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Monday Morning Update 2/4/08

February 2, 2008 News 2 Comments

Your gas dollars at work: check out Sidra Medical and Research Center, being built in Doha, Qatar as part of Education City and in affiliation with Cornell. Operational funding is $9 billion, an insider tells me, which doesn’t even include the construction cost of $2 billion for the 380-bed facility (but check out amazing virtual tour of how it will look on the site). It’s being overseen personally by Her Highness Sheikha Mozah bint Nasser Al Missned, Chair of Qatar Foundation and Consort to the Emir. Core sciences listed: functional and anatomic imaging; stem cell; genetic, genomic, and proteomic; bioinformatics; and tissue management systems. Opening 2011. All digital. They’re hiring if you don’t mind the heat (over 105 degrees in the summer).

Jobs: Director of IS in Arizona, Senior Software Engineer in WA, Business Analyst in CO.

Listening: Marmalade, psychedelic pop, circa 1967. You would know “Reflections of My Life” if you heard it.

New healthcare CIO blog: Dale Sanders of Northwestern Medical Faculty Foundation.

Health First (FL) chooses Eclipse Project Portfolio Management for starting up its project management office.

Cerner shares drop 10.3% Friday and hit a 52-week low after the company fails to meet Wall Street’s revenue expectations and forecasts weaker Q1 sales, even though earnings beat estimates by the usual penny. Good lesson: publicly traded companies waste time and energy managing the share price instead of the business.

McKesson shares also drop on Q3 numbers announced Thursday: revenue up 15%, EPS $0.68 vs. $0.80, with $0.11 due to one-time charges for “restructuring, severance, and pending legal settlements.” So, those of you they canned have extracted at least a little revenge, that is unless you’re also a stockholder, in which case your involuntary march-out has now doubly screwed you. At least it hurts John Hammergren more than you, unless you hold more than his $14 million worth.

I’m running a comment left by Deborah Peel below, so here’s a related reminder: she’ll speak at HIMSS on Tuesday, 2/26 at 2:15 on “The Privacy Imperative in Healthcare IT”. I’ve already marked that session as a must-see on by HIMSS dance card. I’ll admit once again that I assumed she was a paranoid flake until we swapped a couple of e-mails in which she was thoughtful, rational, and entirely logical. She’s not against healthcare IT, just the lack of attention to privacy it involves. I’m pretty sure if privacy were improved, she would happily disappear from the limelight.

Speaking of patient privacy: how many days will it take before somebody sells the current inpatient medical records of Britney Spears to trash magazines for the gratification of their undermotivated readers? It’s already been announced that she’s under psychiatric care, is on Adderall, and was taking up to 10 laxatives a day. How much more detailed can it get?

Wyse Technology announces its TCX Virtualizer, which allows virtualized desktop users to connect to USB devices.

University of Michigan is on a $1.75 billion construction spree, including a new $51 million data center for the health system.

Sparrow Health System (MI) rolls out the T SystemEV EDIS running on the Motion Computing C5 tablet PC.

I noticed that Misys is an anchor exhibitor at HIMSS. Since they sold off all their inpatient products, that’s a lot of space to show physician office stuff. If you need a place to take a break, I bet they’ll fill lots of the excess space with comfy chairs.

CPSI’s Q4 numbers: revenue down 6.9%, EPS $0.36 vs. $0.39. The company also declares a dividend, which always sends the message that investors are better off with cash for investing elsewhere instead of having the company do something useful with it, like improve its performance.

Medical Associates of Erie (PA) chooses MedAppz for community-based EHRs. I checked out the website to see who runs the company, but apparently it’s a guarded secret, with the “Who We Are” section failing to answer that question, containing only marketing-speak, trite slogans, and stock photos without listing who’s in charge, making it feel distant and impersonal. There’s no charge for that marketing consultation.

The Scottish Centre for Telehealth will pilot Cisco’s HealthPresence, a telemedicine platform built around Cisco’s acclaimed but expensive TelePresence videoconferencing system. For healthcare, it will interface to diagnostic and monitoring equipment. Cisco’s Danny Sands, MD discussed TelePresence in my September interview.

Microsoft wants to buy Yahoo for $45 billion to compete with Google, which is like a guy who’s jealous of his buddy’s gorgeous girlfriend hooking up with two unattractive ones in response.

Omnicell’s Q4: revenue up 35%, EPS $0.40 vs. $0.14. Shares tanked to a yearly low anyway, down nearly 23% on Friday, since investors don’t like declining order backlogs for hardware vendors. Analysts said Omnicell was talking up some big deals during the ASHP Midyear Clinical Meeting in December but failed to close the business in Q4.

Strange: a 31-year-old medical resident accused by her physician husband of bisexual affairs and drug abuse disappeared on September 10, 2001 after shopping at a department store. Investigators initially suspected she took advantage of the World Trade Center situation to skip town, but an appeals court declared her a September 11 victim last week despite no proof that she was in or near the area at the time. They want her name on the memorial. The family speculates she rushed in from her nearby home to help victims.

Leon Medical Center (FL) has started a $6 million NextGen implementation in its five Medicare clinics.

INVISION earns CCHIT’s inpatient EMR certification. The press release headline brags that it met 100% of the criteria, which of course is redundant since you can’t pass with anything less.

The Army’s MC4 combat medical records system hangs in there despite the widespread Internet outage in Asia and the Middle East last week. Combat hospitals had offline-ready systems to fall back on.

The quoted reply of athenahealth’s Jonathan Bush when asked at an IPO forum “how is the President related to you?”: “The President is my cousin, and he lobbied hard for the role and succeeded in the end. We took him. Sometimes we think about putting him back.”

Physician software user groups create a website to advocate allowing England’s physicians to choose their own clinical systems instead of being forced by patient care trusts to standardize.

Sonoma Valley Hospital (CA) blames its financial problems on a billing system outage that lasted several days.

West Virginia University Hospitals will go live on its $90 million Epic system on March 1.

Kaiser Permanente will be Oracle’s landlord in Pleasanton, CA, buying three Oracle buildings totalling 186,000 square feet and renting them back to the company.

E-mail me.

Deborah Peel, MD on Rogue’s Example of EMR Privacy Concerns

As far as I know, there are no existing EMRs that ensure consumers control all access to personal health information. This is a HUGE market opportunity. So, all of Rogue’s highly sensitive old medical records can and will be used, shared, and sold without his consent to discriminate against him and his children (depression has a genetic basis) because electronic health records systems were NEVER designed to ensure Americans longstanding legal and ethical rights to control access to PHI.

Electronic health information systems were not designed to replace paper medical records systems (whose function was SOLELY to help doctors care for patients). They were designed to deliver information to corporate end-users. It will be very difficult and expensive to successfully rebuild existing EHR systems to conform to existing strong state laws, common law, Constitutional law, tort and contract law, the physician-patient privilege, and medical ethics that all require informed consent.

Vendors, insurers, hospitals, drug companies, and data miners do not want new HIT systems that restore our rights to privacy because that will put an end to the billions in profits from the sale of stolen prescription, health, and claims data (IMS Health and the BCBS Blue Health Initiative come to mind).

The original HIPAA Privacy Rule required consent. But the consent requirement was gutted in 2002, legalizing the data mining and data theft that HIT systems were originally designed for. HIPAA is now the data miners’ DREAM regulation — because it puts “covered entities” in control of when PHI can be used for TPO, not consumers.

Learn what Congress and federal agencies are up to and what you can do to stop them from destroying your health privacy by signing up for our e-alerts.

In 2006 and 2007, Patient Privacy Rights and over 50 bipartisan national organizations in the Coalition for Patient Privacy urged Congress to restore Americans’ longstanding basic rights to privacy: i.e., our rights to control access to personal health information. The Coalition was the key force that stopped the HIT bills which had no rights to health privacy. We need your help in 2008.

Rogue, maybe you can sue the hospital (your employer) for disclosing your PHI under strong state laws that require informed consent before the disclosure of mental health records. But first, you will have to have audit trails to prove where your data went and also be able to prove how you were damaged. Good luck.

Or you can be an advocate and work with Patient Privacy Rights to restore and strengthen your privacy rights.

Inga’s Update

Bariatric surgeons take note: a proposed bill in the Mississippi legislature would prohibit food establishments from serving “obese” people. Shares for Gold’s Gym are up; McDonald’s shares down.

CoxHealth in Springfield, MO adds Krptiq ePrescribing solutions.

Less than a month after announcing a secondary public offering, athenahealth withdraws its registration. Seems as if the current market conditions created a risk that athena wouldn’t be able to sell the deal to investors at a price that made sense. Is this an isolated incident or a sign of the times?

Privacy rights “warrior” Dr. Deborah Peel is again in the news. Her Patient Privacy Rights organizations plans to evaluate EHRs and award seals of approvals for those that meet the organizations standards for protecting the privacy of personal health information.

Perot Systems announces it won over 90 revenue cycle solution contracts last year that resulted in the collection of over $2.4 billion in cash and the resolution of $4.6 billion in A/R for its clients.

E-mail Inga.

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Currently there are "2 comments" on this Article:

  1. Privacy and electronic health records: There are several generalizations in Dr. Peels statements which are not true, and that diminishes the strength of an otherwise valid argument.

    “electronic health records systems were NEVER designed to ensure Americans longstanding legal and ethical rights to control access to PHI” – False. Developing access controls to information in general has been a Computer Science discipline long before computerized medical records had been developed. Pretty much any advanced EMR system has access controls built in, along with overrides and datra access audit logging to protect PHI. These access controls are connected to patient consent. What is not there is absolute consumer control over PHI, which in my opinion is just as dangerous as no consumer control over PHI. I am sure both Rogue and Dr. Peel would prefer that their whole medical history is available to the ER doctor in a hypothetical care episode when an unconscious patient cannot give any consent.

    “[Electronic health information systems] were designed to deliver information to corporate end-users.” – false. Anyone familiar with computer systems design would realize that the requirements for data mining and other “corporate use” are often incompatible with the requirements of an online transaction processing system. EMRs have to be designed with the latter requirements, otherwise they would be unusable by nurses and physicians. There are plenty of examples what happens to EMR systems when the users find them too cumbersome to use – they get de-installed.

    Back to the original questions by Rogue. In that scenario, it is highly unlikely that the old information will be easily shareable between institutions, unless there is a specific need for it. The reason is that medical information is highly contextual, so one cannot just get a piece of data and move it around. There are two conceptual ways to share EMR data – an event triggers information push from the data source, or an event triggers information pull from a data consumer. In both cases there must be some need for the information to be provided or requested – for example allergies and immunization history are important pieces of information, which transcends individual encounters, so they are likely to be shared in a patient summary transaction between health care organizations. 10-year old psychiatric visit may be shared if there is a current psychiatric visit which triggers a request for previous such information from other systems, however the privacy controls in the current system would have enforced patient consent in both cases.

    The areas where insurance information is shared among non-healthcare institutions is much more murkier to me, so I don’t have a good understanding about the way information may be shared in such settings.

    For more information on what to look for in EMR/EHR systems that provide the necessary functionality for patient privacy and confidentiality, one can take a look at the HL7 EHR Systems Functional Model: http://www.hl7.org/ehr/downloads/index_2007.asp

    Another specification, which addresses some of the issues of respecting patient consent in the context of healthcare information exchange, is the IHE Basic Patient Privacy Consent (BPPC) profile, part of the Patient Care Coordination (PCC) framework: http://www.ihe.net/Technical_Framework/index.cfm#pcc

  2. You can say all the nice things you like about Deborah Peel but until she

    a) backs up her statement about EHR vendors selling identified data (and breaking the HIPAA law in the process) and

    b) answers the accusations about her endorsement of Microsoft’s HealthVault from Fred Trotter and the rest of the open source zealots (including what she received in return for said endorsement),

    her credibility remains severely suspect.

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