Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
News 6/24/09
From Don Duck: “Re: new CCHIT certifications. Does the EMR-S, which certifies home-grown, single-user EMRs, include groups that have developed an EMR and then sold or loaned it to other groups with common ownership or interest? It seems odd that some EMR companies might go out of business for lack of certification while homegrown versions could live on.”
Here are CCHIT’s slides (warning: PDF) on the topic. It sounds to me that EHR-S sites (which pay only $150-300 per licensed provider and are certified via a “virtual visit”) can be any provider group as long as their product meets requirements for federal standards, security, and meaningful use. The grid says even vendors of comprehensive EHRS with multiple customers can go the EHR-S route, although the per-provider cost would make that unattractive for all but the smallest vendors (although it would let them turf the whole certification issue off on their customers, assuming anyone would buy under those terms).
Microsoft signs with Sentillion to provide single sign-on and context management services for Amalga. Kudos to Microsoft for recognizing the value of offering that level of user experience integration early in the game. I interviewed Sentillion and co-founder Rob Seliger not too long ago (and my sixth question about vendors making their products CCOW compliant was especially relevant, if I do say so myself). My hospital has both SSO and context management in limited deployment, but has finally seen the light and is adding new apps. I’m pretty sure we will avoid some clinical mishaps my keeping the screen-fumbling to a minimum, not to mention improving clinician satisfaction. It’s a nice nod to Sentillion that Microsoft came knocking.
Healthcare Management Systems announces GA of what it says is its largest release, which contains functionality to meet figure CCHIT criteria and to qualify provider users under meaningful use.
A widely reported Cornell study finds that providers don’t tell patients about clinically significant lab and rad findings seven percent of the time. The study methodology isn’t the best, but it’s one of those “sure, it happens” issues in which results are lost in the shuffle or don’t raise the appropriate flags.
Sage Software India announces the launch of a couple of new products for hospitals in India. They have ERP in their name, but that must mean something other than Enterprise Resource Planning since the press release talks about bed assignments and physician notes. ERP sounds more like a product line, according to this page.
Listening: Eric Clapton and Steve Winwood, brand new on Live from Madison Square Garden and recommended by reader Bill. I’m not a fan (Cocaine and Wonderful Tonight are immediate dial-changers for me), but this one’s a keeper, a couple of guys in their 60s sounding better than they did in their 20s. Their cover of Hendrix’s Little Wing is about as good as music gets, with an old-school Hammond B3 keyboard and Clapton doing great stuff on the guitar instead of just noodling around.
Welcome to new HIStalk Platinum Sponsor Keane, more specifically, its Healthcare Solutions Division (HSD). The Boston-based company provides solutions to hospitals and long term care facilities all over the US, including Keane Optimum (hospital information suite), Patcom (patient management), and Keane NetSolutions (browser-based medication management). I’ll let them tell you more: “Keane’s solutions help U.S. healthcare facilities modernize their operations by using technology to prevent medical mistakes, provide better patient care, and implement the most effective treatments, while at the same time achieving cost-saving efficiencies and meaningful returns on health information technology investments. Keane Optimum is especially well suited to help healthcare facilities accelerate the adoption of EMRs in response to the Healthcare IT provisions in the recently approved American Recovery and Reinvestment Act. Specifically, Optimum allows providers to enhance quality, maintain privacy, support clinical decision making and begin to move to a more interoperable environment for improved health care delivery.” Thanks to Keane for supporting HIStalk and the people who read it.
Saint Vincent Health Center (PA) credits Sunrise Surgery (which I think is Surgical Information Systems when Eclipsys sells it) for its compliance with regulatory requirements and quality reporting.
HIMSS gets a page devoted to it on the Citizen Media Law Project for sending a semi-threatening letter to two bloggers back in February, demanding they take down unflattering comments left by an anonymous poster (and also asking them to turn over information that would help it identify that individual). Both bloggers declined to comply but offered HIMSS equal time, which it didn’t take advantage of. I still think HIMSS believes the poster was a former or current employee given that the lawyers doing the pressuring (respectfully, I should add) are labor attorneys. You may also remember that the comments that got the HIMSS corporate panties in a bunch made some pointed (and sometimes bizarre) comments about what the poster perceived as HIMSS influence over CCHIT.
From Weird News Andy: a man sent home on Tylenol from an Australian hospital with what its ED diagnosed as a headache turned out to have a broken neck. The patient said he was told they couldn’t do an X-ray because the radiology department was closed for the night.
I like this article, which says budget-strapped CIOs are turning to “lite” corporate IT using free Web-based tools, open source applications, and software from little-known vendors to meet IT needs. The article cites this blog, which says the average person has more IT capability in their den than at their job: “The new expectations of corporate IT should also turn into an opportunity. If you and I can buy storage at 10c a GB, why are corporations paying hundred times as much? If at any given time, if millions of consumers are talking to each other around the world on Skype for free, why are mobile companies charging you exorbitant roaming fees? If any one can call the Geek Squad and get a one time PC repair visit, why is your desktop outsourcer not charging you on a per usage basis, rather than some monthly charge? Why is your software vendor UI still so 90s – and why do they deliver a truckload of user manuals and documentation? And why do they still need schoolbuses of consultants to help implement? Consumerization of technology should be a broad manifesto for change in corporate IT and enterprise vendors. Let’s face it – we are slower, uglier, exorbitantly expensive, obsessed with security and compliance. Time for a makeover. An extreme one.”
So, with that article as inspiration: what interesting, lightweight, and cheap technologies are you using? I’m really curious. If you’re a provider, what are you experimenting with?
And in that vein, know any CIOs or CMIOs who are innovative and interesting? We’d like to interview them, so hook us up if you can.
I admit it: I have a man crush on Senator Charles Grassley and his fearless probing into how government money is spent (and misspent). His latest target: UCSF’s medical school, of which he is demanding more information to determine whether taxpayer dollars are being wasted on research projects and mismanagement.
The Senator would like this: the VA’s $3 million combat-related brain injuries lab in Texas hasn’t tested a single veteran in its three-year history.
I endorsed the Declaration of Health Data Rights here. What it says: you have a right to your medical information, each data element should be tagged with where it came from, whoever has your information should give you a copy for very little money (and in electronic form instead of paper if that’s how they have it), and you can share your data with anyone you want.
The New York Times covers the medical home concept, highlighting a Duke University project that assigns a primary care specialist to coordinate a patient’s care, also providing a patient portal for making appointments and checking lab results.
Heart failure patient readmissions at Sentara Virginia Beach General Hospital were reduced by 74% by using a heart failure care plan deployed via GetWellNetwork’s interactive patient care system.
Apollo-Bramwell Hospital in Mauritius will be the first Indian Ocean hospital to go live on PACS.
HERtalk by Inga
Right after Apple announced their new phone, I bemoaned the fact that I had JUST upgraded from the 2G to the 3G. Fast-forward (after lots of advice and lots of time on hold with Apple and AT&T and never talking to anyone) to Sunday: I went to the Apple store and was told I was out of luck, there is no way to get the new phone without paying another $199. I suppose I could have argued the point further with some mensa (or whatever they call the managers), but I had no interest in standing in the 20-deep line just to attempt getting a new phone for a better price. If you purchased a 3G2, please tell me it really isn’t worth standing in line for two hours. I did upgrade to the 3.0 software and am SO happy to have search capabilities on my e-mail, cut and paste, and the ability to view email in landscape. I really am a low-maintenance kind of woman.
The Glacial Ridge Health System (MN) reduces its costs 50% by replacing its film-based PACS with 7 Medical’s on-demand PACS.
Baylor Medical Center at Frisco (TX) selects Orchestrate Healthcare, in partnership with Vitalize Consulting Solutions, to perform a readiness assessment of their current systems, provide an analytical review, and present a roadmap for the strategic roll-out of clinical and technical architecture.
NextGen is now a CMS-qualified PQRI patient registry for 2009 and will help eligible physicians submit PQRI quality measures directly to CMS.
RelayHealth and LightHouse1 announce a new partnership to help providers automate payments for patients with healthcare spending accounts and consumer driven healthcare plans. RelayHealth will integrate its EasyCDH solution with Lighthouse1’s OnDemand platform to create the SAS OneCard solution.
Medical tourism in Korea has grown 41% in the past year. Officials attribute the increase on new laws permitting aggressive marketing to attract overseas patients.
Massachusetts takes top honors at Surescripts’ Safe-Rx Awards, which recognize the top e-prescribing states. Massachusetts providers send 20% of prescriptions electronically, followed by Rhode Island at 17%. Vermont was named the most-improved state.
Sarasota Memorial Health Care System (FL) selects the Medicity Novo Grid solution to electronically exchange health information between the hospital and physician practices.
Contra Costa Regional Medical Center (CA) plans to replace its discontinued Mediware Information System with Unibased ForSite2020 periOperative Resource Management System.
Tufts Medical Center (MA) contracts with WaveMark to provide RTIM technology to track physician preference items in its Cath, EP, and interventional radiology departments.
KLAS churns out another report, this one entitled, "Infection Control: Improving Patient Care and Reimbursements.” The study highlights the leading infection control software vendors and their solutions. The featured products are the top-rated Cardinal Health MedMined, Premier SafetySurveillor, and TheraDoc Infection Control Assist.
More medical records are found dumped in the trash, this time finding their way to an Alabama landfill. It’s ironic how much attention is spent ensuring our electronic records are secure while paper medical charts continue to show up in public dumps and recycling centers.
The Trizetto Group introduces a free PHR available to qualified payer customers for providers.
I admit it: I have a man crush on Senator Charles Grassley………
A “man crush”? What the hell is that anyway?
[From Mr. HIStalk] You need to get out more! (or maybe less since I’ve heard it on TV and the Web about a gazillion times) Defined here.
For those like me, that have made our own EMRs, if the $150 price tag means that I have to do eRx, do P4P reporting, and do individualized teaching on each and every patient, then no thanks.
My estimates of such endeavors ( http://www.hcplive.com/mdnglive/articles/PC_Medicare_HIT_mandate ) would amount to a price tag of at least $175000 (plus the $150 x 5 CCHIT fee) over 5 years, minus the HITECH grant money. The way I see it, I’d be extremely lucky to get just a portion of the $44000 promised. CMS has a lousy track record of paying what is promised and in the last 2 demonstration projects, the vast majority of those foolish enough to believe that they would earn something decent got zilch, zero, nada, nichts, ništa, rien, कुछ नहीं, niente, 何もない or known to the rest of us as “NOTHING”. Those that did get paid something got much less than what they were promised.
The CCHIT organization simply is begging for the rest of us to support their endeavors, which has been to stifle the competitiveness of having a free, level playing field where the consumer, not a politician, decides which EMR to use. I still look forward to the day when CCHIT is no more.
Al
re: “Why is your software vendor UI so 90s”- where does that leave most hospital-based EMR interfaces? Are there any certifications for usability out there?
Al Borges,
I’d argue that it’s cheaper to go with something like a Sam’s Club eClinicalWorks solution for an EMR rather than developing your own.
$25,000 + minimum yearly maintenance would be much cheaper than your $175,000 expected costs. Plus you could be assured that you’re meeting the e-rx, data exchange, decision support, etc requirements (whatever they may be).
Ernst Ostrand, the lawyer who sent out the letters to Chillmark Research and Pediatric Practice Consultant regarding the offensive blog postings concerning HIMSS and CCHIT, is no longer with the law firm of Jackson Lewis.
RE: “lite” corporate IT using free Web-based tools. I’m cheap! How cheap are you? Well, I’m so cheap that I purchased a dedicated netbook off ubid.com for $150 and converted the MS 98 OS to that “jaunty jackelope” Ubuntu 9.04 for free and plugged in my MagicJack (no relation to Meditech Magic) device for $19.95 for one year unlimited Internet phone service.
To add insult to injury, if I purchase the five year service bundle of MagicJack, I’ll only pay $59.95. And I thought my Vonage Residential Premium Unlimited Plan at $24.99 per month was a good deal. Vonage actually cost $31.78 with all those nebulous Regulatory Recovery Surcharges, Emergency 911 Fees, and other hidden taxes.
Point to be made here, corporate HIT guys can learn much from the methods of us residential IT guys trying to keep down our cost.
Does anybody else find it disturbing that CCHIT seems to already be the certification body for the ARRA money, despite not actually being that? If anybody from CCHIT is listening (and we know they’re not because they continue to act in this manner) a little, even fake, contrition would go a long way to quieting those who don’t like you.
DrM, it is very disturbing regarding CCHIT. But what is more disturbing is that CCHIT has received bridge financing through HHS, despite complaints on file. I agree with Dr. Borges, CCHIT should be dissolved. At a minimum, Leavitt should resign for the “involuntary dissolution” that was reported on various blogs. CCHIT expects to be the sole certification body, when their own corporation status was “involuntary dissolved” for 10 months. The IRS has uncovered HIMSS paid Leavitt’s salary through 2008. And who is the CCHIT Trustee Chair, who is also HIMSS’ CEO, who also authorized the payment of Leavitt’s salary? H. Stephen Lieber. What other skeleton’s remain in the closet?
>>> I’d argue that it’s cheaper to go with something like a Sam’s Club eClinicalWorks solution for an EMR rather than developing your own.
A-Rod:
For most physicians, I agree that buying a ready-made EMR is the best way to go. I like to tinker, from the days going back to my teenage years when I took apart cars (engine and all) to current modern-day setup of my office where I set up my network, put together many of my computers, and put together my EMR… I enjoy it and would not have it any other way. If I found that full particupation with Medicare was necessary, and/or that the eRx was worth it and/or that the HITECH “significant use” provisions were necessary, I would indeed eventually buy a c-EHR. Of course, you’d have to waterboard me and extract each and every one of my fingernails as well as kill my first born child to convince me to go with anything that HIMSS/CCHIT has tried to force onto the medical community, as I would find it tantamount to being manhandled by an illegal Mafia-like lobbying group.
If you actually do read my calculations in the link that I posted above, the $300000.00 5 year significant use figure was actually a low-ball amount for what “significant use” really implies (see the CMS website for a their evolving definition on this here- http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3466&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType ). The eRx, the reporting, the teaching involved will significantly retard my ability to see a significant caseload that would allow me to make a decent living. On top of that, Medicare payments have declined to a level where even without HITECH, I was about to jump ship in the next few years… HITECH simply has sped up my disenrollment process. Many physicians share these sentiments and I wrote an article on this here- “Congress Passed the Stimulus Bill; What Should You Do Now?”, http://www.hcplive.com/mdnglive/articles/PC_passed_the_stimulus . If enough physicians jump ship, the HITECH Act will be known as the “HITAIL OUT-OF-HERE” Act and the elderly will eventually pressure Congress to get rid of this ill-conceived law that is rife with way too much vendor political influence and politician corruption.
>>> $25,000 + minimum yearly maintenance would be much cheaper than your $175,000 expected costs.
The $300000.00 is divided into 3 parts:
1) Purchase costs, using average cost of $30000 with an average monthly cost of $1500/mo for the typical c-EHR of $125000.
2) “Significant Use” costs of $125000 (see article for particulars)
3) The need to have a $10000/year part-timer just to handle the reporting and extra “electronic paperwork”-> $50000/5 years.
Number 2 and 3 still apply to me if I were to go HITECH, thus the $175000. If I were to buy an eCW c-EHR, then I’d have to add in number 1 for a total 5 year cost of $300000.00.
So in summary, I consider a c-EHR a ripoff and the HITECH “significant use” law an ill-advised poorly thought out law that will fail miserably.
Cheers,
Al
DrM, I just read an excellent post by Scot Silverstein, M.D. dated June 23: “Mark Leavitt, Head of CCHIT: Behind the Times and Uninformed on Health IT Realities?”
http://hcrenewal.blogspot.com/search?q=CCHIT