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Monday Morning Update 7/19/10

July 17, 2010 News 14 Comments


From Friend of Tim: “Re: Yale New Haven. They’ve signed with Epic and the CIO is out.” Verified. Health system SVP/CIO Mark Andersen confirms that YNHH signed a contract with Epic this week (no surprise there – I said months ago that they were going Epic if they could find the money and Mark confirmed). They just brought up Eclipsys Sunrise CPOE and pharmacy a couple of years ago and were also running nurse and physician documentation, so Eclipsys loses a high-profile customer. With the Epic deal done, Mark will be leaving in a couple of weeks after 13 years there. He’s always been gracious and quick in responding to my questions. I wish him the best.

From CP Uh-Oh: “Re: Chicago CPOE error detailed in a Friday happy hour e-mail blast.” The purported e-mail from a Chicago hospital radiologist:

We have discovered a systems issue that may convert CPOE orders for CT examinations without IV contrast into CT examinations with IV contrast in Radiant. I have asked all Radiology Faculty and trainees to be particularly cautious in protocoling CT contrast examinations, and would like to enlist your assistance in carefully checking contrast CT orders. In addition, until the problem is solved, it would be prudent to call CT to verify that contrast will not be administered to at risk patients. Your support is appreciated.

From CPAhole: “Re: Allscripts MyWay. I heard they’ve said they won’t support ICD-10 in MyWay since it will be sunsetted in 2012.” Unverified. I’ll be incognito at the Allscripts user meeting August 5-7, so if I don’t hear anything before then, I’m sure I will there in Las Vegas. Inga and I speculated when the merger was announced that MyWay was the square peg in a round hole, but we were just guessing then, too.


From A Once-Burned Skeptic: “Re: IBM’s $100 million healthcare investment. This strikes me as funny. Didn’t IBM invest roughly the same amount a few years ago by buying Healthlink, which had doctors and nurses focusing on healthcare transformation? If IBM would have simply retained the talent they had from that acquisition, they would be well positioned to do exactly this right now. Call me a skeptic on IBM’s interest in healthcare.” Everyone should be skeptical since companies like IBM and Oracle are always immersing themselves in healthcare for a couple of years, then losing interest after spending a ton of money with little to show for it. IBM couldn’t keep Kaiser as a customer for its expensive custom software development once Epic got traction, blowing through $400 million of Kaiser’s endless fortunes before they were replaced with Epic for $2-4 billion. I’m not sure how its $400 million deal with UPMC turned out. Healthcare IT is one of those things that seems to work backward from nearly every other product: the bigger and more diversified the company selling it, the less impressive the result.


HIStalk readers would have voted Don Berwick into his CMS administrator job given the chance, but only barely. New poll to your right: are the final Meaningful Use requirements for providers too easy, too hard, or about right?

Ed Marx has added his responses to your comments on his Strategic Plans – Getting to 2.0 post from last week. Want him to write about something specific? He would be pleased to hear from you.

CapSite will announce Monday that Saint Like’s Health System (MO) has subscribed to its service, which offers line-item pricing breakdowns from healthcare IT contracts and proposals in 60 categories.

Everybody, me included, is sick of hearing about Meaningful Use now that the regs are final. I think a few more practices in the 1-5 doc range might be interested with the bar lowered a bit, but I’d still bet most of them will run the numbers and pass, at least for now. The final MU requirements, as flexible and less demanding as they may be, still aren’t worth meeting in strictly financial terms, so that means hospitals, large practices, and tech-savvy small practices will get most of the checks. The great majority of practices and hospitals are small (1-5 docs and <100 beds, respectively) and I expect they’ll look at the ambitious timeline, the cost, and the stress on already-stressed doctors and simply say no to Uncle’s strings-attached cash (I’ve always called that my “Free Kittens” theory). We’ll see how accurate all those surveys have been that claimed the only thing holding docs up was upfront EMR cost.

7-17-2010 2-34-18 PM

Another new Epic site: Hurley Medical Center (MI).

Apple’s response to its embarrassing Antennagate iPhone 4 problems have been quite un-Apple like. I can imagine an HIT vendor faced with angry customer backlash over a CPOE bug reacting the same way in sequence: (a) it’s your fault for using our product incorrectly; (b) it’s actually not a problem, but a minor bug that makes it look like one and we’ll fix that eventually; (c) we’re not really sure if it’s a problem, but the best option is for you to spend your own time and money adding on a third-party solution; (d) OK, it might really be a problem, but it hasn’t been reported much, so it’s not a big deal; and (e) OK, it’s definitely a problem, but it’s the entire industry and not just us and everybody needs to do a better job.

GE’s Q2 numbers: revenue down 4%, EPS $0.30 vs. $0.27. Jeff Immelt says healthcare orders, along with oil and gas, were “particular bright spots.” GE Healthcare’s revenue and profit were up, at $4.1 billion and $661 million, respectively.

Verizon announces the Verizon Health Information Exchange, offering a clinical dashboard, patient index, and secure messaging. The MedVirginia RHIO has signed on, presumably meaning that its original (struggling) vendor Wellogic is out. Verizon’s offering runs on the Oracle Healthcare Transaction Base, which I thought had fizzled out years ago after the usual big splash followed by corporate indifference. Just in case it isn’t obvious, Verizon’s healthcare interest surged recently when taxpayer wealth was redistributed to make it more lucrative. Since HITECH, the company has announced services for security, telehealth, and physician data sharing.


A fun story: the guy responsible for killing a proposed Anthem Blue Cross 39% medical insurance rate increase in California is a work-from-home actuary who did part of his analysis from a hospital bed. California law requires the state to accept insurance rate hikes as long as the company proves it’s spending 70% of the premiums to pay medical claims (obviously that idea contains endless misaligned incentives that help keep healthcare costs rising). Hired by the state to double-check the insurance company’s numbers, the actuary found obscure mistakes in some of its inflation projections. Anthem and its corporate parent WellPoint claim appreciation for his diligence and express their relief in being able to hit the state up for less money (anybody buying that?) They resubmitted an increase request for half the original amount and then tried to hire him. A consumer group said, “He slew the giant. It was David versus Goliath, except David was armed with a calculator rather than a slingshot.” His tiny company also offers hospital services, including provider contracting and medical management reviews.

More only-in-California goofiness: 1,000 nursing union members picket the $3 million house of billionaire Meg Whitman, former eBay CEO and current candidate for governor. They’re upset at her promises to cut the state’s budget (including their pensions) even though it’s running a $20 billion deficit. She’s even in the polls with Jerry Brown even though she’s never held office and doesn’t even vote all the time. She’s spending up to $120 million of her own money to gain the seat.

St. Luke’s Health System (ID) loses power for 24 hours, forcing it to go to paper when its backup power systems also fail. My experience with backup generators is about the same as with data backups: they work about 80% of the time, which means IT is going to look really stupid in 20% of the unexpected disasters.

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Currently there are "14 comments" on this Article:

  1. I disagree with Mr. HISTalk’s conclusion regarding EHR Incentives. I believe 5 times as many hospital and 10 times as many physician practices will now pursue the incentives.

    On the medical group side, the elimination of CPOE for all order types makes the EHR incentives a magnitude of order easier to accomplish. Most physician practices include ePresciribing (aka medication orders). The elimination of all of the arcane measurements is the other hurdle cleared.

    The CPOE implementation of the hospital side has a few loopholes: 1. the ability for others to enter orders electronically instead of the physician (is it still cPoe?). 2. The inclusion of ED patients could mean that hospitals hit the stage 1 threshold with an ED system, not house-wide inpatient CPOE.

    I agree with the free kittens analogy (I always say free like a puppy). But, the regulations are now written in a way that many providers already meet, or their original plans would get them there.

  2. IBM likely pocketed more money than Epic in their time with Kaiser. The big numbers referenced continuously regarding Kaiser and Epic are almost entirely for Kaiser deployment, data centers, wiring, staff, servers, workstations, set up, etc.

    Kaiser is the worlds largest non-governmental healthcare delivery system. Epic’s share of those big numbers would likely surprise many people as being a fairly small percent.

  3. Speaking of Epic CPOE in Chicago, there are under reported interoperability dysfunctions with all CPOE which plague trustworthy care as you importantly disclose and report: “We have discovered a systems issue that may convert CPOE orders for CT examinations without IV contrast into CT examinations with IV contrast in Radiant.” Hmmmm.

    Most often, the order does not reach the destination leaving the doctor, or whoever cares about the patient, wondering, “what happened?”

    To have the computer meaningfully rewrite the order is just a wee bit dangerous, would you not say? Is this an example of meaningful uselessness? Will the doctors suffering on a system that can not be trusted disclose whether the interface is fixed? Did the hospital report it to the FDA, the Illinois Department of Health< and Secretary Sebelius?

  4. RE: certain perturbed, petulant, prosaic and possibly perpetual posters, I think Elvis Costello said it best—“Oh, I used to be disgusted and now I try and be amused”

    /Lighten up, Francis

  5. With the Epic deal done, Mark will be leaving in a couple of weeks after 13 years there.

    I don’t understand. After doing a deal, he leaves? What am I missing?

  6. Apple’s response to its embarrassing Antennagate iPhone 4 problems have been quite un-Apple like.

    I can only wonder if Apple had any ham radio personnel on its design teams.

    Rule in ham radio: keep your mitts off the antenna. (Usually to prevent getting RF burns or even electrocuted when running high power, but also to protect the transmitter from damage from antenna detuning.)

  7. Regarding APPLE’s “Antennagate” announcement, I for one can attest that I have not had “one” idropped call after one-week of using it… the first few days without a case (bumper) and the past 4-days added a ‘brand’ case which I had on my former 3G as a personal choice unrelated to antenna issues.

    I feel for those experiencing drooped-calls, but this is so reminiscent of the ’08 release of their 3G iPhone, consisting of no 3G reception, dropped calls and poor battery life. Back then it was determined that there were too few 3G towers to handle the significant bandwidth demand, & as for the dropped calls… I can assure you that my wife & I can venture into a local grocery store together and we’ll both lose reception as soon as we walk thru the doors and she isn’t on an iPhone; whereas on our former carrier, never an issue.

    Is there a perfect Smart Phone out there? Doubtful… and while I am only one of 3M owner’s of the iP4, we cannot ignore the potential of some negative, competitive hype taking place in creating ‘doubt’ in slowing sales? At the end of the day, if you have an issue, return it for an exchange, like you would return any flawed purchase…

  8. The antenna thing is not the first time either. Last fall there was an upgrade that rendered my iPhone, and thousands others complaining on the apple site, totally useless – a big brick – going off for no reason multiple times daily. It took a month to release a patch and no public announcement. So I’m not surprised… and I never upgrade anymore….

    There is no perfect technology vendor… 🙂

  9. After some deliberation, I voted the Golidlocks way and said the released MU rule is just about right. I did so because while it’s still far from ideal, many of the comments were listened to and applied, flexibility was added, and finally, it’s the rule we’re left with: the time to moan and groan is past. Indeed, I think most everyone following this issue is just happy that we finally have a standard to look to as 2011 fast approaches. I’ve prepared a little video summing up the main points over at the Occam PM blog.

    As for the iPhone debacle, it’s not like I have a stake in the fight (yes, I’m one of those dweebs who still has a phone that only, well, makes phone calls), but the part that’s fascinating isn’t so much the problem as the reaction. All products have problems (as Wesley said, anyone who tells you differently is selling something). What makes a vendor stand out is how they deal with the inevitable fallout. This reporting by WP blogger Rob Pegoraro strikes me as a loss for Apple, not because they don’t have the right to delete items from their forum, but because appearing to smother criticism will only feed the conspiracy mill further against the company. If these posts were to be deleted, it would have been better to be accompanied with an official response to them or a solution to the problem.

    However, the whole situation has been great for Apple bashes (these two are particularly funny: The Daily Goat and iProduct)

  10. Response to CPAhole – MyWay sunsetting and ICD-10 conformity issue. I’m not sure where you heard what you stated but I’ve validated with Allscripts that in fact MyWay already supports ICD-10 codes today.

    I’d ask that you verify your information better as you used this information as the basis to put the viability of MyWay in question falsely. Therefore with your information being false I’m led to believe that the basis of your statement-posed as a is false too.

  11. Nice reference to one of the greatest “No I’m not doing DeNiro, really, I swear” DeNiro ripoffs ever…. (yeah, I’m talkin’ to you)


    Francis (aka “Psycho”): Any of you guys call me Francis… and I’ll kill you!
    Platoon (in unison): “Ooooooh”

    Come to think of it — I wonder if “Psycho” could be hired to recite the Meaningful Use doctrine as succinctly and “passionately” as he recites his rules in Stripes….

    …If you have less than 30% of patients with a med order entered via CPOE… I’ll kill you.

  12. Re CPOE issue:

    Suzy, why in the world would the FDA be notified of a CPOE issue? That would be like notifying Streets and Sanitation if your car is not working.
    The requirements would be that the Institution perform a root cause analysis (RCA), review to make sure that patients were not harmed and that the problem is fixed, and institute safeguards to prevent the issue from recurring. I am sure that this was done. What axe do you have to grind?

  13. On 7/19/10 you posted the following:

    “Re: Allscripts MyWay. I heard they’ve said they won’t support ICD-10 in MyWay since it will be sunsetted in 2012.” Unverified. I’ll be incognito at the Allscripts user meeting August 5-7, so if I don’t hear anything before then, I’m sure I will there in Las Vegas. Inga and I speculated when the merger was announced that MyWay was the square peg in a round hole, but we were just guessing then, too.

    After returning from ACE, can you comment?

    [From Mr. HIStalk] I heard nothing to suggest this is true. Allscripts showed a MU roadmap for MyWay and the customers seemed awfully happy with it. 2012 is a ways off so anything could happen, but it looked like it had the full support of Allscripts to me.

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