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May 5, 2009 News 7 Comments

emrrulesFrom Seth Hazlitt’s Nephew: “Re: Sutter. The Sutter project situation reminded me of your Universal Rules for Big EMR Rollouts™, specifically number five: ‘All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and […] will vanish without a trace at the first sign of trouble, like when […] the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.’ Is Jerry Padavano still with Sutter? How long until Jon Manis vanishes without a trace? A year and a half ago, Sutter said it had already spent $500 million, up from the original projection of $150 million. By early this year, it was up to $1 billion. As of this point, what exactly did Sutter get for their $1 billion+ investment?” My Universal Rules piece was a pretty big hit, I have to say. As for Sutter, it’s hard to say other than I was incredulous when they first announced how much they were planning to spend, which turned out to be a small fraction of the final estimate. What healthcare needs are small, specialized systems that interact, but that can be customized and managed locally and individually without making the whole enterprise-wide deployment as vulnerable and as unintelligent as the lowest common denominator of the systems that make it up.

From Pat Cremaster: “Re: Sutter. They couldn’t fund the EMR because of stock market losses and the decision to fully fund employee pensions (too bad other companies make similar promises to employees, but rely on government intervention when their pension goes belly up). It’s also a shame that our healthcare delivery industry requires investment income to fund it.”

From Ian Miller: “Re: e-prescribing. DICOM and HL7 standards are available as free downloads, but the specification of NCPDP SCRIPT Standard for e-prescribing medication costs $655. Wouldn’t it increase adoption to let anyone (like an open source developer) take a shot at creating the e-prescribing killer app by offering the NCPDP SCRIPT specification for free?” I’ve never understood why organizations charge for that kind of documentation when e-mailing out a PDF costs nothing. I admit I’m suspicious about non-profit motives when I see that.


From Lisa Lopes: “Re: HIMSS conference proposals. It is a shame that one must submit them so far in advance. You really have to be thinking about it. So much can change in a year. I always liked roundtables, but there aren’t as many of them anymore. Panel discussions allowing for interaction between panelists themselves and with the audience, I think, are superb vehicles for communication of issues that healthcare IT professionals are dealing with.”

From Lazlo Hollyfeld: “Re: ARRA. After all of the talk about ARRA boosting health IT purchases, clinical spending looks like it will be slowing since everybody is waiting to see what happens over the next 9-12 months. On the other hand, waiting to purchase an EMR system until next year is going to cause some potential difficulty in getting up and running to get paid. Talk about your unintended consequences. Meanwhile, the revenue cycle management vendors just keep humming and moving along as profit margins continued to get squeezed along the entire provider spectrum.” 

From Tom Servo: “Re: Pam Pure. I heard she got a hefty severance package, like $6 million, and new bedrooms and a security system for her horse farm. Meanwhile back at the employee ranch, merit increases were eliminated, profit sharing was eliminated, hours were increased, the fear mentality set in, and people were replaced by terrible Indian outsourcing. Shades of the finance industry.”

From The PACS Designer: “Re: HIStalk’s top 2% ranking. TPD found a website called /URLFAN that rates the popularity of Web sites. Happy to report to Mr. H, Inga, and HIStalk readers that our Web site is in the top 2% of over 3.7 million websites at #80,672. Thanks go to every one of you who contribute to HIStalk to make it the site to go to for the latest health care information and reader comments and writings!” Link.


To think we missed narrowcast content like this when there were just three networks and no Internet: this Web page deals exclusively with hospital food around the world. You will be shocked that most hospital food is dietician-approved, yet thoroughly unappetizing. Captive employees, of course, are shafted by their hospital employer on overpriced cafeteria meals (and the minuscule employee discount is one of the first budget cuts made). The most heinous act you can commit in a hospital, other than abducting a newborn, is daring to refill your $1.75 waxed paper cup from the soda dispenser like every fast food restaurant lets you do, thereby costing a billion-dollar hospital operation a budget-busting three cents. Boot camp recruits and prisoners eat the same prepackaged food from the same soulless food service outsourcers, so it’s about what you would expect (maybe openly rebellious employees and doctors should be punished with a Nutriloaf diet).


Since we’re on the “how fancy do your hospital buildings need to be” debate, this story from India is interesting: Lessons From a Frugal Innovator, subtitled “The rich world’s bloated health-care systems can learn from India’s entrepreneurs”. Example: heart bypasses are done under local anesthesia, but they have triple the IT adoption of US hospitals. Columbia Asia, a US company mentioned here before that operates hospitals in poor countries, is featured. “Columbia Asia … left America to escape over-regulation and the political power of the medical lobby. His model involves building no-frills hospitals using standardised designs, connected like spokes to a hub that can handle more complex ailments … Its small hospital on the fringes of Bangalore lacks a marble foyer and expensive imaging machines—but it does have fully integrated health information-technology (HIT) systems, including electronic health records (EHRs).”

Speaking of the “how much should healthcare cost” debate, this reader quote was quite insightful: “In healthcare, VALUE equals OUTCOMES divided by COST. Buildings increase COST dramatically and probably don’t affect outcomes. Cancer patients CANNOT afford those buildings, nor can the current and future healthcare economy in America.” (substitute “IT” for “buildings” and you have the beginnings of a great platform debate). If we want to compete globally, our outcomes are going to have to get a lot better at a lower cost, so the window-dressing stuff will have to get a hard look. Deep down, most of the people who run this country wouldn’t dream of getting their own insured care where the peons go (any more than they would eat in a soup kitchen or live in a welfare-paid nursing home). Only in healthcare and education is discrimination so multi-faceted (race, age, income, location, etc.) “Less expensive” is an insult, i.e. “when it’s my family, I want the best of everything even when there’s no medical advantage, especially when I’m not paying.”

From the McKesson earnings conference call related to the technology business: (1) software sales are down because of the economy; (2) implementation delays hurt revenue recognition; (3) RelayHealth and the revenue cycle business were the bright spots; (4) layoffs and other expense cuts were made in fear of a delayed market recovery; (5) McKesson expects a stimulus boost in the IT business, but not until FY2011; (6) in Randy Spratt’s new role as CTO, he will have some level of oversight over the software line; (7) they’re in no hurry to replace Pam Pure; (8) acquisitions may be in the cards; and (9) hospitals will provide the highest margins. Sounds like Lazlo Hollyfeld was right (above): ARRA may have an eventual impact on vendors, but smart ones know what customers are willing to buy now (anything that either saves or makes them money, of course).

Sounds like Montefiore Medical Center aspires to be the next MedStar Health, who sold its internally developed Azyxxi analytical tool to Microsoft. Montefiore congratulates itself via press release for using the Clinical Looking Glass tool it developed. Mentioned: it’s being used by the NYC Department of Health and “is being considered” by DoD healthcare. 

Every hospital systems vendor is cobbling together some kind of H1N1 surveillance tool. If only they could roll out customer-requested enhancements as quickly.

The health department in New South Wales, Australia commits $74 million US to replace paper-based systems in 188 hospitals with an EMR.


Several folks mentioned in the reader survey that the format and/or ads make it hard to read HIStalk. Solution: click the View/Print Text Only link at the bottom of any article. You’ll have a very readable on-screen version that can then be printed if you have some reason to do that (maybe load 3×5” card stock in the printer so you can carry HIStalk around like John Glaser does).

Another non-shocking finding: doctors override most computer-generated clinical warnings. The article doesn’t reach a firm conclusion as to why that is, so I will magnanimously provide that for you: (1) doctors don’t really like being used as a typist, so bugging them in their less-important (at that minute) role as a medical decision-maker is jarring and interruptive; (2) most clinical warnings are worthless since they don’t take many patient factors into account; (3) alerts are harsh warnings, not useful guidance; (4) companies that provide clinical databases are ultra-conservative, so they’re going to flag questionable problems because the alternative is to join the doc in a malpractice lawsuit if the warnings aren’t exhaustive and something goes wrong; (5) alerts are one-size-fits-all, both patient and doc. Kidney transplant patients trigger renal warnings for nephrologists to read at zero value added. A smarter system would tailor the warnings to the user’s capabilities and special interests and also allow the user to grade the helpfulness of each alert type to determine whether it should display next time. (6) most alerts relate to allergies (fueled by highly questionable and poorly documented patient reports) and duplicate orders (nearly always already known). Nobody that I’ve seen has introduced a truly 2.0 alerting function; software vendors tell programmers to use the third party database and the result is unspectacular. The ultimate worth of alerts is easy to measure: how many of them do doctors ignore? 90+% is common.

I’ll add this about clinical systems: automatic stop orders are not only a hopelessly outdated concept, they harm far more patients than they help. Nobody worries that a drug will run too long, but everybody constantly fears that a critical drug will be artificially stopped under some misguided Joint Commission-encouraged policy from 1975. With electronic systems, physicians are reviewing all orders all the time and in a context far more useful than a one-off renewal notice. Why hospitals don’t eliminate them is a mystery.

I doubt Medsphere will include this quote in its marketing materials even though it’s coming from a high-profile OpenVista customer. Jordan’s technology minister, when asked about using open source, said this: “It will cost you more, by the way. We are working in the hospital sector, using open source. I think that in the beginning, the cost will be higher. In the long run it could be better. You have to develop software to interface with the open source, which will cost you more.”

Shareholders of IBA Health approve changing the company’s name to iSOFT Group, reflecting the brand name of the product and company it acquired awhile back.

A newspaper editorial observes the institutional nonsense that pervades every hospital. “Part of the problem is the computer. If the medication isn’t listed there, you don’t get it. It might just need to be renewed or re-entered, as meds have a sort of built-in renewal date. ‘Would you please call the doctor and check?’ you ask. ‘I will put a call in,’ is the reply, which is code for you won’t be getting that medication for a good long time. If you hear, ‘the pharmacy will have to be called,’ then you might want to call a friend and see if they can bring you some Tylenol … Something has taken a nurse’s good judgment away and has allowed a computer to trump it; has allowed her to look directly at a new IV line and conclude, beyond reason, that there is no IV medication prescribed. Something has forced doctors to have fewer firsthand conversations with their patients, for shorter periods of time, and to share less information.”

John Halamka got a ton of press that proclaimed him a visionary for having a VeriChip implanted in 2005, but he finally admits everyone who hooted and howled back then about the lack of utility in having under-the-skin medical data was right. “As a technology it’s dead. Use the network, use the cloud to store your personal health records. Or in a pinch, use a USB drive. But the implanted RFID chip is not as a society where we’re going.” One of my satirical news item on April Fool’s Day 2006 was this: “CIO Logs Full Year Without Showing Up at the Office. (BOSTON, MA) John Halamka, Chief Information Officer of CareGroup Health System, did not spend a single day at work in 2005, according to a Boston Globe review of expense records. Health system officials had no comment. ‘Check my vitae – I hold six positions in five organizations, plus I do a lot of speaking,’ Halamka stated in response to a reporter’s question. ‘I can’t say I started out planning to miss all of 2005 in that one job, but it just worked out that way. What I give them in quality more than makes up for any perceived shortfall in quantity.’ A CareGroup source told the Globe that discussions are underway to track Halamka’s location by the identity chip implanted in his arm last year. ‘I’d rig the damn thing up to a doggie fence and give him a few volts when he wanders, ‘ said the source.”

E-mail me.

HERtalk by Inga

Perot Systems releases its first quarter earnings: EPS $.24 vs. $.23 on $621 million in revenue, down from $680 million.

Harvard Medical School closes temporarily after a probable case is identified, an MIT student who picked up the virus while in Mexico and possibly shared it with colleagues at the Harvard Dental School.

SCI Solutions announces it has signed an agreement with Saint Thomas Health Services (TN) for SCI’s Schedule Maximizer and Order Facilitator solutions.

Medical transcription company Administrative Advantage selects the ZyDoc Medical Transcription platform.

Final attendance figures from HIMSS: 27,429 total registrants, down 6% from last year, and 907 exhibitors, down 4%. Over a fourth of attendees were first-timers, indicating a high churn rate.


The 60-bed Bates County Memorial Hospital (MO) selects the MedGenix financial and patient management system.

Authorities investigate a $10 million extortion demand for the safe return of over 8 million patient records and 35 million prescription records that were allegedly hacked from the Virginia Department of Health Professions computers. The FBI is assisting Virginia state officials investigate the incident that came after hackers infiltrated the Health Professions computers last week. They posted this boast on the home page: “I have your [expletive] In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :(For $10 million, I will gladly send along the password.” This fool is going to be so easy to catch that it isn’t even funny. Hey, we’ve got your $10 million – where can we meet you?

The Robert Wood Johnson Foundation awards Project HealthDesign $5.3 million. The project, whose mission is to support the creation of a new generation of personal health records, is based at the University of Wisconsin.

MEDITECH adds Vitalize Consulting Solutions to its list of approved advanced clinical consulting vendors.

Virtual Radiologic receives FDA clearance for vRAD RACS, Virtual Radiologic’s own PACS solution. The company will roll out the software to its affiliated radiologists over the next several months, replacing the commercial software it licenses.


Some news in honor of Cinco de Mayo: thieves in Mexico realize that everybody is wearing blue surgical masks because of H1N1 fears, so they’re donning their own to blend in with the crowd when making their getaway.

E-mail inga.

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Currently there are "7 comments" on this Article:

  1. RE: Allscripts and E-Prescribe. The clients are complaining that they have not been given the tools to implement E-Rx. They have received failed promises of hot fixes and newest promise is Monday May 11. Lets hope so as they clients may very well lose the Medicare incentive. Physicians must utilize E-Rx for 50%, lets hope they have no vacations scheduled for the remainder of the year.

  2. Re: automated clinical warnings. Your 6 observations should be embedded in a Verichip and implanted in EMR vendor big wigs and their developers where it could set off a siren or shock whenever broaching clinical warnings discussions. (Hospital CIOs should have “Mr. HIStalk’s Universal Rules for Big EMR Rollouts” implants. Maybe John Halamka knows of some unused or second-hand ones they could get a deal on.)

  3. HIMSS Conference requires conference proposals nearly a year in advance? – Absurd. Funny thing is that those in health care point to the key role that HIMSS will play over the next several years with all of the money flowing into Health IT.

    It will be an important voice for their hospital vendor constituency but the HIMSS Annual Conference is among the walking dead. They just don’t know it yet.

  4. RE: MEDITECH adds Vitalize Consulting Solutions to its list of approved advanced clinical consulting vendors.

    We were so thrilled when MEDITECH spoke to us and let us know that we were approved as one of their Advanced Clinical Consultant’s that we jumped the gun on our formal announcement! VCS will be added to MEDITECH’s approved Advanced Clinical Consultants webpage. However, the actual link has not yet been added to MEDITECH’s website and therefore clients will not yet see VCS’s name on the webpage. VCS is working with MEDITECH Marketing to get the link on the page in the near future. Can you blame us for being so excited?

  5. Inga, I think you entered the wrong link on you 5 de Mayo story. For a long time I thought you did so intentially, calling out Perot as masked theives. Then I noticed the Perot link was the same from one as the one on the top of your post and figured it was just an error…

  6. FYI – Medsphere and OpenVista are not involved in the ongoing implementation in the Hashemite Kingdom of Jordan.

  7. The statement about standards being free versus having to purchase is not correct. NCPDP membership is $650 per year and that includes all of the standards that NCPDP creates, including the different versions. During that year, any updates to the standards are also available free of charge with the membership. Also included in the membership is the ability to attend NCPDP quarterly work group meetings at no cost, and attendance at NCPDP educational sessions and Annual Conference at a member fee. I believe if you check with other like organizations, you will find a fee of some type as well since the organizations must receive funding to continue the creation of work.

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