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Monday Morning Update 6/13/11

June 11, 2011 News 22 Comments

From South Bend Snoop: “Re: Press Ganey. CEO Rick Siegrist is resigning. There are rumors of a possible sale of the company to GE, J&J, or 3M, which seem farfetched.” Unverified. I didn’t realize that he co-founded TSI, PatientFlow Technology, and HealthShare Technology.

From Mr. Roboto: “Re: Meditech. They’ve always steered clients to JJWild, now Dell. A former Meditech person told me that Meditech was getting financial considerations for every system sold by JJWild. I find it highly unlikely that Dell (like JJ) is doing anything technically proprietary for Meditech except throwing them a fee for each system sold.” Unverified.

From Komodo: “Re: Meditech. Dell and Meditech have a gentleman’s agreement that Dell will supply all 6.x hardware and therefore design consulting, leading to application and conversion consulting. Now that Dell is becoming cozy with Epic, Howard Messing may be re-thinking this position since his customers don’t like the no-choice solution. I hope you can get Howard to respond.”

6-11-2011 1-51-54 PM

Welcome to new HIStalk Platinum Sponsor The Advisory Board Company. I’ve been a fan of the DC-headquartered company for quite awhile since I’ve always liked their super-summarized best practice guides covering big hospital issues such as capacity management and medication errors (I made myself look like a star once by skimming their throughput document and applying its recommendations to my hospital’s particular bed management challenges). Other than best practices research and tools, the company also offers clinical research, leadership development, BI and analytics, and consulting services. The ABCO connection to HIStalk, however, is its Crimson Initiative, a physician performance management analytics solution that gives hospitals (and their physicians) a 360-degree view of physician performance measures such as patient satisfaction, compliance with order sets, and adherence to key quality and utilization metrics. Crimson is used by over 400 hospitals and contains physician analytics and benchmarking information covering 15% of the entire country’s admissions. Paul Roscoe, CEO of the Crimson business unit (and former president of Sentillion and GM of Microsoft Health Solutions Group) e-mailed me awhile back to say that his Sentillion experience with HIStalk was so positive that he asked ABCO’s marketing team to sponsor, saying that HIStalk is “insightful, thought-provoking, funny, and a great source of inspiration for my iTunes collection,” of which the latter is of course the most satisfying to me. You may recall that Advisory Board acquired University of Michigan spinoff Cielo MedSolutions in February 2011, which gives it capabilities in population management analytics and patient registries for physician practices that support risk-based arrangements by making sure patients are current on preventive care and screenings. Thanks to The Advisory Board Company and its Crimson Initiative for supporting HIStalk.

Speaking of Crimson, above is a video from Robert Wood Johnson University Hospital that describes a pilot study that reduced length of stay by 8% and cost per case by $276. Another study by Memorial Hermann found that it saved $358 per patient admission.

Larry Garber MD, medical director of informatics for Fallon Clinic (MA), sent over a press release indicating that as of May 23, Fallon doctors make up more than 10% of those who have successfully attested to Meaningful Use. An amazing 99% of Fallon’s doctors have achieved MU with their use of its Epic system.

Chris Rauber, a reporter for the San Francisco Business Times who I exchange information with fairly often, is writing a story about UCSF’s IT struggles and needs insider sources (anonymous is OK). If you can help him out with details and confirmation, he would appreciate an e-mail.

This week’s e-mail from Kaiser CEO George Halvorson talks about their control of hypertensive patients through use of a care team, proactive interventions, evidence-based medicine, and EMR tracking. The result: Kaiser went from 44% of hypertensive patients controlled to 80% (vs. the national average of less than 50%).

6-11-2011 12-50-16 PM

I’m not sure what to make of these survey results: 40% say it’s a good, technically reasonable idea to give patients a list of all views of their EHR information if they ask, while 32% like the idea but think it’s too challenging technically (which would have been my vote). A solid 28% think it’s just a bad idea in general, which puzzles me a bit since I’m not seeing the downside. New poll to your right, following up on all the discussion generated by Thoughtful CIO’s guest post about “why Epic?”: what factor is most responsible for Epic’s sales success?

My Time Capsule editorial that’s seeing daylight for the first time since April 2006: If You Want Testing For Usability, Reliability and Maintainability, Tell CCHIT. A sample: “CCHIT standards that address data management within the four walls will prepare organizations to feed the data demands that RHIOs will create. As I’ve said before, a RHIO without data-ready members is like TV cable with no programs.”

Vince Ciotti says he has received quite a few e-mails from his fellow memory lane strollers about his HIStory series, so his latest chapter should unleash golden memories from the sunny slopes of long ago: the story of McAuto, once a household word (in HIT-related households, anyway), but largely forgotten today.

Retiring Compuware co-founder and CEO Peter Karmanos Jr. says he has two goals to accomplish before leaving the company in two years: boost annual sales of the application performance management division from $250 million to $2 billion and to get an IPO done for Covisint, whose healthcare offerings include the Covisint ExchangeLink Platform for connectivity among hospitals, practices, and HIEs.

E-mail Mr. H.

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Currently there are "22 comments" on this Article:

  1. Regarding the survey on giving patients a list of all views of their EHR information if they ask, you describe being perplexed that about a third of individuals think it’s a bad idea.

    Our hospital EMR has a screen those of us who have legitimate EMR access can see the list of names of individuals who have a “declared relationship” to a particular patient. For my inpatients, a relatively brief stay of about a week is associated with a list of about 50 people who have accessed the patient’s chart. With longer stays, there are even more people who access the chart. So some of my patients have a list of more than a hundred different people who have accessed the chart in some way in the course of an admission.

    As a psychiatrist, I am particularly sensitive to issues of who is accessing my patient’s charts and why. On one hand, I think patients should be able to request access. On the other hand, the vast majority of patients are not going to understand why such a broad range of people have accessed their chart. Many of these individuals work “behind the scenes” in pharmacy, dietary, laboratory medicine and other areas so most have never actually had any direct interaction with the patient. Explaining to patients why so many people have accessed their information would need to be an essential aspect of any program but it has nothing to do with the purely technical aspects of sharing this information. And it could take a considerable amount of time for front-line practitioners to address (from what are likely to be rather irate patients).

    As a patient and employee of the hospital, simply knowing that someone has accessed my chart wouldn’t tell me much. Instead , I would like to know what exactly they have accessed and whether that access is consistent with what their role in my care really is.

    The other downside to giving patients access is that this will be used as an excuse for not taking other steps to protect the privacy of information that a patient may view as particularly sensitive for them. This may include psychiatric information, substance use information, reproductive health information or even demographic information such as sexual orientation. Nationally, people tend not to want to give patients control over who gets access to what specific information about them. The argument is that retrospective audit trail review with punishment of individuals who violate privacy is a sufficient protection. But once privacy is violated, it’s too late. And not all individuals who do violate privacy are detected and/or punished, which also makes this approach to privacy protection problematic as a sole mechanism.

    Again, I am personally in favor of giving patients access to this information but there are downsides and additional privacy protections are also essential.

  2. Your poll questions about Epic miss the point. Epic is successful because it focuses on the patient, and because Epic tells the truth.

  3. Thank you, Vince, for the stroll down McAuto memory lane… there were many greats in those days: Chuck Miller, Stephanie Massengill, Wayne Carney, Art Randall, Rich Roark, Bob Powers, Joe Mason, Arlen Dominic, just to name a few. And yes, there are a few of us still out there aside from Melinda. Whatever happened to Nurse Jane?

  4. RE: MEDITECH and Dell. Given that 6.0 is relatively new, MEDITECH has seen value in working with a single vendor (Dell) to get the new platform stable and to work through the technical issues. MEDITECH likes a certain amount of control, cooperation and discretion when they try something new and their old partner Dell has been able to provide them with that. MEDITECH has indicated it will open it up to other vendors at some point.

  5. For LeftCoaster: Nurse Jane lives on Maryland’s Western Shore with her young son and her dog in a charming cottage with an apple tree and a bay window overlooking the Chesapeake Bay.

  6. Thanks Vince. I’m still waiting for the adoption of light pens by SMS. I still remember our ward clerks punching the CRT’s with such feroicity that I thought a light pen would burst through the back side of the terminal. Somehow they never broke the glass. The memories are fun.

  7. Apparently, I need it explained to me slowly and in detail. What truth is Epic telling? What lies issue forth from everyone else in this game?

    It’s just such a moralistic statement to make about Epic’s success that I’m a bit flummoxed.

  8. Looking at the Epic survey that is ongoing…saying that Epic has superior functionality is just another way of saying that competitors are weak.

    Hey WTF. Seems like Larry Garber and George Halvorson’s organizations are getting alot of value out of their Epic systems. Maybe we should ask them if their physicians are as unhappy as you say they are.

    I want some of that Kool aide!

  9. I don’t know anything about Larry Garber and never heard of Fallon Clinic before MU. I do know several Kaiser docs practicing at Kaiser locations in California and Georgia, and none of them really like the system. Some dislike it, most just don’t care and use it because it’s there. I’ve never met anyone who is impressed with it. When they find out what it cost, not one person I’ve talked to said it seemed worth the price. My relatives who are patients there like having online access to their chart and having their MD use an EMR, but again none of them are overly impressed with the program itself. It’s anecdotal evidence, but then so is everything else in HIT it seems.

  10. While we are at it – can someone explain why Epic’s approach “focuses on the patient” compared to all other vendors?

    Is this simply a warm and fuzzy way of saying single database?

    Because I haven’t heard of anything in the way of Epic SW design or implementation that is revolutionary in its patient focus – is this just another great of example of good marketing/yummy Kool-aid?

  11. I think it is the grape kool aid…definitely grape. Grape is always the best seller at curbside stands.

  12. Re: Epic’s “focusing on the patient”. It sure feels great to say that we’re spending all of this money “for the sake of the patient”, but if the software isn’t easy to use, than all of the altruistic posturing really doesn’t mean a thing. And this is not a comment just focusing on Epic, but rather all healthcare software – is it such a terrible thought to maybe focus some of the design on the benefit of the clinician rather than just the benefit of the patient? After all, in the end it is the provider who is providing the care, not the EHR.

  13. All of these folks throwing good money for an inflexible EPIC design will be singing the blues in 10-15 years…….what happens to a company in which one person makes all the critical decisions, and there are no shareholders, and that one person either passes on, or simply retires????

    $100million or more is a lot of investment to put into a company with no possible succession plan…….The HealthCare IT market is cyclical~ EPIC is getting it’s 15 minutes……when the clock runs out on them……..many CIO’s are going to have “A lot of ‘splainin to do, Lucy!!!!”

  14. Here is a non-biased observation on Epic:

    1) Product works..at least gets the job done
    2) Epic is very successful at implementing product
    3) For the above reasons Epic has become the “safe” choice for CIO’s and boards.

    1) After meaningful use has passed, hospitals will be stuck on an antiquated platform. Any upgrade that Epic offers will be the equivalent to a net new platform.
    2) Epic does not play well with others. Though single system, single database has its benefits, the trend in every other industry outside healthcare is interoperability.
    3) Because of #2, it will be more difficult for hospitals to adoptive “disruptive” technologies as they come available. In other words, you are kind of handcuffing yourself to their system.

    Short term – 3-5 year Great decision
    Long term – 5-20 Questionable decision

  15. Thanks, I wish I could take credit for thinking of something revolutionary…but I can’t. Surprising how the second part isn’t discussed more by industry analysts and research firms. Difficult to bite the hand that feeds you I guess.

  16. It is clear that Epic has been successful in selling the vision and, in fact, has delivered a successful integrated solution. It does work but does not represent the ideal solution. I am not sure if any product can, especially in the long run.

    Epic’s success is due in part to the product but equally, at least, to the ongoing support of the Epic install team which is indeed vigilant in responding to issues and concerns from the users at the client. This vigilance takes on a messianic oversight that becomes unbearable. If the client Epic staff or, god forbid, the CIO, resists the urges of Epic, the message is sent to the CEO that the IT team is unsupportive. The next steps are predictable – the IT teams surrenders to the pressure and/or the CIO exits.

    Epic does have many weaknesses – it does not integrate well, the reporting is almost nonexistent and several of the modules are quite weak.

    Buckeye is correct that the real proof will be in the 10+ year future. Other vendors face the same challenges but are unable to gain the executive traction that Epic has demanded and received.

  17. Buckeye, Anonymous32 and Former CIO:

    Could you expand on your observations about the long range forecast with EPIC in terms of current and future integration and adoption of emerging technologies?

    Even though privately held, it’s not clear to me why the company would shrivel up if the current dynasty comes to an end. It’s also unclear why purchasers of Epic would be worse off than purchasers of the other vendors in 10+ years. Don’t they all have to grow and evolve in a productive way that addresses clinical reality?

    It seems like regardless of which EMR system one chooses you end up being handcuffed to their system. Is there something else with EPIC’s infrastructure that makes it worse in this regard than other companies?

    Which of EPICs modules are especially weak? In terms of reporting, how does this compare to other systems’ reporting capabilities.

    I have no experience with EPIC but our facility uses another major vendor — our EMR has a LOT of functionality gaps as well as nonexistent reporting.

    If EPIC is so bad, why do the major academic centers all seem to by forking over their cash?

  18. Curious George –

    The mystery is why healthcare seems to be bucking the technology trend of interoperability, partner friendly, vendors that practically every other industry has been smart enough to figure out.

    You are absolutely right, all vendors have challenges over the next 10 years. But there are clearly vendors that seem to be set up to be more successful than others in the future. That is what is intriguing with Epic. Here you have a system that is built on ancient technology, is far from being interoperable, and is not very apt to allow others to “play” in the sand box.

    Now to their credit, they do other things very well (implementation, stability, etc.) The functionality of the system seems to do the job to get the MU money. That is why many people make the decision. These aren’t stupid people, they are very smart and want to get some immediate funds and relieve board pressure to get to MU.

    In some ways though, an Epic decision may be short sighted after the MU hubub passes and the capital investment isn’t even close to being paid off and you are stuck with 20th century technology.

    Hope that helps a bit….

  19. I agree with Mr. Buckeye. He sums things up well.

    Epic is built on ancient technology, and at my site, it seems whenver the hospital has an upgrade there’s a six week period in which reports cannot be run, because Epic’s database is so shaky, many of their tables need to be rebuilt.

    The EMR does a good job of getting one to MU funds, and let’s face it the EMR works and that would be my guess as to why many sites are going in that direction, and then I would also say academic and large practices can be intellectually lazy, and sometimes get caught up with “keeping up with the Jones'” so to speak, so if my neigbor has one, I want one, too.

    However, most of my colleagues in the industry that have tried to use it for Professional Billing, cringe and wish they had never left their old system. Interoperabilty, also seems to be a challenge. Ultimately, in the very near future, regardless of which system you are on, yours will need to be able to communicate to others, easily. Epic claims they have the code written to be interoperable, however, when one approaches them regarding exchanging data from another system, they always seem to put up resistance and seem to try to sell you that life would just be easier if you went on their system.

    All systems have gaps. The question is, who has the financial resources and the administrative infrastructure to ensure that R & D is being invested to ensure both today’s workflows, and tomorrow’s technology are sufficiently funded, staffed and developed. I fear a privately held company with no board or shareholders to report to, may get complacent and with no assurances of succession, that kind of investment would make me nervous.

  20. OK, we have been hearing a lot about epic vs cerner. How much really comes down to marketing? Epic says it’s all about the patient – as some posted – meaning single database. I would say congrats to epic for positioning it that way. In spite of their technological difficulties, epic has done an excellent job of getting to the physicians. In the end, who really makes the decision about a software designed for physicians?

    I can see a better world; where IT and clinical come together to make “integrated” decisions on their EHR vendor. It is up to the vendor though to help them get there. Epic seems to be winning the war on words. How else did they become the vendor of “truth”?

    I’d like to see it get more interesting. Let’s say that the entire vendor community communicate more in terms value, less on feature functionality. More vendors get to the actual decision makers – not just IT. Then bring all decision makers together: clinical, IT, execs.

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