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Monday Morning Update 5/5/08

May 3, 2008 News 13 Comments

From Frazier Thomas: "Re: Misys. I read the the Misys press release about Daughters of Charity. Vern makes a reference, twice in fact, to Daughter’s Of Charity ‘Hospital’. I wonder if he even knows there is no such Daughters Of Charity HOSPITAL? It’s a whole health system, Vern. I guess I should cut him a break. He’s probably got a whole lot on his mind wondering what kind of employee he’ll be for Glen."

From Labrat: "Re: Baylor. The shake-up is true and relates to a conflict of interest issue. The BHCS rumor mill suggests that criminal charges could be pending."

From Up to You: "Re: NAHIT. More info on NAHIT and its stasis following Scott Wallace’s departure at the end of March. Includes some info on the organization’s financials, too." Link (although Modern Healthcare, despite carpet bombing the industry with free paper copies, inexplicably locks its online version behind registration, so you may not be able to read it).

From I-Wish: "Re: paper. Today I visited a new doctor. I downloaded my CCR-compliant medical history from my PHR to an encrypted memory stick. I arrived 10 minutes before my appointment time and handed the memory stick to the receptionist, who uploaded my medical history into the office EMR. I was immediately taken back to the exam room to see the doctor. Then I woke up!! In reality, I arrived 30 minutes before my appointment, filled out 20 pages of  information that required me to put my name, SSN, DOB and insurance number on every page. I then waited an additional 40 minutes to get into the exam room and spent nine minutes with the doctor and was out the door and done! I have been working in Healthcare IT for 15 years now and nothing seems to have changed in the average doctor’s office for the $ billions spent. My dream is to have one doctor visit in my lifetime that does not require a piece of paper! I am a baby-boomer and it doesn’t look good. Maybe for my grandchildren?"

From Terminal Stare: "Re: CIO credentials. Have you noticed how many new CIOs don’t even have a graduate degree these days? No clinical credentials and minimal education – remind me again why they’re paid more than doctors?"

Thanks to HISJunkie, whose HTP/RelayHealth tip gave HIStalk readers the news at least 12 hours ahead of everyone else. Transaction processor HTP and its 65 employees will stay in Columbus under the RelayHealth name.

McKesson will pay $13 million in civil penalties for failing to report suspicious pharmacy sales of controlled substances to the DEA.

University of Michigan Health System finishes its online order entry project, claiming a 29% reduction in medication errors and a 40% drop in turnaround time for urgent meds. None of the press releases mentioned who their vendor is and the intrepid reporters didn’t ask that painfully obvious question, but I believe it’s Eclipsys Sunrise Clinical Manager.

McGill University develops an automated anesthesia system it calls McSleepy that continuously monitors and adjusts anesthesia doses in response to patient conditions. Pretty darned cool.

This ought to get Deb Peel stirred up: UCSF not only inadvertently opens up patient information over the Internet, it does so while sharing patient data with a for-profit company that targets potential hospital donors. UCSF admits turning over information on 31,000 patients over several years to Target America. It paid that company $12,000 a year to match patient names against lists of known donors, board members, and community service supporters (as well as street addresses) so the rich ones could be hit up for donations (what the marketing types call "receiving our messages and ongoing communication"). Information about 6,000 patients was open to Google searches for three months. UCSF didn’t announce its problem until six months after it found out. Too bad Britney wasn’t on their list – they could have scored a nice privacy gaffe trifecta.

Former Deloitte manager Maria Russo will join Jewish Hospital & St. Mary’s HealthCare (KY) as CIO.

Wal-Mart will make some kind of big healthcare announcement Monday morning at 8:30 Eastern. It must be about prescription pricing since the company’s $4 generic guy is on the agenda.

NovaRad signs a RIS/PACS deal with a 1,500-bed hospital in India.

LMS Medical, the Canadian vendor of the CALM patient safety software for OB, will delist its shares from AMEX, but continue trading them on TSX.

Highly annoying: you get a teaser e-mail headline about some "10 Biggest Career Suicide Moves" or "5 Most Important Technologies You’ve Never Heard Of," so you get suckered into clicking the link. When you get there, it’s some idiotic vanity cartoon presentation that you have to click through one page at a time. I don’t have the time or interest in sitting through some crappy video, podcast, or slideshow. I like to skim, not be held captive, even though web guys keep trying to turn the Internet into TV (which I don’t watch for the same reason). There’s no video or audio on HIStalk for a carefully thought out reason: those are for people whose lips move when they read. You’d need at least 60 minutes to get what you could read on HIStalk in five. That extra 55 minutes is my gift to you.

St. Jude Medical signs a deal with Microsoft to work on integrating data from implantable devices with HealthVault.

Strange: a 56-year-old musician in a Steely Dan cover band dies of liver failure after being turned down for a transplant because of marijuana use. His use of it, ironically, was medically approved for his hepatitis pain.

Fresenius Medical Care (Germany) earns CCHIT ambulatory EHR approval of its Acumen EMR software for nephrologists.

Senior citizens are apparently doddering fools who require a SeniorPC, a dumbed down offering from Microsoft. "Think of it as a simplified way to do it all: e-mailing, word processing, plus managing prescriptions, finances, travel planning and photos. There are even word games and number games for keeping the puzzle skills sharp." Yep, Grandpa can just sit back in his drool-covered Barcalounger in his Sansabelt pants and Velcro tennis shoes and punch the optional oversized keys to order prescription refills, do crossword puzzles, and look at pictures of dead relatives, pretty much life’s rich bounty for those in God’s waiting room, at least as Microsoft apparently sees it. Maybe there’s a large print option for games, porn, and celebritard gossip for the more tuned-in geezers. Getting old sucks, but you don’t have to go down without a fight.

Six more organizations get ONCHIT money for NHIN demonstration projects, including the financially strapped Cleveland Clinic and Kaiser Permanente.

E-mail me.

By Kipp Lassetter MD, Chairman and CEO of Medicity

Regarding the reader comment about CalRHIO, I’d like to set the record straight for HIStalk’s readers. Having won the CalRHIO selection process, I can say that Medicity has never been asked to “pay” CalRHIO anything. What we did offer CalRHIO as part of our RFP response was assistance in building a sustainable model and with network development activities with the expectation that we would be paid back with the success of the network. Their has been ZERO financial exchange between CalRHIO and Medicity or between any of our anticipated subcontractors (Perot, HP, etc.).

We do understand that while we were willing to go “at risk” for our services, other vendors were proposing large fees to cover these activities with no guarantee that the activities would be productive or successful. We feel we prevailed because we were the most qualified to partner with CalRHIO. CalPERS recently has performed extensive due diligence on the CalRHIO business model and value proposition. For those readers that are not familiar with CalPERS, they are the third largest purchaser of health care services in the nation and currently have around $250 billion under management for the benefit of their members.

Both the national healthcare consulting firms of Watson Wyatt, and Mercer were involved in evaluation effort on behalf of CalPERS. The fact that CalPERS came to the decision to “DIRECT” their health plans to participate is far more than CalRHIO “hype”. There is an old country saying that summarizes the comments very well: “the dogs bark, but the caravan moves on".

Bar-Coded Medication Verification
By Laureen O’Brien, CIO, Providence Health & Health Services, Oregon Region

I recently read the Brev-IT commentary about bar-coded medication verification (BMV) systems that claimed they are "generally primitive, hellishly difficult to implement, and badly designed from a nurse workflow perspective".  I can agree with only one of these claims — they are hellishly difficult to implement.

These systems are anything but "primitive," as they integrate information from multiple systems (ADT, pharmacy, nursing) to allow the use of technology (barcode readers) to quickly validate the "5 rights" of medication safety (right patient, drug, dose, route and time) to prevent medication administration errors.

And what is required to gain this safety after BMV is implemented? The nurse must sign on to the system or scan his/her ID badge, scan the patient’s wrist band, and scan the barcode on the medication. Within seconds, the nurse knows the "5 rights" have been verified or knows there is a problem.

When fully implemented and fully utilized, these systems are proven to enhance patient safety and reduce the risk of medication errors. Granted, implementing a new task into the nurse’s work flow adds time to their already busy schedule. But in healthcare, since when is taking more time to do a task safely considered an unacceptable workflow? I would think that doing something unsafe would require workflow adjustments to correct the unsafe practices. 

Try to find a patient who will argue in favor of the nurse not practicing safe medication administration so the nurse had a better "workflow". I’ve scanned the literature and have yet to find that argument. There are lots of articles that speak to nurses getting around the BMV systems and the safety they impart. Why are these discussions so often referenced? We know that use of a BMV system can and does prevent medication errors.

It is 2008. These systems have been available since the late 1980s. There are really no good excuses for not implementing them.

If your hospital is not doing BMV and not planning on doing BMV, shame on you. Your long-term financial status may be in jeopardy, as informed patients start looking to facilities that do use safe medication practices. You know that BMV systems provide enhanced safety, your board knows it, and the public is becoming more educated daily.

Hellishly difficult to implement? You bet, but no more so than implementing any clinical IT system. It is implementing change. Change is difficult. It is also the right thing to do.

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Currently there are "13 comments" on this Article:

  1. Regarding the UCSF item in Monday’s update:
    I would be very surprised if the other shoe doesn’t drop on the “privacy trifecta” — besides Ms. Spears, there are plenty of influential folks in the Bay Area who may have been treated at UCSF, who also are not too keen on unauthorized sharing of personal information.

  2. With regards to Terminal Stare’s comments on CIOs without graduate degrees – giving a graduate degree to a person doesn’t make them a CIO any more than handing a scalpel to someone makes them a surgeon. While I am certainly not down on graduate degrees and they do provide one type of measurement of a person’s capabilities, I have met many people in IT that are worth their weight in gold and some have had graduate degrees, many didn’t. Give me someone that has drive and can think – they get more credit for these qualities than for the number of hours they sat in a classroom.

  3. Smalltown CIO, your reply on the “CIO Credentials” is spot on. A leader is a leader is a leader… period. The person holding down the position at the top of any operational area needs to have excellent leadership qualities. Many of these qualities are inherent and cannot be learned.

    Over the years, some of the best people in organizations I’ve been responsible for have not even had a degree at all. Conversely, some of the most inept could have used help from Vanna White to manage all the letters after their name (and that’s no knock on Vanna either)!

    Companies who “move along” people just because they’ve added a degree or a certification are practicing poor management themselves. They fail to take into account that their staff is made up of people and not machines with specs.

  4. Not big on the degree being the measure of the man (or woman). I’ve seen so many people with MS and beyond fail miserably. Advanced education is sometimes still just a hobby for the wealthy in this country. I’ll take the guy who got a BS degree and worked his butt off and learned all the parts of the business long before I’d take a guy who sat in MS classes for 2 years.

    Smart people are smart people not because they stayed in school 2 more years. It’s because their brains process information efficiently and have the capability for inductive reasoning, not just experiential intelligence.

    Give me the guy who can figure out that walking out in traffic is likely going to have a bad outcome on his own.

  5. O’Brien’s defense of bar-coded medication verification (BMV) systems is undoubtedly earnest. But it’s mostly wrong. [See “Comment on BREV-IT” in the 5/5/08 Monday update] O’brien starts with summary quote from a previous posting about ” bar-coded medication verification (BMV) systems that claimed they are “generally primitive, hellishly difficult to implement, and badly designed from a nurse workflow perspective”. [O’Brien then adds:] “I can agree with only one of these claims — they are hellishly difficult to implement.”

    Later Ms. OBrien informs us that use of bar-coded medication verification systems (also called barcoded medication administration (BCMA)) ensure the 5 rights of medication administration. And later she tells us that failure to install them is endangering patients and our insurance status.

    This is wishful thinking about barcoding; and BMVs/BCMAs are helpful tools. But they are indeed very primitive– forcing nurses to circumvent them almost 1/5th of the time. Their integration with the pharmacy and with CPOE is only partial, they cause significant extra work for RNs, and they often lead to errors becasue of a false sense of security. Saying they are not primative is like saying that cars in the 1920s were as safe and as sophisticated as they could ever get.

    Nurses override them countless times each day because of problems with the technology and because of poor integration with other technologies or other work processes.

    BMVs/BCMAs hold promise. But we must stop being guilt-tripped by everyone who has gone through hell to implement flawed HIT system because they think they have grown from the process and thus others should suffer accordingly. Anyone willing to carefully look at the problems with these systems will see how poorly they work in real life in the hospital units. CIOs may live to promote technology, but our patients have a better chance of living if our HIT is not oversold, under-tested, and blindly accepted.

  6. RE: University of Michigan Health System – yes, it is Eclipsys Sunrise Clinical Manager, and the article gets it right that the projects have been highly successful by just about any measure. Managed expertly, with excellent external support from Eclipsys and Acro Service Corp.

  7. BostonHITman and Smalltown CIO both make good points, and this has been a debate for a long, long time not only within Healthcare. It was a big debate in IS shops in general, some saying that an IS background and credentials were essential and others declaring great leadership abilities to be even better, etc.

    Given the potential impact and overall responsibility of the position of CIO in healthcare, we need to bring in people with proven leadership abilities AND great credentials. Proven abilities to move an organization far ahead, coupled with a strong and deep knowledge through rigorous education (and experience) is the best of both – so, it seems to me we ought not to think we must choose between the two. Get ’em both. It would be great if we we minnions could outright demand that sort of leadership, but it’s evident that those who hire CIOs in Healthcare are as susceptible to bad hiring practices as any industry – but, I know there are CIO candidates with both qualities “out there”.

    That said… if you must to choose one over the other… real leadership is best, but only if they know how to find and trust those with the knowledge they lack.

  8. Also for those readers unfamiliar with CalPERS: it is a bloated, powerful organization. While its purchasing power is beyond question (they have cut costs), it is a parasite on the public coffers of California. Most people with no vested interest in it do not sing its praises. CalPERS, the CTA/ CalSTERS (teachers union/retirement), and the CCPOA (the correctional officers) are the first triumvirate of California. These are all state agencies that lobby the government. Any potential for conflicts of interest? Nah.
    Now it wants to grow even bigger…

  9. To Terminal Stare: Who has the agenda for improving healthcare and IT? The person that questions the academic credentials for CIO’s or the person that has already garnered the trust of stakeholders in the industry and landed the job of CIO (with or without a master’s degree). There is no good excuse for Terminal Stare’s questions. He/She is either an unemployed CIO wannabe with a Master’s degree or someone in academia trying to drive admissions. I’m guessing it is the former. In reality very little of what I’ve learned in academia in either my bachelor’s or master’s program (both fully accredited) has been relevant to healthcare IT needs. It is more about what the professors and deans want to teach rather than what the industry needs. The best way to prepare for being a healthcare CIO is a very good question. Especially with financial systems maturing relative to clinical and collaboration.

  10. Re: Baylor – Are you sure these are recycled rumors regarding the Baylor shake-up of 2006? I find it hard to believe the same thing is happening again and so soon.

  11. Recent political history aside, When selecting cabinet members, would a new administration feel that it would be a bad decision to appoint someone as the Secretary of Transportation if that person didn’t have a pilot’s license, a license and experience driving a bus or perhaps having served as the captain of “The Love Boat”???

  12. The Secretary of Transportation may be likened more to the CEO, in that the CEO has the highest perspective on the total business and most certainly needs less detailed knowledge of the technical aspects – and is generally best they have strong ability to communicate and persuade, etc. A CIO, on the otherhand, is answerable to the tech aspects and responsible for tech direction and depth, as well as expected level of employee technical expertise. It’s a balancing act, because they need to understand the foundations enough to have a world-class BS meter (which comes from education and experience) ; but they also need enough confident leadership qualities to stand back and not micromanage. Either technical ignorance or management ineptness seem to end up with big troubles.

    It’s good to see (I’m not in academia, btw) that some universities are finally beginning to deal with the realities of health informatics in a way that actually matters. There aren’t too many yet, but it’s a beginning . The same thing happened with Computer Science degrees. In the early ’80s, a few colleges began offering a BSCS degree because it was a hot issue, but the content behind it was rediculous. A good programmer out of the local 2-year tech school was many times more valuable than any BSCS degree of the day. It took a few years before that degree began to have more meaningful substance generally, and I think that’s happening with health informatics today.

    I’ve never been CEO or CIO, and I have few credentials of my own – so this is just my humble opinion.

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