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Monday Morning Update 1/21/08

January 19, 2008 News 5 Comments

Francisco Partners acquires practice management software vendor AdvancedMD, a pretty good billing and scheduling performer in KLAS.

Charges against a suspect in the 2003 murder of a Cerner sales associate are dropped for police misconduct but will be re-filed, the prosecutor says. The 25-year-old Connecticut-based rep was in Kansas City for a Cerner sales conference, went to a bar and strip club, left to buy cocaine and methamphetamine, and was later shot dead in a prostitute’s bed in a crack house during a robbery attempt, according to testimony.

ZDnet says Misys is one of the “biggest open source health care outfits.” For making one tiny, zero-demand niche connectivity product available, sort of? Either ZDnet drank some purple Kool-Aid or it only takes one product to reach the Big Outfit list in healthcare.

Richard Temple, CIO of Saint Clare’s Health System (NJ) is profiled in Information Week.

GE Healthcare’s Q4 numbers: revenue up 6% to $5 billion, earnings $1.04 billion, down from $1.08 billion. Immelt blames Medicare for lower profits. I’m sure Medicare blames GE for higher costs to taxpayers.

Memorial Health of Savannah will lay off 130 employees in its elimination of 180 positions. They’re combining RT and PT, which seems odd. The president says the level of care won’t change, they’ll just become more efficient. If that’s the case, I’d lay off the management team who waited until now to make it so.

SMDC Health System (MN) bans drug company gifts and hauls off 20 shopping carts of mugs, pens, and notepads. The drug company trade organization, naturally, is horrified at the terrible misunderstanding in which they were cast as anything less than noble. “It’s a bit draconian. But the onus is on us now to do a better job of explaining the job and the importance of marketing representatives. Unfortunately there are a lot of cynics in America who want to think the worst.” Unfortunately, a lot of those cynics are right.

A new CHCF report reviews federal HIT initiatives. Summary: the President’s agenda hasn’t improved HIT/EHR adoption, NHIN is wasted money because it won’t work, EHR certification efforts turned out to be the easiest project, state and federal privacy laws need to be merged into something usable, the government isn’t exerting its purchasing influence to encourage HIT adoption, and ONCHIT isn’t doing enough to get federal support.

MedPlus is chosen as the preferred LIS for the Canadian healthcare system.

Green Bay (WI) hospitals get a mention in the local newspaper for their physician portal project, for which Medicity is the vendor.

NAHIT’s still working on defining those five acronyms (HIE, RHIO, EHR, EMR, PHR) so they’re holding two-hour work group sessions at HIMSS. The press release quotes the chief marketing officer (!) of NAHIT (which they insist on calling The Alliance, which sounds sinister and mysterious) who says the definitions “will remove a major barrier to HIT adoption.” Say, what does HIT mean since she used that acronym? Healthcare or hospital? Is healthcare one word or two? I smell more BearingPoint contracts! And maybe a follow-up study on how the HIT floodgates will open once these five pesky acronyms that confuse no one are put in their grammatical place by big government contractors more than happy to undertake fool’s work as long as it pays well.

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Inga’s Update

Add a couple more products to the 2007 CCHIT certification list. Intergy by Sage and Noteworthy EHR 6.0 by Noteworthy Medical Systems gain approval this week.

The current issue of The Annals of Family Medicine has a report on the state of EHR adoption for FPs in academic facilities. A survey showed that 72% have implemented an EHR and another 18% plan to do so in the next 12 months.

E-mail Inga.

Art Vandelay on Patient Command Centers

I share Jim Stalder‘s vision of a patient command center. I never considered using SNMP and Zenoss as a core engine for communication of information from the devices. Merging Jim’s concept with what I have been thinking for some time, the patient command center is similar to the air traffic control center at a busy airport. The air traffic control center knows who is arriving, when and where they are leaving, and they share status with all the others on the ground and in planes.

My vision is that the patient command center will be a physical or virtual department where traditional admissions, financial folio, bed, transport and discharge management are handled. It will manage service desks for IT, facilities, clinical engineering, and equipment, as well as clinical alerts and data from medical devices and the computerized patient record for singular issues and trended problems. It will monitor throughput bottlenecks, such as ED, OR, and patients ready for discharge.

I had envisioned using real-time location tracking systems (RTLS) integrated with a real-time data store of ADT, orders, billing, enterprise scheduling and results data. Large screens with various real-time reports would be available. Think of this like the status boards for the Emergency Department on steroids. With a complex event processing (CEP) engine monitoring the information, the proper resources could be alerted to the status of the facility, patients, and staff at any point in time via visual queues on the big board, a user-specific screen, or various reports. Alerts could also be sent to the device of choice, i.e., PC, handheld, Crackberry, local mobile phone. Sorry nurses, it looks like there is another job for you to consider – Command Center Czar.

SNMP isn’t that complex. What are the chances of getting the medical device vendors to add this to their devices? It already runs on the private networks and servers they use. In my opinion, the companies to watch in this space are Cerner, with their medical device push, and Philips, with their recent acquisitions. All-in-one vendors like Epic and Meditech are also well positioned with the data their systems have – in theory.

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Currently there are "5 comments" on this Article:

  1. Great comments – at my organization we are managing RS-232 terminal servers with SNMP. Great clarification – I would not see using SNMP for all aspects of data capture, only standard systems management (i.e., heartbeat, firmware checks, on UPS). If the key devices have embedded browsers, all the easier to execute web services to capture the necessary information. The command center is ambitious but it is a shame to have all that information available and not do anything with it. Especially as we enter the winter season where bed availability can be an issue. If we can increase throughput and proactively address issues before they arise, we are serving our patients, their families and our staff better. Many organizations already have centralized service desks for some functions and many also have bed management groups, this “kicks it up a notch” to allow better cross department coordination and information sharing. Also, what is measured and monitored is naturally improved. “We have the technology… we have the capability to make the world’s first patient command center… better than it was before, better, stronger, faster than it was before.” Sorry, a little 6 Million Dollar Man reference.

  2. Art – I can see you and I are thinking along the same lines. We have most of the information available to us already, it just needs to be mined real-time and presented in a usable manner. Frankly, I think the biggest challenge in any type of Patient Command Center is organizational buy-in. The technology is the easier part. We’ve already got “big boards” in the our ED and L&D which track patient status, orders, location, physician, etc. That information could be expanded and integrated into a common platform with customized views for particular job functions or process flows — but it would all be in one overlay system that included upstream and downstream status. However, doing so would take an “organizational” approach and not the traditional “departmental” approach to managing patients. Taken far enough, you could not only better manage current patient throughput and turnaround, but start to forecast demand for downstream services and equipment needs. Not to insinuate that patient care is a factory by any means, but I’m sure any folks in the manufacturing industry reading this are saying to themselves — “we’ve been managing our supply chain, manufacturing processes and distribution like that for years. Clearly the technology exists. The challenge is re-engineering the processes to take advantage of it.” — and isn’t that true of everything?…

  3. Beautifully stated Jim, this type of data awareness in real-time could break the traditional organization and ‘people’ silos. Real-time data access leaves no time for ‘political spin’, creative interpretation or the like. Organization change management (the culture, norms, etc. – the “Who Moved My Cheese?”) by far is the hard part. As more data becomes visible in and outside the organization, and these same organizations get to the root cause of issues, change should be inevitable – at least for the successful organizations. I feel so energized (or maybe that’s the Starbuck’s) – like starting a new buzzword – Transparency 2.0.

    This is exactly why I love the web, you find you share a concept with someone; you can virtually dialogue, incorporate various viewpoints and tips (i.e., Bob’s caution about using SNMP in its rightful place) and evolve.

  4. I know that this will sound like I am oversimplifying the situation and also, I am not completely up-to-date on what has been built into the existing NHIN plans, so bear with me while I impose my own thoughts on the subject of the NHIN.

    I have often wondered if the NHIN could be built on an enhanced Gnuetella or Napster architecture. Imagine a physician working within Meditech, Epic or whatever vendor’s system and deciding they need to search for outside information on a particular patient. They submit a query, much like a person does in Napster or Limewire. Each HIT vendor has written a front-end for their system to retrieve inquiries from the network, process them and forward as needed. The inquiry is propagated across the NHIN. The physician then sees his screen populate with potential “hits” based on the search criteria. (Bear with me, I realize that security / privacy are huge issues, but I think the system could be modified to accommodate this.) The physician could then highlight those returned results he/she is interested, click a button at which time the browser requests the patient data from the selected systems and then pulls the data into a cohesive record that could be explored by the physician.

    Here are a few of the hurdles that would need to be overcome:

    – Security and Privacy – the patient needs to have the ability to “opt-out” in terms of what is shared on the network with a further option for a “break glass” capability in the event of a serious medical emergency. Perhaps the patients enroll in the network and answer a series of questions and options that determine exactly how their information is shared. The HIT vendor’s through their front-end software could use this patient privacy / security database to determine how they respond to a given request from the network. Also, the information has to travel across the network encrypted and all systems would need enough security to know they are talking to a legitimate requestor.

    – Standards need to be finalized for passing normalized information between the vendor systems and the client browser software need to be formalized so that the client can properly tabulate the results.

    – The “fuzzy” logic used in the querying needs to be sophisticated enough to adequately match up patients with a high level of accuracy. The query needs to contain enough information that the returned results are “reasonable” – perhaps a rating in terms of quality of the match could be listed with each returned entry. (It would be nice if we had a single patient identifier, but I’m not holding my breath that we will see that for many years.)

    Some advantages to this environment:

    – The HIT vendors still have control of their products and can develop their own “client” software to access NHIN. Some HIT vendors might choose to imbed the available patient information from the NHIN into their own stored data, while some vendors might have the user go to a separate query screen to retrieve results from the network – separate of the stored patient information.

    – I believe the system could be developed in a way that the patient has control of his/her information.

    – It provides a single, proven mechanism (Napster / Gnuetella) for making requests across the network and then retrieving results. There would need to be modifications to these mechanisms to ensure all sites are queried, but the concept is proven.

    – The HIT vendors would write a front-end for their own systems to participate in the NHIN. This would help eliminate the need for each healthcare organization, RHIO or other entities from having to develop their own methodologies.

    I am not naïve – I know there are tons of holes that this sort of architecture introduces that would either need to be filed or could eliminate thie architecture from contention. In addition, as I mentioned I have not kept up in the details of the current NHIN models – maybe this is the approach that they are pursuing. However, I at least hope they have considered this architecture.

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