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Monday Morning Update 6/20/11

June 18, 2011 News 10 Comments

From Cheesy Politics: “Re: Epic. At least one Wisconsin political blogger sees it as evil. She does have a point: isn’t HITECH about government getting more control over health information to be able to push out mandates?” I read that post when it was published, but like most partisan blogs, it was a bit too hysterical for me to mention here. Not to mention factually incorrect, saying HITECH has set aside “almost $100 million in total” for EHR incentives (oh, if only) and that the Health IT Policy Committee that Judy Faulkner sits on is “the federal Health IT board.” I agree that the government runs healthcare and will continue to expand its influence over it, but that’s to be expected – they’re paying for most of it in the form of redistributed taxpayer money.

From The PACS Designer: “Re: Prezi. In a recent blog post on HIStalk, Will Weider mentioned that he used Prezi as his online presentation software which he preferred over other possible choices. Prezi seems to be more user friendly with its zooming whiteboard concept, and is gaining more popularity because this feature.” It can “Prezify” your PowerPoint slides, I note. Price ranges from free to $159 per year. PC Magazine gave it 3.5 stars in October, mostly because of limited design choices, but said presentations are “an animated visual feast.” I’m not sure that’s enough reason to switch, especially if you aren’t already using PowerPoint’s animation tools (and let’s face it, for most in-person presentations, those “animated visual feasts” would be super annoying, so I’d save them for making videos).

From Former CIO: “Re: corporate proxy reports. Not healthcare related, but amazing.” A corporate governance group highlights corporate proxy disclosures that are bizarre:  one company’s CEO agrees to spend 80% of his “business time” on the company’s affairs, up from the previously agreed on 60%. I have to say I was disappointed – the proxy disclosures are nothing compared to the perks executives get that aren’t disclosed. Even non-profit hospitals and groups are quite generous with the executive bennies: cars, private club dues, travel, and big bonuses. Clueless VPs get fashionable technologies to screw up, meaning they’ll make impatient calls to the CIO to demand that the on-call field support tech be sent over to their summer home to fix the hospital-provided, state-of-the-art laptop that the VP’s teenage son messed up while torrenting porn.

6-18-2011 11-01-26 AM

Several readers have e-mailed over the years saying that they would like to support HIStalk’s sponsors, but can’t easily figure out who offers what products and services from the ads. They suggested an online guide similar to the one that HIMSS puts together for conference exhibitors, where you can look up companies by category. Great idea, so we’re doing an HIStalk Resource Center that does exactly that. You can navigate by company name or category and jump between companies by breadcrumb links. You can also request information by clicking a “send RFI” link that will let you contact a company directly without having to fool around with composing an e-mail or finding the contact form on their site. It’s a work in progress. I’ve added a tiny clickable banner right below the Founding Sponsor ads that will take you there.

When Ricky Roma left his A Few Good Men parody rebuttal to Dr. Jayne’s complaints about IT, I knew it was too good to not promote to the main page of HIStalk instead of leaving it as a comment. Your reactions proved me correct – it’s darned funny and, for those of us who have worked the IT side of the house, a good description of why IT shops don’t always have the budget or labor to support Apple’s latest gizmo. In case you weren’t around or paying attention back in 2009, check out Ricky’s excellent Tales of the Dark Side (a  snip: “Remember, the demo is an illusion. A lunch demo, doubly so. ”) I’ve been pestering him to write more for HIStalk ever since. If I thought an outpouring of support would convince him, I’d start a petition.

6-18-2011 1-49-46 PM

Not good news if you compete with Epic: while survey respondents give differing reasons for its success, combining answers 3, 5, and 6 together suggest that more than 60% believe it’s because Epic’s product is better. New poll to your right: is it OK that an electronic medical record contains scanned documents along with discrete data fields?

Watching: In Plain Sight, my new favorite Netflix series. You could neatly categorize most people by the character they find most attractive: federal marshal Mary Shannon of the Witness Protection Program, her sister Brandi, or her partner Marshall (who I guess would be Marshal Marshall). Brilliant acting and writing, like this quote: “The second revelation came as I sat at the bar in morose solitude, pondering the cantilevered relationship between bartender’s gut and lower extremities. And this is important, so pay attention. Before the big bang, before time itself, before matter, energy, velocity, there existed a single, immeasurable state called yearning. This is the special force that, on a day before there were days, obliterated nothing into everything. It is the unseen strings tying planets to stars. It’s the maddening want we feel from first breath to last light.” And Listening: Yes, The BBC Recordings 1969-70. Truly amazing and polished, complex music played live by guys in their early 20s, one of my favorite bands (through Relayer, anyway). Stupendously good.

Cerner forms a joint venture in Saudi Arabia to offer Millennium to hospitals there, working with a government-owned investment firm and a business development group.

Dr. Jayne is interested in learning more about IBM’s Medical Record Text Analytics solution (a spinoff of Watson), so if you’re an in-the-know IBMer, feel free to contact her. She missed last week’s Webinar on the topic, I assume.

6-18-2011 10-00-25 AM

I see from his Facebook updates that Ed Marx has reached the top of Mount Kilimanjaro, Africa’s tallest peak at over 19,000 feet (that’s an earlier training pic above, just in case you were thinking that it doesn’t really look all that tall). Ed’s an ardent HIStalk supporter: he voluntarily writes for us (very well, I should add); he Likes all of our Facebook posts; and he graciously took time out of his HIMSS schedule to speak at our sponsor lunch in Orlando. Therefore, I quite reasonably conclude that Ed is the man.

My Time Capsule editorial this week from 2006: Before You Buy, Look at the Impact on User Productivity.

6-18-2011 6-17-33 AM

ONC is using some of its tsunami of taxpayer money for publicity: ghost-written blogs, contests, and now advertising. The one above has a new “campaign” that I’m guessing came from an expensive PR firm: "Putting the I in Health IT.”

Weird News Andy summarizes this story as “The government paying more than necessary and offering less than effective options? I’m shocked, shocked to find that is going on here! </casablanca>” UCSF researchers say Medicaid could save a lot of money by paying for drugs that are on WHO’s Essential Medicines List, which is used by 131 of 151 countries surveyed, instead of letting each state make up their own inconsistent lists. If you’re a fan of creeping socialism, you’ll be happy to note that 20% of the country is on Medicaid. Sometimes I get the feeling that those of us who pay taxes to support everyone else are getting to be a tiny minority.

Speaking of Medicaid’s wasting of money (was that redundant?), North Carolina’s project to replace its Medicaid claims processing system is now two years behind schedule and more than $200 million over budget, not to mention that the state will also pay EDS another $110 million to process claims over two years since the new system isn’t ready. The contractor is CSC, the company that’s even more behind and over budget in Britain’s NPfIT boondoggle, also responsible for Medicaid system problems in other states. The state isn’t blaming CSC, though – they say it’s the federal government’s constant Medicaid tinkering that keeps changing the specs. The state is offering to change the five-year, $287 million contract to a seven-year, $495 million one with Uncle Sam picking up 90% of the tab. I have several reactions: (a) never hire CSC to do anything; (b) North Carolina is obviously ignoring my advice since CSC’s punishment for missing budget and deadline is to get more money; (c) as everybody who knows billing is well aware, the government may talk efficiency and modernization, but its arcane Medicare and Medicaid payment requirements ensure that providers can adopt neither; and (d) it’s pathetic that a mid-sized state has to spend $500 million just to manage Medicaid payments (small compared to Medicare) and none of that money does anything to improve population health or patient care – it’s just an administrivia management system created by an unholy alliance of contactors, lobbyists, and government employees (many of those in the latter category planning an eventually profitable exodus to one of the first two.)

6-18-2011 11-33-42 AM

Minnesota Public Radio runs a surprisingly comprehensive and balanced article on electronic medical records in rural hospitals, covering (a) the benefits; (b) the penalties; (c) the shortage of HIT labor for both providers and vendors; and (d) the likelihood that EMR pressures along with healthcare reform will force rural hospitals to sell out to bigger and better-funded organizations or shut down completely. A quote from the CEO of a 14-bed hospital (above): “I’m not sure that even God’s bank has enough money for electronic medical records. Are we working on it? We’re working ourselves crazy. Eighty percent of our capital budget every year goes toward implementing another aspect of EMR.” The article talks a lot about Duluth-based SISU, a non-profit hospital consortium that offers Meditech systems, hosting services, group purchasing, and IT expertise.

Clueless Internetters who probably couldn’t name the Secretary of State or point out Canada on a map focus their limited intellectual capacity on tracking down Haynes Management, a 21-employee real estate company that supposedly fired an employee whose wife was diagnosed with cancer. In their haste to become part of a viral mob reacting emotionally to the one side of the story they read, the nitwits Google over to Hayes Management Consulting (apparently deciding that the N in Haynes is insignificant) and start sending hate e-mail. Hayes issues a press release denying that it’s them. When Inga e-mailed me the press release, I gave an instant reply: “Hayes is brilliant for using this to promote themselves. It’s fun to write about, so I bet it will get picked up.” Which it has. 

6-18-2011 12-14-30 PM

Lehigh Valley Hospital-Cedar Crest (PA) kills a kidney transplant patient, a 51-year-old nun, with insulin when defective blood glucose testing strips erroneously show her as hyperglycemic. Communication problems were also involved: a nurse from the hospital’s remote ICU monitoring station noticed the difference between results from the test strips and from blood draws, but didn’t tell anyone.

Chuck Friedman, ONC’s chief science officer and one-time #2 guy there, is leaving to run an informatics program at University of Michigan. We told you on June 8, courtesy of rumor reporter Roman DeBeers, that he was quitting, although Chuck ignored my e-mail asking for confirmation. ONC’ers sure like those academic appointments.

Here’s Vince’s latest HIStory, for which he credits the help of Bob Haist of SMS/ISD and Bob Pagnotta of MDS/Tymshare.

Dell will spend $80 million on an ad campaign pitching its capabilities beyond selling commodity PC hardware, with one of the four TV ads showing a doctor. 

Strange: the medical school dean of the University of Alberta is demoted to professor after parts of the graduation speech he delivered were found to have been taken verbatim from a similar speech Atul Gawande gave at Stanford last year. Graduates claim they Googled a particular phrase, “velluvial matrix,” on their smart phones as the dean spoke, allowing them to follow along from Gawande’s original speech. It was a giveaway since Gawande made the phrase up, as he explains later in his own speech: “OK, I made that last one up. But the velluvial matrix sounds like something you should know about, doesn’t it? And that’s the problem. I will let you in on a little secret. You never stop wondering if there is a velluvial matrix you should know about.”

University of Florida gets a $500K NIH grant to create EHR alerts using genetic information, which will influence treatment decisions involving an unnamed drug to prevent heart attack and stroke (which I assume is clopidogrel). 

A Maryland infrastructure company gets a $45 million contract to work with a China-based counterpart in developing a cloud computing center to host electronic medical records in that country.

Utah announces Clinical Health Information Exchange (cHIE), a statewide HIE (part of the Utah Health Information Network) with participation from Intermountain, MountainStar, IASIS, and University of Utah. It’s actually been around for a year or so as I recall, so maybe the announcement was related to broader participation.

6-18-2011 12-50-19 PM

Just in case you need something to run on your iPad: Big Fish Games releases the free Hospital Haste, where you “help Nurse Sally work quickly to diagnose, treat, and cure all of her patients.” (obviously they aren’t intimately familiar with what nurses are legally allowed to do).

E-mail Mr H.

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Currently there are "10 comments" on this Article:

  1. Mr. HISTalk is right about prezi. The key is restraint. Just like PowerPoint, most features (like transitions and blinking text) are best unused. Still, it is a great way to get the attention of the audience who is already asleep anticipating slides with a Title and 8 wordy bullet points.

    As long as we are talking about presentations, I highly recommend the book Presentation Zen for creating better slide decks. The author has a great blog too: http://www.presentationzen.com/

  2. Tim – RNs do diagnose, treat and (help) cure patients.

    Term “nursing diagnoses” controversial – many believe outdated with patient-centric records and common patient problem list and plan of care.

    MDs make medical diagnoses, nurses diagnose conditions they observe in role of primary care givers, such as “sleep deprivation”, “fluid volume deficit”, response to pain med, etc. These problems / diagnoses, gathered as part of RN assessments, drive nursing plans of care including expected outcomes and progress vs goals.

    If we analyzed medical records we’d likely see RN interventions (and observations) represent a high percentage of overall “treatments”. RN services are undervalued in part because they’re seen as expense, not revenue generator. And, nursing care hasn’t been billed like ancillary services but buried in room or visit charges with housekeeping.

    Nurses perform many treatments, administer meds / infusions, and provide family and patient education, care team coordination, pain management, palliative and other more holistic care services, some invisible and not recognized. These play key roles in patients’ return to optimal health. As such RNs can lay claim to a fair share of the cure.

  3. Thank you, Ann Farrell, for clearing up the, unfortunately, all too common misconceptions about the vital role that nurses play. They are in a position of seeing the patient more frequently during the day, and gaining the patient’s trust to convey information about their conditions more often that the physician. The data they gather, maintain and act upon is incredibly vital to the patient’s overall diagnosis, treatment and outcome. People who don’t understand that have obviously never shadowed a nurse and tried to gain an understanding of the their workflow and role. Bravo for educating the misinformed!!

  4. Attended AHIP event last week and sat in on the sessions addressing future Health Insurance Exchanges (HIX) that states need to have in place by Jan 2014 in compliance with Affordable Care Act. What became crystal clear is that these HIXs will have Medicaid enrollees which requires that states to upgrade their out-dated Medicaid IT systems. A huge issue that will likely force many to resort to duct tape and baling wire to meet the deadline.

  5. ” Ricky Roma – I’ve been pestering him to write more for HIStalk ever since. If I thought an outpouring of support would convince him, I’d start a petition.”

    Let’s convince him ! I will sign the petition!

  6. Regarding your most recent poll, “is it OK that an electronic medical record contains scanned documents along with discrete data fields?”, I wonder how many of the respondents are clinical versus IT departments. It’s obviously easier to scan documents using current technology than to modify a system to include distinct fields (plus interfaces to pass those messages), but is it really the RIGHT decision? It’s quite difficult to automate surveillance of a scanned document to provide alerts and population health reporting… which is the direction the Federal incentive funds are directing the industry. In addition, one would think it takes the clinician more time to open and peruse documents versus looking at discrete data elements that combine multiple documents into a consolidated view.
    I’d like to suggest a follow up survey to ask if it is the right thing, not the “easy” approach… along with an identity indicator as to whether the respondent is an IT resource or a clinician. Personally, those results would be more meaningful to me.

  7. A little internet research turns up an interesting twist on the commencement speech story — turns out there’s a retro-punk-disco-techno-Gregorian-chanting band named The Velluvial Matrices that is considering suing both physicians for appropriating their name.

    They only have two songs out — a haunting ballad evoking (but not copying) Elvis Costello, titled “The Sincerest Form of Flattery” and the dance hit “Plagiarism Schmagiarism”.

  8. Your blurb about wasted money on Medicaid upgrades makes me want to cry… will our country ever get its act together regarding Healthcare reform?? It’s so frustrating…

  9. Thanks for the inclusion in your Monday Morning Update. Some clarification to your comments left at my original post may be found here: http://bit.ly/jUfwRH . Despite our apparent ideological or political differences, your feedback – positive or negative – was appreciated.

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