Readers Write 10/16/08

Thanks to all who participated in the live chat with Glen Tullman of Allscripts on Wednesday evening. It’s pretty cool that a CEO went on live with a blog and its readers (recall, too, that Glen was typing his own responses in real time!) Glen passed along a message to everyone that he was happy with the chance to connect. If you missed it, you can scroll through the transcript here.

From the Floor of the American Academy of Pediatrics Convention
By Willis Jackson

I’m tired and burned out, but here is the news from the floor of the AAP show from a veteran booth slut.

The traffic was not bad, as attendance was up this year. The Hynes Convention center is a bit awkward (multiple floors, each floor is "split" in the middle), but most vendors we spoke to thought it went well. The last few years, the AAP floor has not been strong.

The sharks are in the water. About 15-20 EHR/PM vendors who haven’t set foot near a pediatric show in the last five years are suddenly in the house. Some claim pediatric customization, but that just means growth charts and some templates they got from a practice. Why now? We all think that it’s the CCHIT money … the Feds, et al, have thrown the chum over the back of the boat and the sharks are circling. Meanwhile, the AAP’s COCIT committee can’t must enough $$ to get a decent program and none of these companies can be bothered to help underwrite them.

The Allscripts booth did not have a corrective sticker slapped over the logo on Monday morning. They also didn’t have many people stopping by, either. Misys, I believe, may be the only mainline EHR/PM vendor who WASN’T at this show.

Word on the street, and I heard this from more than a dozen folks, is that Office Practicum is "the only pediatric EHR to consider" right now. Personally, I have to concur. They have leapfrogged everyone, including (and especially) eCW, NextGen, etc. Every person spoke to who attended the EHR showdown said that OP crushed it, though one person gave a half nod to iMedica, if I remember correctly.

The GE booth was big, quite sparse, and usually empty as well. The sales people were on their phones rather than attending to customers. We presume they were checking the Dow.

A small group of well-known pediatricians is focusing on creating a centralized, Web-services driven clinical data repository for things like pediatric dosing, immunization algorithms, etc. Ultimately, it looks like the goal would be to pass the ownership of this desperately needed material to the AAP. If you don’t get it, imagine a quarterly HL7 download from the AAP against which all of your pediatric norms, etc., could be compared. Right now, it’s a mess. I’m hoping it works.

The nagging flies throughout the conference were the folks from Phreesia (phreesia.com – like "Frees Ya!" – get it? – they say it has to do with a flower, I don’t buy it). It’s the "Patient Check-In Company." They have a Tang-orange tablet (with a mag strip reader) that walks patients through the standard questionnaire process on the tablet. Your standard patient kiosk concept, except that it prints the report and the entire thing is ad-supported. Client after client, potential and otherwise, stopped by and said, "You have to go work with those guys. That thing is so cool!" So, we stopped by. And, no, they don’t interface with any EHRs or PMs yet. It prints the report. From their FAQ: "Q: How does Phreesia work with EMRs?  A: Phreesia is compatible with EMRs." By this standard, so are paper charts. And the mag strip – which would be really really cool for collecting co-pays and reading insurance cards – doesn’t work yet either. Yet again, a vendor has chosen to take the pharma+ money up front  rather than build a good product to interface with others. Wasn’t that the PCN model, almost 20 years ago?

Clinical Software Review -  Microsoft CUI – Introduction
By The PACS Designer

The Microsoft Common User Interface has been released for review and user input based on Microsoft’s Silverlight platform. This Microsoft CUI introduction requires you to download and install Silverlight 2 Beta 2 on your system. Once you download it,  reboot your system and launch the application to see how the Microsoft CUI works in daily practice. Here us the download link.

After logging off and relaunching your system, open the Microsoft CUI by clicking this link.

We are going to launch the "Patient Journey Demonstrator".  Once you are on the Patient Journey Demonstrator page, you are going to be navigating the "Explore UI" section first, so click the "Launch Button" under "Administration". Follow the steps below to learn the best method for navigating:

1. You will notice four physicians have their day’s schedule posted. The "Red Bullet" before Dr. Cox’s name indicates he is busy. Click the bullet to see the contacting options that are available to reach him.
2. Next, move your cursor over Dr. Cox’s box and drag it to the right and place it over Dr. Yu’s box. You’ll notice that the two doctors with green bullets are now first and second in the order of physicians. The "Green Bullet" means they can accept new patients in their daily schedule.
3. Dr. Cox has called to say he can’t see Hao Chen at 8:10, so drag Hao Chen to Dr. Gibbons at 8:10 so he can see the same doctor as his father, John Chen.
4. Click the "Clear Box" in the upper right hand section for Dr. Gibbons to see his entire schedule for the day. Also note that the other three doctors are on the right and can be clicked to see their daily schedules.
5. As the last step for this lesson, navigate by clicking the "Clear Box" of the other boxes so you can see the information they contain.

This ends the first lesson, come back to HIStalk to get the next lesson when it is posted. TPD will be doing a review of "Find a patient" next.

Rumor has it that Cerner’s Neal Patterson is trotting out his old "shot heard ’round the world" e-mail. You know, the pizza-and-parking lot one that sarcastically referred to EMPLOYEES instead of the HR-friendly “associates” because everybody was goofing off (I always write it as ASSociates because it sounds exactly what you’d expect dopey HR types to sit around dreaming up from their happy little floating HR cloud).

Somebody sent his internal-only e-mail to the press back in 2001, while the stench of dot-com smoke was still hanging heavy. Investors were spooked. Shares dropped fast and hard. Neal lost millions overnight while everybody was enjoying a good laugh at his "ready, fire, aim" approach.

Neal got the last laugh. Cerner headcount, profits, and his bankroll are immeasurably larger than they were back in 2001. And in a “goes around, comes around” kind of nostalgia, he’s supposedly proudly brandishing the famous e-mail to employees again, a shot across the bow as a reminder that he wasn’t kidding then and he isn’t now.

Here are some often overlooked facts about the original e-mail. Neal was griping about employees who were working less than 40 hours a week, which is an entirely reasonable bone to pick. He scolded his managers, not the slackers themselves, following the chain of command. It was a raw message intended for (and sent only to) the management team.

This is about as direct as you can get: "I think this parental type action SUCKS … what you are doing, as managers … makes me SICK … the majority of the KC based associates are hard working, committed to Cerner success and committed to transforming health care … this is a management problem, not an EMPLOYEE problem."

It wasn’t personal. It wasn’t even unreasonable (although the 60+ workweeks described are a bit much).

Neal isn’t some emotionless Wall Street hack brought in to push paper. He’s the founder, the owner, and the undisputed boss. When Cerner got too big for him to impose his will directly, he followed the chain of command in telling management to fix the problems he was seeing. Management by nastygram. That’s his right.

Everybody had great fun complaining and commiserating. Some EMPLOYEES left. Those with less backbone or fewer career options just kept whining safely out of Neal’s earshot while turning in fictitious timesheets.

Maybe one benefit of today’s economic meltdown is Depression-era common sense. Nobody promises lifetime employment. Nobody said work is always fun and fulfilling. Nobody promised that the boss might not occasionally behave like a horse’s ass in expressing disappointment in individual or group performance.

Employees with guts or valued skills don’t stick around to whine – they just move on. That’s how you hurt an unjust company (if there is such a thing) or an insufferable boss: you leave them, forcing them to forge on with a workforce of scared and compliant underperformers who have nowhere else to go. If the company thrives, you were wrong. If the company tanks, you were right.

Whether Neal is indeed rattling his e-mail saber again is irrelevant. The feel-good era of "associates" is over, if it was ever anything more than an illusion to start with. When jobs are hard to find, lots of people would love to have yours. Those would-be EMPLOYEES might even work harder, cheaper, or with less complaining. People tend to do that when they’re broke. That’s not to say that any particular company will start treating employees badly, but those who do will find it easier to keep them.

In that regard, Neal’s e-mail wasn’t the ranting of a tyrannical CEO. He was, as he often is, simply ahead of his time.