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Monday Morning Update 12/27/10

December 26, 2010 News 14 Comments

From The PACS Designer: “Re: Flock. As the number of social web sites continues to increase, it becomes a challenge to keep up with all the goings-on amongst your web friends. Now you can have all your social web sites in one browser with Flock. You can view HIStalk’s Facebook and Twitter sites in one place to keep your browsing activity from consuming too much of your time. TPD hopes everyone had a Merry Christmas and wishes all a Happy New Year!”

From Nicole: “Re: Merry Christmas. My kids like reading HIStalk with me and often ask me to read them the news clips. My son (the oldest) likes the business news, my daughter liked the story about Zsa Zsa’s husband.” That’s fun. I’m hoping HIStalk isn’t your story of choice because it puts them to sleep faster at bedtime. I’m a fan of  “out of the mouth of babes” wisdom, so I’m picturing them at HIMSS passing judgment on speakers and booths. I bet they would have priceless observations.

From FamilyPhysician: “Re: instant messaging. Doximity lets you find any healthcare provider in the US (not just your hospital system) and communicate via text securely if they agree. I use it from my iPhone, but you can also use it from the web. Hospitalist groups in my area are using it as well as outpatient docs like me.” This isn’t quite the objective testimonial it seems since it came from a Doximity co-founder, but I’ll allow it since the product seems pretty cool. You can only give it a test drive if you’re a doc since the sign-up form checks your name against a list of licensed physicians.

12-26-2010 10-43-24 AM

From ChiefCookandBottleWasher: “Re: Jim Stalder. You interviewed him a few years ago. He has joined Cook Children’s Health care System in Fort Worth as their new VP/CTO. They’ve gone through a number of IT leadership changes over the years.” Verified, according to his LinkedIn profile. I assume he replaces Tracy Waller, who left in August to work for an oil company services company as an IT consultant. Jim was CIO of Mercy Health Services (MD) when I interviewed him three years ago.

12-26-2010 7-34-57 AM

I expected readers to vote their preferred form of FDA regulation of clinical systems in order of least- to most-comprehensive. That wasn’t how it played out, although survey topics stirring up more emotion seem to generate less reliable results. For whatever reason, the most-restrictive choice (vendors must prove safety and effectiveness the same as drug makers) was the #1 choice. New poll to your right, for providers: is your software vendors’ enhancement road map more focused on making new sales than meeting the needs of existing customers? You are welcome to leave comments.

Listening: Patto, described by the reader who suggested it as “raw, bluesy rock n’ roll with a jazz twist.” The band was obscure even its 1970-73 lifespan and tracks are hard to find on the Web, but it still sounds good (to me, it’s UFO meets Steppenwolf). Check out the guitar solo on this one. The namesake founder, who also started up Boxer, died in 1979 at 36.

12-26-2010 11-39-23 AM

John Stone is named CIO at Fairmont General Hospital (WV). 

It’s eight weeks until the HIMSS conference, just so you know. I’ll be starting up the HISsies in the next couple of days. Below are the results from last year. I’ve already decided to add two new categories, Most Fun Vendor and Best Informatics Professional, but the floor is open for your ideas of additional categories. I like to change them up a little each year. I’m thinking about adding a Lifetime Achievement Award as a serious award.

2010 HISsies Winners

Smartest vendor strategic move
athenahealth guarantees Meaningful Use

Stupidest vendor strategic move
GE Healthcare loses enterprise clients

Best healthcare IT vendor

Worst healthcare IT vendor
GE Healthcare

Best CEO of a vendor or consulting firm
Jonathan Bush, athenahealth

Best provider healthcare IT organization
Cleveland Clinic

Provider or vendor organization you would most like to work for if salary, benefits, and job title were not factors

HIS-related company in which you’d love to be given $100,000 in stock options that can’t be cashed in for 10 years

Most promising technology development
Smart phone apps

Most overrated technology
Speech recognition

Biggest HIS-related news story of the year
ARRA/Meaningful Use

Most overused buzzword
Meaningful Use

When _____ talks, people listen
David Blumenthal

Most effective CIO in a healthcare provider organization
John Glaser, Partners

HIS industry figure with whom you’d most like to have a few beers
Judy Faulkner, Epic

HIS industry figure in whose face you’d most like to throw a pie
Neal Patterson, Cerner

HIStalk Healthcare IT Industry Figure of the Year
David Blumenthal

12-26-2010 12-45-18 PM 

Each year right about now, I start getting more e-mails asking about the HIStalk event at HIMSS. We plan to have the sign-up page live by January 15 or so. I can tell you this one’s going to be memorable – the sponsor, [name coming soon], is going crazy with super-fun ideas that the 500 or so lucky attendees will enjoy (Inga and I keep trying to probe their upper limits: How about we shine a giant HIStalk logo on the outside of the building? Done. Say, wouldn’t it be cool to bring in a professional video crew so I can run party video on HIStalk afterward? You got it, Mr. H.) So for you as a prospective attendee: Did you ever want to feel like a celebrity on Oscar night, making a dramatic entrance on the red carpet while sipping an IngaTini and being interviewed on live camera? Do you like great food and an open bar? Do you like the idea of a full-length concert at HIMSS with a real band playing on a real music hall stage? Did you enjoy the “Inga likes my shoes” contest last year, all the other fun beauty queen sashes, the HISsies, and surprise guests? Would you enjoy special recognition for physicians in the audience, beautiful ladies in their best party fashions as orchestrated by Inga, and maybe even a King and Queen winner just like at your prom? It’s so big and crazy that the sponsor convinced me to use the name to which I was jokingly referring to it as our plans got more ambitious: HIStalkapalooza, sponsored by [name coming soon]. So there you have it: HIStalkapalooza, Monday, February 21, 2011, 6:30 until 11:30 p.m. Eastern at BB King’s Blues Club in Orlando. Thanks very much to [name coming soon] for helping me honor HIStalk’s sponsors and readers in a soon-to-be-legendary way.

Weird News Andy’s radar picks up this story: Beth Israel Deaconess Medical Center (MA) admits that its surgeons miscounted vertebrae in three surgeries in the past three months despite taking the usual precautions, causing them to operate on the wrong part of the spine. The hospital says human error was involved and it can’t find a connection, although two of the three surgeries were performed by the same surgeon. The hospital also admits that it is working to fix problems found by inspectors, including using a checklist developed by another hospital to help surgeons mark their site correctly.

RAND had glowing things to say about CPOE in its 2005 study paid for by Cerner and other HIT vendor. Its new analysis, sponsored by a non-vendor group, finds that healthcare IT hasn’t generally improved the Core Measures scores of hospitals using it. However, the conclusion of the study’s lead author isn’t that HIT isn’t effective, but rather that outcomes measures are too broad to show HIT-related improvements. It was the usual drawing room type study that linked readily available but questionably useful information together to draw new conclusions: the HIMSS Analytics database, the AHA survey, and Core Measures numbers. It would be great if the effects of HIT were so dramatic that overall outcomes improved (not just Core Measures ones), but that’s probably not realistic, especially over a short timeframe. You’d have the same problem trying to make a quality case for almost anything: management changes, process redesign, policy changes in the use of drugs or devices, or better credentialing of staff. Measuring quality isn’t as easy as measure drug safety and effectiveness, where it’s not that hard to set up control groups, measure specific and immediate physiologic changes of effectiveness in patients, and monitor for easily recognized adverse reactions.

12-26-2010 11-58-33 AM 

Thanks to Imprivata for its support of HIStalk, joining us as a Platinum Sponsor. I think you may infer from the above that the Lexington, MA company is justifiably proud of its #1 rating in KLAS’s Single Sign-On category. The company offers the OneSign single sign-on suite (say that three times …), OneSign authentication management, and the Imprivata PrivacyAlert system that detects and audits EMR snooping. Resources: a OneSign webinar, an overview of OneSign VDA for virtual desktops, and a data sheet covering PrivacyAlert and its out-of-the-box data support for Millennium, Sunrise, Meditech, and other healthcare apps. You might also want to check out Identity 360, the company blog. I don’t recall if I mentioned this, but OneSign Secure Walk-Away won the Security Innovation of the Year award from the British Computer Society two weeks ago. It uses a webcam to detect when a clinician walks away from their logged-in workstation, forcing a new user log in with their own credentials to improve security and avoid medical mistakes. I interviewed CMO Barry Chaiken just a few months ago.  Thanks to Imprivata for keeping the HIStalk wheels turning.

Strange lawsuit: a neuroradiologist and an endocrinologist playing a round of golf take their second shots of the first hole and head off to find their balls. The endocrinologist finds his and takes his shot, shanking the ball into the head of the neuroradiologist, blinding him. The neuroradiologist sues the endocrinologist, saying he should have yelled “Fore!” The appeals court throws out the case as had two previous courts, saying that the neuroradiologist was standing 15-20 feet from the endocrinologist at a 50-80 degree angle, making it unreasonable to expect the other golfer to yell “Fore!” before swinging since nobody was even close to his expected line of fire. The neuroradiologist’s attorney probably did little to elicit sympathy for his client, who has been unable to practice full time since the original 2002 incident, by claiming his eight-year lost income is “more than you and I will ever make in a lifetime.”

Canada-based healthcare document management solutions vendor Accentus acquires two transcription companies: ZyloMed (FL) and Transolutions (IL).

12-26-2010 10-59-45 AM

Virtual Radiologic completes its all-cash, $170 million acquisition of Nighthawk Radiology, paying a 100% premium to the market closing price of NHWK when the deal was announced in September.

A gastroenterologist’s editorial in the Cleveland Plain Dealer says EMR should stand for End of Medical Rapport, an unwelcome technological intrusion into the doctor-patient relationship being pushed by insurance companies, the government, and EMR vendors. I don’t buy this a bit since my doc is a big EMR user and, if anything, it makes our time together more valuable to me. As in most of life, it’s not what you have, but how you use it. His method: (a) we chat for a couple of minutes before he even looks at the screen since the assistant or nurse has already entered my vitals and chief complaint; (b) the monitor is placed on the desk beside the patient chair, so we’re still sitting close to each other and the monitor is to our side instead of between us; (c) he quickly looks up the information he needs, then turns back to me for the rest of our session; (d) he doesn’t type while we’re talking and generally hardly at all while I’m in the room; (e) if we’re talking about something, like my lab values, he pulls them up on the screen and we go over them together. Now my doc is great overall: he doesn’t wear a white coat because he thinks it’s too authoritarian, he always leads off with a friendly handshake and some chit-chat, and he is highly supportive of helping patients find their own healthcare answers, so it could be that his patient style is just so good that the EMR can’t overcome it. Maybe someone should write a how-to guide for docs on how to minimize EMR disruption since I’m pretty sure it can be done.

I don’t think I’ve ever watched a soap opera even once (being a non-viewer of Unemployment TV, I didn’t even know they were still on), but apparently on All My Children last week, someone named Greenlee got into a hospital’s computer using a stolen password to find out that someone was pregnant. Scenery-chewing overacting and hammy dramatic gestures ensued, I’m certain.

E-mail me.

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Currently there are "14 comments" on this Article:

  1. I saw Doximity in action and was really impressed. We’ll see how well doctors adopt it, but it’s definitely a really interesting play in that space.

    I’ve been to the BB King in Orlando before and it’s a fabulous venue. Just be sure to leave the dance floor free for Jonathan Bush to cut a rug. Looking forward to the HIStalk party.

  2. Re: RAND

    Its new analysis, sponsored by a non-vendor group, finds that healthcare IT hasn’t generally improved the Core Measures scores of hospitals using it. However, the conclusion of the study’s lead author isn’t that HIT isn’t effective, but rather that outcomes measures are too broad to show HIT-related improvements.

    It is most fortunate that with just a little adjustment to the endpoints, we’ll be able to prove health IT will revolutionize medicine.

  3. I was literally shocked to see that you can lobby RAND for results as you can Congress. In this case, Cerner plied RAND, and then Rand “experts” testified to Congress. Compliments to the Congressional Budget Office who in May of 2008, filed a report stating that the RAND estimates were too high. Do ya think?

  4. “Provider or vendor organization you would most like to work for if salary, benefits, and job title were not factors

    If there’s no salary, benefits, or leadership opportunity, why move to a dump like Madison to work in an IT shop that uses 30 year old programming technology? I’m sorry, a slide and a treehouse were cool when I was 7, but not enough to make me move to Madison and work for free.

    The official HISsie for “Vendor Mr. H has an irrational affection for” goes to: Epic!

  5. @HISSIEfit – most of the Epic programming is .NET these days. You’re probably referring to MUMPS, their underlying production database, which is the same age as UNIX (over 40 yrs, btw). Last I checked, UNIX and its derivatives (LINUX and BSD) ran about 2/3 of the internet, so 40-yo tools aren’t, by definition, bad.

  6. Howard Thompson Says:

    I was literally shocked to see that you can lobby RAND for results as you can Congress.

    No, really, we have the capacity to transform health with one thunderous click of a mouse after another! This was according to (former) HHS Secretary Michael Leavitt.

    All we need to do is tweak the metrics a bit and spend a trillion dollars or so.

    And buy a lot of mice. I recommend Apple’s new mice. They work thunderously well.

  7. Re: EHR in the exam room, I have done this for 14 years with great success (based on my own feelings about it and positive feedback from patients).

    I have a sizable monitor that faces both me and the patient and I look up and enter information as needed during the visit. The arrangement allows the patient to see the monitor as well as I can, and for me to see the patient to pick up on non-verbal communication.

    The fact that the patient can see me take notes as they’re talking reassures them that I’m indeed listening, and also allows them to correct my misunderstandings or mis-transcriptions (“no, doc, I said I get pressure in my chest, not pain!”). Of course, it is also helpful to be able to show the patient test results, images, trends in numerical parameters (like weight graphed against BP), etc.

    It also changes the dynamic of the patient visit, but in a positive way, I think. No longer is the medical record a thing of mystery (did you see the Seinfeld episode where Elaine was branded a “difficult patient” and every time she’d make trouble the doc would frown and scribble in her chart?). It also requires a very up-front approach to situations that can be sensitive, like when I believe that a patient has a chemical dependency issue, or where I wonder whether they are drug-seeking. My style as a physician has evolved in part because the EHR requires that I share my concerns in areas like these earlier with my patients than I might do if I could hide my impressions within a paper-or obscure electronic-record. I think that’s a good thing. When there is a high level of emotional intensity during the visit, I do take my hands off the keyboard and give the patient full eye contact.

    As always, YMMV.

  8. DrM, MUMPS is a programming language, created in 1966. Microsoft’s .NET is a framework that programming language functions within. UNIX is an operating system. C was the language actually developed to work with UNIX. C++ and Java are the most common programming standard languages today. So, in short, Epic does use a 44 year old programming language.

  9. There’s an old saying that MUMPS isn’t a programming language – it’s a fraternity.

    That said, the history of said language is very interesting and EPIC and others have certainly wrung a lot of water out of it over the past nearly half century. For those that don’t know their history of the language and the companies that have embraced it to varying degrees and purposes, this summary does succinct job:

    Judy Falkner started with MUMPS when she was was just a babe in grad school and obviously continues to be enamored with its’ superiority for the guts of EPIC’s EMR. Google Judy and MUMPS and you can find many of her authored and co-authored papers dating back to 1979.

  10. I’ll second Mr. H’s opinion of how EHRs can actually help physician-patient rapport. My mother’s long-time family physician recently installed a full computer system, and since she’s heard me discuss the entire HITECH/EHR situation before (ad nauseam), she made sure to take some mental notes to report back to me. In her opinion, the entire visit was made better because both she and the doctor could see the information at the same time, going point by point through the data.

    Since the physician hadn’t seen her since the EHR transition, he made sure she looked the record over to double check its accuracy. In her prior experiences, trying to fix mistakes in paper was … difficult, to say the least, and very painful. With the EHR, she was able to immediately glance through and confirm things. In fact, she said she felt more knowledable about her health than she had in prior visits. Plus, she felt the doctor shared more than he had formerly: not because he had purposefully witheld info in the past, but because now he didn’t have to shuffle through stacks of paper to remember everything. In her experience, the EHR was a definite improvement. Now she just wishes she could get email reminders and log in to check lab reports instead of waiting for a phone call. 😉

  11. Dr. Herzenstube – Bravo! We should all have a physician like you.

    No matter what you think about EMRs, the fact remains, ask any clinician if they would go back to paper and they’ll say no. It’s the best we currently have and it will only get better in the future.

  12. I know this is outdated because I’m behind on my reading over the holidays, but I just couldn’t help but respond to the following:

    1. Provider or vendor organization you would most like to work for if salary, benefits, and job title were not factors

    I worked for Epic for several years in the not so distant past and frankly you couldn’t pay me enough to return no matter what you give me for a title..

    2. HIS industry figure with whom you’d most like to have a few beers
    Judy Faulkner, Epic

    Perhaps you all didn’t know but alcoholic beverages are strictly forbidden at all Epic functions and as if that weren’t bad enough – when you work at Epic you are also not allowed to drink in public when you travel – not even a few beers. Irony?

  13. Interesting comments on how an EMR changes the clinician-patient dynamic. My experiences have been the opposite – with two different healthcare systems that tout their large adoption of EMR technology. Both times the clinician spent most of their time in front of the screen typing – barely looked at me….and they complained about how they had to spend a lot more time with the computer.

    One of the EMRs was Epic, the other Vista (CHCS)…..some of the most busy screens I’ve ever seen on any type of application. Horrible ergonomic layouts in my estimation.

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