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Monday Morning Update 5/4/09

May 3, 2009 News 14 Comments

pdf From Deborah Kohn: “Re: Kaiser’s PDF formatted PHR. PDF Healthcare is a Best Practices Guide (BPG) and Implementation Guide (IG), published in 2008 by two standards development organizations (ASTM and AIIM). PDF Healthcare is not a vendor, product, or service, nor is it another standard. PDF Healthcare describes little known attributes of the Portable Document Format, an international, open, ISO-ratified and published standard that is freely viewable on almost every laptop/desktop around the world, to facilitate the capture, exchange, preservation, and protection of health information, including but not limited to personal, handwritten documents, structured or unstructured clinical notes, structured laboratory test result reports, (unstructured) word processed reports, electronic forms, scanned document images, digital diagnostic images, photographs, and signal tracings. Until members of the PDF Healthcare Committee were told by HIMSS09 staff members that as an ‘unsanctioned HIMSS09 event’ our PDF Healthcare demonstration in the Hyatt Hotel McCormick Place had to ‘cease and desist’, PDF Healthcare was successfully demonstrated to an enthusiastic audience. One demonstration showed how clinicians in Southern California securely exchange patient health information with only a 3G phone, encrypted USB drive, and a printer.” I found the above participant slide on the AIIM site, so maybe someone can chime in as to whether it’s going anywhere.

It really bugs me that HIMSS locks up every possible meeting venue so that nobody can do anything without HIMSS approval anywhere near the conference site, the one time a year where people can connect without add-on travel costs (I’m pretty sure the most interesting events would be unsanctioned). I still say there needs to be a conference designed for the benefit of attendees, not exhibitors, with more and better educational sessions that are cutting edge, not submitted a year in advance with occasional unvetted conflicts of interest. A non-profit or small company shouldn’t have to spend GE-like dollars just to get a once-a-year audience in Neon Gulch.

From Curiously Underfunded: “Re: stimulus. Does anyone know how the physicians will go about collecting the stimulus funds? I keep reading about the qualifications, etc. but have not been able to find anything about how to apply!”

Jon Manis, CIO of Sutter Health, posted a comment in the HIStalk Forum about its Epic project. Not to be outdone, Neal Patterson (or so he says) posted the full text of Jon’s e-mail to staff (thanks to the readers who sent a copy of the e-mail to me as well). The original post by Francisco Respighi was a bit more speculative, inferring mass layoffs, which may or may not be the case. None of this is to cast judgment on Sutter, of course, but to call attention to what’s going on in the industry in general. Sutter has to run like a business, so if they are forced to make tough decisions that change long-term plans, then they probably aren’t the only one.

Speaking of Sutter, it signs a contract for Ingenix Impact Intelligence, giving doctors in the Sutter network access to metrics, utilization, and disease management information.


EHRtv posts its HIMSS interview with Jonathan Bush, conducted at the HIStalk reception. I’m really impressed with the video quality of what Dr. Eric Fishman has put together – it’s like watching TV, complete with high-quality titles, transitions, and great audio. Many people think YouTube is the standard for Internet video, not realizing how bad their proprietary compression and streaming technologies are (great for putting up cell phone video of a dog chasing its tail, but not great for anything you want to watch or listen to for more than 60 seconds). Some others of the many interviews he’s posted: David Winn of e-MDs, Tee Green of Greenway, and former Congressman Richard Gephardt. It’s really interesting to see and hear these folks directly. I saw Dr. Eric and he was working his butt off at HIMSS, seemingly everywhere with his camera crew. I think EHRtv is brilliant. I keep bugging him about how it works technically, so he’s probably pegged me as a fanboy stalker.

Thanks to everyone who completed my reader survey. I’ve already got a to-do list of reader-stimulated ideas that I’ll be putting in place. One expressed concern that the survey implied big HIStalk changes, even though it’s the same old survey I’ve been using for years. Not so — I’m not looking for new sponsors, planning to make any part of HIStalk a fee-based subscription, or adding new kinds of advertising (to answer specific speculation). I’ve been extremely fortunate that companies e-mail me saying they are interested in sponsoring, I e-mail back a rather primitive information sheet on page views and all that, and they either sign up or I never hear from them again. Probably 90% of those who get involved do so simply because they derive value from reading HIStalk and want to give something back (I know that sounds hokey, but I’m happy to report it’s absolutely true). Anyway, if you like HIStalk in its decidedly amateurish form, you will be pleased to know it’s not going to get any slicker (but you will like a few tweaks that were suggested, I think). I sent Inga the results Friday evening and got her “wow, they really like me!” reply minutes later, so she’s happy she scored well in the “what parts of HIStalk do you like” question (I rated her highly myself). And the question that had us both preening: “Over the past year, reading HIStalk has helped me perform my job better.” Those answering yes: 79%. That’s the ultimate metric and I’m really proud of it.


One other item from the survey. I’m surprised at how many industry newcomers read HIStalk to learn about healthcare IT (a third of readers have been in HIT for less than 10 years). I’m going to do whatever I can to better serve that audience. Some folks said they are ashamed to admit that they don’t know some of the acronyms or products I mention, while others said they would find great value in having HIStalk content segregated by topic (so if you wanted to see everything about Cerner, for instance, you could look in one place). I don’t know where I’ll find the time, but I may try to put together something like that in some kind of encyclopedic format, maybe with reader contributions (that screams Wiki, doesn’t it?)

People have asked about being able to view article comments easier. Options:

  1. Click the Show Comments link at the bottom of an article to display the comments posted for it.
  2. The Recent Comments list in the right column shows the most recent commenters and which post they commented on.
  3. I just added a new Comments Page that shows the first few lines of the 30 most recently posted comments. If you see one you like, you can click the title to jump to the article, or click the commenter’s name (below the blue box) to jump directly to that comment (this is a new WordPress plugin that I installed to try to address the reader’s comment question).

Picis is offering a free Webinar called Best Practices to Help Improve Clinical and Financial Performance in the ED on May 12.

The local paper covers the ED computerization of A.O. Fox Memorial Hospital (NY). It’s McKesson, I believe.

Most of you (60%) don’t know or don’t care about Oracle’s acquisition of Sun, according to the last poll I ran. It will be a good thing for HIT, said 22% of respondents, while 18% said it will be bad. New poll to your right: if you are in hospital management, is the financial mood better or worse than it was in early winter when both the economy and the weather were bleak? Some say it’s looking up in general, so I’m interested in what’s going on at your place.

Someone posted a YouTube video of a demo of Cerner PowerChart using MPages at Lucile Packard Children’s Hospital at Stanford. MPages allow creating scripts or Web pages (including AJAX apps) that launch from tabs on the Millennium application screens. It’s pretty cool to see information widgets being dragged and dropped to create a custom Web page like iGoogle.

On HIStalk Practice: Dr. Lyle on information overload, Dr. Gregg Alexander on the creatively maladjusted, and our usual medical practice-related news and snark. If you want to be a guest author, either one-time or ongoing, let me know.

Markle Foundation releases its report (warning: PDF) on “meaningful use” and “certified or qualified” EHRs. Its seven principles: clear metrics are needed; use of information and not software alone should be the goal; use of existing electronic information such as medication lists and lab results should be rewarded first; ambitious goals should be phased in; EHR certification must include capability to achieve meaningful use and to also address security and privacy; ARRA support should include lightweight, network-enabled systems and not just big iron EMRs; and patients and families should be able to put their EHR information in whatever personal health record system they like. A bit different from the HIMSS “buy more stuff” approach, although both emphasized outcome metrics. The gripe with both: representation was heaviest from vendors and high-profile nonprofits whose people have the time to spend on non-revenue generating activities (unlike the average small-practice doc who’s trying to survive and, despite the preponderance of healthcare they deliver, who is also minimally represented by all these thought leader think tanks proposing their future).

Jay Parkinson gets more press than anybody else who’s running a three-doctor practice for primarily healthy, young, cash-paying patients, so it’s not surprising that Newsweek picks up his story, complete with the requisite hipster fawning (although at least omitting the usual GQ-like stubble-and-black-pants photo shoot), but also pointing out that his radical model benefits himself as a capitalist more than society in general. He follows the usual script, bashing insurance companies, EMR vendors, “old people” (meaning anyone on the wrong side of 40, apparently), and anyone who doesn’t spend their day on Facebook (“We’re starting with those who get it. Facebook started in 2004 at Harvard. It wouldn’t have started with old people. But you know what sucks? Now your mom is friending you.”) You know what sucks? Having a problem like a heart attack or chronic illness and learning that your franchised 2.0 photogenic IM-and-Facebook doctor doesn’t want anything to do with you. That’s where most of the value (and expense) of the healthcare system exists, not in having someone willing to bike over to your loft to prescribe sore throat ampicillin before your midnight poetry reading.

Hospital layoffs: Metrohealth Medical Center (OH), 270, Reading Hospital (PA), 106.

The former IT director of a Houston non-profit organ donation center pleads guilty to deleting its electronic data (including backups) after she was fired in 2005. She’s facing up to 10 years in jail.


Where will this fit in the PHR and financial responsibility market? Quicken Health Expense Tracker, a free, Web-based tool available for customers of a few insurance companies.

Number of hits Googling “swine flu”: 263 million. Number of deaths of US citizens from it: zero. Value to TV stations, newspapers, and J&J, the makers of Purell: priceless.

EMR vendor MedLink International says it has signed a deal with CBS Radio to develop what it seems to think will be a WebMD competitor, a revenue sharing portal tied to six New York affiliates of CBS (formerly Infinity Broadcasting, currently in near-collapse after Howard Stern left for Sirius). Unlikely. In the mean time, the one to beat might be Everyday Health, a mashup of several other sites that bought Revolution Health’s old site and draws more traffic than WebMD.

Odd: an illegal alien who gave up custody of her severely brain-damaged four-year-old daughter while fighting a drug charge and being evicted for not paying rent is fighting deportation and trying to regain custody. The daughter is a citizen since she was born here; at stake is the potential multi-million dollar proceeds of a lawsuit against Vanderbilt University Medical Center, which the mother claims caused her daughter’s problems by puncturing a vein.

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Currently there are "14 comments" on this Article:

  1. Re: HIMSS
    The shame is that the organization was hijacked a couple of years ago by people who saw in it a potential for self-aggrandizement and personal wealth building.

  2. Jay hates medical practices (except his own), software vendors (except his own), and anyone older than him (except his own boss at Myca and anyone else willing to be his star maker). He should start Jay’s Medical Insurance Company so he could profit from his media-carried disdain there too.

  3. No definitive word yet from the NVCHS meeting last week on how docs are going to get paid through the ARRA bill or how it is going to change over the course of the planned 5 years. Some points on getting paid:

    – Dr. Rapp from CMS acknowledged the fact that paying individual docs is going to be a challenge for CMS initially because of the strict annual cap on financial incentives available.

    – Got mentioned by a few individuals about the possibility of instituting some type of waiver for FY2011 so that docs who aren’t ready at the start date but can demonstrate some kind of intent will be able to still get the max reimbursement available. I bet good money this happens or that the program gets pushed to a slightly later date.

    – Lots of talk on “meaningful use” to get paid but nothing definitive. Likely going to have to wait until late summer/early fall to have more clarity on this issue. Quality reporting (like PQRI) is going to be a part of this but lots of debate on how fast to implement and how feasible it is for most docs to do this.

    – As for the submission data to CMS (or another third-party entity) to get paid, there were several ideas floated and none of them were concrete enough. Leavitt and Clancy mentioned this idea of a clinical dashboard that will handle submissions. Complete “pie in the sky” stuff that is largely nonsense at this point and completely unrealistic even in 2-3 years for most vendors & small practice. Others mentioned HIEs as a possible aggrator and submitter (again fat chance in 2 years for most providers) and the issue of registries (now there are 31 certified registries submitting data to CMS for PQRI). Likely it is going to be a bit messy in 2011 and probably rely heavily yet on administrative data.

    Basically NVCHS was lots of talk last week and short of much substance on dissemination strategy, implementation support, data transmission and submission, and mostly importantly on how to get paid.

  4. “You know what sucks? Having a problem like a heart attack or chronic illness and learning that your franchised 2.0 photogenic IM-and-Facebook doctor doesn’t want anything to do with you. That’s where most of the value (and expense) of the healthcare system exists, not in having someone willing to bike over to your loft to prescribe sore throat ampicillin before your midnight poetry reading.”

    Tim: U R a funny guy! If you ever get tired of the healthcare industry you should consider a career as a comedian or sarcastic talk news pundit. LMAO!

  5. Nice to see someone finally categorize Jay accurately.

    LOL. The truth hurts, and it’s super that HISTalk has the guts to call it the way it is.

    Keep up the good work!

  6. I had to make a tough choice for that Fast Company photoshoot. Wear the cool black t-shirt or the other one that says “I <3 HIT: Where everyday is 1986 day!”


  7. Kudos on the JP angle. I’m not a primary care doctor, and I applaud the idea of doing things a little different, but how is his practice any different from the “ritzy” concierge practices? Sounds like cherry picking to me, except he’s taking it one step farther (cash-only AND young/healthy). He may be gettin’ his, but that’s coming at the expense of many other primary care docs taking care of the non-well-off and/or sick, working long/off hours, etc. – the stuff that doctors tend to do. His condescending tone towards those old geezers that are too busy caring for their patients to Facebook and IM reflects mighty poorly on his part.

  8. Why all the JP hate? I agree with some of the comments in the Newsweek article – this is not the future of medicine. The patients are paying a monthly fee + fees for appointments, tests, etc. And he still recommends you have high-deductible insurance for hospital stays.

    But here is what I do like about it — its different. It’s attracting attention. How would health care in this country be different if doctors didn’t have to submit insurance claims, but rather patients submitted their receipts for medical expenses (sort of like you might do today for HSA)? What if insurance companies had to be accountable to their real customers (the patients)? That wouldn’t be a perfect system either, but is it (or should it be?) too much to ask to patients to take some responsibility for both their health care, and the financial aspect of their care?

    And I like JP’s angle that doctors in his practice can actually get paid enough, doing primary care, to dig themselves out of the huge valley of debt they rack up in med school. If the article is right, and only 25% of our docs are doing primary care (in the US), then that suggests another piece of this system is broken.

  9. re JP…not a thing has changed, except that really nice looking MYCA UI has not broken wide yet.


  10. I used to think that Jay Parkinson’s model of providing access to inexpensive primary health care for uninsured New Yorkers was terrific. Then he decided to stop practicing medicine, jump into entrepreneurship, make a whole whack of money with speaking engagements (where he, very rudely, disrespects “old people” and affronts the notion that universal access to basic health care should be a right) and uses his mouth to dig himself a giant grave. The lack of primary care physicians is a huge problem, and Jay leaving after a paltry year in practice to fulfill his capitalist aspirations is not helping. Thanks, Mr. HIStalk, for being open-minded and calling it as it is despite last year’s glowing profile on JP.

  11. For Curiously Underfunded the challenge for reimbursement is that we still do not have clear definitions of what constitutes “meaningful use” or “certified EHR”. Do know that the folks at HHS are working feverishly, burning the midnight oil to get the terms defined and out on the street for public comment. Predict we’ll see something out of HHS/ONC no later than mid-June.

    FWIW, did a post on the “meaningful use” topic last week that may give you some idea of what to expect. http://chilmarkresearch.com/2009/04/30/making-meaningful-use-well-meaningful/

    As for Jay P. well Mr. H, do not quite share your strong feelings about this as I do like pretty much anyone who is trying new things in this staid industry sector, and Jay and his team are definitely doing something different. That being said, the hype regarding Myca & Hello Health is far far ahead of reality and would be good to see the press take just a bit more of an investigative approach rather than fawning over the new doc on the block.

  12. Re: Googling “swine flu” you are incorrect; a 23-month old boy died in Texas.

    [From Mr. HIStalk] He was a visitor from Mexico. I said “US citizens.”

  13. I also wonder where Quicken Health Expense Tracker will fit. The bigger question is how long is the implementation time. If you look at the dates for press releases announcing the partnerships and then the “go live” dates the data suggests it takes too long to implement for ever gain traction.

  14. re: PDF Healthcare— PDF H is a great resource and toolset for the ‘endusers’ in HIT ….. doctors, nurses, patients; these are the people that are forgotten by all the Ivory Tower and Regulatory people. Big Vendor world thrives on the latest regulatory crisis (currently RAC)….. and the recent IOM study faces the hard reality that HIT is all about billing, coding, malpractice and regulation;….. these issues largely get in the way of patient care in the trenches of healthcare delivery ……. remember people…. this is what it is all about: healthcare delivery! From exposure to PDF healthcare committee there are many great practical things brewing of a grassroots nature to help these endusers involved in the REAL world of actually delivering the care. Non clinical people just fail to see that much of what we deal with is ‘unstructured’ data, and must remain so for practical recording as well as other reasons. Personal experience with development work in PDF shows it to be a fabulous ‘currency’ for unstructured data…. able to meet any requirement thrown its way; PDF H is one of those practical things that needs major attention if we are to get things done in a practical manner to digitize Healthcare data exchange

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