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Monday Morning Update 5/11/09

May 10, 2009 News 13 Comments

From Stan van Man: “Re: Sage. I just got an e-mail from one of the people who was cut at Sage who told me that Sage Healthcare RIF (don’t you love that acronym) was 500.” My company contact tells me that Sage North America reduced headcount (employees plus open positions) by 500, but that’s throughout all of Sage, not just Healthcare (which took a relatively minor hit).

From Dr. Lyle: “Re: Cerner MPages. I’m a long-time Cerner user and have many bruises to show for it. However, I am cautiously optimistic about MPages as it appears to be what many of us have been asking for: a Web-like front end to the data and functionality in the system. At the very least, it allows users to use HTML and similar programming to create a user interface which displays disparate data in the way they want, such as creating a diabetes screen that brings together meds, labs, physical exam findings, and evidence-based findings. At the very most, there may be some opportunity for interactivity via data input (e.g. change a variable to see how it affects the data) and ordering (e.g. meds, tests) on that very screen. In other words, they are beginning to go down the road of separating the data from the application and interface and allowing end-users to create the displays and customized functionality we believe will work best for us. While this might seem like common sense, most EMR vendors continue to work in a closed, three-tier system (data, application, and interface) that does not allow for this level or ease of customization. It could lead a new paradigm of what an EMR is and does, shifting EMRs to become a platform that holds the data and applications, but allowing interfaces to be in the hands of the users.” Dr. Lyle refers to his blog entry on EMR usability. I liked that idea going back to the mid-1990s, when vendors or users of character-based systems turned them into something that looked slick and brand new by using screen-scraping tools like Attachmate or Seagull to create GUIs that could even tie multiple applications together under the covers. It would be cool if a vendor app could provide functions and tags that would work like ColdFusion or PHP, giving users control of the display and maybe extending its functionality by doing lookups into other systems, links to Web content, or databases or running self-developed functions. Customizing screens, screen flow, and reports is most of what users want to change, not the underlying database or internals, so that would be powerful.


Speaking of MPages, I found this site, run by techies at UW, Stanford, and UAB, which is trying to build an open community of MPages developers.

From Josh: “Re: reusable components. I thought it was worth reiterating a point in your 5/6 update: ‘What healthcare needs are small, specialized systems that interact.’ This diametrically opposes the notion of ALL of the major HIS vendors to date. The idea of small, standards-based reusable components rather than monolithic, interconnected systems is called Service Oriented Architecture (SOA). There are a number of successes in other industries and the core notions (Enterprise Service Bus, Agile development, composite views, etc.) are readily understood in the software development community. What seems not to have been done is the transformation of provider requirements to force deconstruction of these systems. I’ve long been flabbergasted at the interface inflexibility in most commercial HIS offerings and the uselessness of data we generate in applications not intended by the designer. It’s time that the providers start dictating detailed requirements to our vendors – and SOA may be the mechanism to do that.” That is an interesting paradigm – CIOs have pushed the “off the shelf” idea to the point that prospects rarely put system design issues into their contracts, either accepting the product as-is or choosing a different one. When I worked for a vendor, I hated the idea that we couldn’t do something specific for a customer unless we rolled it into the base product, which either meant we had unhappy customers or a Frankensteinized product with a bunch of jerry-rigged bolt-ons added just to make some weird customer happy (usually one of our biggest customers, no surprise there, who bring both unreasonable influence and illogical processes to the table). I like where this discussion (and the one above) are going. If software could be customizable while remaining supportable, everyone wins.

I just posted a summary of the 2009 HIStalk reader survey. I didn’t e-mail blast it since not everyone cares about it, but if you’d like to know what readers suggested and what I think I can accomplish, check it out.

England’s Department of Health gives BT $150 million in advance payments despite what the Guardian says is “years of delays, system failures, and overspending …” and a temporary government ban on Cerner rollouts because of system problems.


I’ve hosted a visit by Traveling HIT Man, my new BFF (that’s him, helping me edit today’s post). He’s looking for the next stop on his HIT tour (see the pics of where he’s been), so if you’d like to have him come to your place, let me know and I’ll send him your way. 

HHS announces members chosen for the Health IT Policy Committee (advises ONCHIT on interoperability) and Health IT Standards Committee (advises ONCHIT on standards and certification). Both committees hold their first meetings this week in Washington.

Odd: two motorcycle riders in India, one of them a Dell software engineer, ride around pulling the scarves of girls for some reason. Locals caught them and beat up one of them, but the Dell guy escaped, only to be arrested later and charged with criminal intimidation and assault with the intent to outrage modesty. His punishment is to sweep the floors of a local hospital for one hour per day for a month.

Patient Safety Technologies, the sponge counting system company, names board chair Steven Kane as CEO following the pursuing of other interests of David Bruce, former president and CEO.

Cooper University Hospital (NJ) gets a local newspaper mention for going live on its $30 million Epic project.

swineflushot geraldford

The swine flu is coming and humanity will be wiped out! Old-timers have heard this before, in 1976, and we even had a vaccine then (although it had a couple of minor problems: it didn’t work and people who got it sometimes died. But hey, some people died who didn’t get it, so evidence is inconclusive.) Concerned Americans who heard about today’s crisis on celebrity gossip sites have responded to this serious risk to their health by drinking, speeding, smoking, having unprotected sex, chowing down on superhuman junk food portions, and taking a bottomless pharmacopeia of dangerous prescription and illicit drugs. 

President Ford — uhh, Obama — has a great health care plan, other than it will cost $1.5 trillion. I’ll let Sen. Ron Wyden of Oregon speak for me: “You go to a town meeting and people are talking about bailout fatigue. They like the president. They think he’s a straight shooter. But they are concerned about the amount of money that is heading out the door, and the debts their kids are going to have to absorb." The article wisely observes that “one person’s wasteful spending is someone else’s bread and butter,” saying that doctors, hospitals, and drug companies are going to raise holy hell about any attempt to pay them less, even for good reason.


Chinese hackers break into Cal-Berkeley’s health sciences servers, giving them access to the health data of 160,000 students and relatives. Nobody noticed for six months.

The UCLA Medical Center employee who pleaded guilty to selling celebrity medical records to the National Enquirer has died of breast cancer.

A university does the “buy some old drives from eBay and see what’s on them” test. What they found: Lockheed Martin ground-to-air missile plans and its personnel records, medical records, pictures of nursing home patients, correspondence from a Federal Reserve Board member about a $50 billion currency exchange, and security logs from the German Embassy in Paris.

Speaking of which, thanks to the reader who reminded Inga about the need for offsite PC backups (since my trusty USB hard drive sits two feet from the PC, giving it little chance of selective survival in a fire or disaster). I’m doing a 15-day free trial of Carbonite.

Here’s what I love about hospitals: a 17-year-old high school athlete goes to the ED of Kadlec Medical Center (WA) with a shortness of breath. She is correctly diagnosed by the ED staff as having a pulmonary embolism, almost unheard of in young, healthy patients. The next night was prom night, so the peds staff brought in her dressed-up boyfriend and classmates, made her up in her prom dress, took pictures, set up a CD player and disco ball in her prom-decorated room, and provided a candlelit dinner for the couple (with Jello for dessert, of course, since it’s a hospital). “We are totally blown away by what they did,” the mother said.

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Currently there are "13 comments" on this Article:

  1. That story about Kadlec was great. It is what healthcare is all about when it is working at its finest – treating the entire person. Thanks for sharing the story.

  2. “doctors, hospitals, and drug companies are going to raise holy hell about any attempt to pay them less, even for good reason.”

    First, I don’t believe in lumping Doctors and drug companies together is really fair. Secondly as long as Wall Streeters get salaries in the six figures right out of college, American CEOs get 400 times the average workers salary (That is almost 20 times more than the ratio in the next higher country.) and a football player receives $80 million (40% of which is guranteed without playing one second of a game) and none of them have the slightest responsibilities of a physician, I do not understand why the rush to reduce their salaries to the lowest common denominator. Of course this is line with my belief that pilots should be the highest paid employees in an airline.

  3. On SOA: It is a game changer. Large vendors have an incentive to downplay its importance and small vendors (should) see it as the future.

    Run and hide from anyone who advises your organization to set up SOA governance before you have even deployed services. And follow Nike’s advice – Just Do It!

  4. I have been using MozyPro Remote Backup for about a year. The first back up is a doozie but it is relatively cheap and works during times when your machine has extra cycles.

    Check it out…

  5. Cerner MPages and Josh on Reusable components

    I really like where this discussion is going. Being late into HIT, my 2 cents are :

    a. I thought a lot of the ‘portal’ players were taking care of the customization requirements at GUI level at hospitals. Why more vendors cannot incorporate such functionality is due more to their own insecurity, than lack of hospital demands.

    b. A lot of GUI level “customization”, or should I say configuration is taken care by using Business Process Management (BPM) tools – at a layer higher than legacy or proprietary applications – as is increasingly common in many other industries. The larger hospital chains in my opinion can more easily use BPM to achieve re-usability, rather than the longer timeframes of getting HIT vendors to move on SoA.

  6. To Arkay, It’s interesting to see your comments about healthcare salaries. – Nursing salaries have not gone up much more than 10% in 10+ years ($29 avg. in 1996 to $32 avg. in 2008). I guess that is considered keeping the cost of healthcare down. When you cost prohibit the people doing the real care. Nurses salaries also are 8 – 10 times less that doctors. No wonnder there is a shortage of nurses and a decrease in the quality of care.

  7. Discussion on data extraction and screen design reminded me of the Google guru who left for Twitter – we all have our GUI issues to bear, but the Google folks appear to be just short of certifiably disturbed…who will be on your committee to decide down to the pixel EXACTLY what your screens will look like and how many variations you must report data on before a final design is accepted?:

  8. BS, if your definition of BPM is the same as mine, i.e. the BPM associated with SOA…I’ve seen the tools, and I don’t think any HIT vendor supports any kind of BPM tool to reuse…anyway I’ll stop there. It’s difficult to argue with such high-level statements with anything longer than “um, no.”

    I’m fascinated by the concept of application extensibility, and, even short of taking the full-blown SOA approach, there’s a lot you can do with a good plugin model. Particularly on the UI. Plugins (or custom UIs) bring their own problems, but not insurmountable ones.

    There’s a fuzzy boundary between what we all know and love as “customization” that includes behavior, and this thing I call plugins. I’d say we’re definitely talking about plugins when the vendor has not anticipated what specific customization you’d like to make. So adding custom fields to a screen: achieveable without plugins; it’s a customization. Doing basic data validation on that custom field: still customization. Adding instant address check to a screen: requires plugin, unless the vendor anticipates this need.

    Anyway just throwing that out there, not much to say besides “I hope we all adopt SOA” and “I like extensibility.”

  9. I second the Mozy endorsement. I got on a cross-country flight last year with my notebook, and my hard drive died 5 min after altitude. My data wasn’t so invaluable that I would pay for clean-room recovery, but I couldn’t imagine losing it all. Fortunately, I use Mozy so I was able to restore all my data to a new drive, 2500 miles from my home. Didn’t lose a thing. Best part – once you set it up, you never have to remember to do anything more.

  10. I don’t understand all your fancy words and abbreviations. It is all too complex for my tiny brain to absorb. I’m just a lowly unfrozen caveman IT guy.

    But I do know one thing about healthcare IT:

    BPM bad…..SOA good!

  11. BPM tools (AKA “Business Process Management”; in the context of SOA) are explicitly built to tie a bunch of services together into a kind of workflow. The idea is that, once you’ve got your SOA rolled out, you can rework your business processes with these high-level BPM tools, making your business nimble. Maybe (to use a business example) you have an insurance verification service, and you need to … I don’t know, have someone spot-check after the computer system has done its automated insurance check. So you go into your fancy BPM tool and add a little box on the workflow, and … some implementation magic happens … and now you have an extra screen wherein someone can spot check the insurance verification results. All this without going to the vendor.

    Bad example, sorry. I’m trying to show the difference between simply swapping out services (which is mostly achievable with interfaces we have today) and intercepting/adding workflow around/rearranging the services, which is something BPM theoretically offers. Haven’t tried it/wouldn’t know.

    The problem with BPM, even in the best case, is that the first step is to get your pile of services. We’re not there, thus BS’s assertion is flawed. Anyway, if anyone’s trying to sell you on BPM, definitely ask for an example of how it can help. Hopefully their example will be better than mine 🙂

  12. Years ago I programmed forms for a local hospital on Epic. They eventually decided it wasn’t worth the effort to pay me to do new projects when the IT department could typically do something good-enough for free. One of my last experiences was when the oncology department was willing to foot the bill for me to build a 1-page form that did exactly what they wanted. IT heard about the project and 2 weeks later the IT guy had configured a couple of screens that were good enough to cost me the job.

    As for development options in a big vendor system, when I threw in the towel in 2005 they already had SDKs for GUI screens, custom data entry forms, web applications and had at least two customers using their SOA. The real problem is that paying programmers is bad PR when the CIO has just spent millions on a new system that supposedly does it all.

  13. I don’t understand Epic. It seems as though it costs too much money. Your large operating budgets and limitless capital budgets frighten and confuse me.

    I don’t know. Because I’m a caveman — that’s the way I think. There is one thing I DO know. Healthcare IT needs to rethink what is a reasonable amount to pay for technology.


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