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Monday Morning Update 12/22/08

December 20, 2008 News 25 Comments

From HIMSS Staffer: "Re: conference call. On a Friday HIMSS conference call, HIMSS staffers bragged about being the sole source of information for congressional staffers and the new administration. Said that was something they had worked towards for the past couple of years. Not everyone is convinced that vendors that develop systems that don’t even talk to themselves (Epic at Stanford, Kaiser, and PAMG, for example, can’t share information) should be driving this discussion. Nor that EMRs are going to improve quality or cut costs."


From UKIE: "House calls. Pioneering company uses system built on Adobe LiveCycle ES to enable housecall physicians to provide care to patients anywhere." Link. Janus Health, a San Diego developer of technology for house call doctors, develops a Web portal for charting and communication that lets doctors work from anywhere. I’m a little suspicious, though, at the gigantic announcement on the site that the company has secured a "broad" patent for any kind of house call-related technology, its prominence and wording suggesting that infringement lawsuits against companies with even unrelated house call technology is possible.


Ingenix Consulting, of which the former Healthia Consulting is now a part, is doing a big project and needs up to 50 clinical implementation consultants. Check their job page (although this posting is fresh and may not be up for a couple of days). I know a lot of folks have been cut loose in the past couple of months, so this is one of few big-scale hiring efforts I’m aware of. Healthia, of course, sponsored the HIStalk event at HIMSS last year, which was chock full of cool, smart healthcare people (that’s the Healthia people above, who look quite happy even though they were not having spirituous beverages like everybody else). 

Lots of hospitals have been cutting back on travel and education. I’m not sure that’s a bad thing. It seems like having people constantly running around to conferences and hearing the same messages makes them all think alike. Healthcare is notoriously imitative, where nobody is willing to do anything original or risky unless they can find a handful of other hospitals that have already done something similar (meaning nobody’s doing anything original or risky, of course, since everybody is average by definition). Tough times may finally unleash some desperation-inspired creativity.

New poll to your right: do you agree with the HIMSS recommendations to the incoming administration?

Lisa Romano is promoted to VP and chief nursing office of TeleTracking Technologies.

Henry Schein Practice Solutions launches DDX, an application that connects dental practices to dental labs (or medical practices to medical labs). The requirements page recommends Schein’s Labnet system on the lab end, though, so it may not be all that useful unless everybody is running Schein apps.

CCHIT opens a 31-day public comment period on the 2009 certification criteria, including those for PHRs.

WSJ has a video interview with Microsoft’s Steve Shihadeh, which also featuring gratuitous shots of a Microsoft sign and flag. Nothing new.

The Picower Foundation, a big philanthropic organization with $1 billion in assets, shuts down after getting burned by Bernie Madoff’s $50 billion Ponzi scheme. The foundation was started by a big Alaris Medical Systems shareholder who pocketed $1 billion when the company sold out to Cardinal Health. On the other hand, Jeffrey Picower, the Alaris shareholder, has had his own business and charitable dealings questioned by the SEC, with the now-defunct foundation being one. You know economic news is grim when a $50 billion fraud case barely makes the front pages among all the bailout stories involving several additional zeroes.

Hospital layoffs: Piedmont Medical Center (SC), Monmouth Medical Center (NJ). At OHSU (OR), executives take a 20% pay cut and may forego bonuses that averaged nearly 40% of base pay, holiday parties are canceled, and salary freezes and layoffs are coming. Cleveland Clinic has implemented a hiring and salary freeze for non-patient care positions.

In happier news, congratulations to the information systems department of Southeast Georgia Health System, which wins the holiday door decorating contest ("holiday" being the bland but legally acceptable substitute for "Christmas" or "Hanukkah" or "Kwanzaa" or any other observances that might conveniently fall into the December/January timeframe when the vast majority of us celebrate Christmas but can’t call it that).


Technicians working on the computerized security system at a brand new New Jersey psych hospital inadvertently unlocked all the doors on at least two occasions, allowing at least one patient to elope (that’s the word that came to mind since I’ve heard it used to refer to psych patients getting out, but it probably sounds funny to non-healthcare people, kind of like the annoying, contrived use of "naive" to describe patients who aren’t big narcotics users, i.e. "opiate-naive").

Three VPs leave clinical trials software vendor Etrials as the company restructures. The new CEO is Denis Connaghan, who you may remember from his HIT days at IBAX under Jeff Goodman. The announced plan: "get as many of our people close to our customers, and, really, to remove layers from the organization and become really customer-focused." If that’s a new plan of action, then no wonder the old CEO got himself eloped.

I’ll be around writing here and there this week (maybe), but if you won’t, have a wonderful Christmas, Hanukkah, Kwanzaa, Festivus, New Year’s, or National Bicarbonate of Soda Day.

E-mail me.

HERtalk by Inga

A couple of former Misys execs find new homes. SciQuest names Gamble Heffernan VP of marketing and Charles Lambert accepts an interim post as finance director for Helphire. Hefferman was the Misys VP of Community Solutions and Labert served as CFO.

ACS names David Bywater managing director of the Healthcare Solutions unit.

Healthcare informatics company Med-Vantage appoints Peter Goldbach, MD its new president and CEO.

Mission Regional Medical Center (TX) selects the IntelliDOT Phlebotomy Specimen Collection system.

CHIME awards several educational scholarships to its members. The winners of the CIO Boot Camp Alumni Scholarships are Robert Eardley, associate CIO at University Hospitals in Cleveland; Diatta Harris, director of IT at Erickson Retirement Communities (MD); and Nanda Lahoud, administrative director of value realization at THR. CHIME also presented the Edge Scholarship to Carol Roosa, CIO at Monadnock Community Hospital (NH) and the CHIME Women’s CIO Scholarship to Bridget Haggery, VP/CIO at Oregon Health & Science University.

St. Agnes Hospital (MD) names Dr. Norman Dy as physician director of pay for performance and core measures. (that’s a title I’ve never heard)

A former ER nurse is named  president and CEO of Pocono Health System/Pocono Medical Center. The hospital board of directors chooses Kathleen E. Kuck, who has spent the last year serving as interim president and CEO. During the last year, her achievements include the implementation of an EMR.

WellPoint Foundation president Caroline S. “Caz” Matthews joins the Perot System board of directors.

IPC acquires North Florida Hospitalists and Orange Park Hospitalists (FL). IPC now has over 600 physicians on staff, serving over 300 facilities.

Ochsner Health System (LA) implements WebDefend software at its seven hospitals.

Presbyterian Healthcare Services (NM), Marin Medical Practices Concepts, Inc. (CA), and St. John’s Medical Group (MO) select Medical Present Value to automate the payor contract management process.

The CEOs of two California medical companies are charged with billing Medicare over $3 million for equipment not provided patients or for items they knew patients didn’t need.

St. Joseph’s Hospital and Medical Center (AZ) plans to add a videoconferencing system to connect hospital specialists with referring physicians in the community. The Clinical InfoNET system will also be used as a CME tool.

SAP announces that MetroSouth Medical Center (IL) has selected and implemented its enterprise applications solutions across its healthcare system. The SAP applications include financials and procurement tools.

E-mail Inga.

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Currently there are "25 comments" on this Article:

  1. To HIMSS Staffer – the reason the systems, like Epic, do not “talk” to themselves is not totally because of the vendor, but it is because there is no standardized vocabulary, set of data definitions, and universal interface standards. Take it from those of us who have had to implement both inflexible and somewhat flexible systems (Epic) that allow users to define many of the fields they need, the flexible systems meet the users’ needs in the local deployment. I’d say anyone who doesn’t understand that, “shouldn’t be driving the discussion” either.

  2. Plus – Epic has a completely free Care Epic tool to allows any Epic site to share patient records on their “Care Everywhere” network and has been busting their butts trying to get people on board. Talbert and Memorial Care – both in California – were highlighted at their User’s Group Meeting in Sept 08 as being live and with something like a 1000 charts linked across two different Epic systems. They also referenced Care Elsewhere which will connect Epic to non Epic EMRs as the standards finalize.

    Epic will tell you that over a dozen places have decided to move forward on this and several are in active implementation across the country.

    This isn’t a tool issue any more. Just time for people to figure out the legal and privacy issues and get on with helping patients.

    This isn’t one to bash vendors, or at least Epic, on.

  3. It would be interesting if those who vote “no” on the survey re HIMSS recommendations to the Obama team could indicate what they disagree with. A lot of effort went into developing the document, and most if not all stakeholders were represented. I’m not saying it’s perfect, nor implying that HIMSS is or should be the sole source of input to the folks in DC who are trying to figure out how HIT fits into healthcare transformation. I am suggesting that if you’re not part of the effort, it may be that your valuable ideas won’t be heard.

  4. Whose fault is the lack of “standardized vocabulary, set of data definitions, and universal interface standards”?

    It would be easy to point the finger at the vendors, but their clients have not made these things a priority. And the clients have not made it a priority because they have no incentive to share data.

    It’s all about how we structure payment for healthcare. Until that changes, HIMSS’ $25 billion is spitting into the wind.

  5. CareEverywhere and CareElsewhere allow any Epic System to share records, as well as ensuring that records are always up to date – that is one of the tricky parts of communication. If two places exchange records, but then update independently, you have a fork in the EMR structure where there is info in two different locations. Every exchange after that creates another fork – this is a problem Epic has solved with this technology. They have numerous options, including patient administered and clinic administered options, emergency care options, etc… In Madison, where UW/Dean/GHC are all on Epic, they can all share information with each other instantly and all have up to date records on their patients.

    As ArtSpeaksTheTruth said, there are certainly reasons to bash vvendors, and I will add certainly reasons to bash Epic. This is not one of them. They only thing, as previously stated, stopping this from being implemented between every Epic site is customer legal and privacy concerns. The only thing stopping this from being implemented between Epic and non-Epic EMRs is the lack of standardization, although Epic can support transmitting CCR documents and similar documents structured to existing standards. The communication protocols, in addition to the EMR structures, are where standards are needed and lacking. I will add that, while I’m not a huge fan of Epic, this is something they invested very heavily in, developed entirely in-house, and did very well. They will lead into the future on this – they’re the only vendor I know of that developed a communication/exchange solution that is infinitely scalable, unlike most other solutions today that rely on central EMPI servers, central list servers, and/or central switches. Any approach that requires one server to act as a hub will fail on the large scale – even now, servers and clusters aren’t powerful or reliable enough to serve as hubs for 300 million people in the US, or more outside.

  6. “ that EMRs are going to improve quality or cut costs.”

    Its precisely this mindset that’s puts the slow clinical uptake of IT in to perspective. Of course there is evidence. It’s not just in the early adopters in Healthcare, it’s in every other industry that takes on the challenge of implementing an information technology strategy. There is a huge amount of evidence it can and will improve productivity and outcomes. And as the technology is allowed to mature, those improvements only get better.

  7. “New poll to your right:” You’ve described it that way multiple times now. At first, I just assumed one of us must be dyslexic – but now I see it’s because you and I are on different sides of the screen. Duh.

  8. On Epic…

    Looks like lots of “defenders” of Epic. But my question to all defenders is this: Why does Epic have such a terrible reputation for working with other ISVs. In speaking with these companies, virtually all of them far smaller than Epic, but a couple far larger, there is universal agreement that Epic is incredibly difficult, if not impossible to work with when it comes to getting data out of their systems to populate others.

  9. On HIMSS…

    The HIMSS Blueprint is nothing but a self-serving document, self-serving for vendors that is. Went through most of the 45pgs, not impressed. Did a post on it, breaking down the recommendations in the Exec. Summary – you’ll find it at http://www.chilmarkresearch.com THere was even a better post (with great comments) by Rick Peters over on The Health Care Blog (THCB) that is definitely worth a read – thought provoking.

  10. Back off, HIMSS. We need to focus on universal coverage and controlling drug costs. Maybe after healthcare workers can afford their own healthcare we can look at expensive electronic toys for all.

  11. I thought the poll was pretty narrowly focused- there was quite a bit more in the document other than CCHIT certification. But you’re right about participation- I haven’t seen any posts here or on any of the other sites about the transition team’s invitation to host healthcare reform discussions. Maybe a HISTalk-hosted webforum focusing on a response/addendum to the HIMSS submission?

  12. Everyone grips about standardization of vocabulary and data definitions, what are some examples from different EMR’s? And why can’t company invest in a tool like ETL work on creating a transformers for the different types then sell them as add ons to EMRs?

  13. Cowgirl – I suspect that many of the “nay” votes were concerned about “fairness” or some related snivelry, but I must ask: who qualifies as a “stakeholder?” You want $25 billion; are you speaking for the taxpayers? Do you and the HIMSS technocrats really care if everyone else pays to fund such an initiative, so long as it further insulates your jobs? I doubt it.
    Asking the opinion of HIMSS as to the best way to reform healthcare is a bit like asking the contractor who installs granite countertops what the best addition you could make to your home would be. Consider the source. I have never had the opportunity to quote myself, but I think it is appropriate here. This came from a recent response to Ralph Fargnoli, when he parroted the line that massive investment of tax dollars in HIT would cut costs.

    “Nothing mandated in Washington can decrease costs in the healthcare industry (except euthanasia perhaps). Every act of government costs the people money; every mandate costs money to comply with it. Do you truly want to cut costs of delivering care… or would you rather just shift the burden from one person to another (spreading the wealth)? Can you give us an example of another industry where massive investment of public money had the effect of lowering costs?”

    Lacy and others with a fetish for “free” healthcare would do well to follow the link posted by John@Chilmark. Very insightful.

  14. HIMSS should be careful about its bragging:

    1. It’s early in the new administration. Sheesh, they haven’t been given the keys yet.
    2. Healthcare is on the backburner until 2010. They have to deal with unemployment first.
    3. Rest assured, HIMSS staffers aren’t the only ones talking to D.C. congressional aides. Most major hospitals, health systems, pharma cos., device companies, EMR cos., etc. all have their lobbyists on the ground talking to them. Also, know that the businesses are there too talking about health care costs and ways to reduce those costs.
    4. But in the end, IMHO, all this talk of standardization is moot until we fundamentally change the way that we pay for health care in this country (i.e. it can no longer be on the backs of business.)

  15. @Cowgirl in the Dust

    First of all – HIMSS hardly represents everyone. I can’t imagine who represented me as a stakeholder.

    And, here is what we disagree with – a giant pork barrel of money to force out all of the existing, poorly received, poorly adopted, and badly implemented products from the legacy vendors that control HIMSS. Let’s see some original thinking on fixing healthcare, and not global rollout of the products based on the system that doesn’t work.

    We all know how this story goes. Under the guise of an “emergency”, the government will spend more money on the problem than there are people in the industry to support. So, the money will go to the big, established players who are well connected and have no market incentive in making things better. I’m sure something called “Halleburton Health Care Division” is in formation right now…

  16. Jedi Knight has touched upon an important point here. How often do we hear pleas for more tax money phrased in the context of an emergency or “crisis?” Similar to “wars” on poverty, drugs, terror, etc. This has been the statist M.O. since Wilson. “We ‘have’ to spend your money; it’s a crisis.”

  17. To John@Chillmark – Epic doesn’t have the best reputation when working with other vendors but it is far better than Siemens, McKesson, and Cerner. Eclipsys has been about the best I’ve experienced and Epic an easy second. The issues come in the way each vendor uses the loose HL7 data exchange specifications and does the vendor have a means of easily identifying differences, working them, and noting & displaying disparate data. I’ve never met a CBC that was defined the same way with similar reference ranges and I’ve seen few vendors that deal with data display of this nature in a similar fashion.

    To Curious – the best work I’ve seen for data exchange surrounds archetypes. With some of the tools they’ve defined, the concept moves from the theoretical and approaches the workable. The amount of work is daunting but there is a framework. IHE has also done some great work, IMHO, with XDS and PID. XDS seems to start in concrete areas with a definable scope, gets the vendors and users engaged, and shows concrete deliverables. The CCR is a good example of what could be moved into concrete use cases to work through the seamy details.

    In the end, many people interpret this space very differently. Some believe federated records are the answer, others believe open publish-and-subscribe message exchange is the answer and still others believe in open push interfaces that make every repository the ‘king’ for its intended purpose. Yes, I am leaving-out PHRs. So many organizations have so much to learn with just getting their own houses in order before large-scale external data exchange is done. I for one, advocate starting with the basics (examples = medications, allergies), and then moving to other areas (examples = basic encounter lists, pointers to textual or image summaries, text summary of a care plan). We can look for a perfect solution and get nowhere, or we can just agree to start somewhere and take a few steps forward while remembering we are here to support those caring for the patients.

  18. To add to why Epic may or may not have the greatest reputation for working with other systems:
    1. The Epic databases are very fault tolerant, which led to lots of faults existing for years with data type mismatching, invalid data being accepted, etc. Nearly all of those problems have now been resolved.
    2. Epic’s EDI folks are pretty overworked and understaffed, and have been that way for years. Lots of last second work gets done. Interfaces don’t get built until they’re needed by a customer. Instead of Epic management investing in development that will get used later ahead of time, they skimp until the last second. Epic’s a great company for reaction, proactive work is pretty much a fantasy. Serious flaw in strategy and culture there.
    3. Epic’s model of how patients, accounts, coverges, visits and stays work is pretty different than m any of its competitors, which can make interfaces very difficult (but not impossible). It should be noted that Epic’s model is a good part of the reason why Epic’s been selling so well. I have my doubts that making a universal data model to cover all healthcare IT products will be beneficial to progress in the field.

    Most of this stuff is what I’ve heard Epic EDI folks say or encountered myself. There’s other reasons on the culture side, but a lot of this stuff has received some serious attention from Epic in the last few years.

  19. I totally agree with your view that people who celebrate Christmas are being persecuted. In these parts 4 local radio stations started playing Christmas music 24/7 in early November. I miss the days when a radio station could start playing Christmas music right after the 4th of July. Before you know it they might be forced to wait until after Thanksgiving before they crank up the Christmas tunes.

  20. Wow; that has “ad absurdum” written all over it. Typical arrogance from a pseudo-intellectual. There is a world of difference between what Mr. H. described – an overly sensitive work culture that frowns upon any overtly Christian display or statement (but smiles approvingly at such from Jews and Muslims) – and what you have referred to as “persecution.” Nobody said anything about feeling persecuted, but you responded in truly zealotous fashion. Richard Dawkins would be proud. Merry Christmas!

  21. “an overly sensitive work culture that frowns upon any overtly Christian display or statement”

    No, I agree completely. We are so sensitive about Christmas that we are forcing radio stations to wait until early November to start playing Christmas songs, while I have been hearing radio stations play Ramadan songs since July.

    Free Baby Jesus!!

  22. Wompa I think that was a joke. Christmas music in July? More a commentary of the real or perceived “fundie” perspective of this blog, and some who post on it.. me thinks.

    I wish some politics were left out of here personally and wish we could get back to why Mr. Bush is not trying to save his business model by trying to convince Americans that sending jobs to India is a good way to create jobs in America. Especially when the campaign rhetoric was all about creating jobs in America. And why I.T cannot possibly work in Healthcare. But that’s me personally, more of that less Amway and war on Christmas please HISTALK!

  23. B2B – I get it. He is half-arguing and half-joking, but it isn’t very original. He is trying to prove that because his rediculous examples don’t exist, that anything on the same theme is just as ridiculous. He is attempting a “reductio ad absurdum,” but it is really a Straw man argument (and a logical fallacy). He has not refuted anything, because he cannot.
    I can’t say that I have noticed a fundamentalist tone here. Fundamentalist in what sense? That most people celebrate Christmas and find PC pandering to minorities to be both disingenuous and harmful to our culture? That’s fairly mainstream, irrespective of what people will say publicly (especially at work). Do you apply “fundie” to my positions on free-market solutions and government intervention? Please elaborate.
    Your other question is more complex, so I’ll leave you with this to ponder: if US companies got the same quality of work for the same price from a US worker as an Indian worker, would they bother going overseas? Other than around-the-clock-development, there would be no advantage. It is a cost/value consideration (like everything). Until American cost goes down or quality way up, it won’t change, absent protectionist intervention of course.

  24. You all can stop pretending. I know what is really going on here. Today is the first Day of Festivus, and you all are preforming “Airing of Grievances.”

    I was so worried I was the only practitioner.

    Happy Festivus to everyone.

    Time to go perform the feat of strength against my girlfriend and my dog.

  25. Wompa, I’m not making any sort of argument, strawman or otherwise. I agree with you. 2 months of Christmas music, decorations, advertising, creche sets on the town square, and people insisting that it is an insult to the Baby Jesus to say happy holidays instead of MERRY CHRISTMAS are not enough. We need to put those minorities in their place.

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