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December 29, 2009 News 10 Comments


From C’mon Man: “Re: would you buy an EHR from this man? Or a demonstration of how easy it is to smile at the patient, hold the computer, and enter data all at the same time. I do not get it, why is anyone fussing? This ad has sold me, outdated CCHIT and all.” Hey, have some holiday compassion: it’s tough making a living trying to get doctors to use EMRs they don’t really want. My first thought reading the “gift that keeps on giving” part of the ad: the old joke about syphilis.


Note to Mississippi Governor Haley Barbour: don’t ask a question if you don’t want to know the answer. The Gov, getting his tweet on, sends out a blurb pitching cost cutting. An administrative assistant in University Medical Center’s nursing school tweets back, suggesting that maybe he should get his medical exams during normal working hours like everybody else instead of requiring employees to come in after hours on overtime. The Governor’s Office is not appreciative, tracking her down and demanding that the hospital’s compliance officer deal with her. They did, citing HIPAA laws in telling her to quit or be fired even though she didn’t know anything about his health first-hand. The Governor’s Office claims they didn’t contact anyone.

I just noticed that the verified e-mail subscriber count has passed 5,000. Thanks to everybody who reads HIStalk. I can’t express how satisfying and humbling that is, especially when I’ve had a sucky day at work (not today, though – it’s great with everyone taking time off, although the long winter grind starts in earnest next week).

From Thanks: “Re: KLAS. Thank you for publishing the article on KLAS. I was really upset that you never said much lately about this. KLAS is a big scam.” The Readers Write article by Swearingen Software CEO Randall Swearingen drew quite a few diverse comments. Some believe KLAS is an evil money factory, while others say their approach is reasonable. Not that you care, but here are my observations about KLAS.

  • I have contributed to KLAS surveys (although not recently) and never detected any suggestion of impropriety. I found their information useful and referred to it fairly often, although not to the exclusion of doing my own homework. I wouldn’t have paid for the subscription and reports.
  • I would like to see more statistical transparency in their methods, preferably by external and impartial oversight. Adam Gale said he welcomed this in my 2007 interview with him, but I haven’t seen any changes.
  • I don’t believe it when KLAS insists that wild result swings (the “first-to-worst” phenomenon) is a reflection of vendor changes. I think it highlights the problem of trying to extrapolate hard statistics from squishy interview data, no matter how many mumbo-jumbo graphs you include.
  • KLAS doesn’t claim to be the Consumer Reports of the industry (see Adam’s comments in my interview). They are a survey company, not a software testing company. At best, they accurately summarize information that vendor customers have given them.
  • KLAS has always taken specific data of limited usefulness and wildly extended it into all kinds of repurposed reports that mean very little but that provide extra sales revenue. I have always ignored those anyway, so I can’t say that bothered me.
  • The KLAS business model is the same as that of HIMSS: providers pay little to nothing, but their participation motivates vendors to pay to play. Whatever they are selling, vendors keep buying of their own free will.
  • Like every other survey-based award, vendors who score well plaster their results everywhere. Those who don’t complain that the process was rigged.
  • For me, I paid the most attention to the user comments rather than the fancy graphs and stoplights. For we provider-siders, I bet I could provide an equally valuable service by just contacting a lot of verified system users, asking them a handful of questions, and publishing the results.
  • My overall conclusion: the evils of KLAS are really a reflection of the evils of its provider and vendor members. Vendors try to game the system without getting caught, while providers unwisely overweight the value of KLAS in making their IT decisions. All of that is highly profitable to KLAS, but more power to them for creating a niche that still has minimal competition and strong business after all these years.

Back in 2005, I wrote an editorial pitching the idea of a standard healthcare database schema. I’ve seen other folks pick up that idea lately. Given the push for interoperability, I still like the idea. Here’s a snip of what I said then:

This is where my noodling got out of hand. Why can’t every vendor voluntarily or mandatorily use the same database layout for core information? How many ways can you express and repose standard elements such as date of birth, gender, address, etc.? Vendors can, when under duress, feed their data to a standard interface. Why can’t all systems just use an approved core set of tables, updated by the same core set of business rules, and then add their value through additional related tables, GUIs, business rules, etc.? Everyone’s patient database could look and work the same. Seen one, seen ’em all. Customers would be as thrilled by this idea as vendors would be appalled by it. Standard reports would work for every hospital, not just those of a particular vendor. Data translation for third-party reporting would be a no-brainer. Conversion of one system to another would be a piece of cake. Hospitals could easily merge and un-merge with each other to their heart’s content, with data conversion and extraction being assured. You might even have your choice of database software, given an Internet-like abstraction layer that supports everything from Oracle to Cache’. Talk about your interoperability!

An unconvincing article a couple of months ago concluded that remote monitoring of ICU patients by intensivists had little impact on outcomes. I can’t see the full text of this new JAMA article, but it seems much more conclusive, even though its conclusion is the same: “Remote monitoring of ICU patients was not associated with an overall improvement in mortality or LOS.” It’s the CPOE problem, however – many of the institutions had it, but weren’t really using it (although that in itself might, as for CPOE, give an organization reason to question its own capabilities before whipping out the checkbook).


LifeBot announces GA of its VoIP-based workstation for EMS telemedicine, offering full compatibility with digital radio systems.

Inga’s got a couple of great interviews running on HIStalk Practice: Scott Decker (new president of NextGen) and William Zurhellen, MD (a pediatrician and CCHIT expert panel member who has some shockingly frank things to say about the state of EMRs, CCHIT, and standardization).

Listening: Ben’s Brother, slightly whiny Britpop that still sounds good, although I eventually needed some nasty chick music to offset it and headed over to desk-drum to L7 for the zillionth time.

OHCHIT has an upcoming conference call to talk about the $6 million it will spend to get universities to develop a health IT competency exam (warning: PDF) for degree-less HIT people, a little chunk of its $120 million Health IT Workforce Development Program.


Greenway Medical rolls out its PrimeSuite EHR, PM, and interoperability product to Bethesda Healthcare System (FL).

Northwestern Medical Center (VT) gets CON approval to implement Meditech for $5 million, also expecting $577K in stimulus money as a result.

Odd lawsuit: a man sues Barnes Jewish Hospital after he claims he slipped on a Q-tip while visiting a patient, causing extensive injury, disability, and suffering.

E-mail me.

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Currently there are "10 comments" on this Article:

  1. The KLAS service can be valuable to bot the vendor and to the buyer if it is used properly. Any information gathered by telephone interviews should be verified by the potential buyers own analysis and telephone sampling. Any variances need to be followed up on by further analysis. The service can be helpful in that way.

  2. No one is asking KLAS to be the ‘Gold-Standard’ of gathering feedback from providers on the various IT solutions they utilize. Really just a bit more transparency and improvement on their methodology. That’s all.

    BTY – Consumer Reports has several issues with their methodology too and they aren’t nearly as transparent as they seem either.

  3. Re: KLAS

    HISTALK interview of Jonathan Bush:

    You must feel pretty good about the Best in KLAS announcements.

    I love KLAS when we’re at the top and I have questions about their methodology when we’re not (laughs). I get skittish when someone asks me to endorse KLAS when we’re at the top because I know that someday we won’t be and it won’t be for the right reasons. In the mean time, yes, I couldn’t be happier.

  4. My complaint about KLAS is different. Generally, I really appreciate their survey data *for use within my company* and not for sales purposes. Who else asks questions like “Quality of Training” and “Would You buy again?” and “Worth the Effort?” That data – and the customer comments (often mis-filed as positive or negative) are true gold and worth every penny we pay them.

    However, I don’t like the fact that they still haven’t figured out how to distinguish ratings by specialty or really break apart the scores given for the EHR vs. the PMS from the same company.

    For the first example, you will note that Athenahealth is given the top score for PMS in the 2-5 doc category. The company I work for – no need to name us, you can look it up if you care – beats them…TROUNCES them…in something like 30 of 32 categories. Really. We crush them. But we don’t get the award. Why? Because we’re specialty focused. Now, I understand their reluctance to put us in the spotlight. And I don’t want docs from all the other specialties calling us – it would waste all our time. We are definitely a small, niche player. However, I *don’t* like that the docs in the specialty I DO know about think that these other vendors are the “Best In KLAS” when, in fact, we eat their lunch (good as Athenahealth is). It sucks to go to our big Academy meeting and see the vendors bring out all their awards while we have nothing. All the printouts in the world make us look like conspiracy theorists.

    Does an OB care about how well a plastics office likes a vendor? Not as much as they care about other OBs’ opinions, obviously.

    For the second example, for years it seems like they have docs filling out the scores for a vendor’s entire suite of products, often inflating the PMS scores in the process. The classic example is from a well known EHR/PMS combo that we all know well – you may have seen them at the giant retail store while shopping for the holidays – whose EHR [subjectively speaking] isn’t bad, but their PMS leaves a lot to be desired. Yet, the PMS scores well. I had a KLAS person admit that they needed to work on figuring out who is filling out their surveys – do we want the out-of-touch doc who loves his EHR filling out the PMS survey? How about the multi-site administrator who knows nothing about patient flow filling out the EHR piece? I don’t know if I’m communicating this subtle point well, but this speaks to the transparency of their data. I’d *love* to see these same results by job title!

  5. Having implemented software applications in many hospitals, the concept of a standardized database is always rejected due to the common “but we’ve always done it this way!” syndrome.

    Something as simple as Right, Left and Bilateral requires a committee and several meetings because their old system used R, L, and B or Rt, Lt and Bil.

  6. When it comes to patient safety and outcomes, KLASS and any other “rankings” are useless. Make the devices accountable to safety and efficacy of medical care, period.

    As for the Santa ad, by your comment, you have shown yourself to be a great straight man, Mr. H___What is the difference between syph and an EMR? Ypu probably know the punch line if you ever worked the wards.

    As for medical care at a distance as JAMA reports:
    “’Remote monitoring of ICU patients was not associated with an overall improvement in mortality or LOS.’ It’s the CPOE problem, however – many of the institutions had it, but weren’t really using it (although that in itself might, as for CPOE, give an organization reason to question its own capabilities before whipping out the checkbook).”

    It just goes to show that bedside medicine has not been supplanted by unaccountable by managing the medical chart. What a discovery! The CPOE problem has nothing to do with it. If the same study was done with bedside care and order wrting v bedside care with CPOE and decision support, you may also be shocked, absolutely shocked, at the wash or even better yet, that CPOE and decision support proves to be compatatively dangerous.

    And with that, I wish everyone a happy clicking new year.

  7. Regarding Remote Monitoring of ICU patients – Many would consider this research a reason for not proceeding forward with remote monitoring. Working in rural healthcare, I would suggest the opposite. There are many more reasons to use remote monitoring other than improvement in patient care including:

    – Keeping the patient local so that it is much easier on family members to stay in contact with the patient.

    – Formal access to intensivists by local family physicians for consultative purposes.

    – While not a valid reason by many, there is a financial benefit to the rural hospital by keeping the patient at their facility.

    Yes, there many not be an improvement in mortality rates, but it does seem to suggest that it doesn’t do any harm either and still provides additional benefits.

  8. Follow up on the KLAS commentary. I work for a small vendor in one of the niche areas rated by KLAS (no need to name the company) and we have been the number 1 vendor in our main category for 4 years now. What’s interesting about that is we are much smaller than our big competitor which is about 3 times our size and until the middle of 2009 we never paid KLAS for anything. As a matter of fact, we barely talked to them and never told them anything about who our customers were……We are the poster child for rebuttal in pay to play arguement.

  9. KLAS is controversial for a variety of reasons. Mostly because many providers assume a level of precsion in KLAS’s metrics and rankings that are unwarranted because KLAS’ survey methodology and statistical analyses is fundamentally flawed. And despite KLAS’ efforts to the contrary, survey responses are oftentimes and easily manipulated by the vendors. No serious market researcher or statistician would assign credbility to their metrics or rankings. However, theire is some value to the comments despite the flawed survey methodology. Relatively speaking, KLAS should not have anywhere near the level of credibility of a JD Powers or Consumer Reports. Instead, Zagat’s is more comparable. Should prospective buyers use KLAS to screen vendors? It may be somewhat directional but certainly not definitive.

  10. Hey, Statistician:

    Methodology and numbers aside, I’d love to hear how a vendor could “oftentimes and easily” manipulate the KLAS results. I’m like “market researcher” above – we learned about our KLAS scores when one of our partners called and said, “Hey, nice scores.”

    I even called them once to point out that an extremely positive comment on our behalf (“…they only hire people who have worked in a medical practice for 3 years…”) was not at all true. Once they realized I was the vendor calling, they all but hung up on me. I wasn’t even complaining about a negative comment.

    For all of their problems, they do seem like earnest and honest people.

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