your data from just your hospital or practice is not worth much (believe it or not.) it isn’t until you combine your data with other data sources that it becomes statistically valid and useful, after filtering all the inconsistencies and garbage that tends to get into data sets. you should advocate vendors aggregate your data become wildly successful and negotiate your piece of the pie in the form of lower costs should they actually succeed (as long as they do not violate patient / physician privacy.) if we continue this closed-minded approach, we exacerbate the problems in healthcare.

  3. We implemented DB Technology’s RAS and RASi about a year ago. The RAS product takes the feed from our Siemens Eagle system. As a result we’ve stopped printing and decollating green bar paper!! (Paper cost savings was about $70K annually). We replaced an ancient document imaging system with RASi. With both applications, users can’t seem to get enough. Our roll-out to multiple departments has exceeded expectations. There are a few quirks to the system — and we may have to spend some money on a customization or two — but the deployment of the system has been a huge success and we look forward to implementing other functions. Vendor support has also been very good.

    Keep up the great work, Mr. HISTalk and Inga.

  4. Hi all,

    I needed some help. Can Mr. H or anyone share their thoughts/experience on ambulatory EMR rollouts in hospital based clinics, especially one they are replacing an existing vendor based/home grown ambulatory EMR.

    I needed thoughts on whether a ‘big bang’ approach works better than a phased implementation approach.


  5. RE: Azyxxi – Microsoft’s Health Solutions Group is always happy to hear constructive feedback, good or otherwise. Points made about the information request process on the Azyxxi website are appreciated. A direct e-mail link (info@azyxxi.com) has been added under the “Contact Us” and the “Stay Informed” links.

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