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Monday Morning Update 9/14/09

September 13, 2009 News 17 Comments

From Ex-Cerner Guy: “Re: Cerner. Not only does Cerner re-sell the data they collect, but it’s part of their Lighthouse agreement and the client gets to pay for the privilege of giving their data away. Look closely at the wording of the agreement — it’s in there. It’s good to read their contracts closely. It’s more fun to sit in on the negotiations and watch the squirming.”

From The PACS Designer: “Re: Govt 2.0 Summit. Tim O’Reilly, of Web 2.0 fame and founder of O’Reilly Media, had some interesting comments at the Gov 2.0 Summit about turning government into a platform to foster true innovation in the years to come.” Tim’s got some shopworn analogies about the iPhone and Twitter in case you haven’t had enough of those, making the point that third-party products should plug into the “government platform” to build citizen services, no different than the Interstate system and the Internet (oops, more analogies). All I could think of was the cool movie Startup.com that documented the quick ride up and equally quick ride down of Govworks.com, which was going to make the founders zillionaires by allowing people to pay parking tickets online. Where were you during the dot-com wars?

From Needs_Gas: “Re: Eclipsys. A recruiter says they have a new model and will be partnering with third-party firms to provide services.” Unverified.

From Luke O’Scyte: “Re: anonymization. There is no such thing as real anonymization any more due to the science of re-identification. You can uniquely identify 87% of Americans with only zip code, date of birth, and gender. Release of such information by companies like Cerner should not be allowed.” I’ve covered that topic before, but it’s worth another mention: all you need is a second database that state or federal governments sell cheap and you can re-identify most of the records in a “de-identified” set. Luke sent a link to a fun article describing a well-intentioned 1990s mandate from Massachusetts state government to release anonymized data covering state employee hospitalizations, which sounded great until a grad student mailed the medical history of the governor to his office. She had easily obtained his full record of his diagnoses and prescriptions by matching the anonymized employee data to a voter database she bought for $20. Only six people in Cambridge shared his birth date, only three were men, and only one (the governor) lived in his ZIP code. That grad student was Latanya Sweeney, now a noted Carnegie Mellon professor and privacy technology expert.


The Conficter worm shuts down takes down all hospital information systems in the Cayman Islands. What’s most interesting about the story, though, is that the article quotes new CIO Dale Sanders, who has been on the job less than a week and who, until recently, was CIO at Northwestern Medical Faculty Foundation. I’m interested in how he ended up there since that sounds like a fun move. I’ve been to the Caymans several times and my impressions are (a) it’s beautiful with stunning green-blue water great snorkeling; (b) it’s also horrendously expensive and has a bad exchange rate on the US-to-Cayman dollar, and (c) it’s an international haven for tax-dodging corporations and shady banks (was that redundant?) whose physical presence is a post office box. Oh, and it has a turtle farm and rum cakes.

Opinions about working at Epic are mixed on Job Vent, which is always entertaining as well as hardly reliable. General observations of those posting: (a) they hire only easily controlled new grads of any major; (b) job evaluations and promotions are based only on hours worked; (c) if you quit to work for a customer after the mandatory one-year waiting period specified in the contracts of customers, you are an untouchable who isn’t allowed to interact with current employees; (d) the money, benefits, and the non-cubicle environment is nice for new grads. Some of the posters claim a 1984-type environment where employee conversations and Web activity are monitored, warning of the “thought police.” One pro-Epic cheerleader claims, “We hire scary-smart people, so if they can’t cut it at Epic, they will still be a rock star somewhere else” which maybe means in a different industry since 22-year-old philosophy grads with zero work experience of any kind aren’t exactly in high demand in HIT. As a capitalist, though, I like the model: pay a little more than you have do, bring people to a location where they have few career alternatives, demand more than you should expect, proclaim cheap meals and snacks a benefit instead of a way to get extra hours out of employees who might actually leave for lunch otherwise, keep enough quirk on hand to fool wide-eyed noobs into thinking that wintry Wisconsin farmland is a hip Silicon Valley Midwest, and keep a big file of backup resumes to feed the churn. It’s working for Epic and, greenhorns or not, they innovate more than their competitors.

Cerner will hire 12,000 new employees by 2020, Neal Patterson says to the government of KCMO to soothe the civic feathers he ruffled by choosing the Kansas side of the border for his soccer and HIT complex.


Thanks to Kronos for becoming an HIStalk Platinum Sponsor. The Chelmsford, MA company offers a wide range of workforce management systems that optimize the cost of delivering quality care, minimize risk due to noncompliance with requirements, and maximize productivity. Some of its applications include timekeeping, human resources management, payroll, workforce analytics, employee scheduling, and absence management. They have several research and case study papers on their site. My thanks to Kronos for supporting HIStalk and its readers.

Results from my poll about vendors notifying customers when their software has patient-endangering problem: 37% said their vendors were bad about that, 39% said mediocre, 25% said good. New poll to your right: how much impact will Dell have on the healthcare IT market now that it will offer EMR hardware, software, and services?

I like this idea: an online debate on whether to implement CPOE vs. barcoded medication administration first. It features two highly regarded pharmacists with informatics expertise. 

I think I may have joked before that RHIOs might as well try for ARRA grants as regional extension centers since they often don’t have a business model otherwise. Apparently it’s no joke: the Harrisburg Health Information Exchange (PA) submits its grant request

Another reason to ignore stock analysts who cover industries they clearly know nothing about: this article covering Dell’s announcement about reselling EMRs is full of eye-rolling inaccuracies: (a) the headline says Dell will “make” electronic records; (b) it calls EMRs “the device”; and (c) it opines that Dell’s big competitors will be Google and Microsoft, apparently confusing PHRs with EMRs.


An odd lineup on yesterday’s CBS News Sunday Morning: “Dennis Quaid discusses electronic medical records; the end of ‘Guiding Light’; poetry; upcoming fall films.” Dennis’s G.I. Joe did great until word got around, disappearing without a trace after three weeks. He’s up next in the sci-fi (or is it Syfy?) thriller Pandorum, which opens September 25. The trailer looks lame to me, but my taste varies considerably from the apparent mainstream.

Merge Health extends its agreement with Russian medical equipment vendor Rossyln Medical, which will integrate Merge’s PACS technologies into its custom solutions.

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Currently there are "17 comments" on this Article:

  1. The comments about selling of data and provision of de-identified but largely re-identifiable data help instantiate my observations of an increasing cross-occupational invasion of healthcare by non-healthcare personnel, starting with the IT professions.

    While I think such concerns are probably overstated in terms of the dangers of distributing flu data, and applaud Cerner for its efforts just in case this flu turns out to be the “big one” (I think that unlikely, but my grandmother told me about friends dropping like flies in 1918-19), I think the erosion of territorial boundaries ultimately harmful.

  2. so, if you are posting results from a ‘hardly reliable’ website, what does that make yours?

    Judy openly admits to A. That’s hardly a ‘scoop.’
    B and C are just lies.

  3. If Eclipsys has a new model and will partner with 3rd party vendors that will mean all of us will have the opportunity to work with some really great people who were laid off from Eclipsys last week. We just hire back the great one’s they let go. What a business model. Just makes me want to bang my head!

  4. I just read the comment on the site that I believe led to this piece of your summary:
    “(c) if you quit to work for a customer AFTER the mandatory one-year waiting period specified in the contracts of customers, you are an untouchable who isn’t allowed to interact with current employees.”
    One key word makes this incorrect: “after”
    Change that to “before,” and you’ve got it right.

  5. Ah, yes… the Week of the Cayman Conficter. I walked into the office to meet my new boss on the first day of work and she grabs my arm and says, “I’m so glad you’re here! All of our systems are down…everything! We have to convene an emergency meeting of the leadership team!” Gulp…sweat beads on the forehead. Long and stressful week but one of the most fun problem solving challenges I’ve ever faced. I finally made it out to the beach today and have a sunburn to prove it. 🙂

  6. re : “so, if you are posting results from a ‘hardly reliable’ website, what does that make yours?”

    You miss the point. Like Glenn Beck et al, he is just reporting on rumor. You know, “I am not saying EPIC are crazy, but people are! No smoke without fire”. That way you can say what you want! You should try it, apparently its very liberating.

    For instance; “I am not saying the president was born in Kenya, but people are! All the president has to do is release the long form, then this will be over! Just to be clear I am not saying the president was born in Kenya.”

    And repeat.

    See how that works?

  7. Re: Epic. I am fairly early in my career with some experience working as a Wall Street analyst. After covering healthcare, I applied at Epic with the intention of stepping into the industry from a sector analyst type role. All of the interviews went well, up until they asked me to do an online “personality assessment”. This quiz was filled with questions asking whether I feel tired after a really really long day at work. Shortly after taking the assessment my application was rejected. I guess the assessment is designed to sniff out folks who are wise to companies wanting to underpay for overworking their employees.

  8. Re: Epic – C was partially true. Couldn’t work for a customer (unless it was Kaiser) and have contact with any Epic staff. I can think of a few customers that had former employees who become someone we couldn’t talk to.

    Hours “Worked” did go a long way – some people would log more hours than they were at work, though.

  9. Security and Exchange Commission records show UPMC received 74,787 shares of Cerner stock in 2005 from exercising warrants issued by Cerner to UPMC in 2001. What was the deal? Does it Cerner giving the data of other hospitals to UPMC?

    UPMC and Cerner have been involved in joint efforts to sell the recordkeeping system to health care facilities in the United Kingdom. Where is the data going from the hospitals in the UK?

  10. “Like Glenn Beck et al, he is just reporting on rumor.”

    Can we drop the ideological bs? Glenn Beck did not make up Acorn tapes.

  11. I think Epic simply defines a standard and then honestly tries to stick with it. That applies to so many areas within Epic that it would surprise the average person who’s grown up in a world where people rarely do what they say.

    Do you have to kill yourself to work at Epic – nope. Do you have to work hard – yup. Will they ask you to leave if you don’t work hard – yup. Will they ask you to leave if you don’t meet your commitments – yes, and quickly.

    I think the people of Epic take a lot of pride in themselves and in their co-workers. When you watch them it is pretty amazing – they depend on each other and they can count on each other to come through on their commitments.

    Work ethic is something that is fair to hire for and fair to fire for. The days of feeling like you deserve a secure job or big raises no matter how you perform simply because you’re in the USA are numbered, if not already gone for most.

  12. She had easily obtained his full record of his diagnoses and prescriptions by matching the anonymized employee data to a voter database she bought for $20. Only six people in Cambridge shared his birth date, only three were men, and only one (the governor) lived in his ZIP code. That grad student was Latanya Sweeney, now a noted Carnegie Mellon professor and privacy technology expert.


    All of which would be very interesting IF TRUE. Latanya Sweeney hasn’t proven anything concrete. She made an assertion. Supported it with one rigged example and viola, case closed. Now it’s become the she-bible. She is wrong and I aim to prove it. Stay tuned.
    Dierdre M., Ph.D. and Carnegie-Mellon alumna.

  13. Re: Ex-Cerner guy: “…the client gets to pay for the privilege of giving their data away”. While I suspect that some amount of the contracting discusison on ‘Lighthouse’ was not shared in Ex-Cerner guy’s post, I tend to agree with S. Silverstein in questioning the integrity of those who would sell that which is not *theirs*. This ultimately results in higher costs for all including providers, payors and patients which manifests ultimately in higher taxes. In other words we are subsidizing poor information system design. Unlike S. Siliverstein, I don’t believe we should demonize “IT Professions” anymore than we should demonize all lawyers because some legislate poorly or manipulate the Law. We have great lawyers, great IT Professionals, and “us” Healthcare Pundits need to acknowledge those professisionals can and will navigate us through this very complex time. Let’s not throw the baby out with the bath water…

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