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Monday Morning Update 10/5/09

October 4, 2009 News 10 Comments

From Cernerfan: “Re: Barts 18-week backlog in thousands.” In England, Cerner Millennium is blamed for the jump from 1,700 to 23,000 patients whose referrals don’t meet the 18-week target from referral to treatment at Barts and the London NHS trust. They’ve been live since April 2008, so the “things are shaking out” excuse is getting a bit long in the tooth.


From The PACS Designer: “Re: Google Sidewiki. Google has a new feature called Sidewiki that permits useful information to be added to any web page. The Cleveland Clinic is using Sidewiki to add heart disease information to enhance details about the disease and its prevention.” I have to admit that I hate this idea with a passion. Users can now take control of Web sites, splattering unvetted comments onto any site without the owner’s permission or involvement (they call it “contribute to any web page”, in other words, even those to which you weren’t invited to contribute). Who’s to say that the nasty comments on Cerner.com didn’t come from a competitor? It’s a step backward for sites like this one that already allow nearly unrestricted comments, but exercise some control to keep the conversation civil, the facts accurate and relevant, and the personal attacks limited. Using some third-party tool also splits off what should be a threaded conversation, with Sidewiki hijacking for Google’s benefit conversations that could have been better served with existing technology. Sidewiki is a really bad idea, but I’ll predict that Google will kill it anyway after it gets wrapped up in a few slander suits over malicious postings. In fact, I seem to remember that a similar technology met a timely death for exactly that reason not too long ago, although I don’t remember its name.

From EHR Geek: “Re: FierceHealthcare. Rumor is that Mr. HIStalk was named one of FierceHealthcare’s Nine Healthcare Bloggers worth a click. We love us some Mr. HIStalk!!” Thanks to the folks there for the mention.

From Electric Slide: “Re: vendor evaluation. Are hospitals that are evaluating vendors still using Gartner’s Magic Quadrant, KLAS, or HIMSS Analytics? Given ARRA, it would seem like the value has diminished and both charge a lot of money from the vendor side.” I’ve always thought that, for major purchases like clinical systems, hospitals mostly went with less logical criteria: (a) how enamored the hospital executives are with the vendor’s vision, executive charm, and marketing fervor (all of which usually are negative signs rather than positive, but are widely accepted); (b) whether they just want to dump an incumbent and try their biggest competitor as something new; or (c) CIOs choosing the option that looks like the least work and risk for IT (i.e., just buy more stuff from current vendors). I can only speak to the selections I’ve been involved with personally, but those (oddly, for science-based organizations), usually ended up being influenced by intangible BS like the Vision Center, personal relationships that really should have required the hospital executive to recuse themselves from the selection, or either buying the same system as a competitor (to show them up with better utilization) or what they didn’t (to avoid being labeled as imitative). Any resemblance to an orderly process driven by the needs of clinicians and their patients was purely coincidental.

From J-Lo: “Re: HIMSS. Enjoyed your reception, but it was hard to hear and kind of frustrating that people stayed in their typical cliques rather than a whole bunch of mingling. I did meet several new folks cuz I made the effort, but maybe, just maybe you and Ms Inga could come up with a way to integrate your guests a bit more.” I agree completely. We need some gregarious event ambassadors to get people talking (I had high hopes for the strippers from year before last, but as I should have known, spirited conversation wasn’t their long suit). Former A-V club geek Dr. Gregg Alexander has promised to help out with improved presentation logistics now that we won’t be constrained by the limited capabilities of a hotel ballroom, so I’m looking forward to fog machine effects and maybe Inga flying in on a wire.

From NHIN-a-new: “Re: NHIN. This exclusive confab last week may be worth analysis – did we just hear the sound a door opening? Looks like ONC is exploring a really interesting way to apply the NHIN to the reality of consumer environments. Think linking the ATM network to your cell phone – now that would be a ‘cool technology of the week.’ As long as there is enterprise aggregation of data we need the structure the NHIN provides in standards and specifications (the work going on inside the NHIN project on details specs and governance issues is absolutely amazing!)  And this session shows a way to coordinate these two innovations.” John at Chilmark Research reports that the government’s intentions for the Nationwide Health Information Network maybe be changing from a data exchange platform for provider data to a “Health Internet” that is more driven by and beneficial to consumers. That makes sense based on some of the buzz around new federal CTO Aneesh Chopra and his interest in “government as a platform”. I’ve been saying all along that “meaningful use” ought to be based on the data providers contribute electronically rather than paying them for simply replacing paper with EMRs, so perhaps this is a step in that direction. Everybody (except the government and its Medicare payment rules) knows you ought to be paying for the result you want.

From Lips Kudlow: “Re: EMRs as medical devices. This is truly frightening. It would result in the decimation of an already beleaguered Canadian EMR software industry, not to mention smaller added-value healthcare software vendors. It wouldn’t surprise me if the large vendors (Cerner, Meditech, et al) have lobbied Health Canada to issue just such a ruling, since large companies typically have a vested interest in stifling innovation and competition from upstarts.” Health Canada releases a notice stating that software “use only for archiving or viewing information or images” is a Class I medical device and systems that manipulate, analyze, edit, measure, or graph information are Class II medical devices. That means vendors must be ISO certified to sell those products in Canada. The definition of “patient management software” is a bit vague and sounds as though it was intended to cover physiologic monitors (note the reference to “active diagnostic devices” and “monitoring a physiological condition”), but I’ve e-mailed for clarification.

I’m back on the job, so thanks to Inga for keeping things under control while I was away. She did great, if you ask me. I’ve got a lot of catching up to do and will unavoidably mention items she already covered, but it’s all new to me.

Regional Medical Center (SC) is always doing something newsworthy when it comes to Cerner, whether it involves board members fighting over parliamentary procedure in approving its Cerner contract or having its employees crying racism over including a banana-wielding gorilla in its post-project celebration. Now its board argues bitterly over its proposed $1.3 million purchase of medication dispensing cabinets from Cerner, specifically debating whether Cerner is a sole-source supplier in that marketplace (uhh, ever heard of Pyxis or AcuDose?) The CFO says they decided that only Cerner could provide the cabinets since theirs are “integrated”. Board members argued, shouted, and insulted each other to the point of having to be gaveled down by the chair. Cerner still gets the business, or at least I think it did based on the somewhat confusing recap.

A-Life will connect its Actus computer-assisted coding system to the Ingenix Web.Strat encoder.


Plains Regional Medical Center (NM) learns that its mammography information was hacked two years ago in a breach at the University of North Carolina at Chapel Hill, which provided its previous system for generating mammography follow-up letters.

A reader asked if GE is still selling Centricity Lab in the UK. Inga asked GE and we appreciate their response: “The business has decided to shift its strategy away from forward production on the Centricity Lab product. The demand for it is, perhaps, as strong as ever yet currently concentrated in smaller, community-based EMR settings. We really need to focus on maximizing the personalized service we can deliver to the existing install base and will continue to service and support all current installs (as well as honoring all current orders).”

In Ontario, the hospital CIO who was involved in issuing $3 million in no-bid consulting contracts to a former co-worker steps down. Diane Beattie and her employer, London Health Sciences Centre, have agreed to part ways, but now the politicians are arguing over the $451,000 in severance pay she will receive for her 21 months on the job. Her contract called for severance of a full year’s salary plus a month of pay per year of service. Maybe someone ought to investigate who approved that kind of a deal, which is somewhere between remarkable and nuts (her employer says it’s a “standard contract for senior staff in teaching hospitals”).

Oracle’s Larry Ellison on cloud computing: “I remember I was reading W and I read that ‘orange is the new pink’ and ‘cloud is the new SaaS’ or ‘cloud is the new virtualization’ … maybe I’m an idiot, but I have no idea what anyone’s talking about. It’s just complete gibberish … I’m going to access data on a server on the Internet and that’s cloud computing? … These people who are writing that crap are out there. They’re insane.”


HHS secretary Kathleen Sebelius will address the 6,000 attendees of the Cerner Health Conference on Tuesday, talking about healthcare reform. Any irony is unintentional.

Beaumont Hospital (MI) CIO Paul Peabody will retire after 35 years there, part of an executive restructuring. 

My poll on who readers would like to work for given comparable jobs offer drew 527 responses, which I’m guessing indicates some level of either fraudulent voting or vendors encouraging employees to vote for the home team. Anyway, take it for what it’s worth: Epic won with 30%, followed by McKesson (17%), Meditech (13%), Cerner (12%), Eclipsys (11%), GE (11%), and Siemens (6%). New poll to your right, raising a moistened finger into the air to detect a shift in the winds of economic change: over the past six months, how has your employer’s economic situation changed?

The layoffs just keep on coming at Texas Health Resources.

Cerner digs deeper into the life sciences, licensing its Discovere system to clinical trials vendor Quintiles. Part of Discovere is the former First Genetic Trust technology that Cerner bought somewhere along the way. Quintiles signed an agreement with that company back in 2001 and took an equity position in it. The Discovere modules include biobanking, research registries, public health investigator workflow, clinical trials management, and adverse event reporting.

I ran across an overview (warning: PDF) of Cerner’s LifeSciences, which apparently involves selling patient data from the EMRs it hosts. “Through our data mining of our vast warehouse  of electronic health records (EHRs), you can accelerate development processes and reduce business risks. This is when Cerner LifeSciences makes it possible to analyze anonymous, HIPAA-compliant, EHR-derived data for efficacy and safety.” That’s an interesting business. Long-time readers will remember that I’ve cautioned previously about providers selling off their data rights since they have more value than you might suspect. Cerner is pretty smart to include contract language that allows them to sell anonymized customer data to drug companies, getting it free, in essence, from its IT customers.

Several hospital nurse executives provide testimonials about the contribution of the Kronos employee scheduling solution to their Magnet designation.


West Tennessee Healthcare CIO Jeff Frieling gains additional responsibilities as VP of hospital services.

Another big hospital CEO retirement payout: Valley Medical Center (WA) gives its CEO a $1.73 million retirement bonus even though he’s not retiring. The hospital put the money aside in 2003, payable if the CEO retires after his 60th birthday or if he is fired or demoted (!). He’s still working at $900K per year and still has a separate pension plan for whenever he really does retire, courtesy of the local property owners whose taxes support the hospital. The hospital issues the boilerplate lame excuse that every other over-paying hospital uses: “It’s a highly competitive market, and our board feels that in order to keep someone of Rich’s caliber, he needs to be compensated as such.” Are they admitting that it’s such a dump that nobody would sign on for the pittance of, say, $500K? $250K? Like Wall Street, nonprofit hospitals are clearly out of control in their executive pay practices.


This is interesting: the orthopedics chair at Bronx-Lebanon Hospital Center (NY) e-mails an unsolicited testimonial to the vendor of an iPhone aviation pre-flight checklist app. The doctor had modified the templates to create pre-surgical checklists for total hip, total knee, and arthroscopy, one of which reminded him to check a particular patient’s lab result. The outcome, in his words, was “a life was saved.”

TeleTracking Technologies acquires small RTLS vendor RadarFind.

Odd hospital lawsuit: the family of a man who died of a heart attack in the ED sues the hospital, claiming the ED doctor let him die so he could steal the patient’s $16,000 Rolex.

SUNY Stony Brook will expand its use of PatientKeeper, adding its ePrescription and Pay for Performance modules. ePresciption will be live by the end of the year in time to qualify for the 2010 Medicare incentive payment. PQRI will also be running in time to get that incentive.

UK stock analysts postulate that the three divisions of Misys (healthcare, banking, and treasury and capital markets) could be split off into their own companies to increase shareholder value, also guessing that Allscripts will be the first since it’s about the only bright spot the company has. Meanwhile, some nuggets from the Allscripts-Misys earnings call: (a) “Some of our competitors are talking about a pause; we’re surely not seeing it.”; (b) Allscripts is working with Henry Schein in implementing the big North Shore-LIJ deal recently announced; (c) a new factory-type Enterprise rollout has cut deployment time and hours by 50%.


A reader sent in a flyer for a series of invitation-only Apple executive briefings covering the iPhone in medicine. The ones in Chicago, Reston, and New York are over, but sessions in Boston and Cupertino will be held later this month (we geeky programmers are amused at the address of Apple’s executive briefing center: 4 Infinite Loop). I’m certain it was oversight that Inga and I haven’t received our invitations yet.

GE Healthcare’s joint venture with Bangalore’s Wipro is enhanced to become GE Healthcare’s sole vehicle in India. GE CEO Jeff Immelt predicts that healthcare products and services developed cheaply in India will be exported to the US, helping manage healthcare costs here.

Former FCG president Steve Heck joins Impact Advisors as VP after a couple of years at Navigant.

This doctor doesn’t mind using a computer: a former pediatrician is ordered to appear before North Carolina’s medical board, charged with failing to report his DWI arrest and for using the PC of a practice for which he was working to write pornographic stories.

A Children’s Boston research article says EMR data can be used to help doctors identify domestic abuse. The most positive correlation for females was for injury, poisoning, and alcoholism. For men, it was mental health conditions.

E-mail me.

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Currently there are "10 comments" on this Article:

  1. Thought this might be of interest

    Message from the Chief

    Welcome William C. Schoenhard

    Deputy Under Secretary for Health for Operations and Management – Veterans Health Administration

    October 2, 2009

    On behalf of Secretary Shinseki, Deputy Secretary Gould, Acting Under Secretary for Health, Dr. Cross, and all of us at VA, I would like to welcome William C. Schoenhard as the new Deputy Under Secretary for Health for Operations and Management, VHA, effective October 8, 2009. Bill, a former executive with one of the largest Catholic health care systems in the country, will join a strong group of health care professionals as he moves into his new role as chief operating officer for our 21 Veterans Integrated Service Networks (VISN). He will also be responsible for VHA administrative programs, including business operations, health care contracting and logistics, facilities management, canteen services, health care engineering, and safety and technical services.

    Mr. Schoenhard is no stranger to teamwork or organizational transformation. As executive vice president and chief operating officer at SSM Health Care, he guided SSM through the largest period of institutional growth in its history, and developed and implemented a series of systems, policies and procedures which are considered industry best practices. In 2002, SSM became the first health care recipient of the Nation’s highest Presidential honor for organizational innovation and performance excellence – the Malcolm Baldridge National Quality Award.

    A Fellow of the American College of Healthcare Executives (ACHE), Bill was ACHE’s Chairman for 2006-2007 and received its Exemplary Service Award in 2009. He serves on the Board of Trustees and Executive Committee of the American Hospital Association and served as Chair of the Missouri Hospital Association, receiving its Distinguished Service Award in 2007. In 2003, he was appointed by Missouri Governor Bob Holden as the only health care executive to serve on the Missouri Commission on Patient Safety.

    A U.S. Navy Officer, Bill served in the Philippines and Vietnam as Damage Control Officer on the destroyer tender USS Samuel Gompers.

    He and his wife, Kate, have a son, Tom, a daughter, Sarah Skinner, and two grandchildren, Charlie and Ellie.

    We are delighted that Bill Schoenhard has agreed to join us here at VA and look forward to the hard work we will do together to transform this organization to better serve Veterans and their families.

    Personal Regards,

    John Gingrich

    Chief of Staff

  2. From Lips Kudlow: “Re: EMRs as medical devices. This is truly frightening.”

    EU’s already gone in that direction. From the Swedish Medical Products Agency:

    Improving patient safety in the EU: Many Medical Information Systems should be classified as Medical Devices


    Thursday, June 18, 2009

    Correctly functioning Information Technology (IT) systems for health care is a prerequisite for ensuring patient safety. However, applicable regulation is rarely applied, mainly due to the lack of useful guidelines on how to classify the IT-systems. A national working group in Sweden has prepared a guidance report that will help increase compliance with the Medical Device regulation in the EU, thus improving patient safety.

    An increasing number of serious incidents, with IT-systems involved, have been reported from the health care sector in recent years. In most of these cases, existing regulatory regimes have not been applied, either by manufacturers or by health care providers. As a result, the assessment of safety issues has become unclear because the manufacturer’s responsibility is vague.

    For this reason, in 2008 the Swedish Medical Products Agency (MPA) initiated a national working group with the aim of providing guidelines for the classification of IT-systems intended to be used in health care. The working group has now prepared a report, intended to serve as guidance for both manufacturers and end-users. At present, there are no guidelines of this kind in Sweden, or the rest of Europe.

    “Many parties, including the European Commission, have expressed interest in our work. We believe that it will improve the quality and safety of medical information systems. A common approach to product classification is key” says Lennart Philipson, Scientific Director.

    One important conclusion from the working group is that the Medical Device Directives is the most suitable regulation to be applied.

    “Our market surveillance of medical information systems will be based on the conclusions in the report from now on. If a system falls within the definition of a medical device, the requirements for CE-marking shall be applied” says Mats Ohlson, Chairman of the working group.

    Manufacturers need to adapt to applicable standards when it comes to quality systems, risk management and usability. They will also need to establish post-market surveillance routines to regularly assess products on the market.

    The working group consisted of members from the Swedish Medical Products Agency, the National Board of Health and Welfare, the Swedish Association of Local Authorities and Regions, Swedish Medtech, the Swedish Standards Institute, Swedish Electrical Standardization and notified bodies through Intertek Semko.

    More here: a report entitled “The Medical Products Agency’s Working Group on Medical Information Systems: Project summary” is available in English translation at this link (PDF): http://www.lakemedelsverket.se/upload/foretag/medicinteknik/en/Medical-Information-Systems-Report_2009-06-18.pdf

    In that report:

    “A general opinion of the health care providers represented in this Working group is that from a patient safety point of view, it is desirable that stand alone software and systems intended to, directly or indirectly, affect diagnosis, health care and treatment of an individual patient shall be regulated under a Product Safety Regulation.”

    HIT vendors need to be agile due to shifting conditions in the marketplace … like any other producer of goods.

  3. Kudos to Canada, Oh Canada.

    Adverse events due to patient management systems are on the rise. Each week, there is another risk discovered by users. Remedies are non-existent. HIT sellers are in business to make money. Patient safety is irrelevant to them.

    Small companies should do it right from the start and put the big ones out of business.

    The heavyweight producers of HIT are culprits. They manipulated Congress while selling antiquated equipment that does not work safely or efficiently. They are selling HYPE. Nothing else.

    The US is throwing good money after bad thinking that the current workflow software will offer savings. RAND analysis was wrong.


    In order to clear out the cumbersome HIT that is polluting hospitals, users from Canada need report adverse events due to HIT to Health Canada.

    Frustated users from the US need report patient adversity and HIT product dysfunction to the FDA.

  4. Adverse events due to patient management systems are on the rise. Each week, there is another risk discovered by users. Remedies are non-existent. HIT sellers are in business to make money. Patient safety is irrelevant to them.

    Are you ever going to provide any evidence to support these claims?

  5. Wouldn’t it be easier if we just wore tin foil on our heads and stayed in bunkers? Do we have proof of any of these claims?

  6. Re: A reader asked if GE is still selling Centricity Lab in the UK. Inga asked GE and we appreciate their response: “The business has decided to shift its strategy away from forward production on the Centricity Lab product. The demand for it is, perhaps, as strong as ever yet currently concentrated in smaller, community-based EMR settings. We really need to focus on maximizing the personalized service we can deliver to the existing install base and will continue to service and support all current installs (as well as honoring all current orders).”

    Do you know if this applies to all Centricity Lab products? (TriWin and Ultra?)

  7. “The Discovere modules include biobanking, research registries, public health investigator workflow, clinical trials management, and adverse event reporting.”
    Turn this module on to the company’s Millenium Patient Care products since the vast vat of adverse events are not beingt addressed as reported at Barts in the UK.

  8. Google Sidewiki . . . that’s scary. So now anyone can visit any website and post comments or added content to someone else’s website? That seems a violation of owning and managing the content of your own website. Now anyone can come along and post anything they want on your website. Reading Google’s proposed uses for this tool is even scarier in that they suggest people add medical content to sites like the CDC – Who’s validating the accuracy of that content? Who’s responsible for anyone acting on that content? What if someone dies as a result of misinformation?

    I can think of all kinds of inappropriate uses from a business competition perspective that makes this tool a potential major problem, but from the medical perspective, owners of web pages must be given the right and capability to selectively enable or disable this feature for their website. If Google doesn’t provide that, I see lawsuits in the future.

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