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Monday Morning Update 6/2/08

May 31, 2008 News 15 Comments

From Dr. Know: "Re: Stanford. Spoke with a physician at Stanford today. They recently went live with Epic. The physicians are in revolt: ‘takes too much time and is very difficult to use.’  Also, if you admit a pediatric patient through the ER and they need to be admitted into the children’s hospital, all of the information needs to be re-entered manually from paper, as Lucille Packard runs Cerner and it is not interfaced with Epic, which is running at Stanford Hospital."

From kcstar: "Re: Jay Parkinson. For all of your fawning, it seems he was more of a self-promoter than a physician. The outcome was predictable, and as he even stated, ‘unsustainable’." Link. I interviewed him, but I wouldn’t say I fawned. He has some good ideas and I like the idea of going off the grid (as Scott Shreeve says), but he’s not fault-free. He thinks he’s got the entire system figured out despite being a new med school grad, he seems to be a bit smug, his kind of medical practice has zero relevance to the 99.99% of the country that’s not in New York City treating young and healthy hipsters for the occasional sniffle, and he seems to hate just about everything and everybody involved in medicine outside his little world. For a brand new doctor, he’s shrewdly wangled his 15 minutes of fame, but can his "tear it down and start over" ideas scale and is he really the best spokesperson for changing medicine just because he does magazine interviews and blogs and sometimes finds time to see a patient for cash? Time will tell. Give him credit for some pretty fresh ideas, at least, even though his experience with the non-fresh ones is minimal. I’m happy he took the time to be interviewed here since few in the industry had heard of him back in November and the ensuing debate was interesting.

Speaking of 15 minutes of fame, Dann, who started the HIStalk Fan Club on LinkedIn, let me know that it’s up to 58 members, which I find astounding and immensely gratifying (especially when I see the roster of highly accomplished folks who signed up – thanks!) I keep thinking I should offer something in return, like dibs on signing up for the HIMSS shindig or something (which, FYI, looks to be on track). Having a fan club is pretty darned cool, especially since being anonymous eliminates the possibility of egomania.

I do my share of Neal Patterson ribbing, but I’m also on record as being a fan in many ways (started Cerner and stuck around, didn’t sell out to some conglomerate, says whatever he damn well pleases). Case in point: Google is sweet-talking Cerner about jumping on the shaky Google Health bandwagon, but Neal is keeping them at arm’s length since he doesn’t buy the PHR concept, which he calls "electronic shoeboxes" that put the onus on consumers for record-keeping. I’m with Neal on that one. Consumers might use healthcare search engines and social networks, but they aren’t going to keep reliable medical records.

If you get Healthcare IT News, your information is available to anyone willing to pay $150 per thousand addresses for list rental. HIMSS calls the publication a "member benefit," i.e. you get a subscription by default to boost its ad rates, but apparently the benefit isn’t entirely yours. I must be the only person who has thousands of industry e-mail addresses that I won’t share with anyone.

Ah, to have minimally inquisitive publications willing to print whatever companies send over. Health Imaging News crows about McKesson’s "unveiling" of MyPacs.net. A 10-second Google fact-check would have shown that to be false: the original journal article describing its development was accepted in 2001 and the site was announced at RSNA 2002. Unless "unveil" means "bought the original company and put out a press release," it most certainly was not just unveiled.

Fundraising software vendor Blackbaud, whose products are used by many hospital foundations, will buy struggling competitor Kintera for $46 million in cash.

The 12-hospital group in Canada whose MEDITECH systems were down is back online. The company blames a corrupted file, but the media report says two US hospitals had the same problem at the same time. Seems suspicious that three customers all had corrupted files simultaneously.

Wyoming is considering allowing CNAs to administer medications, but only for specific drugs, most of them non-prescription. A waste of time, it would appear, since patients seldom need only those meds, so the nurse would have to go behind them to finish the med pass anyway.

Ontario will invest $109 million to improve ED efficiency, with part of the money set aside for IT.

Thanks for reading. If you aren’t getting the e-mail update or Brev+IT, you can sign up to your right (and I won’t sell your information). I’m always interested in rumors or thoughts, easily submitted by clicking that big green Rumor Report box to your right.

E-mail me.

Art Vandelay’s 10 Tips for Finding IT Budget Cuts

1. Create a list of all contracts. Detail the benefits of the components to the business. Document the key terms. Be sure to include the impact of canceling and restarting maintenance. Look for consolidation opportunities. Also look for areas of low impact if a cut occurred. Possibly negotiate longer-term maintenance deals (ex: go from one-year maintenance to three-year). Review contracts for network carrier services, cellular and wireless data, pagers, real estate leases, and power.

2. Review your application inventory and document functions. Look for overlaps and apps with few benefits. Consider the cost of consolidation and migration.

3. Review the project inventory budget impact. Consider initial and recurring costs. Look for overlaps, low tangible benefits, and those with long paybacks. Consider leasing hardware or software. Also consider risk-based contracts for services.

4. Create chargeback reports if you aren’t doing so. This requires developing a list of all costs and an allocation method. Look for business units with an inordinate amount of costs with little tangible return. In more progressive organizations, the reports allow leaders to monitor and adjust their variable costs with some explanation of the impact.

5. Create a database of staff ratings including true performance reviews. Next, align the output with the project inventory and application importance or benefits. Identify staff that can be cross-trained to pick-up other projects in the pipeline if a staff reduction occurs.

6. Run a zero-based budget with a fair-minded financial analyst involved. Note the areas where cuts occur so you are ready if asked.

7. Analyze the use of your reporting applications. Provide real examples of where the tools can benefit this type of analysis, such as staffing, lost revenue, cost reporting, and supplies.

8. Consider virtualization and consolidation. Potentially related benefits include reduced power consumption, heat generation, and maintenance costs Align hardware with key benefits. Focus investments in hardware on those platforms benefiting the business the most as well as where you have the most skills.

9. Bid all hardware purchases even if it moves them away from your standard suppliers. Minimally, this gives you leverage to keep your suppliers honest.

10. Consider use of open source software where you have or can buy or build skills.

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Currently there are "15 comments" on this Article:

  1. Twas Inga fawning …

    [Inga Says:

    Cough, cough. Um, Dr. Parkinson, I am in desparate need of a house call.

    Mr. H told me he had interviewed you. If I had known you were so adorable I would have insisted he fly me to NYC to handle the interview myself.
    November 5th, 2007 at 11:09 pm]

    Twas me predicting…

    [DZA MD Says:

    1 word…cherry picking. just a concierge practice for the worried well. not even close to a national solution for healthcare crisis in this country. one year from now he will be doing something else, and no one will recognize his name or game. but i’m not bitter…

    /30 year combat veteran (ED/Hospitalist)]

    and Mr Histalk right on as usual…

  2. While I think I appreciate the post, you should first get your facts straight about my training. Since graduating from Penn State COM in 2002, I’ve done a pediatric residency and a preventive med along with my MPH at Hopkins. I would only consider that recent if my hair was about as blue as the people running things right now. Also, no matter what you think I’m doing its highly likely you don’t yet understand and are not thinking about how to start a business. It doesn’t take much to understand that you have to target a certain market or demographic if you will before expanding to the masses. I don’t really feel like waiting 10 years on pilot studies and federal reimbursement reform to implement the Internet in healthcare delivery. Nearly every other industry did it years ago and its revolutionized industries and the consumer experience. Its embarrassing to be in a profession so behind the times only because the industry you love has decided to continue its absurd profitability at the expense of doctors and patients. . Maybe you’ll get what I’m doing someday in the near future, but in the interim, stick to the facts and please do the research before publishing errors to your readers.

  3. At least Inga is around to lighten things up. But Inga, I wouldn’t put myself in such a precarious position based on what all these boys tell me about you.
    You’ll have to find some other house call doc for you.

    And DZAMD…I wish I could time travel to, first, your retirement celebration and, second, to one year from now. Keep on pluggin’ away. At least you found the only “important” specialty out there. It blows my mind how condescending you are to primary care doctors, especially pediatricians. But I’m used to “smart” doctors like yourself without a lot of insight as well as people in your generation just “not getting it.” You’re also very busy I’m sure and don’t have time to even read more than two sentences about what I’m doing with Myca. It’s a whole new world sir. Please turn it over to us and go your merry way.

  4. Mr. H,

    I’m surprised by your comments about Google Health and Cerner. Neal Patterson’s comments sound to me like someone trying to protct his turf. My guess is that Google is approaching Cerner, Epic and other EMR vendors to move them into the 21st century by allowing the patient data they have stored in their databases to be accessible to the patients. Neal’s comments about PHR’s being nothing more than shoeboxes is dismissing the value that we patients will gain when forward thinking vendors allow us to actually see the data stored in the EMR.

  5. Mr. H,
    Afraid you and your dated HIT cohorts, ala Cerner are not quite seeing the bigger picture here as it pertains to consumer control of medical/health records. Certainly agree that many consumers will not readily take on this task. But there is a significant and growing portion of the population that will. Time to look forward, not backwards and as for Cerner, well, that is just them trying to protect their turf

  6. Wow…I was a little more of a fan of Jay until I read his rather nasty comments here. While I admire his drive to push healthcare and HIT to the next level, I’m afraid his dream might be thwarted by his attitude. You’re not going to make any friends by being defensive and coarse. And, for the record, I’m not an old & stodgy member of the HIT old school.

  7. Thanks North Carolina. I’m not trying to be nasty to anyone except people who think the status quo is good enough. We all know it’s not and some of us are more inclined to try new things with the hope that we’ll start streamlining some processes and deliver better care to more patients. I have some very outspoken critics who I think have some sort of Google alert on my name…and the anonymous DZAMD is one of them. Anytime my name pops up on the more popular blogs, he’s there to cut and paste the same argument. Literally…


    Anyways, I have no tolerance for people who are so close-minded they criticize any attempt to make things better for doctors and consumers. Doctors are getting squeezed every day and I’m trying to find solutions to help them do their job much better and gain more professional and personal satisfaction with their lives.

    Doctors should be coming together to support one another rather than slandering one another. That’s why I want DZAMD to go on his “merry” way and retire. Lazy, cut-n-paste criticism is simply counterproductive to the plight of physicians — especially those in my generation who didn’t experience the financial windfall of the 70’s and 80’s.

    Again, North Carolina, I’m sorry if I lost you as a fan, but please understand I will defend my creation to the naysayers because I strongly believe in making the doctor and patient experience much more meaningful to us all.

  8. If I retire people actually get sicker and suffer.
    so i think i’ll stick around and see what happens…

  9. I think that Google and Microsoft are both in the health IT space for the $$$s. I’ve heard them both at different times just come out and say it. And, I don’t mind it a bit, but I think we should understand their interest for what it is. There is a fortune to be made in medical search and if they can earn the right somehow to be the place you go to (or stay in) to do your medical searching, then they’ll benefit from the ad revenue related to that searching. Google has perfected making money from “free things” but nothing is really free. They charge the advertisers a ton of money for exposure to the patient / consumer. They sell the billboard space on your path to healthcare.

    Vendors like Epic have everything that Google offers via a MyChart type solution without the patient having to be responsible for it. Plus, it comes with a built in self service capability to reduce the cost of operations on the healthcare provider.

    There’s no magic, this isn’t philanthropy or anything of the like. It’s just simple business. Unseen as to how it will play out. For G or M to succeed, they need to steal a slice of the patient attention away from healthsystems. Yet healthsystems need to have a tighter electronic connection to the patient to keep costs down and outcomes higher. G & M want that slice to profit from it and are willing to do some work to get it (the free stuff). The healthsystems need to figure out if they will fight to keep the patient relationship in order to benefit from the patient self service and improved outcomes.

    Unfortunatly for a healthsystem to sell advertising space to their patients would be seen as unethical. Google and Microsoft know that and are likely willing to cut some back room deals to “do it for them”. I’d watch who associates with them and how. And, G &M don’t like to openly talk about what is really happening. They like to put the thin veil of doing something good for society over it.

    When this one is over I think we’ll see something similar to the drug company detailing type interactions with physicians again. It’s about advertising and influencing patient purchasing decisions. That’s where the real money in healthcare is and has always been.

  10. NotBuyingIt,

    I think you’re missing an important point in your argument. Patients have relationships with numerous providers many of whom are not using the same EMR. Google and Microsoft are working to offer a single point where patients can access all of that data. The industry hax a long way to go before that happens but Epic, Cerner and the others don’t have an interest in supporting that without their own pockets getting lined somehow.

  11. Mike, you’re correct, but again, the same standards that will allow an EMR to feed Google or Microsoft allow it to feed other EMRs. Peer to Peer basically, just like Napster started out. If doctors don’t want one more middle man sucking out a few more bucks, they can always go P2P. Question is – Who will play the role of the RIAA is this one?

  12. Well, this discussion on Google and MS is quite interesting.

    My view (BTW, just finished a market report on the PHR market, find it over at ChilmarkResearch.com) is the following:

    1) Google & MS are businesses, they are public companies, they have shareholders, so of course they have a business case for defining and supporting their efforts in healthcare, including these consumer plays. I don’t have a problem with that at all and actually see their entry into the market as raising the overall quality, security and privacy of PHR solutions going forward.

    2) In speaking with numerous 3rd party PHR vendors as part of compiling the report these vendors universally reported that EMR vendors refuse to play ball. The EMR vendors drag their feet in opening up their systems, even when their customers ask them to. No EMR vendor has a vested interest (ie business case) to support opening their systems. Unfortunately, standards are not mature enough nor adopted widely enough to make it happen either. These vendors will be kicking and screaming till the end.

    3) Epic MyChart and any other EMR consumer portals certainly have advantages, but all patient portals are tethered, and always will be to the host EMR. These systems do not provide a longitudinal record of health for the consumer and should they move, change physicians, whatever, its not like the consumer can easily take that tethered PHR and all the data in it with them. Google and Cleveland Clinic as well as BIDMC are providing portability and from what I hear, at least at Cleveland, much to the chagrin of Epic..

    3b) In addition to the tethered issue, patient portals also do not capture the full health record for those who may have multiple physicians.

    3c) And let us not forget the disintermediation of healthcare with medical tourism and retail clinics. An EMR-centric patient portal can not and will not address this issue.

    Many changes are afoot and as I outline in that report I mentioned earlier, the entrance of Google and MS into this market has some extremely broad ramifications across the entire healthcare sector that I don’t believe we can even imagine in our wildest dreams.

    Stay tuned, “The Revolution Will Not Be Televised”

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