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Monday Morning Update 6/29/09

June 27, 2009 News 12 Comments

The Association of Medical Directors of Information Systems (AMDIS) files its response (warning: PDF) to ONCHIT’s proposal for the definition of “meaningful use.” Its recommendations:

  • Rewrite the standards from the point of view of patients
  • Clarify how ARRA payments will be determined
  • Focus on consistent use to capture problems, meds, allergies, histories, prescriptions, and vital signs, plus having that information coded so it can be shared
  • Defer quality reporting until 2013 to give doctors time to routinely collect the needed information
  • Take out anything that requires CPOE because it’s loaded with the possibility of unintended consequences
  • Hold technology vendors accountable for data exchange capability by making that part of certification.

Publicity-seeking missile Jesse Jackson, apparently fantasizing that he was there with Jackie, Tito, Jermaine, Marlon, and Michael as one of the Jackson 6, has insinuated himself into the limelight yet again, this time to dramatically repeat the obvious: the cardiologist who was in Michael Jackson’s house when he died needs to be found and interviewed (duh, Jesse). I’ve already made a bet at work that toxicology results will find at least one each of a narcotic, antidepressant, and stimulant, but the gossip sites say it will be more like a broader, Elvis-type blood-borne pharmacy since MJ was strongly rumored to have been a Demerol and Oxycontin addict in the past and, like a lot of celebs, had found himself some Dr. Nick-like docs willing to write anything he wanted even if it was likely to harm him (a Beverly Hills pharmacy sued him in 2007 for over $100K (!!) in unpaid prescription bills). Like former father-in-law, like son-in-law, sadly. Surely the tabloids are floating around offers to buy illegal copies of his medical records.

The final results of the HIStalk poll on HHS’s meaningful use draft: 20% think providers will achieve it too easily, 42% think the criteria are too hard, and 38% say they are about right. New poll to your right: do you think, as the technology journal article insinuated, that doctors and hospitals have intentionally resisted computerization to keep the public aware of how profitable their businesses are?

Also to your right, in Beta mode to see how many of you enjoy nerd humor like me: Dilbert. You can see the current strip, but also click the date link at the top to pop up a calendar and choose any date going back to 1989 or so (to the Phil, Prince of Insufficient Light days). My favorite is anything with Dogbert Consulting Company.

Justen Deal already told you this a couple of weeks back, but a new Canada Health Infoway report confirms: after eight years and $1.6 billion spent, EMRs contain information on only 17% of Canadians, far short of its 50% goal. Given its apparently failure to deliver what was promised, the organization’s response was: (a) we still might make it by the end of 2010, and (b) what the heck, it’s creating a bunch of HIT jobs, anyway. I guess our countries really are a lot alike. I was interested in the CEO’s educational background, but it’s never mentioned in his bio, which seems odd. 

Sentry Data Systems announces its new Claims Guardian application, which matches pharmacy procurement bills to charges for benchmarking, identifying missed billing opportunities, and documenting costs for submitted claims.


Cerner shares closed at $61.59 on Friday after hitting an all-time high, valuing the company at $5 billion and Neal Patterson’s shares at $344 million. Had you bought $10,000 worth of CERN in 1990, those shares would be worth $1.5 million today, for all us Neal-bashing losers (see stock chart above covering 1990 to now, with CERN in the blue and the Down in the red, no pun intended). Allscripts hit a yearly high Thursday and closed Friday at $14.74, but still way short of 2000 prices that were in the 80s. CEO Glen Tullman, predicting company growth, tells Jim Cramer, “we’re just getting started.” McKesson is in the 40s, way off its pre-HBOC prices in the 90s in 1998 despite paying massive CEO dollars.


But maybe your best HIT stock buy of all would have been NextGen parent Quality Systems. Your 1998 investment of $10,000 would be worth $627,000 today. The graph above shows the Dow (green), CERN (red), and QSII (blue). 


India’s national e-governance project will roll out Web-based telemedicine software called e-Sanjeevani, a .NET-based solution that’s claimed to be “the world-wide leading provider of connected medical devices or medical equipments, peripherals, and software used in telemedicine.” e-Sanjeevani was developed by CDAC Mohali, an ISO-9001:2000 certified R&D institute. I like its goals, which include “To provide multi specialty health care to the common man at the most affordable cost.” Maybe we should use it here to connect to specialists in India since our common man can’t afford it either. 

New York State Senator Pedro Espada owes the state and the IRS hundreds of thousands of dollars from the operations of his medical clinic/medical home, which gets funding from the state health department. The clinic paid the Senator $460K last year, but omitted that payment from its IRS filings. The clinic says it was promised $200K to convert to an EMR, but has received only half that amount. The Senator has been in hot water before, claiming a vacant apartment as his district residence and charged (but acquitted) of using clinic money to pay off his campaign debts.

China will restrict viewing of Internet-based medical research papers about sex starting next month, another step in a series of crackdowns that include requiring new PCs to have filtering software and requiring Google to block politically sensitive results from its searches. Medical information sites will be required to implement technology that will restrict sex-related medical research papers to medical professionals.

I’m torn: Microsoft is selling its Windows 7 Home Premium upgrade for $49.99 for a couple of weeks, temporarily discounted from its insane list price of $120 (Apple’s Snow Leopard will be only $29 and $49 for a five-license family pack, plus their stuff seems to be much less trouble–prone). Reasons against: (a) I have no unmet operating system needs since XP works fine for what I need, which is mostly to use Firefox to get to Google Apps and Gmail; (b) my Vista upgrade was a disaster, with all kinds of flaky behavior and lack of device support, (c) installing it requires a complete reinstallation of everything on the drive; and (d) I keep thinking of that Office 2007 ribbon bar, surely the stupidest and worst-designed software “feature” in recent memory, and wonder what similarly unpleasant surprises might have been tucked into Windows 7. I could load the release candidate version, but it’s just as risky in all those same ways except financially.

Speaking of Apple, I found its site for medicine and clinical practice. It’s a pretty short list of Mac-based EMRs, though, and I’d hope doctors wouldn’t choose a system just because it runs on a Mac. From the screenshots I’ve seen of some of those systems, they’re not much different from the hundreds of Windows-based apps out there.

Thieves in Canada who stole a truckload of computer monitors that a local hospital was donating to impoverished schools in Africa return them after finding out where they had been headed, attaching a note saying “sorry for the trouble, hope you forgive us, hope those kinds in Africa enjoy.”

Great news! Frugal politicians say they can try to fix healthcare for only $1 trillion. Let’s hope the government doesn’t run out of currency-printing green ink before it all turns to budget-busting red ink.

Jeff Amrein, who sold Advanced Imaging Concepts to Allscripts in 2003, moves on to his next venture: an online poker site called Hog Wild Poker Leagues. I thought the whole poker thing was as passe as swing music and pacifier-sucking teenagers, but maybe not.

Imaging vendor Merge Healthcare is added to the Russell 3000. Shares have been on a tear, jumping from around 40 cents in December to $4.30 now following major restructuring and a new private investment a year ago. Timing is everything, though: the share price was at nearly $30 in early 2006.

Odd hospital lawsuit: a heart surgery nurse sues her hospital employer, claiming she was demoted for complaining that a surgeon threw a 4-by-6 inch hunk of heart tissue at her during an operation and joked about it. His humorous line wasn’t mentioned, but I pictured him belting out Janis Joplin’s Piece of My Heart.

The surgeon general under the first President George Bush, who is now (but probably not for long) a VP of Florida Hospital in Orlando, pleads guilty of labor charges at her former New York health commissioner. She forced state employees to work overtime doing tasks such as having security guards move furnishings in her house and publicly chewing out state guards for mishandling her personal shopping bags. The inspector general’s report sand she added “new dimension to the definition of ‘arrogance’ and ‘chutzpah’." She’s also the sister-in-law of Father Guido Sarducci for you old school Saturday Night Live fans.

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Currently there are "12 comments" on this Article:

  1. >>> The final results of the poll on HHS’s meaningful use draft: 20% think providers will achieve it too easily, 42% think the criteria are too hard, and 38% say they are about right.

    Has anyone ever thought about asking the providers? Who the heck cares about what other people think when it’s the doctors that have to put up with the increased paperwork and layers of beurocracy. Whoever at the HHS conducted this poll is out of his mind…

    What they SHOULD have asked is “Should the vendor-inspired ‘meaningful use’ of EMR legislation be scrapped altogether since it’ll raise the cost of medical care, eventually force physicians from participating in Medicare and Medicaid, and that 96% of physiciains are not now doing it?” (Accoding to the NEJM article last year, although 17% of physicians own a c-EHR, only 4% of physicians are using all the necessary capabilities.)


  2. I don’t understand…your looking for a business reason to purchase technology. Why not just buy Snow Leopard or Windows 7 just because.

    We bought CPOE because our Board of Trustee’s thought it was a good idea.

    Go buy the OS…then try to get your family to use something they didn’t want or need AND require them to change behavior.

    You don’t need a REASON to buy technology, c’mon…you know that.

  3. RE AMDIS: Take out anything that requires CPOE because it’s loaded with the possibility of unintended consequences.

    I agree in part with AMDIS approach to “meaningful use” except the issue of deleting implementation of a structured template know as CPOE. Must admit that I am confused and do not understand the rationale for “unbundling” a clinical event capture device. It reminds of the adage of throwing out the baby with the bath water.

    Healthcare is generating a Category 5 Hurricane of data but subsequently producing a famine of actionable results including unintended consequences. Without a structured template, vis-a-vis cookbook medicine such association with CPOE data set, how does the EMR system discern what is relevant clinical events from clinical absurd data? Extemporaneous care can be a dual-edged sword; harmful or heroic.

    CPOE has the advantage of proposing to the healthcare industry evidence based medicine promulgated by peer review and adoption of successful clinical experiences. If you do not include specific data elements for the structure of your database, then how can you propose a legitimate query for who, what, when or where? Besides the obvious benefits for electronic chart abstraction, if the clinical event is documented by a template prompt, then we can ask structured and or ad hoc questions about the outcomes of clinical transactional events.

    Still confused about recommending taking out CPOE? Maybe the provider can fill out a paper form like a lab requisition to go with the EMR entry!

  4. @Alchemist, not sure what you’re missing about CPOE, they’re basically saying that there’s no way most organizations can achieve that within the 3 yrs they need to get the stimulus money (which is what this is all about), which is a true statement. Check out the FCG study from 2003 that looked at how long it took people to implement, they estimate 18 mo-3 yrs, and that’s assuming you’ve got everything in place to go forward (like network), and a purchasing process of ~6 months (fantasy at many institutions). And this is CPOE only (much worse if you have to do the full EMR).

    Given the state of the economy in general, and hospitals in particular, and the fact that it’s still unclear whether or not there’s money on the table for CPOE, most places are going to have a difficult time pulling the trigger right now, and that means they’ve already missed the $$ (~3 yrs left for yr 1 hospital money). We also don’t know what the actual metric for meaningful use is going to be, so if it’s >90%, if you don’t have CPOE already halfway through the process you can forget any chance of achieving it. The 58% of ppl who voted anything other than “too hard” on the survey are on the same stuff ONCHIT is.

    Even if we, for the sake of argument, hoped to achieve 50% uptake of CPOE by 2013 on the hospital side, you’re going to need ~40% of hospitals to get it in addition to the 5-18% that have it now to reach that. Could the vendors and professionals who do this stuff actually support that number of implementations? Could they do it if we slip the date to 2016? 2020? And by 2020, all that’s at risk if you don’t is 5% of your Medicare payments, which by the way are going to be dropping even further in the near future. The decision making process for a hospital is easy, if you were going to do it before, you’ll still do it. If you weren’t it doesn’t make any sense to start because of this.

    Professional side the argument is more compelling only because the money is greater. However, they have one less year, and are now down to 2 yrs to achieve the maximum funds. And your total costs of implementing are still probably more than the stimulus money, when you figure hardware, lost productivity, training, and ongoing costs, never mind factoring in risk of failure. And for people who don’t accept Medicare/Medicaid, which is growing, none of this even matters.

  5. RE; Snow Leopard — check out the fine print on the low priced upgrade and you will notice that it only applies to systems purchased since Oct 2007 with Leopard installed. Won’t even run on Power PC machines. I like the Mac but if you do a long term cost comparison for OS upgrades between Microsoft and Apple it isn’t even close, Microsoft is much less expensive.

  6. RE: RXPete

    You do realize that a Mac OS gives far less headaches than a Microsoft product in that same time span, right? Not too mention Mac did switch architecture to Intel, so it has the same effect as going from XP to Vista (with the much needed increase in RAM pushing many people to new hardware), so not really sure where you are going with that argument. Either way, in the end I am paying for convenience…like you should for an OS. You just want everything to run how it’s supposed to…and I get that almost 100% of the time with my Mac. Can’t say I even approach 80% of the time with my Microsoft product…much less a commitment from them to fix anything so that I can get peace of mind with Microsoft like I do with my Apple products.

  7. @rxPete – not true about the pricing limitation. Pulled from the Apple site at: http://www.apple.com/macosx/specs.html – “Upgrading from Mac OS X v10.5 Leopard. If your Intel-based Mac is running Mac OS X v10.5 Leopard, just purchase Mac OS X v10.6 Snow Leopard when it’s available and follow the simple installation instructions.” No asterisk, no fine print, and directly below the stuff about the $9.95 upgrade if you bought a Mac after a certain date, so it’s the right place for that sort of thing if it existed. It would be a highly odd business decision if they tried that anyway, and impossible to enforce because I could just purchase it off of Amazon if they tried any “register your Mac” nonsense. Also no idea where you get your upgrade cost numbers from, my Windows numbers may be slightly less than my Mac only because I skipped Vista, but it’s still probably more because I had to buy a new XP license when my MB died because the OEM one wouldn’t transfer (transferred my OS X license to 3 Macs in the meantime).

  8. The details of the letter from the Association of Medical Directors of Information Systems (AMDIS) to Dr. Blumenthal referenced above are very different from the impression given by the summary.

    While some of the suggestions seem good to me, (for instance, ‘meaningful use’ should be seen through the patient’s eyes), a careful reading of the rest of the letter reveals a commitment to CCHIT-certified systems as opposed to having the new national HIT Policy Committee define ‘certified EHR’.

    AMDIS recommends:

    Use only EHR systems that are considered “safe and effective” by a trusted authority.

    . . . we recommend that the most important 2011 stretch goal for most physicians and hospitals will that physicians and staff become regular and appropriate users of those core EHR functionalities that are relatively easy to implement and use in EHR systems certified under the 2008 CCHIT criteria.

    As I read the letter, the core recommendation is to have all physicians start to use a CCHIT-certified system on a regular and consistent basis, and then address issues of ‘meaningful use’ down the road.

  9. I say buy Windows 7 at $49.99. If you don’t use it in October then sell it to someone else for $50.00. It won’t get any cheaper.

    I have been using Windows 7 and it is awesome. It’s the best MS product I’ve tried in years. I also like the ribbon a lot though ;-)) Windows 7 just works. It’s actually faster on my old laptop than XP was. The install was so freaking fast. It installed quicker than Acrobat Pro.

    The problem will still be for manufacturers to update their drivers (for older devices) for the launch. This is something MS can’t force them to do. However, most have said they learned from Vista’s launch (and their customer’s complaints) and will have them available.

    The only really big change I’ve noticed in the UI is the task bar. It more like a hybrid of OS X’s dock and the standard task bar. It works really well but it will come as a shock to some. There are videos about it that shows how it works.

    OS X is nice too but if you don’t have a Mac then you need new hardware. Personally, I don’t think Apple’s software would do so well if they had to support dozens of PC manufacturers. At least, Windows and Linux let you choose the hardware that’s best for you.

  10. I agree with the suggestion that technology vendors need to be held accountable for data exchange capability. We know what works, and it’s not just an Electronic Health Record in and of itself. It’s the infrastructure underneath the EHR that makes it actually work, including being able to accurately link patient identities across systems and provide real time search capabilities to find the right patient at the point of care. A patient registry performs this critical function and should be part of the requirements. It’s been a proven catalyst for information exchange in Canada, in the NHIN and countless public and private exchanges throughout the US.

  11. RE: Sean

    Mac OSX runs on Intel. Not quite sure what you are talking about with the “new hardware.” You can buy the OS and a blank “PC” and load it up. Mac OSX will even let you load Windows on a partition with your HDD using a free tool called “Bootcamp.” That’s just how incredibly easy OSX is…

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