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Monday Morning Update 4/5/10

April 3, 2010 News 11 Comments

ONCHIT announces $60 million in new grants (sounds like chicken feed in these stimulus-happy days, doesn’t it?) University of Illinois at Urbana-Champaign will look at security, Universe of Texas Health Science Center will study patient-centered cognitive support, Harvard takes on application and network architectures, and Mayo will review secondary use of EHR data while maintaining security and privacy. The last one sounds the most interesting to me.

Merge Healthcare sells $42 million of stock in a private placement to help pay for its proposed acquisition of Amicas.

Former QuadraMed VP Chris Callahan joins Sunquest as VP of product management.


Bill Gates composes a fascinating remembrance of Ed Roberts, inventor of the Altair computer and therefore the father of the PC, who died last week at 68. Of course, Bill and Paul Allen kind of screwed Ed legally to get the rights to sell BASIC to other companies even though they had sold Ed an exclusive license, but I guess Bill’s being sentimental now that he’s earned billions from it. I knew but maybe you didn’t that Ed was a country doctor in Georgia, having gone to med school at 41 and finishing first in his class after selling out his computer business in 1977.

Next, on a very special episode of Weird News Andy: two North Carolina doctors are reprimanded for performing a C-section on a woman who wasn’t pregnant. A resident misdiagnosed her “false pregnancy”, the docs tried for two days to induce labor without success, and they finally opened her up only to find no baby. Nobody had bothered to verify that she was indeed pregnant. In their defense, the resident supervision was complicated and false pregnancies are apparently quite believable without diagnostic verification.


Most of us agree that patients should control the use of their health information, although the question of “to what degree” would likely be more contentious. New poll to your right: what impact will the iPad have in healthcare?

CMS auditors conclude that “alarm fatigue” caused by incessant monitor beeping contributed to a patient’s death at Mass General in January. They also found that the patient’s bedside crisis alarm had been turned off. In response, the hospital has disabled the “off” buttons, put more speakers in nursing stations, and assigned nurses to watch monitors full time. While they were there, the Medicare inspectors also wrote up privacy violations, including having patient names on whiteboards and positioning in-room video monitors so that they were visible to visitors.

A two-year-old dies from a heparin overdose at Nebraska Medical Center. The hospital implements the usual after-the-fact changes that sound good, but really aren’t sustainable even for high-alert drugs like heparin: requiring a second nurse to verify the dose, having pharmacy observe the initiation of the bag, and turn on a hard stop on the infusion pumps.


Nuance announces availability of Dragon Dictation for iPad, available for free from the Apple App Store. It supports dictation and sending e-mails by voice.

E-mail me.

Recommended System for a 200-Bed Hospital with Minimal IT Resources

A reader asked me about which systems I would recommend for a 200-bed community hospital with minimal IT resources. Specifically mentioned were McKesson Paragon, Meditech 6.0, and Cerner Millennium. I assume the hospital wants a broad set of applications ranging from revenue cycle to CPOE. My answer, in essence, was this:

  • I would definitely choose Paragon over Cerner, especially if there’s no legacy billing system that will be retained (Cerner ProFit is still problematic, I think). McKesson has done a good job in bringing Paragon back from its near-death experience and the field reports, while limited, are good. I think Cerner would be overkill for a 200-bed hospital.
  • However, if billing isn’t important, then Cerner’s remote hosted product should at least be considered, even though it’s probably far more complex and than a 200-bed hospital would need. Cerner is notorious for coming well down from list price when pressed since they aren’t selling many new customers, so I wouldn’t pay much of a premium for it. It would also offer a lot capability for the future.
  • Meditech 6.0 is a bit of an unknown since it’s new, but if CPOE is a criterion (as it probably should be), that’s the Meditech version they would want. Company performance has slipped a bit, but they are still eminently solid.
  • I mentioned that CPSI is strong in that bed range, but that I don’t really know too much about their products.
  • I suggested that for a different perspective, the hospital might want to take a look at IntraNexus Sapphire, which offers something a bit fresher than those obvious choices even though it’s not a big company like the others.

So I would rank them Paragon, Meditech 6.0, and remotely hosted Cerner. I didn’t rank Sapphire, but I would still give it a look.

I got 25 reader responses, summarized as follows.

  • Most respondents, especially the CIOs, suggested Meditech.
  • One comment said that Meditech is straightforward and easy to manage, with 6.0 getting good reviews. That reader also asked me about CPOE adoption. The HIMSS Analytics presentation at HIMSS showed a definite improvement in physician adoption under 6.0 vs. Magic. I think CPOE is important even though Meaningful Use so far requires only 10% penetration, so I don’t know if choosing Magic would make sense.
  • A hospital CFO recommended Meditech without hesitation based on personal experience in three hospitals of under 300 beds, where Meditech replaced Siemens, McKesson, and Cerner. He said that Meditech beats Siemens and McKesson on functionality and cost (he didn’t name the specific McKesson product line, which could be Paragon, Series, or Star).
  • A consultant also recommended Meditech, saying it’s generic, easy to install, requires minimal training, and requires low maintenance.
  • A CIO said it’s Meditech hands down, “not the most advanced, but it will keep you out of trouble.” That’s a solid point – nobody fails with Meditech, so they get an implicit cost advantage due to reduced risk.
  • An IT person from a 100-bed hospital provided an informative comment about Meditech C/S, to which the hospital had migrated two years ago from best-of-breed systems. They are very happy to have traded interfaces for integration. Putting in Meditech increased the IT staff from five to 10 employees.
  • A CIO recommended Meditech, but said it won’t be cheap and 6.0 may still have kinks. He says Paragon’s functionality is a step up from Meditech, but that CPOE may not have been released yet. He also made a good point: Meditech is so widely deployed that it’s much easier to find independent implementation people.
  • A consultant recommended CPSI, Healthland, and Meditech on the basis of integrating administrative, financial, and clinical applications without a lot of IT overhead. However, she also cautioned that prospects should push hard to get Meaningful Use criteria in the contract. She observed, correctly I think, that it’s amazing that big vendors can’t seem to figure out how to scale their pricing and delivery to serve this large market of small hospitals, although lower price points may have cooled their interest.
  • A CIO had this interesting comment: “An affiliate relationship with an existing Epic customer. You get all the benefits of Epic without having to host.”
  • A hospital IT director suggested the resource issue should put the hosted Cerner suite at the top of the list.
  • One reader suggested two systems that I hadn’t thought too much about: CPSI and Siemens MedSeries4. I always forget that MS4 is still around, although I would certainly find out about CPOE usage.
  • A reader suggested Paragon, noting that it’s being installed in larger hospitals and doing well.
  • I liked this perspective from an IT director in a hospital of similar size and IT capabilities. She said they realized that their functionality requirements weren’t much different from those of bigger hospitals and the smaller vendors backed out for that reason, so they are looking at Millennium or Siemens Soarian and options for a quick build, remote hosting, and possibly outsourcing some of the application support to the vendor.
  • A hospital IT project director suggested QuadraMed QCPR, saying it hasn’t been well marketed but noting that it has lots of functionality for both inpatient and outpatient clinicals as well as ancillary departments. She also noted its track record in big hospitals, its recent award in Saudi Arabia, and its configurability and rules engine.
  • A consultant says his company usually recommends Meditech and Paragon and can host either. He does not recommend Siemens because the contracts are too restrictive.
  • A hospital analyst suggested Cerner.One reader ranked them as Paragon, Meditech, and CPSI.
  • A consultant said his choices in order would be CPSI, Paragon, and as a low third choice, Meditech.
  • One reader gave his picks as MedSeries4, Meditech, and Paragon, all from larger companies with a better chance of survival.

Thanks very much to everyone who took the time to respond. This is excellent information for the reader (and for me). We ought to do this more often.

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Currently there are "11 comments" on this Article:

  1. “Recommended System for a 200-Bed Hospital with Minimal IT Resources….We ought to do this more often.”

    Would be interesting to see this type of recommendation for small to medium sized ambulatory practices, if you could weed out the biased vendor responses you’d undoubtedly get.

  2. Paragon is a great solution if you don’t need a Patient Focused Longitudinal Cradle To Grave EMR/EHR..and don’t care about never being able to go paperless..

  3. 200 bed hospital: If the hospital has some type of relationship with a larger health system or an academic medical center, which has Epic, the larger organization can extend their Epic install to the smaller hospital. I am not sure what kind of relationship needs to exist, but it is another option to consider.

  4. OMG. Major system defects were ignored.

    Did the CMS “auditors” know what they were looking for? As these investigations go, a bunch of DOH nurses who never used defective, user unfriendly, time wasting, and distracting CPOE and EMR equipment asked the nurses why the patient was neglected. Human error. The heartbreak of alarm fatigue. HIT and CPOE are innocent bystanders.

    I thought the HIT and CPOE systems were to improve safety.

    Two chits for the adverse events column.

    “CMS auditors conclude that “alarm fatigue” caused by incessant monitor beeping contributed to a patient’s death at Mass General in January.

    A two-year-old dies from a heparin overdose at Nebraska Medical Center.”

  5. Paragon, New to market for CPOE but in a year or two might finally be lower risk. meditech, no install on Version 6.0 to begin for 18 months. Sign today, Pay today kickoff in 18 months, great…..Cerner, Profit still an issue. Remote hosted solution cheap but network costs raise total cost of project and Physicians still do not really liek the product. MS4, solid performer, issue is legacy system that Siemens is pushing Soarian at these sites first instead of starting with MS4. MS4 meets a 200 bed hospitals needs better but Siemens needs their flagship failing product Soarian sold. Quadramed QCPR. proven clinical product but less than 100 installs mostly due to Quadramed/Misys poor marketing over the years. CPSI has too little functionality and is installed by inexperienced implementation folks typically. Epic hosted relationship solution?? Only if you want what the hosted hospital has built and is going to build in the system. As an adjunct hospital you will not get the functionality you want necessarily, the larger host hospital will get what they want and you might get 5% of what you request.

  6. I learned these points of information, Suzy:

    MGH uses a homegrown CPOE so it must be safe and efficacious. OP med records is Centricity, by the way.

    Nebrask Children’s uses Eclipsys CPOE.

    Neither have been implicated and will never be to continue the dream of HIT, the savior.

  7. Pooh bear nurse. The site in question was Nebraska Medical Center which I do not believe is an Eclipsys CPOE site, not sure what CPOE (if any) they use.

    Their neighbors across town, Omaha Children’s are an Eclipsys site, and although cited in the article are doing so only to illustrate what steps they DO take when managing the ordering and adminstering of heparin, and in their quote specifically adress the use of the computer and logic with the dispensing system to prevent the error that occurred at NMC.

  8. Suzie,

    I went to visit a relative in a health care facility today. They weren’t encumbered by any technology. The pills came mixed in a Dixie Cup. Mom just put ’em back like an Irish woMan should – sip o Coca Cola and hope for the best.

    Health care as Suzie would approve.

    Get over yourself. HIT may not be perfect but it sure is better that what happens without it.

    A personal challenge to you – what can you do to make things better? What can you do to post ideas for how to make things safe, not just rail against IT?

    It’s time for you to step up your game. Can’t just bitch about cars cause there are car accidents.

  9. A second to the notion of doing the recommended software suite more often. Not to outclass KLAS but rather to get issues out on the table about the real drivers that need to be considered when viewing the vendor flashmob experience of RFP review.

  10. Re: Recommended System for a 200-Bed Hospital with Minimal IT Resources

    Given the request for systems requiring minimal IT resources, why not consider opting for a comprehensive system on top of existing HIS to improve their utility/usability and leverage existing IT investments. A system like PatientKeeper with interface and integration experience offers workflow applications, including CPOE, and can be had at a lower cost in less time than ripping and replacing existing systems in favor of a single comprehensive system. The latter option would actually require INCREASING limited IT resources. Just a thought.

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