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July 2, 2008 Readers Write No Comments

Circadian Rhythm of the Organization
By Art Vandelay

All organizations seem to have times when they are and aren’t receptive to certain communications and changes. In order to convey this concept to my staff, I found an effective metaphor, the human circadian rhythm. This rhythm is the master clock for a human being (ex: when we sleep, when we are awake). This graphic explains it all.

When I use the rhythm to explain an organization, the clock applies to an entire calendar year, rather than a 24-hour period. The "clock" for the year is impacted by the overlay of the fiscal year and the seasonality of the business. For providers, the timing of the arrival of the new residents is another example of an impact. For payers, open enrollment is an example of an impact.

Many times in the information systems department, we are separated from the rhythms of the organization. We may have the best intentions, a great idea, and the perfect message tailored for the perfect audience, but introduce them at the wrong time. My organization is nearing its "fastest reaction" and "best coordination times" (see the graphic at 14:30). So this is when I look to introduce ideas where we are making broad changes. Examples include changes to our work request and project management processes. It is also the time when I start floating trial balloons on capital investments for the following year. In the same vein, I wait for the right time to celebrate the successes (see 21:00 – a "happy bed time story").

Finding your organization’s rhythm is an important part of a communication approach, as is tuning the message for the audience. Avoiding the bad times (ex: 2:00, 8:30), can be a key to success.

The PACS Designer’s Open Source Software Review – DBDesigner 4/MySQL Workbench
By The PACS Designer

DBDesigner 4 is a popular open source database that has been in existence for many years. It is now renamed MySQL Workbench 5.0.23 with the help of Sun Microsystems and the developers of DBDesigner 4.

DBDesigner 4 is a visual database design system that integrates database design, modeling, creation and maintenance into a single, seamless environment. It combines professional features and a clear and simple user interface to offer the most efficient way to handle your databases.

DBDesigner 4/MySQL Workbench can be compared to: 

(1) Oracle’s Designer
(2) IBM’s Rational Rose
(3) Computer Associates’s ERwin
(4) theKompany’s DataArchitect

DBDesigner 4/MySQL Workbench 5.0.23 is available for Microsoft Windows and Microsoft Vista only. With the release of the upcoming MySQL Workbench 5.1, support for Linux and OS X platforms will be added to enhance its usability. Additional MySQL Workbench 5.1 enhancements will provide live database querying functionality and should grow to a fully featured SQL IDE.

DBDesigner 4/MySQL Workbench 5.0.23 has reached the 400,000 download level, so it is a popular database choice of those who want an open source solution. Now that DBDesigner 4 has the support of Sun Microsystems in its merge into MySQL Workbench, users can feel confident that they will get support from a broad base of developers.

TPD Usefulness Rating:  9.


EMRs: Free May Not Be Cheap Enough for Physicians
By Mr. HIStalk

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter for a "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in March 2007. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

Now that Stark restrictions have been relaxed, hospitals are rushing headlong into the ambulatory EMR business. It makes sense. Hospitals have a lot of technology expertise and private physician offices usually have none. The government wants to increase the embarrassingly small number of EMR-capable practices, so throttling back Stark is a free solution that makes almost everyone happy.

Are EMRs the peace pipe that will suddenly bring the traditionally wary partners/competitors together in a long-awaited passionate embrace? Probably not.

Community-based physicians are often scornful of hospitals, seeing them as a hotbed of meddling management, questionable quality, and carefully hidden profits. Imagine what they’ll think when they first encounter hospital IT types, those grudging emissaries of a department built around rigid conformance to rules, perpetual understaffing, and a vision for the common good that squelches the individuality and self-determination that doctors thrive on.

Hospital CIOs like service-heavy, expensive vendors that won’t get them fired. They also like standardization and vendors that offer the theoretical possibility of integrating office-based EMRs with inpatient systems and RHIOs. For those reasons, I expect most CIOs will favor EMRs from big-iron, old-line ambulatory vendors like Misys, Epic, and Allscripts.

These are the vendors that small practices studiously avoid in many cases. They dislike them for the same reasons CIOs love them.

I spoke about this with Jonathan Bush, CEO of athenahealth, at the HIMSS conference. He has an interesting perspective, although not surprising considering that his company sells simple, easy to use systems that increase physician income through reduced claims denials.

Bush described the EMR offerings of the big, inpatient-oriented vendors as “elephant’s ass systems.” The little two-doc practice sees the hospital IT truck back up and out comes a complex application with loads of customization options, stacks of thick manuals, and no direct support except what the providing hospital has decided to offer. Free or not, there’s training to attend, configuration choices to make, and conversion from existing systems to plan. Oh, goody.

Doctors aren’t that thrilled with EMRs. Most of their benefit goes to insurance companies, studies have shown. Until pay-for-performance kicks in, there’s not much incentive. Plus, docs are always paranoid that hospitals will see how much money they make.

Benefits aside, EMRs take more of the doctor’s time to use. Something that’s free but consumes an hour or two more of the doctor’s day is hardly a welcome gift. All the doctor has to sell is time, and suddenly there’s less of it available.

Bush predicts what he calls a “hairballing up” of these feature-rich EMRs. The hospital may spend the money, staff a support center, and hand-hold the implementation, but there’s still a good chance the doc will throw up his or her hands and announce, “I’m not using this. I don’t have the time.” Then, they’ll either ditch the whole EMR idea or find an easier-to-use system that gives them a financial benefit.

Remember when insurance companies and hospitals gave away free PDAs with all kinds of supposedly doctor-friendly software on them? Docs lined up to get one. No one was smart enough to realize until afterward that asking for a free gadget was hardly a commitment to change practice patterns.

Perhaps hospitals have underestimated this hairball effect. They’re giving doctors systems that are mostly loved by hospitals: feature-rich, committee-designed for a large range of practice settings, and with extensive clinical capabilities that may or may not interest the physicians who are expected to use them enthusiastically.

It’s great that hospitals will help drive EMR adoption by private medical practices. Hopefully they’ll give the docs a voice in choosing systems that they’ll use before spending too much money on a monolithic system that may not fit all.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update.  To subscribe, please go to:  https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

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Reader Comments

  • BeenThere: Edit.. Your blog will be missed. Always great insights. They were appreciated!...
  • BeenThere: You blog will be missed. Always great insights. They were appreciated!...
  • Mr. HIStalk: That's not overly picky at all! (although I'm saying that as an overly picky grammar curmudgeon). Solstice: the exact...
  • debtor: I'm spending my own money to go to HLTH. I go to JP Morgan almost every year and HIMSS every couple of years. This year,...
  • Obfuscator: Not to be overly picky, but isn't Spring an equinox, and not a solstice?...
  • HIT Girl: I'm glad I know have a description for what I have experienced in two jobs now, "Moral Distress". I am not a clinician,...
  • Vendor Insider: Spring equinox, not solstice....
  • The Druid: Mr. H, Check https://en.wikipedia.org/wiki/March_equinox Apparently the vernal equinox in the northern hemisphere and...
  • st: shoptalk - goldenglobe hip happening NRF - oscars old , manufactured HLTH , HIMSS ...do the math... -retail and ...
  • Susan Hassell: You can't simply pile on more work and expect employees to not be stressed. How about not reducing FTEs until you implem...

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