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Monday Morning Update 2/7/11

February 5, 2011 News 23 Comments

From Secundum Artem: “Re: David Blumenthal. You should do a poll about his replacement.” I’m game. Nominate your recommended replacement here. I’ll put the responses together in a final vote once I get the most-nominated candidates. The result won’t carry any influence whatsoever, but it will be fun while we wait to see who gets the job.

From Asystole: “Re: 100-fold insulin overdose. Sorry, that’s not a function of low pay or working conditions. It’s a function of licensing incompetent people dependent on technology to cover their lack of knowledge. No math skills, can’t calculate a dose without a computer.” I don’t disagree, other than pay does figure into the equation. In many areas, nursing home RN salaries are at bottom of the food chain and, not surprisingly, so are some of their nurses. You have to be really dedicated (or in low demand for clinical or legal reasons) to accept being underpaid while dealing with the number of nursing home patients who are uncooperative, combative, and suffering from dementia. Obviously critical thinking skills were a problem here (“hey, does anybody know where we keep those 10 ml insulin syringes?”) and are no doubt in equally short supply elsewhere in healthcare. And for employees who like having a computer tell them what to do, nursing homes don’t use them much, so that’s another challenge. I don’t hear the technology advocates insisting that LTCs go digital for patient safety and efficiency reasons, probably because the largely for-profit nursing home industry has no money compared to non-profit hospitals (consider the irony).

From Lilliputian: “Re: Epic non-competes. For the folks who say they are illegal, the trick is that Epic swings a big stick with customers and consultants to make sure that folks within their year aren’t hired.” Unverified, but heard often.

From JustBecause: “Re: Ingenix. Charging its customers $25K to stay with them, if you want to upgrade to the claim scrubber version that supports ICD-10.” Unverified, but I’ll leave it to readers to weigh in on the general issue: is it unreasonable for companies to charge existing customers for upgrades necessitated by regulatory changes? Lots of EHR vendors are charging premium dollars for upgrades needed to meet Meaningful Use requirements, but those changes took away development time that could have been spent elsewhere and the timeline was short. I’d guess that most readers agree with me that maintenance fees probably weren’t scaled to cover government-mandated enhancements, but then comes the gray area: what level of surcharge is reasonable?

2-5-2011 4-46-51 PM

I’m in full HIMSS mode, assembling the HIStalkapalooza beauty queen sashes, salvoing e-mails with Inga about the work we need to do to prepare, and setting up all of our recently added sponsors. Someone said they envy me because of all the HIMSS fun, but it’s all work for me. The latest I’ve ever stayed for the HIStalk reception was 9:00 p.m. because I have to stay up half the night writing that day’s HIStalk (I ate nothing but Subway the last time the conference was in Orlando). Above is a picture from that HIStalk reception at the Peabody that year (2008) that I ran across. I never get many reception pictures, so I’m hoping I do this time around.

2-5-2011 5-26-09 AM

I’m happy to hear that so many readers have found work-life balance, with only around 16% saying they work 60 or more hours per week in their primary job. New poll to your right: what’s your take on the PCAST report’s recommendation of a universal healthcare exchange language based on tagged data elements?

A UK male nurse who prosecutors say killed his first wife and tried to kill his second, both times to collect insurance money, told a former lover that being a Cerner contractor in Saudi Arabia gave him a military rank of colonel. 

Maryland hospital is under fire for its delivery room policy banning cameras and cell phones and allowing no baby pictures to be taken until at least five minutes after delivery and only then with the medical team’s permission. The hospital’s stated concern: the privacy of its employees. The unstated concern: hospitals have lost malpractice lawsuits when videos taken by parents captured evidence of improper care. It’s interesting that some businesses record everything on video everything to protect themselves legally, while hospitals and practices are scared to death that cameras will catch them screwing up. Which they would, no doubt: you could do an interesting medication error study by putting a helmet cam on a nurse or a patient. In fact, I’ve just had one of my can’t-miss business ideas: a malpractice law firm could visit hospitalized patients and offer them a free stuffed animal Nanny Cam for their rooms in return for the inevitable lawsuit business that would result from a review of the images.

2-5-2011 6-15-28 AM

Thanks to new HIStalk Platinum Sponsor Merge Healthcare of Chicago, IL. We connected when I interviewed CEO Jeff Surges a couple of weeks ago. Merge is mostly known for RIS/PACS and innovative medical imaging software, but has expanded its product line to include radiology-focused solutions for billing, document management, and operational dashboards; cardiology and cath lab; clinical trials; master patient index; integration tools and services; kiosks; a laboratory information system; MRI; perioperative solutions; and a clinician access portal. Wall Street must like what it sees since the stock price has jumped 45% in the last 30 days. Drop by their booth at HIMSS and they’ll tell you about iConnect, the company’s comprehensive solution for interoperable image exchange and management. Thanks to Merge Healthcare for supporting HIStalk.

The VA announces the first four winners of its innovation competition, which will receive funds to run pilot projects: mVisum (cardiology data on mobile devices), Agilex Technologies (VistA on mobile devices), MedRed (collaboration tools for caregivers of traumatic brain injury patients), and Venture Gain (wearable sensors to detect heart failure).

2-5-2011 7-03-20 AM

Billian’s HealthDATA is supporting HIStalk as a Gold Sponsor, which I appreciate. The Atlanta-based company provides healthcare contact and facility data (hospitals, ambulatory surgery centers, and long-term care facilities, for example). I checked out their hospital information, which includes statistics, affiliated organizations, contact names and titles, e-mails addresses, and financial and quality indicators. Most interesting to me is that they also have information on IT installations and upgrade plans (sample here) that I would love to get my hands on since I’m always needing to know who runs which systems, who’s the IT contact at a given hospital, etc. so I may need to find out what that costs. Thanks to Billian’s for supporting HIStalk.

I found this brand new YouTube video from Billian’s that demonstrates the new version of its portal, which covers over 40,000 healthcare facilities. They’ll be showing it at HIMSS.

DrLyle provided some information on the HIT Geeks Got Talent sessions at HIMSS. On Monday at 12:15, eight contestants (vendor coders, spare bedroom programmers, whoever) will do two-minute demos of their cool software, judged by Jonathan Teich (Elsevier), Erica Drazen (CSC), and Dave Garets (Advisory Board Company) and voted on by the audience using cell phones (apparently non-cell users are disenfranchised). The top four will move to Tuesday afternoon’s finals round, where they’ll do 10-minute demos to pick a winner. DrLyle explained that he got the emcee job not only because he runs a healthcare innovation program, but because “I’m a shorter, darker, and hopefully funnier version of Ryan Seacrest.” I like the idea, especially when considering the non-spontaneous “dark room with monotonic, over-rehearsed people reading from slides” sessions that predominate.

Speaking of overly rehearsed speakers, I just now cracked myself up with memories of peering into the Speaker Ready Room at previous HIMSS conferences. It’s hilarious to watch a roomful of suited-up, badge ribbon-bedecked presenters warming up by reciting their presentations with eyes closed and practicing their histrionic podium gestures in a sparsely furnished room in front of nobody in between bouts of anxiety-induced nausea. Too much practice is why 90% of the sessions are like watching a motorized Abe Lincoln at Disney, with speakers moving and speaking awkwardly while losing the audience’s interest in about two minutes (imagine Audio-Animatronics Abe reading from PowerPoints crammed with bullet lists). PowerPoint encourages formulaic Ben Stein-like recitations, but it does allow audience members to just grab the slide printout and run if they don’t need to have the slides read to them books-on-tape style. In fact, if it wasn’t for going to parties, hanging out with pals, and taking an Orlando vacation on company time, you could probably bag HIMSS completely and just buy the audio proceedings for a few hundred dollars, thereby gaining the audio advantages of “attending” every session plus being able to use the fast-forward button that would be ever so handy in those meeting rooms.

McKesson and General Dynamics sign a deal to create a centralized EHR for DoD. The announcement implies that an existing McKesson solution is involved since it references “the proven capabilities of McKesson’s EHR solution.” I’d be interested in knowing which MCK product was so strong that it was an obvious DoD choice (and what taxpayers are paying General Dynamic for bringing it to the table).

A New York hospital named by the state as an overseer of a failing nursing home files suit against the nursing home’s owner, HCA/Genesis. The hospital claims HCA/Genesis is threatening to pull out all IT equipment and services, not too surprising since the hospital was already planning to build a competing facility when asked to manage theirs for 18 months. 

2-5-2011 4-41-54 PM

Labor management systems vendor Kronos announces Q1 earnings of $37 million on revenues of $176 million. Which reminds me: why does “revenue” require a plural form? Is “revenues” different from “revenue?” I could look it up in “The Free Dictionary,” but the entry above tells me I might not want to trust the result.

2-5-2011 9-37-23 AM

FDA approves the first iPhone/iPad app for viewing medical images, although its 510(k) clearance was qualified in saying it should be used only when workstation access isn’t available (right). Mobile MIM passed FDA’s tests and its review of radiologist usage under variable lighting conditions.

Germany’s big HIT vendor, CompuGroup, reports Q4 numbers: revenue up 9% and net income up 131%. Revenue was lower than expected, primarily due to poor US sales. Its previous US acquisitions include HealthPort, Noteworthy Medical Systems, and Visionary Healthcare Group.

This is unusual: Roundup Memorial Hospital (MT) asks the local clinic to help it run its operations after the hospital ends its contract with a hospital management company. The clinic will help the hospital install electronic medical records. Actually, the clinic already operates a hospital from a 1993 merger, so it’s not exactly just a medical practice. I assume from the hospital’s name that it refers to cowboys, not weed killer.

2-5-2011 10-32-54 AM

University Hospital (UT) apologizes to 700 patients whose statements contained a phantom $2 million charge item. I found this funny: before the hospital implemented its new billing system in December, it mailed out a sample of the new billing format to patients, showing a mocked up bill for phony patient Dora Billings. Several recipients sent in checks for Dora’s bill. The article didn’t say if Medicare was one of them.

Aetna beats estimates with its Q4 earnings of $255 million, up 58% over last year. The insurer says it has a $1.2 billion war chest for acquisitions, with an analyst predicting that Aetna will buy other companies like Medicity, for which it paid $500 million a few weeks back.

Sponsor Updates

  • Orchestrate Healthcare aligns with L-3 Global Security & Engineering Solutions and its Ingia data translation platform to offer an HIE solution.
  • 1450 is named the exclusive North American distributor of Frisbee, a transcription workflow system that routes physician dictation to a transcriptionist and then allows the final Dragon-generated and approved transcription to be sent directly to an EMR. The video demo is here. There’s an iPhone version, too.
  • The Anson Group blog has a post called What The FDA Doesn’t (and Does) Regulate May Surprise You.
  • Emergency department systems vendor EDIMS has a number of position openings: clinical site support specialist, project lead – application systems and data, senior interface analyst, and senior .NET developer..
  • FormFast posts an article called Workflow Automation – Where to Start.
  • MEDecision will showcase ACO and patient-centered medical homes technologies at HIMSS.
  • Holon’s Central Order Entry Pharmacy medication management solution goes live at all facilities of Greenville Hospital System University Medical Center.
  • Sentra Data Systems is attending the 340B Coalition Winter Conference in San Diego this week.
  • Carefx and IBM will provide NHS trusts with a real-time patient portal for clinicians.

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Currently there are "23 comments" on this Article:

  1. I look at the work hours from the other side of the coin – 50% are working more than 50 hours. This is a tough business and will get tougher. Better be ready to work.

  2. maintenance fees – most contracts include a clause about ‘regulatory compliance’. Both meaningful use and ICD-10 are in question. I would love to hear an attorney’s opinion on this. I could make a case either way.

  3. Re: Epic non-competes. For the folks who say they are illegal, the trick is that Epic swings a big stick with customers and consultants to make sure that folks within their year aren’t hired: I can say with certainty that there are one or more consulting firms who direct dial staff at Epic for a “thumps up, thumbs down” before any new hire.

  4. Good wishes to Dr. Blumenthal. Well, you know then, but, he is too certain of the panacea of HIT systems he pushes an American doctors. As a Harvard academic, he should be more scientifically open minded about these systems. Whoever is the expert who they appoint as successor should be more clinically aware of risk and benefit rather than HHS puppet. On WSJ bloggers, you know there is report he had malpractice suit before he came here. Well, then that may no be big deal but he should be open about HIT in this suit since HIT was at Harvard then.

  5. How does the McKesson/General Dynamics/DoD thing relate to the recommendations that DoD and VA coordinate their HIT efforts?? I’m sometimes slow….

  6. Requiring vendors to supply updates for state and national regulatory requirements should be a part of every contract you sign. I’ve been doing this with very little pushback on all my IT contracts for years. They are going to have to do it to stay in business anyway, and all their customers will need it, so why shouldn’t it be an expectation?

  7. While ‘McKesson and G.D.I.T.’ sounds better than having SAIC design and build one from scratch, it still doesn’t sound like a recipe for efficiency and innovation in an environment where both are sorely needed. Would I sound cynical if I were to imagine that it sounds more like a ‘low bid’/’inside job’ combo, keeping contracting goodies in the hands of those who already have them with no real promise of success?

  8. Couple of comments –

    EPIC non- compete. In the end, it is Epic who will feel the pain of prohibiting former employees to go to work for consultants or clients. They are already reeling with the “young kids’ comments. EPIC can not have the controls that they have today as a large scale vendor.

    On ONC – they need to hire a person who can give more than 2 years to the job. If there is no continuity in the message or leadership it becomes another government revolving door and will eventually lead to missing money, and missing the overall objective.

  9. Epic Non-Compete
    Don’t forget what Epic tried to do to the former Philips employees a few years back…but, they backed off when pressed, like most companies do.

  10. I think people fail to understand what is coming with the workforce issue.

    The Epic approach isn’t meant to hurt employees. It is meant to protect customers.

    Watch what is unfolding already this year as we edge toward the edge of the MU Cliff. Hospitals and clinics are losing IT staff in significant numbers already.

    Epic makes a fair trade and they do have a right of return. If you came to Epic from Health IT they generally let you go back.

    If however, Epics makes the investment in a new person, they ask that the new person make a commitment that is fair. And, they share this approach openly with both customers and consultants.

    It might not be perfect, but it makes an important difference to customers. That’s why customers support the concept and will honor it without ever having to go to court. Same with consultants.

    I know you get a few bitter people who feel burned in some way by it, but it’s a short wait and there is nothing preventing them from joining a customer site who is installing different software. Probably would be good experience for them anyways.

  11. Regarding work/life balance …

    The providers I’ve chatted with, at least those in C-suite positions, don’t really expect to find balance, and are candid in their expectations when considering new hires. If you’re not prepared to work before 8 and after 5, then you need not apply.

  12. Interesting. I work for Ingenix on the sales side, I have not been told to charge anything for ICD10 5010 upgrades. I dont’ know of any of our divisions doing so

  13. Re: I don’t hear the technology advocates insisting that LTCs go digital for patient safety and efficiency reasons, probably because the largely for-profit nursing home industry has no money compared to non-profit hospitals (consider the irony).

    Couldn’t agree more about LTC. And the saddest fact is that probably 90% of all of us eventually will end up there (the remaining 10% being those who succumb to earlier deaths or are fortunate to afford at-home family caregivers)!

  14. I’d be very interested in more information on the issue Cowgirl brings up. Why is there a strong recommendation that VA and DoD work together, and then DoD signs a deal with McKesson? Isn’t this just AHLTA revisited?

  15. Some random comments related to:
    “EPIC non- competes, hiring new grads and failing to understand what is coming with the workforce issue.”

    I have followed this discussion for several years. As an RN with lots of HIT experience, but not with EPIC, I would have loved to applied there for their implementation team. But since I’m not a “new grad”, figured that wouldn’t happen anytime soon. Too bad for EPIC though, as they’re losing out on many folks like me would could bring valuable skills to their organization. It’s no secret that demand for skilled IT workers, especially those with a clinical background, has already exceeded supply. And my bet is that EPIC won’t be able to go on forever only hiring inexperienced “newbies” and molding them, much like Pharma did/does. Customers will demand their best and brightest and most experienced. They already do!
    Further, if a true free marketplace was working then employers would retain good employees by taking care of them and fear of losing them to the competition would be less of an issue. Sure it’s going to happen, but right now most employers are happy to poach a competitor’s employees, they just don’t want the competition poaching theirs!!

  16. In 2008 I asked the booth babe wearing the “Kiss me I’m Inga” sash for a kiss, and she turned me down.

    The next year I wore the “I’m Inga’s booth babe” sash and no one asked me for a kiss!

  17. Frankly, I don’t want a world of union-run IT shops headed by SEIU types but it is absurd that a company should be able to severly inhibit the future livelihood of their workers for a year or more.

    We have already created an economy where employers call most of the shots and have almost all of the bargaining power yet apparently that is not enough and we need nonsense like noncompete agreements. Question is what is enough for employers?

  18. I agree, Lazlo!! (and am definitely not pro-union either) Appropriate protections for intellectual property should be sufficient. I’m even okay with non-competes for company officers who tend to receive golden parachutes, but handcuffing all employees just because they can…seems almost un-American. Supposedly they used to do 6 months and now it apparently is 1 year. What’s next? 3 years? 5 years?

    And for those who say the non-competes are unenforcable, how many employees can or will hire a lawyer to fight it? And if you “win” your case but Epic still “shuns” the ex-employee and leans on customers to do the same, then the “win” is rather hollow.

  19. Re: non-competes…wondering if anyone has ever refused to sign one and, if so, what happened?
    If we ALL refused, it would seem they’d be a thing of the past. I’ve seen employees fired or laid off after 6. 12, 24 months and more for whatever reason the company comes up with, In this day and age with a bad economy, seems to me that the risk is mostly on the employee.

  20. Signing the non-compete is a requirement for employment at Epic – no sign, no job. I get that there is an investment involved for any company hiring ‘newbies’, but perhaps Epic should look into the reasons why their employees would want to leave and seek employment elsewhere. Their employees are extremely bright, and mostly very personable folks – perhaps a carrot vs. a stick is the answer? Either way, if you can wait out the non-compete Epic experience is a cash cow.

  21. @Anonymous #16 – As with many things you read on the Internet, the generalization that Epic only hires new grads is a vast oversimplification. Unless you have applied, and have been rejected, it is not certain that you would not be hired. Of course, knowing that the company name is Epic, and not EPIC would only help in a future application 🙂

    Also, good point regarding “poaching” of employees – AFAIK, one of the reasons Epic customers will not hire former Epic employees before their year is over, is that Epic will not hire a customer employee under the same conditions…

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