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Monday Morning Update 12/7/09

December 5, 2009 News 12 Comments

From Interesting: “Re: Courtyard Group. Encore Health Resources (Dana Sellers and Ivo Nelson’s latest company) is in detailed talks and due diligence to merge with or acquire Courtyard Group. Courtyard Group recently had a large layoff because of decreased sales due to the ‘trouble’ they got into in Canada.” All unverified. I e-mailed Ivo, but haven’t heard back.


From Scritti Politti: “Re: Cerner in the UK. The editor of E-Health Insider likes their recent go-lives and UPMC’s involvement.” It’s hard to tell whether early problems really were Millennium or the terms under which NHS decided to implement it. As in Australia, a lot of the issues seemed to be related to localization, local support, and how the government wrote the contract and the implementation plan. I’m thinking it’s the Gartner Hype Cycle – NHS promised a lot, struggled early, and looked like a disaster, but the individual trusts doing their own thing with either Cerner or iSoft seem to slowly be coming up the curve and making good progress. Big government IT projects (including here) usually flop, which is why the VA’s VistA is even more remarkable (although the fat cat contractors weren’t involved early enough to mess it up – that came later).

From Todd Johnson: “Re: Stephen Hau interview and Shareable Ink. Stephen is absolutely correct. 100% physician adoption is the keystone to successful implementations, and you can only achieve that by enabling the physician’s natural workflow. Since the next wave on the path to Stage 6 EMR adoption is electronic physician documentation, vendors are turning their attentions toward how to efficiently capture notes. In my view, there are three critical success factors. (1) Systems must provide the speed of dictation or paper with the value of exchanging and analyzing structured information. (2) Physicians must have the freedom and flexibility to enter information in a way that is convenient for them as individuals. In the ED, a tablet PC might be most effective, while in a surgical setting, dictation is more logical.  Residents, the next generation, demand typing. (3) Revenue capture must be a byproduct to provide strong financial incentive for both the hospital and physician practice. Ultimately, you risk achieving 100% physician adoption if any one of these areas fail.” Todd is the president and co-founder of Salar, Inc.


From Former Bruin: “Re: UCLA Medical Center. Please confirm the rumor that UCLA Medical Center is looking to replace ClinicComp Essentris. I heard they are going through a selection process.” I e-mailed CIO Virginia McFerran, but she hasn’t responded. I’ll let you know if she does.

From Timber Roller: “Re: Epic. Are they changing their technology? They have a job posted for server systems that asks for experience with Linux, Oracle, or Microsoft SQL.” I hadn’t heard that, although maybe that’s for MyChart or portal stuff. It doesn’t sound specific enough to make me think they are abandoning Cache and MUMPS, but I’ll allow others to chime in.

From Maxwell Hammer: “Re: TIPAAA conference. I read this review of the lead speaker. That last line got to me.” Here’s the quote, source unknown and excerpted somewhat:

I was most troubled by the first part of the TIPAAA conference, which was a presentation by a VP from [vendor name omitted]. His job right now is to meet with hospitals, IPAs, HMOs, etc. … His basic pitch is that the money is there and you should help your physicians take advantage of it. The easiest way to do this is to buy them an EHR (using the Stark Law exemption), and then have them sign their ARRA money over to the hospital …Whenever someone questioned any of ideas, he would respond that they were just afraid of using an EHR and that they needed to embrace the changes and move forward … What drove me crazy was that the veneer was rather thin and that the entire pitch was about money; not about health care, improving quality, or doing a better job.

From Bernie Tupperman: “Re: Kaiser. This week’s e-mail from CEO George Halvorson outlines making chlamydia detection a priority.” Here’s an e-mail snip. I’ll say this — he’s the best, most easily understood writer/teacher I’ve seen in a CEO chair (I joked with Bernie once that surely the marketing people ghost-write his stuff and he says George really writes like this).

Early detection requires a care system that cares enough about women patients to make chlamydia testing and detection both a priority and an active agenda. That would be us … We know how well we are doing relative to the rest of America. We have the best scores … Our electronic medical record gives us an incredibly useful tool so we know who has and who has not had their tests. Combining our commitment to helping women detect and cure the disease with our systematic support of women’s care put us in a position where we do a better job then almost anyone on chlamydia detection … Smart people need to do smart things in a consistent way to get our care teams to those levels of success. Congratulations to our caregivers who care enough to make a difference in so many women’s lives.

You may have noticed a theme that several of the people we contacted to confirm rumors this time around didn’t respond. That happens pretty often, so even when we don’t mention that we tried and failed, it happens. Inga is good at chasing down stories, but sometimes our contacts are out of the office or don’t get back to us. As an example, she e-mailed someone at HIMSS to ask about expense reimbursement and/or honoraria for annual conference keynote speakers (since a reader wanted to know whether David Blumenthal’s expenses will be paid by taxpayers or HIMSS) but hasn’t heard back yet.


IT has improved patient safety nationally, 61% of reader respondents said. New poll to your right: what are your plans for the HIMSS annual conference in March?

Students in a University of Saskatchewan iPhone developer program design a physician diagnosis reference, although they are hamstrung a bit because of copyright issues with the AMA data that powers it.

Listening: the Hairspray soundtrack. I might be the only straight guy who likes the remake, singing along badly to Good Morning, Baltimore and I Can Hear the Bells. I’m also desk-drumming to Southern Culture on the Skids, reader-recommended surfabilly from Chapel Hill, NC, and more to my usual tastes, Brit rockers Travis.

Quantros and Allscripts integrate their respective products to create a Web-based care management solution.

An interesting problem: if 40 million people suddenly get health insurance, rural areas don’t have nearly enough primary care doctors to see them. The reason is obvious: the doctors go into specialties and geographic areas where the pay is better.

The economic planning committee of Taiwan, whose EMR usage is at 95% in hospitals and 56% in clinics, says it hopes to hit 100% within five years.

ONCHIT reorganizes, with five offices reporting to David Blumenthal: Economic Modeling and Analysis, Chief Scientist, Deputy National Coordinator for Programs and Policy, Deputy National Coordinator for Operations, and Chief Privacy Officer. The CPO will be appointed by HHS Secretary  Sebelius. 


Welcome and thanks to Philips, a new HIStalk Gold Sponsor. Talk to them about their fee-per-study iSite PACS replacement program, which lets you affordably move off your outdated, clunker PACS to a shiny new one. You can also check out what’s new, fresh off their RSNA announcements. Thanks to Philips for helping power HIStalk.

Michael Simpson’s deal as SVP of QuadraMed: $330K base, up to 50% bonus, 90,000 stock options, $50K relocation, expense account, $3,000 per month temporary housing, guaranteed 12 months’ severance plus regular bonus unless terminated for cause, and a year’s health coverage.

Shares in athenahealth hit a two-year high Friday afternoon after the company stated expectations of annual revenue growth (30%) and profits (40%) through 2014.

Bizarre: a UK student, unable to contact a female acquaintance on whom he has a crush, leaps to the conclusion that she has died. He buys an axe, breaks into the morgue of the local hospital, and spends 90 minutes inspecting documents, computer records, and bodies, all on Valentine’s Day this year. The judge orders him to get medical help.

E-mail me.

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Currently there are "12 comments" on this Article:

  1. Re: Epic abandoning technology.

    We are not abandoning MUMPS/Cache at all. We export nearly all of our data in the Cache databases to SQL for writing Crystal reports (among others). Obviously we must test theses reports, so we have various non-Cache databases on site (thus the need for that type of server expert).

  2. “although they are hamstrung a bit because of copyright issues with the AMA data that powers it.”

    Being required to pay for and use a proprietary coding system (CPT) to process claims seems absurd. Shouldn’t the coding system be placed in the public domain?

  3. Re: Epic’s Architecture – Linux, Oracle and SQL Server – they run their data warehouse and analytics platform optionally on Linux or UNIX and Oracle or SQL Server. I believe there are also options for Windows Server but this is reserved smaller locations. Epic provides solid technical services related to the configuration and support of these platforms. The information from Cache is copied to a shadow operational data store, still Cache-based, on a slight delay (5 minutes or so), and it is copied on a typically longer interval to the relational database (Oracle or SQL Server) for more standard analytics. This is their Clarity product. It is fronted by Crystal Reports and sports a large Epic-delivered and customer-added report library (“Community Library”).

  4. The following concepts were sent to Blumenthal’s blog about Beacon. The moderator decided not to post it for all to see.

    “Does this mean that Blumenthal authorizes experimenting on patients without their consent? Just slip a little unproven CPOE and CDS into their care and hope that it will not result in delays, duplicate medications, incorrect tests, and dysfunctional communication! What is the difference between using an unapproved medication and unapproved CPOE equipment? No great problem, just a few deaths here and there.”

  5. in respect to e-health insider=The likelihood is high that with the army of UPMC “musclemen” on the Newcastle campus to protect its investments and its product, that silence will be enforced, as they accomplished in Pittsburgh.

    There is potent silencing effect of threats of sham peer review to discipline physicians who are declared disruptive and disgruntled by Cerner and the Trust Administration because of complaints about the computerization horlicks.

    Jon Patrick wears a badge of courage. Threats of peer review will silence many a critic.

  6. What about using those “unproven paper forms”? What about using those “unproven handwriting parsing down in the pharmacy”? What about using those “unproven steps involving nurse judgment”? What about using those “unproven flow sheets” in the ICU?

    So much in healthcare is “unproven”.

    That’s why we have doctors and nurses applying judgment.

    Get over yourselves on this issue.

    CPOE is helpful when done right, and a train wreck when done wrong. Just like any other function in healthcare.

    What you need to “prove” or “regulate” is a hospitals use of the CPOE toolset. The tool sets themselves are fairly generic.

  7. It’s hard to tell whether early problems really were Millennium or the terms under which NHS decided to implement it.

    It’s hard to tell whether early problems really were Millennium or the terms under which NHS decided to implement it.

    I was there for the NHS implementation of cerner….
    The biggest problem with that implementation is that they had a 3rd party (Fujitsu and BT) involved in the implementation. That was part of the contract so it worked like this:
    Cerner would train Fujitsu/BT staff, who then went on to gather requirements from the trusts or do the training. Even though it was cerner’s software being implemented, cerner had limited interaction with the trusts. Yes, we could go to the meetings, and ask questions, but in the end, BT and Fujitsu were in charge of training, testing, and every implementation I was on, it was a complete mess. Also, when the contracts were originally signed with the NHS, Cerner’s salespeople did a lot of errors in selling the solutions. Yes, they normally promise the world, but this time around, not only did the cerner salespeople promise the world, but they promised the wrong functionalities of the products. So the salespeople said, yes, the application has a workflow of a, b, c, d; the reality was the application has a workflow of d, c, b, a, so cerner had to specifically write code for the NHS in limited time, and you cannot even begin to imagine the nightmare that caused. So the problem was from very early on.

  8. Luis G is correct in playing the blame game.
    Why do you suppose the Brits are planning to stop the river of green into the pockets of the HIT companies? Are CPOEs the zhu zhu pets of health care? The Brits may think so.

  9. Re: Electronic physician documentation and 100% physician adoption. Todd, what if the fastest physician documentation method – dictation and transcription – could also exhange and analyze structured information? Wouldn’t that solve the physician adoption probelm while enabliing the physician’s natural workflow? Some transcription vendors are already doing this (Webmedx,MModal, Stentel). Mark Anderson calls it “Discrete Reportable Transcription”. Could at least answer #1 on your wish list in the near future. Beth Friedman, RHIT

  10. rxpete: “Being required to pay for and use a proprietary coding system (CPT) to process claims seems absurd. Shouldn’t the coding system be placed in the public domain?”

    You’d think so, wouldn’t you? Especially with a federal law (HIPAA) requiring their use and their publication in the Federal Register.

    But, no. The AMA employs full time lawyers who stamp out any Fair Use vision of CPT codes. They make over $70 million a year in CTP copyrights and are not willing to give it up easily. I love how the AMA works against it’s own members!

    Note that this problem doesn’t exist with ICD-9/10 codes.

    I know this, and a lot more, because I received a cease-and-desist letter (25 pages long!) from the AMA a few years ago as the result of a popular FREE on-line CPT tool I made. It exists no more. Thanks AMA! If you want a Dan Brown-esque conspiracy story, dig around and learn about the source of the CPT codes…they didn’t all come from one place and they weren’t all seamless integrated. Many people had similar ideas at the same time, but you don’t hear about them any more…the AMA snookered a few of them.

  11. “Big government IT projects (including here) usually flop, which is why the VA’s VistA is even more remarkable (although the fat cat contractors weren’t involved early enough to mess it up – that came later).”

    They do when run primarily by apparatchiks and not insiders.

    The reasons why VistA has been as successful as it has are easy to understand. See the book “Medical Informatics 20/20: Quality And Electronic Health Records Through Collaboration, Open Solutions, And Innovation” written by some of those insiders, http://www.amazon.com/Medical-Informatics-Electronic-Collaboration-Innovation/dp/0763739251 .

    They also really “get it” about the issues causing IT to fail. See p. 18-20 , available via Amazon in book preview mode if you have an account.

  12. re: Beth Friedman:

    Good point. I agree that natural language processing coupled with transcription/voice recognition is a powerful tool for harnessing structured information. It also promises to be an easily adopted solution. One downside, however, is availability. With EMR products, the note begins to take shape (and be available to other providers) as information is documented throughout the day/event. For acute care, this can be a nice side effect of EMR’s (particularly during the transfer from one service tot he next).

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