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Monday Morning Update 10/26/09

October 24, 2009 News 29 Comments

From Croc Dundee: “Re: academic censorship! The Australian Ministry of Health has forced the withdrawal of Dr. Patrick’s essay on EHR problems in the ED in NSW. See his page now – the download is disabled. Was Cerner involved?” Beats me, but Scot Silverstein archived a copy. It’s anecdotal, opinionated, and more of an editorial than a research study, but interesting. The fact that someone doesn’t want me reading it sent me looking for a copy. Jon Patrick tells me the university took it offline late Friday afternoon and he’s meeting with them Monday to find out why. Rumor has it that complaints were made.

From Fil_Peed: “Re: Eclipsys User Conference. Mr. Pead’s ‘joke’ went over like a lead balloon. Here was the opportunity for him to make a mark on the client base, many of whom he was meeting for the first time, and instead he makes an off-color analogy to what one should do in bad economic times and customers started walking out.” I’ll withhold judgment until someone tells me what he said.


From HITGhost: “Re: lost data. CalOptima reports that its claims imaging vendor, ImageNet, accidentally sent out unencrypted DVDs that contained claims from 68,000 of its members. The DVDs were sent to CalOptima via certified mail, but never reached CalOptima. CalOptima actually posted this information and identified ImageNet on its home page.”

From Avon Calling: “Re: a paperless and telephone-less, state-of-the-art hospital. Babies turn blue, but are always OK. Did Han write the classic CPOE-caused mortality paper from this hospital? And with all of those computers, there are gaps in the record?” UPMC’s Children’s Hospital of Pittsburgh is criticized by the state health department for not responding to a report in which a baby’s mother claimed her baby turned blue but nurses didn’t respond to the emergency alarms. The mother says the nurse’s emergency alert phone wasn’t working, but the hospital disputes that. According to the investigation report, the alarm phones that were claimed not to work were from Emergin (Philips). Children’s was indeed the subject of a 2005 journal article that showed that the use of Cerner Millennium for CPOE was the second-best predictor of patient death, behind shock but ahead of coma (I criticized that conclusion right after and I’ll stand by that – the hospital made some spectacularly bad implementation decisions).

From Ex-Cerner Guy: “Re: Methodist-Gary. They have lost $220 million over the past five years. The consultant was suggesting Meditech, a system they might be able to afford and still be able to pay the consultant.” It’s hard to believe that one hospital would, over just a few years, sign with Epic, drop it for Meditech, and then contemplate going back to Epic.

Speaking of Cerner, St. Bartholomew’s Hospital in London faces fines of $650,000 per month for lengthy patient backlogs that it blames on the “dreadful” Cerner Millennium. I doubt it’s that simple, but blaming the computer is always convenient.

Listening: Muse. I mentioned them before, but I cannot get enough of this band, maybe the best music I’ve heard in a few years. The live album, Haarp, shows they aren’t just studio overdubbers. My highest recommendation.


Welcome and thanks to Dentrix Enterprise, now a Platinum Sponsor of HIStalk. The company is featuring its Dentrix Enterprise Electronic Dental Record, the industry-leading paperless, centralized record system for community health centers. You can read a product review by the National Network for Oral Health Access here (warning: PDF – it’s on page 29). Dentrix Enterprise is a wholly owned subsidiary of Henry Schein, Inc. a Fortune 500 company with annual sales of over $6 billion. Thanks much to Dentrix Enterprise for supporting HIStalk.

GE says the rumor about its Centricity Cardiology layoff is not true and that the system continues to be sold, installed, and developed. Instead, my contact says, “We’re just migrating the business from local to global over the next few years and have shifted some resources for future project development to avoid redundancies.” Sounds like the product is fine but the people working on it aren’t.

A fun practice EMR comment from Gartner’s Wesh Rishel: there are hundreds of systems, not including those developed by “nephews of doctors.” On ARRA: “If they put up $44,000, they don’t want the doctor to buy (Microsoft) Office and open a spreadsheet.” He also predicts that those hundreds of EMRs will shake out to 10. The same article (which is excellent and objective, by the way, since it was written by a local paper’s reporter) quotes Cleveland Clinic CEO Toby Cosgrove on EMRs: “Whether it will drive down quality, I don’t know. It doesn’t increase efficiency or lower costs.” Cosgrove says he told the President that the biggest savings will come from e-prescribing.


A Mass High Tech article covers Lawrence General Hospital’s IT systems, including its Picis ED PulseCheck system that an ED doctor says reduced wait times by more than 30 minutes and reduced ED walkouts from 6% to 1%. It also notes that transcription costs were reduced by $600K per year and revenue was increased by $5 million for IV charges alone through accurate documentation. The hospital will replace most apps (not the EDIS, though) with McKesson Paragon.

The e-mail update subscriber list just passed 4,800 people, some of whom are your archest of enemies and competitors who will read (and possibly act on) time-sensitive news before you if you haven’t entered your e-mail address in the Subscribe to Updates box to your upper right.

CPSI announces Q3 numbers: revenue up 8.7%, EPS $0.37 vs. $0.38.

Two universities get ARRA grants for EMR projects related to genomics. University of Virginia will collect $1.9 million to create a genome-enabled EMR that will be part of Epicare. Vanderbilt is given $415K for its Vanderbilt Genome-Electronic Records project, which will look for a link between blood values and arrhythmia and also develop natural language processing tools to mine EMR data.

Bloomberg profiles rookie private equity manager David Brailer, whose Health Evolution Partners has invested $120 million of California pension money from Calpers so far. He says he will invest $150 to $200 million each year starting next year. A pension consultant comments, “No matter how you look at it, $1 billion is a lot to allocate to someone with no track record.” Some of the biggest investments so far involve radiology. One investment that sounds interesting is in Triveris Inc., which offers an add-on insurance plan just for diabetics that emphasizes preventive care using software to identify diabetes risk. It’s part of Health Network America.

TriZetto issues a press release to notify an impatient world anxious for yet another PHR that “additional features and functions” of its own version will be ready by year end. The opening sentence of the breathy press release is possibly the most awkwardly structured and confusing sentence I’ve read lately.



Not Yet sent a copy of an October 16 letter sent by Senator Chuck Grassley to Cerner and nine other big HIT vendors (I posted the full letter here). The Senator said, as the ranking member of the Senate Committee on Finance, that he is collecting information about healthcare software defects. He cites “learned intermediaries”, “hold harmless”, and “gag orders” clauses that let software vendors shift responsibility to users and prohibit them from disclosing defects. The Senator asks whether the vendor’s contracts include those provisions, asks for copies of all user correspondence involving software complaints or concerns, requests documentation of any lawsuit settlements, asks whether the vendor has offered financial incentives to facilities or providers to get them to choose its products, and wants to know how the vendor tracks reported defects.


My most recent poll asked about your plans for Windows 7. The voting was pretty evenly divided, but reading between the lines is interesting. Around 37% of reader employers plan to use Windows 7 compared to 61% of those readers themselves. New poll to your right, suggested by a reader: what would your reaction be to seeing the CPHIMS credential on the resume of a job candidate?


Perot (soon to be Dell) announces that it has been contracted to develop a plan for a city-wide RHIO in Changsha, China.

NIH awards the University of Florida a $12.2 million stimulus grant to develop a Facebook-like social network that will allow scientists to find research opportunities.

The creator of the MySQL database says Oracle should sell it to a third party to soothe antitrust concerns about its Sun Microsystems acquisition. Suggested buyers were Red Hat or Novell.

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Currently there are "29 comments" on this Article:

  1. Senator Grassley’s letter is obnoxious. He’s just trying to score political points, while trying to intimidate ten vendors. I doubt that Grassley received complaints about each of the ten vendors.

  2. Note: Prof Patrick asked me to pull the archived copy of his EHR article pending resolution of the issues Down Under, so the link above will no longer work.

  3. Re: “Emergin Phones” – Emergin provides middleware that operates like an interface engine to connect various devices and systems to cell/VoIP/Local Mobile phones, pagers, and computers. Examples include:

    – Medical devices (details: patient monitors, telemetry)
    – Nurse Call and Code Blue Systems (details: Dukane, GE, Rauland)
    – Other Building Systems (details: Fire Detection, HVAC, Security)

    Often, they connect Vocera, SpectraLink, or Cisco phones. It was essentially noted in the report that there was alarm fatigue – (12,000 alarms). They limited the alarm types to 6 that were being sent to the phones via Emergin. Emergin is NEVER supposed to substitute for a primary alarm for a ‘Life Critical System’, especially with Code Blue. Primary alarms are supposed to be locally visible and audible and they should always sound and show at appropriate central stations, such as the nearest manned nursing or care team station. Much like the comments around Cerner causing errors, medical devices, phones, and middleware tools like Emergin can be configured incorrectly to contribute to errors through alert fatigue, ping-ponging responsibility, and improperly directing audible/visible alarms – just to name a few. This isn’t rocket science, but the human factors of the environment, workflows, variations by staffing levels, time of day, and the limitations of the individual technology platforms (ex: message throughput, display size) need to be taken into account.

  4. The Phil Pead report of his joke at the annual user’s conference is a complete lie. You should verify your sources before you let crap like that get posted to this site.

  5. RE: Censorship in Dysdney_”Rumor has it that complaints were made.” Please check to determine if the complaints about the essay were made by Cerner or an HIT associated trade group. It is relevant because of the timing of the censorship and the delivery of the letter you posted from Senate Finance to Cerner.

    You state: “It’s anecdotal, opinionated, and more of an editorial than a research study,” Is that not what the HIT industry has done to convince Congress to spend the billions of dollars on these anecdotally proven sustems?

  6. It is sad state of affairs when all our technology, training, and knowledge has not produced a single CIS that we can point to and say “We finally got it right”.

  7. HIT observer writes:

    “Senator Grassley’s letter is obnoxious. He’s just trying to score political points, while trying to intimidate ten vendors.”

    Yes, as ranking member of the Senate Committee on Finance with jurisdiction over Medicare and Medicaid, tasked among other things with protecting the public, there is absolutely no change this evil repuuuuuuublican is actually doing his job.

    Reaching for that bottle of Fen-fen and Vioxx…yum! What a combination!

  8. On the Bloomberg article:

    – Reality interesting piece on Brailer (its Bloomberg so I expect a more serious and through look than I would something at CNBC or Fox Business which really isn’t even a legit business channel) but I was amazed by these comments:

    “Legislation won’t affect secular trends, so the best way to put it is that we’re looking past it.”

    I agree to some point particularly on the supply-side of the equation but how can Brailer seriously say something like that? If anything, the big trend was been for VC and private equity to really reach out to hire firms in DC area that have a good handle on where legislation is at and make their bets accordingly. You have to when the Fed is taking such an active hand and thinking about legislation that so fundamentally touches touch wide parts of the economy.

    “Calpers’s portfolio lost 23 percent of its value in the year ending June 30, the worst year since its founding in 1932. Its private equity bets dropped 31 percent in value, the system said July 21.”

    When is someone going to call out private equity firms largely for the frauds that they are largely are. These shylocks take more than a pound of flesh if a company eventually sells and goes public and if the funds taking an absolute beating have these funds have the past 12-18 months it is largely “oh well.” Its like the house in a casino. They always win to some varying degree.

    What I really wanted to see in this article is what does Brailer think are going to be the exit strategies for the companies that he has already invested in and when does he expect to see this with some of his earlier bets?

  9. good luck to senator grassley. As an oldster, I can recall when vendors were paranoid of automating clinical processes because of product liability concerns. Supposedly the Republicans fixed that. Maybe this is actually a healthy development toward getting truly functional and legally acceptable products!

  10. Sure, Senator..we’ll spend countless hours pulling together company information so you and your hack friends can mishandle, misuse, misappropriate, misinform or whatever “mis” that you people are so used to doing. The most disingenous letter i have ever read, and who says Cerner has to do what they say. More government scare tactics. Neal should rip the letter up. That in no way is written in a good spirit of partnership. Bullying tactics by a US Senator who doesn’t know SH*T from Shinola when it comes to HIT/CPOE. Stay out of the private sector moon bats!

  11. While I think it is good for the Senate to hold HIT companies accountable where they should be, Grassley’s letter is not the way to do it. He is asking for ALL DOCUMENTATION for the last 2 years for all products and all clients from large HIT vendors. It would take several people several weeks to compile all that for each vendor. Then it would take several Senate staff several weeks to go through it all. And very little will come from it. It’s a nice thought, but Grassley sounds ignorant about HIT and seems to just want to bully these companies to make himself sound tough.

  12. You said you wouldn’t pass judgement till someone told you the Phil Pead joke at the EUN , thus the outraged response seemed a little over the top. Doth someone protest too much?

    Can someone find out exactly what WAS said and the context and let us judge for ourselves.

  13. Speaking of Cerner, St. Bartholomew’s Hospital in London faces fines of $650,000 per month for lengthy patient backlogs that it blames on the “dreadful” Cerner Millennium. I doubt it’s that simple, but blaming the computer is always convenient.

    The scoop is that when cerner sold the software to London, the salespeople made a mistake on how the software functioned; cerner had to go back and customize the software so that it would work the way the sales people sold it. So believe me, blaming the computer software in this case is quite appropriate.

    In other matters…Muse is great. The Resistance song has become an anti new world order anthem. When Glen Beck tried to say how great muse is, Muse called him and say to stop promoting them b/c as we know, Beck is just another schil for the globalists!

  14. It has become evident from Histalk’s excellent reports and the comments by the readers that the HIT manufacturers have been hiding behind hype. The risks of their devices are not understood and the industry has avoided scrutiny. Blumenthal makes statements that are not scientifically valid.

    The lives of our patients should not be subject to the control of unregulated devices made by companies hell bent on profit while suppressing the facts.

  15. What happened to today’s Dilbert link?

    [From Mr. HIStalk] I have a love-hate thing with the Dilbert widget. I like reading it, but it drags down the site sometimes with slow load times. I’ve taken it off and put it back on several times.

  16. It’s unfortunate that Senator Grassley’s actions are needed. There are a lot of embarressing and ugly skeletons in vendors closets. Vendor actions in covering these up are inappropriate and maybe illegal. It has resulted in painful and expensive decisions by other customers that would not have made if the truth had been known. Hopefully the Senator will stimilate vendors to start behaving in the customers best interest once again. The Senator should be warned to be careful where he stands when he starts shaking the trees.

  17. Praetor – Do you fee the same about the various classes of medical devices? What about pharmaceuticals? I am sure you don’t ever prescribe anything that is off-indication.

  18. Interested to see what the response to the Windows 7 survey would have been if you added a “Ditching Microsoft for Mac OS X, Snow Leopard” given Apple’s recent promotion of the new MacBook, iMac and Magic Mouse coincidental to Microsoft’s latest OS release.

  19. “Do you fee the same about the various classes of medical devices? What about pharmaceuticals? I am sure you don’t ever prescribe anything that is off-indication.”

    Lazo, All other classes of medical devices and pharmaceuticals have been approved by the FDA. Vendors have ambiguously described CPOE devices and their functions and so far, have avoided FDA regulation.

    The entire industry, the safety of patients, the acceptance by physicians,and the progress of improvement would have been advanced had the industry not been as deceptive. Whether hospitals and their patients have been victimized is another matter.

  20. Without the ‘learned intermediary’ clause, all those HIT and CPOE devices that calculate, suggest, inform, or do anything with the diagnosis or treatment of disease will become medical devices, and will all be immediately withdrawn from the market (at the FDA’s request), and then we will all get to wait for them to get their 510k clearance (or waiver) before they can be returned to the market. Be careful what you ask for Senator, you might get it.

  21. If HIMSS were worth a damn they’d organize a vendor boycott of Iowa and leave them and their ethanol in the dark. I am sure the Senator would be happy then. Bet he doesn’t even email.

  22. As former director of published information resources at a major pharma company (begins with “M”), I managed part of the staff that had stewardship of current research and historical data.

    We responded to legal holds and requests for production of sometimes massive numbers of documents by various stakeholders on a regular basis. The information was very organized; a football field sized room for paper data, a microfilm room dating to the company’s founding, offsite vault storage by a contractor for archives, and massive computer-based records as well.

    If a company wants to work in the healthcare sector, it should be prepared for these sort of investigations. They are a fact of life in the industry. Welcome to the club, health IT.

    Someone here suggested the recipients tear up the congressman’s letter. From experience, that would just lead to a subpoena, so would not be a very good strategy.

  23. … my somewhat light comment about OS X vs Windows 7 seems underwhelming somehow now (see above)

    oldMster: Similar to S Silverstein, I am a former Engineering Mgr for a Medical Device/Software company and now I’m a PM for a multiple hospital medical center in Healthcare IT.

    With those experiences, I’ve noted that there are both blessings and challenges in developing and deploying Medical Software when regulated by the FDA (Medical Device) and in the Hospital as a Healthcare IT worker where my client is regulated by JCAHO. I assure you there is no one environment that is perfect for the software developer/deployer.

    I can also assure you that regulation *alone* is not the answer, something we are dealing with recent focus in the current Obama administration in our industry. While some are thrilled that there has never been a greater demand for our IT “services”, I’m concerned about the sustainability of the current pace of regulation and consequential hiring of people into this area to process and operationalize said regulation. This may add some value, but it adds a huge cost as well.

    The FDA is already overwhelmed with the responsibilities it has to enforce the Quality System Regulation (QSR) with respect to Class I / Class II devices involving a software component. I’m not sure why we would think a Federal government administration can suddenly create a whole new regulatory environment that controls how we Healthcare IT workers use software in hospitals can regulate us better than we do ourselves.

    I’m *very* supportive of regulation and governing bodies to hold us accountable. That said, the best examples of regulation I saw during my time at a Medical Device company was seen in the option we exercised in choosing a governing body to audit our compliance to standards set to allow us to distribute product to Europe (under the CE, EN46001, aka ISO9001 harmonized standards). That the FDA adopted this same standards under the Quality System Regulation (QSR) suggests the government *did* understand this. I question if the current government has that same intention in Healthcare IT should they proceed on our current trajectory.

    In the end, the best regulation is self-regulation. Any other type of regulation though useful to some extent in creating stiff penalties to those it punishes for misbehavior, it also carries with it increased costs and inefficiencies that may very well make healthcare both less affordable as well as less effective.

    Call to Government and Healthcare Leaders: Let us proceed cautiously and in partnerhsip with one another and seek a *balanced solution* that holds us accountabile without killing innovation in this Healthcare IT field we all cherish and benefit from. Our caregivers and patients are counting on us!

  24. Hmm…I thought that the big vendors were regulated by the FDA…especially if they had a Bloodbank product. Can anyone clarify?

  25. Call to Government and Healthcare Leaders: Let us proceed cautiously and in partnerhsip with one another and seek a *balanced solution* that holds us accountabile without killing innovation

    What innovation has there been in the past ten years that would have been killed by regulation?

  26. Mata Hari: I think if you re-read my message you will note I’m indicating we should partner moving forward more between government and healthcare leaders to balance accountability with innovation which has made this country great. My assertion about “killing innovation” is not about the past 10 years, but what is possible in the future *if* government regulation is implemented too quickly without consideration for the risks to how processes are currently handled. Senator Grassley’s “letter” to HIT vendors is a misuse of his role in the legistlature to own what is the jurisdiction of the FDA in my opinion and so I support the comments admonishing him here.

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Reader Comments

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