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December 30, 2010 News 11 Comments

From HISJunkie: “Re: SureScripts as an ATCB just for e-prescribing. How an e-prescribing clearinghouse be an objective judge about a vendor’s functionality? If I don’t use their clearinghouse, where does that put me? I think the certification process is going to get much stranger in the new year.”

From Athenahealth Win: “Re: win. They just took out a huge Allscripts/GE-IDX install. Should be announced soon.” Unverified.

From Limber Lob: “Re: Maryland Board of Physicians newsletter article on e-prescribing of controlled substances. I really enjoyed the first two and last two sentences. Another EHR skeptic!” It reads: “The health care community has lived through the initiation of electronic health records. They will, we are told, save time and money and reduce medical errors … Use of the term ‘interim final’ by the DEA suggests that this field, and the concomitant federal records, are evolving. For more information, go to the Internet.”

12-30-2010 9-23-54 PM

From Promises Promises: “Re: gag clauses. None here.” This document lists Allina’s terms and conditions for practices that want to use its Excellian (Epic) system. It says Excellian isn’t a substitute for human thinking and requires practices that want to use it remotely to: (a) verify its behavior; (b) don’t rely on it for anything critical – ask the patient instead; (c) don’t use it to communicate any important results; (d) look out for programming errors; (e) test it before letting users on; and (f) don’t disclose Epic’s trade secrets. You’d think they didn’t have much confidence in their $250 million implementation from all the disclaimers, but I’m sure that’s just the Allina and Epic lawyers expensively talking.

Listening: new from Ryan Adams (just to be clear, not Bryan Adams – this one’s from North Carolina instead of Canada and is married to Mandy Moore). Actually, the new double album consists of three-year-old tracks that had been gathering dust until he started his own record label and released the 80s-theme concept album a couple of weeks ago. Sometimes it sounds like U2, sometimes like Tom Petty, sometimes like The Cars or Spandau Ballet. I guess those are the 80s musical references at work. And Watching: Doc Martin on Netflix, which is a very nice British dramedy. If it’s realistic, the Brit GPs store paper medical record folded into a little 5×7 or so envelope, so they must not churn out the insurance- and lawsuit-required documentation like here. I could spend hours looking at and listening to Louisa (Caroline Catz).

I have Uri Geller sitting right here beside me and he’s telekinetically moving your fingers to the Subscribe to Updates box to your upper right, forcing you to type in your e-mail address and name so that you might live a fuller life in HIStalk one-ness. You will receive no spam since I don’t care about money enough to sell or rent the subscriber list to the many companies that keep asking. You will, however, get everything important in HIT as soon as Uri or I push the “send” button.

A family member got an iPad. I played around with it for a few minutes and liked it a lot (amazing display), although I think smaller tablets sold by competitors might be more my speed. It was nice to have a display larger than that of my iPod Touch but a bit much to haul around. I like the idea that you can get a no-contract AT&T data plan for it for $25 per month for 2GB (cheaper than an Aircard, but that’s in addition to your smart phone plan, unfortunately). I’m really happy with my iPod Touch despite still not having played any MP3s or videos on it (I take a second-generation Nano to the gym since I’m rough on stuff there). It is amazingly handy to grab the Touch from the nightstand and be checking e-mail or Web browsing at WiFi speeds within five seconds of having the urge to do so. Mrs. HIStalk probably hates it since on those rare occasions I watch TV with her, I constantly pounce on the Touch to recite trivia from IMDB about whatever she’s trying to watch or do the “alive or dead” quiz about some actor on the screen. The shows she watches aren’t very cerebral, so I think I may be more fascinating anyway, although I don’t have the nerve to ask if she agrees.

Ed Marx has updated his Why I Fired and Rehired Myself post, which he’s good about doing in response to your comments (even the nasty ones).

12-30-2010 9-21-20 PM

Here’s a shout-out for HIStalk pal Michael Christopher and CarePrecise, which offers a variety of ways to access the federal government’s healthcare provider database with data points on three million providers that include UPINS, Medicare IDs, state license numbers, phone numbers, separate tables of newly added and newly dropped providers, etc. They also have medical marketing tools for you vendor types. Michael’s a genius, so you get to talk to him if you buy something (I talked to him once as Real Me and not Mr. H and was mightily impressed, which doesn’t happen too often).

I wasn’t quite prepared for the immediate response to my casual blurb about maybe needing to hire someone to help Inga and me out. I expected to get an e-mail or two, but not from household name type people (VPs, retired CIOs, people who have published or edited magazines, etc.) Let’s just say I’m honored that folks at that level read HIStalk, much less want to help with it, and I want to hire every one of them because they all sound great. It’s a low-rent operation here, so we’ll see how it turns out (I’m behind on responses, but I’ll get there). Several did the same as Inga when she first contacted me years ago: listed 10 sassy, cynical, funny reasons I should hire them. Here are some of the ones I liked as showing a deep understanding of the HIStalk (anti) corporate culture:

  1. I am considered a pain in the ass by 95% (or more) of people who know me.
  2. I know the industry, the jargon, and where some of the bodies are buried.
  3. I really, really want a cool avatar like Inga has, although I firmly insist on a bit of virtual Botox.
  4. Smart-ass, I am (much more fun if you say it like Yoda). Above all, this is the personality trait that appears to be the key to the HIStalk inner sanctum.
  5. I am certain that you’ll get more impressive volunteers to write for you than me. That being said, you shouldn’t pick them because they’re too busy and they suck in their own perceptions of HIT.
  6. My husband says, “I’d hire you. You are smart and cute.”
  7. But enough about me, let’s talk more about me.
  8. I am a passionate sports fan, mainly that of European soccer. I will defend to the end the reason for soccer not blossoming in America is that our social fabric is built on competition, not community, and therefore we cannot support soccer on a national or regional scale. It has nothing to do with boredom or slow-moving play, as we support baseball and American football, which border on tedium with the amount of time-outs, commercials, and gratuitous jock-adjusting. Soccer is like the ballet — no matter how much you hate it, you know it will end at a reasonable hour.
  9. Actually, in all candor, my experience makes me a perfect fit for this role, not OJ and the leather glove, but an honest-to-goodness Isotoner glove-type fit.
  10. I always attend HIStalk events at HIMSS!

I think I’d need one of my attorney readers to help decipher the legalese, but it sounds to me like Cerner and Mayo Clinic prevailed in an intellectual property lawsuit they brought against a former Mayo physician. Mayo said he took his knowledge of a natural language processing application that Mayo was commercializing to Merck, which may or may not have planned to commercialize NLP software (depending on who you believe). Cerner apparently licensed the software from Mayo and sells it as Discern nCode. He wrote it in MUMPS for you haters out there. I lost interest at this point (earlier, actually), but if you didn’t, here you go.

12-30-2010 9-27-09 PM

Wolters Kluwer Health buys EMR training software developed by a research team at University of Tennessee. Its intended audience is schools of nursing for training students on EMRs. UT gets a cut of sales. The iCare web page is here.

Geisinger Health System (PA) notifies 3,000 patients of a data breach that occurred when a former doctor at one of its hospitals e-mailed information about his patients to his home e-mail account. Geisinger says it notified patients because the information wasn’t encrypted even though it’s almost certain that nobody else saw it. So there’s your first HITECH-related action and one that doesn’t involve EMR bribes – it requires providers to send breach notices to affected patients.

Thirty-six top-earning executives at the University of California are threatening lawsuits against the UC system if it doesn’t increase their retirement payouts. The university is changing its pensions (most of us would need a dictionary to know what those are) since they were underfunded by $20 billion by the perpetually fiscally irresponsible state. Among those signing the demand: UCSF CIO Larry Lotenero (paid $377K) and UCLA health system CIO Virginia McFerran ($477K), along with mostly hospital and investment management people. The bank bailout is going to look like a child’s allowance as states start going broke over wildly generous salaries and pension plans, loading their payrolls with double-dipping “retirees” and employees jockeying their positions for their last year before retirement since guaranteed lifetime payments are based on final salary.

Strange lawsuit: a mentally ill patient who had spent years in a psychiatric facility sues its operator, the State of New York, for nearly letting him die with an untreated infection. He wins, but the state asks the judge to give it his $1.7 million award in return for treating him without payment for 10 years. The judge agreed, so the patient got nothing.

Happy New Year!

E-mail me.

HERtalk by Inga

ONC names Surescripts its sixth Authorized Temporary Certification Body, but only for e-prescribing and privacy and security.


Central Florida RHIO names Jeanette Schreiber its new chair. She’s associate dean and chief legal officer for the UCF College of Medicine.

One week after hitting a last-minute snag, McKesson completes its acquisition of US Oncology.

I am back at home after a week of holiday merriment in the land of No Internet. I had intended to make it a working vacation, but underestimated how very slow my connection would be. After two days of pulling my hair out each time the connection dropped, I finally had to fess up to Mr. H that my escape from civilization was not going as planned and that, alas, HIStalk Practice would have to skip a day. Now, as I sit at my desk using lightning-fast Internet, I must say that I am surprisingly happy to back at work. I promise that my renewed attitude has nothing to do with the Help Wanted sign Mr. H posted during my absence, nor the fact that two dozen people more qualified than me are vying to become Mr. H’s new BFF. Actually I am pleased that so many people “get” how fun this job can be and I am hoping it will give both Mr. H and me more time to work on some other fun projects.

voalte pink

Speaking of fun projects: the upcoming HIStalkapalooza event during HIMSS. Mr. H spilled the beans on a few details and I must also make a couple of comments. First, I have high expectations for contestants in the “Inga Loves My Shoes” contest. It’s quite easy to participate – just pick out the most fabulous pair of shoes from your closet and wear them to the party. A trusted Inga stand-in will eye your feet and select the winning footwear. If shoes aren’t your thing but you want to impress the HIStalkapalooza universe (and definitely me), dress your very best and you will automatically be in the running for HIStalk King or Queen. Here is a tip for the soon-to-be-legendary King and Queen contest: if you are wearing a straight-from-the-booth vendor tee shirt,  you will not win this incredible honor. Those wearing tuxedos and chiffon will automatically make the semi-finals. Wearing pirate costumes or pink pants may only get you a Mr. or Ms. Congeniality award. I am trying to convince Mr. H that we need some amazing prizes for our lucky recipients, but no decisions yet. Meanwhile, I am dreaming of IngaTinis, red carpets, and dancing the night away.


An Ohio surgeon is sentenced to a year in prison for having his office manager pose as a doctor while he was out of the office. The office manager for Dr. Charles C. Njoku had previously been sentenced to three years of probation, including one year of home confinement. The two also must pay restitution of $131,000 for billing Medicare and Medicaid as if the office manager were the doctor seeing patients.

I would love to know which EMR this doctor uses. An internist treating a complicated patient complains that her EMR will not allow her to write an evaluation exceeding 1,000 characters. When the physician calls the EMR help desk for assistance, the tech replies, “Well, we can’t have the doctors rambling on forever.” And the industry wonders why doctors resist EMR adoption.

The mHealth market continues to boom, with over 200 million apps now in use. About 70% of people worldwide are interested in owning at least one mHealth application and are willing to pay for it. Countries with large populations and limited healthcare options, such as India and South Africa, are the most interested in mHealth. Look for the number of mHealth apps to triple by 2012.

puget sound blood

Puget Sound Blood Center (WA) is launching the GCI ConnectMD private medical network to connect with Swedish Medical Center, Cherry Hill Campus.

Government auditors report that the CDC lost or misplaced more than $8 million in property in 2007, including a $1.8 million hard drive and a $978,000 video conferencing system. Whoops. The CDC says it has now instituted better controls and that 99% of its property was accounted for in 2009.

A computer tech in Michigan is arrested for allegedly violating state hacking laws and gaining access to his then-wife’s e-mails to confirm his suspicions that she was having an affair. Turns out she was, with her ex-husband. The wife (who is now actually the alleged hacker’s ex-wife) realized the computer had been hacked when personal e-mails showed up in a child custody pleading involving her first husband (hacker was husband number three). Computer geeks, lots of husbands, and adultery – it just doesn’t get much juicier than that.

Sponsor Updates

  • Greenway Medical Technologies announces a new web site covering EHR adoption incentive programs.
  • PatientKeeper is moving to new headquarters in Waltham, Massachusetts in a building adjacent to the Massachusetts Medical Society and the New England Journal of Medicine.



E-mail Inga.

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Currently there are "11 comments" on this Article:

  1. The internist will not be able to bill the max if limited to less than one thousand words: ” would love to know which EMR this doctor uses. An internist treating a complicated patient complains that her EMR will not allow her to write an evaluation exceeding 1,000 words.”

    That the EMR technology allows cut and paste, the one thousand word limit may be bypassed.

    I for one love producing 5 page progress notes for my docs on their accounts, and then signing for them with one thunderous click of the mouse, while they wave to the patients as they breeze by the rooms on rounds.

    That, my friends, is how medicine is to be practiced via EHR technology, playing out in academic medical centers across the USA. If desired, I will produce these progress notes to prove it.

    Are you listenin Senator Grassley?

  2. A Happy New Year to Mr. H and Inga !!! As we are closing out a fabulous year, I wonder what next year will bring in this very unique market..I believe it will be a wild ,wild ride….fasten your seat belts !!!!!

  3. The “Doctor vs. Computer” article, where the physician was trying to use a short text field (obviously intended for the recording of a couple of diagnoses) for a detailed letter to a consultant, is sort of funny. If I find that my cell phone cannot flip pancakes, is that a design flaw in the phone?

    It’s a shame the support person didn’t simply ask “What are you trying to do?” and tell the doc how to create a letter.

  4. NTOS,RN: I think you fail to comprehend that cheaters can be cheaters on paper as well as on an EHR. Cut and paste is a nice function to save some time, but documenting what isn’t done is wrong whether it’s on paper or on computer. What you’re describing is pretty normal on paper well, even without cut and paste.

    Re: Excellian
    Looks like they took a drive over to United Health and borrowed an insurance company lawyer. That’s exactly the sort of language that ends up in most health insurance contracts. It boils down to “we’re solely responsible for creating and maintaining this system at our discretion, but if something goes wrong it’s your fault.” Pile onto that the ridiculous Epic “trade secrets” clause…seriously, don’t tell anyone that the Epic system allows you to see your labs – in color! If I was a physician who worked at Allina, I wouldn’t touch that system in a million years.

  5. Happy Global New Year 2011 !

    For all you U.S. centric HIT heads out there, there is something else out there in the global healthcare community headquarters on the tiny nation Island of Mauritius in the Indian Ocean. If you ever go to Madagascar on HIT business, take an island hop over to Mauritius.


    (Disclosure: No financial holdings or conflict of interest – just good information.)

  6. Not tired of Suzy:

    I am not an apologist for the shortcomings of HIT applications (and their are many), but if docs in your hospital are not performing adequate evaluations of patients on their daily rounds, the problem isn’t technology.

  7. Re: the Epic contract…isn’t most of that stuff common sense? Afterall, we do ask patients their allergies every time they visit & the lab still calls in critical values. And God forbid customers test their system. Sounds like pretty standard stuff.

    Re: MD v Computer. Is Eclipsys really that much of a piece of junk? Can you really not tell the difference between visit types? One would assume her issue was one of both usability and user error…not that their response was adequate, but I’m sure she could’ve easily solved her problem if she’d just asked a colleague rather than calling the help desk.

  8. re: doc v. comp:
    To be fair, not sure Eclipsys was what she was using, since it seems she is talking about an outpatient scenario, not inpatient. Doesn’t mean Eclipsys is any less a piece of junk, but not sure they’re on the hook for this one based on their inpatient system. Anyone know what Bellevue used for their outpatient clinic system?

    I do think it’s worth noting that Dr. Ofri is a writer – and is likely very verbose. From reading her full article, I think she ran out of things to write about that day and decided to pick on the character limit in her EMR. The system I use has no character limit, so it’s not like her complaints are universal anyway.

    Common sense certainly applies, but that’s not a friendly warning, it’s a legally binding disclaimer (read the whole document, not Mr. H’s summary). By putting this text in, Allina are absolving themselves of blame if a software problem leads to a medical error. Epic has tagged along as a proxy as well. In reading this document, if a patient’s care is compromised by some fault in the EHR, Epic and Allina are off the hook. The physician/practice have numerous obligations to protect the interests of Epic, but Epic and Allina have absolved themselves of any obligation to protect the physicians or their patients.

    To quote Cee Lo, “F U” Epic and Allina; you couldn’t pay me enough as an independent practice to sign up for that system under those rules.

  9. @Shbal: Since you are not a lawyer, maybe you could ask one whether your interpretation of the Excellian terms of use is even close to what you claim. As a non-lawyer, I can’t see how you made the jump from the 2-page PDF to “Allina are absolving themselves of blame if a software problem leads to a medical error”.

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