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June 3, 2008 News 4 Comments

From Dr. D: "Re: Stanford. Seems like Stanford Medical isn’t the only lost account problem facing a certain big consulting company these days. Two more are about to fall due to missed milestones."

From DRPend: "Re: CEMHR. I have come to conclude that what’s really required is what could best be categorized as an Central Electronic Medical Health Record (CEMHR). The patient would have audit control and a place for personal information, but the vast majority would be a centralized repository that would take standardized medical data from a variety of sources. I favor the astronomy community standard of using geographically separate, redundant ‘central’ storage centers. I’d use a VMS login security OS with tunneling into other OS and Data environments. This would access a meta language-based interfacing engine to help build record variance recognition rules and provide an audit trail for anyone gaining access to the data. The big issue, of course, is security control, and that would most likely need a neural circuit algorithm based on multiple ID recognition criteria. No one method would work alone, so the whole process would require the kind of cross sectional parallel studies that only the Open source community could provide. Maybe it’s time to have a Healthcare Public Utility created which could bridge the gap between proprietary Software and OpenSource Software."

From Carol Wayne: "Re: Cerner/Google Health. Call me cynical, but I think there are other motives involved here. Of course the patient will not enter accurate medical information – they can’t. They don’t have it all in the first place and no one would trust something typed in by the patient for medical-legal reasons. BUT, if Cerner found a way to enter standardized information into a Google health record, in a fully locked-down, non-repudiated (is that a word?) manner, then the local hospital CIO will want to use that same message stream to populate their own data warehouse. So, Cerner and everyone else will be a step farther away from locking in the customers with proprietary messaging. Also, it will cost Cerner (and the other vendors) a LOT of money to convert to those kinds of standardized messages and no one is offering to pay the bill. So, while they can say that the PHR is useless to the patient/physician interface, there are other reasons to downplay the movement. Any patient with a complex medical problem can see the advantage of having an integrated data feed from multiple providers. Any vendor can see that, too, but wants to get paid. Stalemate." Agreed. Neal’s "electronic shoebox" comment is accurate for what PHRs are today, but of course he has the capability to turn them into something more, yet also has the proprietary interest to avoid doing so. PHR vendors need EMR vendors much more than vice versa. From a patient’s point of view, that sucks, but from a company/shareholder angle, why would I spend resources to help a potential competitor (and my existing competitors) for no benefit? Answer: if customers demand it. So in that regard, only Cerner’s customers can change his mind.

From Bobby Orr: "Re: electronic shoebox. Neal should be careful about throwing stones in glass houses. He already tried to put out a PHR that he charged for (HealthVault is free) with little or no success a few years ago. It was donated (free) to Type I juvenile diabetics and even that had little traction because everything had to be done by the patient (or their parents). Regardless, it is a solid concept, especially for chronic disease management, regardless of who provides the tool." Excellent point — Cerner does indeed offer its own PHR, so Google and MSFT are its direct competitors (and free).

From Dagny Taggart: "Re: Epic and NHS. About nine months ago, a high-level delegation of NHS personnel paid a visit to Evanston Northwestern Healthcare in Chicago to take a look at their Epic installation as a backup vendor. They were very impressed with what they saw, so much of the groundwork for Epic and the NHS has already been done."

From The PACS Designer: "Re: virtual storage networks. In the months to come, you’ll be hearing more about a new concept called the Virtual Storage Network or VSN. It is different from virtualization in that a VSN is an enterprise virtual network addressing storage. It makes efficient use of all storage locations within the enterprise through disc and tape partitioning. For example, if you have 100 PCs, the hard drive of each PC will be partitioned to grant 10 to 12 percent of that hard drive to VSN usage. An advantage that you can gain through this method is, if a PC is stolen, you will not lose the entire record file if parts of the stored file are archived elsewhere."

Listening: The Hellacopters, Swedish punk/pop, on their farewell tour right now.

Clarification: Healthcare IT News is not selling its e-mail list (I wasn’t implying they are, but an unrelated general comment I made might have misled one or two people) and the mailing list it is selling doesn’t include HIMSS members (which their list broker didn’t say in the announcement I cited). The publisher laid on some heavy-handed sarcasm in a forum posting that I didn’t care much for, but I’m still willing to clarify.

The Rockefeller Foundation will host Making the eHealth Connection: Global Partnerships, Local Solutions in June and July in Italy. It’s invitation-only, though.

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Allscripts sent over a transcript of a couple of its customers touting its proposed merger with Misys. A snip: "It supports our best-of-breed strategy. We really went out there and said, Misys is the best on the practice management side, and Allscripts is the best on the EHR side, and we took a risk. We’ve been rewarded and we truly believe that both products are the best in the industry, so this potential merger really supports our best-of-breed strategy." That’s one thought, but here’s another: do enough prospects simultaneously feel that the respective company’s products are good enough to want them both and, even then, which products do you run with to avoid confusing the market? I’m not sure Misys has strong enough PM offerings to match up with the Allscripts EMR, especially with strong competitors tearing up the market on price. Of course, it doesn’t matter at all what Allscripts or I think … prospects will vote with their dollars and nobody can predict that outcome.

Dell Children’s Hospital (TX), less than a year old, gets a rented diesel generator courtesy of Austin Energy after that company’s failover to a backup generator didn’t work, leaving the hospital with power outages on three occasions.

Here’s an opportunity: I’ll be taking a few days off in July and I’m looking for guest authors who can amuse and inform HIStalk’s readers (but not too well since I don’t want to obsolete myself). Inga likes the idea of people whose first name is John/Jon (Halamka, Glaser, Bush), which is a fun. I like CEO-types (Judy, now’s your chance), clinicians, pundits, or celebrities (if you’re connected by one of those six degrees of separation thing to some big star who isn’t illiterate, they’re in). E-mail me if you’ve got the right stuff. I’ll feel better about being away if I know it’s in good hands, along with Inga’s of course.

Walter Reed Army Medical Center says an "outside company" breached one of its PCs, possibly exposing the information of 1,000 patients.

Not surprising: despite what I’m pretty sure were quite a few nominating votes, somehow I didn’t make the ballot for the 100 Most Powerful People in Healthcare even though I’ve never heard of many of the folks who did. I cry dangling chad!

A reader is looking for an HIT colleague from the 70s, Dr. Ed Heller. E-mail me if you can help. Thanks.

Just announced: HLTH Corp. will sell its ViPS data analytics business to General Dynamics.

Jobs: Product Consultant – Sales Support (virtual), Systems Analysts (FL), Sales Executive – McKesson Practice (PA), Executive Project Manager – Nationwide (virtual).

St. Mary’s Hospital (WI) goes live on Epic, one of 20 SSM hospitals that will be implemented by 2011 at a cost of $330 million.

Interesting: a new study gave tablet PC-powered health surveys to adolescents waiting to see a doctor. 59% of respondents screened positive for injury risk, depression, or drug abuse, allowing doctors to address them immediately. I’ve read other studies showing that patient histories are more accurate when completed on the impersonal computer rather than face-to-face or on paper because issues perceived as embarrassing.

An article about a medical tourism conference predicts the future: you take your own blood sample and mail it off, check your result on a web site, then call a 24-hour help line of Indian doctors to get advice on what to do next (or in which country to have surgery). Unrealistic? Not if it saves money.

Speaking of medical tourism, patients are sneaking across the Mexican border for better medical care. From the US side, that is, since hospital care in Mexico is apparently a lot more responsive and less expensive. Says a patient: "U.S. hospitals are too slow, too expensive and treat you like a herd of cattle. It’s a vicious cycle of people and doctors who abuse the system."

The Wall Street Journal reports that hospitals or their collection agencies are selling patient debt in online auctions, raising concerns that buyers (often collection agencies themselves) will strong-arm patients to pay up (a novel concept in healthcare). Auction sites mentioned: ARxChange and Medipent.

The opening of a new Providence Park Hospital (MI) is delayed a month to install EMR hardware.

CMS says that hospitals can pay for custom interfaces to physician practice EMRs without violating Stark.

Just in case you want to read the 2003 employment agreement of the president of Allscripts’ TouchWorks division, it’s on the web for some reason.

Thanks to readers for reading and sponsors for sponsoring. Criticisms aside, I spend a ton of time trying to get you the right information quickly (with the occasional entertainment thrown in). I’m proud that, in my reader survey, 75% of you said HIStalk helps you do your job better.

Idiotic lawsuit: a guy claimed he broke his wrist in a single-car accident in 1999, but the hospital ED didn’t X-ray it. He got surgery later that year after a walk-in clinic visit and sued the hospital and three doctors. He agreed to delay the original 2005 trial date, skipped a 2007 date claiming he had new injuries, and didn’t show up at all for trial this year. His lawyer quit, he disappeared, and the defendants had to hire a skip tracer to try to track him down (with no success). Case dismissed.

Odd lawsuit: a hospital employee sues her employer for not training her to walk across a rug, leading her to fall over it. The employee tripped on a scrub room rug and fell. She’s suing, claiming permanent injuries, past and future pain, mental anguish, impairment, disfigurement, lost earnings, medical expenses, and attorneys’ fees.

E-mail me.

Inga’s Update

I hear that Medventive, a developer of evidence-based medicine software solutions, has raised $3.55 million in Series B funding. Former Sentillion president Nancy Ham is president.

I could use a little funding myself, despite receiving my economic stimulus check in the mail this weekend. I suppose I should count myself lucky that I got one at all, but it’s hard to feel stimulated by $10.78, especially after just spending $100 (!) to fill up my SUV.

Ophthalmic PM/EMR software vendor First Insight partners with DrFirst for e-Rx and medication reconciliation. Meanwhile, Kryptiq is GE’s exclusive Centricity e-RX partner.

A delegation from the Hashemite Kingdom of Jordan trekked over to Midland Memorial Hospital to check out their Medsphere OpenVista installation. I have actually been to George Bush’s home town and found the people very nice, but I wonder if Midland felt a little “simple” compared to life in a Kingdom.

The birth of the new Allscripts-Misys Healthcare Systems, Inc. is still on track, following the expiration an anti-trust regulatory waiting period (13-syllable name and all).

If you are a road warrior, you might want to check out Computerworld’s list of “8 incredibly useful tools for road warriors.” Lots of nifty gadgets mentioned including an oldie but goody, cellophane tape.

Eclipsys and Emerging Health announce a partnership to provide joint services in the NY/NJ/CT area. Eclipsys will leverage Emerging Health’s implementation expertise while Emerging will market Eclipsys and provide remote hosting services.

The Insight Research Corporation, which does market research for the telecom industry, releases a report estimating the US healthcare system will spend $55 billion on telecommunications services over the next five years. That is a compounded rate of 8.4% over the forecast period.

The Federation of American Hospitals, which includes for-profit members LifePoint Hospitals, Universal Health Services, and Tenet spent $630,000 on lobbying in the first quarter. That is about half of what Oracle spent over the same period.

Our little HIT world seems fascinated by the drama going on in the UK and their NHS. It’s somewhat like our culture’s intrigue with Britney’s struggles or the latest celebrity divorce. We’re addicted to other people’s problems because it makes our own struggles seem smaller. If you need to feel better about your little world, read about the recent woes of several trusts that were forced to shut down their Personal Demographics Service after a software upgrade.

The Kroger Company invests in The Little Clinic LLC and plans to expand the grocery chain’s walk-in medical clinics. Kroger operates 26 PA and/or NP-staffed Little Clinics.

E-mail Inga.

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Currently there are "4 comments" on this Article:

  1. If you let EMR Vendors openly advertise from a search feature, even if it didn’t read directly on the patient medical record and only advertised based on what the patient typed in to a search field, every EMR Vendor would offer a “free PHR”.

    And yes, P2P would allow a patient to move their records between any health system they wanted and / or keep them in sync.

    Funny how everyone falls for the slight of the Google/MS hand on this one.

    Epic (and probably others) are touting a non tethered component of their PHR as well. They refer to it as Lucy in the sky. They are talking / showing ??? that it will allow patients to self direct record transfers. And, something binding multiple PHRs is nearing a live date.

    Anyone have insights into what other vendors are offering on this path?

  2. Not another acronym, please. CEMHR. BTW will there also be a CEMuHR? (ie the one on medical un-health). I thought after the introduction in the NEJM of the PCHR we had reached the acro limit, but apparently not.

    In my view, an EHR should be a repository of all health and care related aspects, including observations from nurses, homecare providers, physiotherapists, etc., as well as over-the-counter-drug use and personal and lifestyle observation from the patient himself. Only then it can serve its purpose. And only then it will become one of the main tools in making care as well as cure more effective, also cost-wise. This repository will effectively be (partly) a collection of links. (see also here: http://blog.icmcc.org/?p=1320)

    BTW in the whole discussion I get the impression that the world exists of the US only. Still, there are a couple of people more around, who also have records. It would be nice to have a kind of record that can be used when traveling, in both directions. Also for the long term view, secondary use of data and stuff like that, it would be handy if we would use the same standards and coding worldwide.

  3. Don’t feel bad about not making the top 100 ‘whatever it was supposed to be’ list. It was laughable at best. Nancy Pelosi? George W. Bush? What about A. Neil Pappalardo whose lifetime investment in healthcare IT currently runs approximately 20% of all hospitals in the US and Canada? (Not including those that run MUMPS) That’s real power!

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