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Monday Morning Update 11/22/10

November 20, 2010 News 22 Comments

From SpaghettiCode: “Re: GE. The recent reorganization confirms that they made a huge mistake with the $1 billion IDX acquisition. After many attempts to defibrillate the CareCast business, they finally orged the legacy business under the EMR side and key execs were moved out.” Here are snips of what I had to say about the acquisition in September 2005. I mentioned collaboration with Intermountain Healthcare as a positive (that’s gone nowhere that I’ve seen), although I was focused mostly on the inpatient apps:

If you’re an optimist, you might assume that a mega-conglomerate like GE will pump R&D into the old warhorse IDX products, make them wonderful in a way that a small player like IDX never could … Pessimists would ask for even one example where that has ever happened, including with prior GE acquisitions … Much of CareCast was written 20 years ago by that little band of Phamis employees in Seattle. Does it contain enough intellectual property or technical excellence such that a quick spit-and-polish treatment will make it a world-beater? I don’t think so, but maybe GE does … Conglomerates have a way of screwing up products (McKesson, Siemens, and maybe even Misys.)… IDX needed a white knight. It was devaluing itself day by day, with an embarrassing UK performance and no CareCast sales. The acquisition announcement mentioned that IDX needed a partner with global reach, but it had already created its own opportunity in the UK and blew it. Cerner and Epic were threatening to run the table on them … Somehow HIT companies seem to lose their passion when swallowed up by multinational firms selling everything from light bulbs to Jay Leno. That’s kind of sad, don’t you think?

From Boston Patient Advocate: “Backlash is building by patient advocates against self-appointed ePatients who make a living selling a modified version of their story. They often fail to mention that they misunderstood information they found online, weren’t really as sick as they thought, or that it was their doctors that found the correct treatment or gave them an RX for online communities. Then again, we love myths of the little guy in America.” I ignore news stories in which reporters try to mask their opinionated reporting with phrases such as "debate rages”, “some are questioning”, or “pressure is building”. In other words, I don’t doubt your sincerity, but I’d like to know specifics behind your “backlash is building” assertion. As we say in the medical world, “In God we trust … others bring your data.”

From The PACS Designer: “Re: Continuity of Care. TPD is happy to see that HHS has embraced the concept of Continuity of Care as it is laid out in the ASTM Continuity of Care Record (CCR) and requires providers to include it in their EHR certification submission request. Healthcare organizations will have to include the ASTM CCR in their discharge process to get their EHR certified, and at the same time, we’ll have a chance to transfer information between providers to help eliminate duplication of procedures and reduce medical errors.”

11-20-2010 4-36-58 PM

Eastern Maine Medical Center (ME), preparing for a three-day lockout of striking RNs by bringing in replacements, will shut down all of its clinical systems except the eMAR and go back to paper. Here’s a hint for those living near Bangor: go somewhere else if you’re sick this weekend. Or, if you’re one of those “EMRs are evil” naysayers, this is your rare chance to do some Maine-based medical tourism to receive critical, elective medical care at a paper-based hospital.

The usual list of stuff you can and should do here: (a) subscribe to the updates so you aren’t embarrassed by the idiot three offices down who learns breaking news before you and rubs your nose in it; (b) use the search function to amplify your HIT intelligence in real time; (c) Friend or Like us on Facebook or connect with us on LinkedIn so that we may both pretend to be more popular than we probably are in real life; (d) click some of the sponsor ads to your left to see what they’re up to; (e) visit HIStalk Practice and HIStalk Mobile to get mostly different news particular to physician practices and mobile health, respectively (and sign up for those updates, too, if you want to stay on top of stuff).

Listening: the remastered 1978 debut solo album of former Pink Floyd leader David Gilmour, recommended by a reader. I appreciate that: I really like his music and respect him for his charity work, but I never think to recommend his solo stuff, which at that early stage of his career was kind of Pink Floyd Lite (not necessarily a bad thing). He’s supposed to be reuniting with former bandmate Roger Waters at one live performance of The Wall, which is on tour now.

11-20-2010 4-50-00 PM

Forbes runs maybe the weirdest, worst HIT article I’ve seen, apparently intended to be a cheerleading piece for Allscripts. It claims that open source is about to make its healthcare debut, courtesy of Allscripts (meaning Allscripts Helios, previously Eclipsys ObjectsPlus, which has been around since the 1990s). It claims that many tech vendors have gone out of business because they “chose to cling to closed, proprietary software or hardware” (care to share names and proof of the cause of their demise?) It mumbles something about the need to interface a “computerized drug order system” to an EHR (huh?) It says Judy Faulkner’s statement that you can’t mix and match vendors is an Allscripts advantage, failing to notice that Judy’s company (whose industry-leading product is closed and proprietary) had pretty much killed Allscripts (nee Eclipsys) Sunrise single-handedly since to install Sunrise, unlike Epic, required mixing and matching vendors to cover the many hospital areas it doesn’t address. To top it off, the article uses the old Allscripts logo pulled from Wikipedia instead of actually checking their site directly to get the current one. All of this was a lame attempt to create an interesting, insightful article around an October press release in which Allscripts announced that it would create an apps store for the former Eclipsys Sunrise, which has nothing to do with open source in the first place since nobody’s seeing and contributing to anybody else’s source code (extensibility isn’t the same as open source). It’s just amazing to me how many people write authoritatively but wildly inaccurately about healthcare IT (usually spinning entire articles around press releases and a couple of Google searches) who have never worked a day in either healthcare or IT except as a cheap-seats spectator. Caveat lector.

11-20-2010 7-39-15 AM

A little more than half of respondents to my poll say they’ve seen “hold harmless” contract clauses, although I liked the excellent comment by NotQuite, who pointed out that a “hold harmless” clause is not the same as a “limit of liability” clause. I’m no lawyer, but that sounds legally insightful. Gotham City CIO requested the new poll to your right, for hospital people: does your organization block access to outside e-mail services by physicians using hospital PCs? They block access to Gmail, Hotmail, etc. at his place to prevent the possible transmission of PHI via untrackable e-mail services, which is apparently common in other industries. The new CEO is getting heat from the docs even though they can still use a dedicated PC in the doctors’ lounge or their own PDAs to get to those services. Feel free to add any comments to the poll that would help our CIO colleague.

11-20-2010 8-15-23 AM

Thanks to new HIStalk Platinum Sponsor Orion Health. The international company, based in Auckland, NZ and with US offices in Santa Monica and Boston, offers solutions that include an HIE platform, the Concerto Physician Portal with single sign-on to provide a single patient view across multiple clinical systems, the Rhapsody Integration Engine for inter-system messaging and integration, the Rhapsody Connect solution for connecting to public health agencies, and the Symphonia developers’ messaging system for rapid system integration. The company just reported an 80% increase in revenue for the first half of the year and has 22 HIE sites in 12 countries. In the US, Orion’s HIE solution was recently chosen by the Wayne State University Physician Group and Maine’s state HIE. Rhapsody 4 just came out with new support for SOA integration and Web services, with Philips choosing it as its integration tool. The company offers a much broader product line than I knew about (EHRs, registries, whiteboards, bed management, chart deficiency, etc.) so feel free to cruise over to their site to learn more. Thanks to Orion Health for supporting HIStalk.

McKesson’s Horizon Clinicals earns ONC-ATCB certification through Drummond Group.

Marty Mercer is putting together a HIT sales training class for newbies and is looking for input from industry long-timers. You can help out by completing his short survey like I did. He’ll send me the results afterward since I think they might be fun to review here.

Inga emulates Weird News Andy with this link: doctors warn of the psychological dangers of social networking after an 18-year-old boy’s asthma attacks are found to be triggered by looking at the Facebook profile of his former girlfriend. His mom measured his peak expiratory flow before and after.

The Rural Nebraska Healthcare Network starts construction of its Nebraska panhandle fiber optic network that will connect nine rural hospitals and their clinics.

Vendors beware: patent troll Acacia Research buys 11 patents for wireless physiologic monitoring. Let the nuisance lawsuits begin.

A company that has developed an electronic parking space finder wins at the IBM SmartCamp World Finals in Dublin, but a couple of HIT-related companies were in the hunt: CareCloud (Web-based practice management and revenue cycle tools for practices) and Sproxil (checks the authenticity of drug products via SMS messaging, primarily in developing countries).

Speaking of “cloud”, everybody’s hopping on that bandwagon with as much self-serving enthusiasm as they did previous sloppily defined fad terms (ASP, EHR, clinical transformation). Since HIStalk runs from a Web host, I think I should start referring to myself as a “the leading cloud-based business intelligence and collaboration platform for the healthcare technology and life sciences sectors.” I’m thinking investors will line up at my door dripping saliva at the chance to throw money at me. 

 11-20-2010 9-43-37 AM

St. Paul Heart Clinic (MN) closes its doors, with its 36 cardiologists going to work for either Allina or HealthEast. A key reason, as explained to patients, was the ability to share a common EMR.

Orlando Health (FL) offers local medical practices a discount on GE Centricity.

Weird News Andy likes this story: the call center for TennCare is a women’s prison, as discovered and reported by the overly dramatic and pot-stirring local TV station anxious to use that “breaking exclusive” graphic typically rolled out when someone’s flat tire backs up traffic almost a quarter mile. WNA likes the eloquently expressed consternation of one Leon Rippy, apparently goaded randomly by the TV station to weigh in on the issue of the potential but entirely theoretical impact on patient privacy: “That ain’t good.”

11-20-2010 4-47-23 PM

Coliseum Hospital (GA) investigates a former employee who dropped by to attend a nurse’s birthday party, then logged into the hospital’s computer system with her still-active password and looked at patient information. She’s caught by hospital security, which was apparently more effective than IT security considering the terminated employee’s credentials had not been inactivated. Assuming HR let them IT, of course (and trusting the competency of any hospital’s HR department is indeed foolhardy).

A blog entry in The Economist says HITECH could be as big a bust as NPfIT in the UK, suggesting that France provides a better model:

Maybe the Americans (and the British) should swallow what the French would term their “Anglo-Saxon” arrogance, and look at France. A French citizen presents his credit-card sized Carte Vitale to the doctor or the pharmacist or the hospital and everything—for example, the date and dosage of a prescription—is recorded by a national computer system (which also usually deals with payments). Visit another pharmacy or doctor in another town, and the patient’s details are automatically available. Perhaps this helps to explain why the World Health Organisation in 2000 (the last time it did the exercise) put France at the top of its rankings for health care. By contrast, Britain came 18th and America 37th. Mind you, it may also explain why the French pop more pills than anyone other than the Japanese.

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Currently there are "22 comments" on this Article:

  1. To call them “scab RNs” seems a bit harsh. Some of them might actually be doing it because they believe patient safety is more important than unions and strikes.

  2. You’re right on about the Forbes article. They couldn’t have been more wrong about the industry situation unless they also claimed that the next-generation billing systems from Siemens and McKesson were poised to sweep the market (and work).

    I remember an old adage about the NY Times’ business section. Apparently everyone’s opinion, regardless of their industry (banking, real estate, technology, automotive, etc.) of the Business Section was that it was great, except that it didn’t understand their particular industry.

  3. >>> Or, if you’re one of those “EMRs are evil” naysayers, this is your rare chance to do some Maine-based medical tourism to receive critical, elective medical care at a paper-based hospital.

    Oh cool! I wonder if they’ll begin getting those drug pens again. Ever since the HITECH Act was signed in by obama (note little “o” after recent elections) I’ve yet to see a pharma pen at my office. I really miss them…

    Motto for that story- when the going gets rough, people go back to paper-based records!

  4. GE – Carecast has been a dead horse for several years. Only a complete re-write would have *maybe* saved it. GE has all those programmers in India – too bad they didn’t figure that one out and now to watch the rest crumble…

  5. Tis known very well that US will follow UK in HIT failure with massive wastes of moneys for they approach the same way and never look to learn from history.

    Congress might know of this well but then, do no thing takes hold because no one is accountable. NHS in UK near bancruptcy. US giving money away to venders without a safe system improving outcome and cost.

  6. Nice job calling out the Forbes HIT Article! Is it me or do some journalists forget that they need to do their homework first?

  7. That Forbes article seems like it was essentially an advertisement/press release handed to the writer by Allscripts.

    That being said, the obvious spin is to discount the entire article completely as nonsense. It does bring up interesting points. Open source has existed for a while in HIT – it’s called Medsphere. It also highlights a major issue with Epic’s software which will become an issue going forward. Epic’s software just doesn’t work with any other software, regardless of what the company tries to force-feed in its press releases and users group cheerleading. Judy’s goal is to create a situation where hospitals become entirely dependent on Epic for their EHR needs, and unfortunately too many hospitals are falling for the short-term gains and ignoring the long-term losses. Epic’s products are not particularly innovative and are built on archaic technology. When the time comes for the acceleration of technology development in healthcare, Epic will become the rate-limiting step due to lack of updated technology or integration with non-Epic products. It’s a chronic problem in HIT though – short-term decisions made by people who lack foresight and know much less about technology than they think they do. We’re handcuffed in healthcare by our own ineptitude, and Judy Faulkner is making a mint off it in the meantime. I’m no Allscripts fan – I think a couple of their products are nice, but most of it is junk; still, at least they’re thinking beyond today and forming a strategy for tomorrow.

  8. Re Allscripts and Open Source:

    The first time I ever heard Glen Tullman utter ‘open source’ in a favorable light was during his Oct. 6, 2010 address to the Senate Committee on Veteran’s Affairs Oversite Hearing in which he said:

    “It is our (Allscripts) belief that usability and interoperability are core to the success of true health IT adoption and should drive not only the development of individual products but also the infrastructure underpinning health information exchange efforts. Allscripts clients share information successfully today in the private sector and with colleagues in the VA and the military health system. For example, in Hartford, Connecticut, we have been partners in a project for almost two years that has not only led to widespread health IT adoption but successful implementation of open source health information exchange technologies.”

    In fact, it was not Allscripts at all that delivered the open source solution to Hartford Hospital that recently when live; it was Misys Open Source Solutions (“MOSS”).

    Having Glen act a mouthpiece for healthcare is bad enough. Having him begin to position Allscripts as an ‘Open Source” company is laughable at best. If Glen truly believed the statements he made, he would have been promoting open source solutions for interoperability in his company’s connectivity strategies long ago when Misys made the technology freely available (when they were connected at the hip before the Allscripts-Misys demerger.) Having been able to speak with Glen directly on this subject and having multiple opportunities for Allscripts to adopt open source, I find his new-found open source religion to be insincere. From where I sit, it would appear that with the dissolution of Allscripts ability to differentiate themselves and its desire to send a shot across Judy’s bow at Epic, they are merely grasping at straws. But if I am wrong, we’d be happy to work with Allscripts in their attempt to offer real open source solutions. Additionally, I am sure the community would gladly embrace them but they’ll have to play by the open source rules of transparency, meritocracy, and legitimacy – provided that code is actually delivered. Oh code? Yes, real code must be delivered. “Glenergy” won’t work here!

    I don’t fault Dan Michelson for his ill fated attempt to deliver the shot as his understanding of what open source is and what we are trying to do in the community can fill a thimble. And although Dan has been pushed down in the new Allscripts-Eclipsys organization, he remains part of the “FOG” (Friends of Glen). So I am sure he is simply trying to deliver the message. The ambiguity evidenced in the message is consistent with the Allscripts open source strategy.

  9. Open source and Allscripts – seems like a good joke to me. Is it April fools day or Turkey week? I would ask all of you to look underneath the covers of Allscripts, their products, outsourced everything, internal controls and client interactions. They need to focus less on glorified press releases and more on how to run their business – all of their fakery will catch up with them – its just a matter of time.

  10. From The PACS Designer: “Healthcare organizations will have to include the ASTM CCR in their discharge process to get their EHR certified”

    Actually, this is not entirely accurate. There is no NIST requirement in any certifiable module that requires the generation of a CCR.

  11. As a former IDX employee the acquisition by GE was only good for the few Gods who lived in Burlington VT. The house was already crumbling after the UK debacle, they fell behind EPIC back then, and management did not have a clue how to save the ship once competition came into the market. Their clients are left out in the cold now, having to spend millions to change over to EPIC. Just imagine, 90% of medical schools run your products, and now they can’t leave fast enough. GE shareholders should sue for the waste of money IDX has become or maybe they should sell it? Overall it is a great business case of what not to do from both side – what not to buy and how not to screw up a good thing.

  12. Responding to SpaghettiCode’s GE post, I was just at the AMIA conference in DC last week and the GE-Intermountain Health was presented as an example of a “successful” partnership of culture and execution. Intermountain explained their goal of getting out of the development business and creating a commercially available solution for the market is being achieved. They explained the the 5 year project is in alpha implementation with two other partners but didn’t mention who they were. (5 years to get to alpha – definitely not being driven by investors)

  13. “Or, if you’re one of those “EMRs are evil” naysayers, this is your rare chance to do some Maine-based medical tourism to receive critical, elective medical care at a paper-based hospital.”

    This is an opportune time for comparative effectiveness research…CER as they say. Everyone is watching you Maine. Show us your data.

  14. David Gilmour joined Pink Floyd in 1968, so you’re making me feel awfully old saying that 1978 was his “early career.” Is it time to Set the Controls for the Heart of the Sun?

    [From Mr. HIStalk] I probably should have said his “early solo career”, but unfortunately, it’s a true statement either way! He’s one of three surviving members of PF (Syd Barrett and Nick Wright having died not long ago).

  15. From The PACS Designer: “Healthcare organizations will have to include the ASTM CCR in their discharge process to get their EHR certified”

    From Jim Tate: “Actually, this is not entirely accurate. There is no NIST requirement in any certifiable module that requires the generation of a CCR.”

    I think both of you are correct, since I believe there are NIST requirements for CCD creation. The ASTM CCR standard is a data set specification, for the purposes of transferring information for continuity of care across settings. It is not a single monolith thing to be created or referenced – some parts of the data set are applicable in some cases. and not in others.

    The standard format for the CCR data set is the CCD specification, which uses the Clinical Document Architecture format to represent the CCR data set. HITSP constrained the CCD specification, and created several document specifications, most notably the C32, which describes a patient healthcare snapshot document based on the CCD specification, and the C48, which describes an encounter-based summary (discharge summary or referral request summary). The C32 is completely built out of CCD sections, and the C48 is also to a large extent based on sections defined in CCD, with only few additional pieces of information particular to the encounter-level data they represent. The description of the CCD sections as constrained by HITSP is in the C83 specification, and these sections are reused in the C32, C48, and other document specifications.

    So in the sense that the CCR data set is being required as part of the MU certification process, it is required via the CCD and HITPS C32 requirements. TPD linked to a press release that I think muddles the distinction between the CCR data set specification, and an adjunct to the standard, which contains an alternative XML format for the CCR data set. While that alternative XML format can be useful for giving concreteness to the CCR data set, it is not well suited for practical healthcare data exchange. When Google Health decided to use that format, they had to limit that use to a subset of the XML format (and thus a subset of the CCR data set) in order to deal with the non-determinism present.

    The stage 1 MU final rule includes a requirement for receiving the CCR adjunct XML format. In my opinion it is a step backwards as it moves resources away from improving the CCD sections that were specified by HITSP in order to handle a different format for the same data. It is important to understand that the CCR data set is not a general solution for all continuity of care data exchanges. Discharge summaries, consult notes and other clinical documents cannot be represented only with the CCR data set. They do include, however, parts of the CCR data set. This is why the CDA/CCD section approach from HITSP is more appropriate – it is based on reusing the building blocks in C83 so that complete continuity of care data exchange and interoperability can be eventually achieved by adding the necessary components in a stepwise fashion.

    Keith Boone has some thoughts on how to move forward with stage 2 of the MU requirements, that I think are worth considering: http://motorcycleguy.blogspot.com/2010/11/some-thoughts-on-meaningfuluse-phase-2.html


    HITSP C32: http://wiki.hitsp.org/docs/C32/C32-1.html

    HITSP C48: http://wiki.hitsp.org/docs/C48/C48-1.html

    HITSP C83: http://hitsp.org/Handlers/HitspFileServer.aspx?FileGuid=717d69a5-6bc4-4f8b-a22c-197130b50567

  16. So true about GE and IDX- they lost a lot of great GE folks during the 2005 acquisition. My team was one of them….of course there is the argument that they gained great IDX people- but the migration felt more like GE was becoming IDX, than the other way around…lessons learned either way. I fully agree with your sentiments about IDX and CareCast..let go of the dead weight already

  17. Networking rural hospitals and clinics in Nebraska — and other rural parts of the country — will be immensely helpful.

    I was born in NE, and when they say “Rural” they *really* mean rural — in a way most Americans can’t imagine: the population density around these centers is about *one person per square mile*.

  18. From all the chatter in this thread, you’d think the HIT industry was actually an R&D industry selling experimental technologies as they come out of the development shop, rather than selling tried and true, proven products that will revolutionize medicine…

  19. Note to self: If Tim Elwell wants to do a project with you, do it. Obviously, Hell has no fury like a self-described “deal-maker” scorned.

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