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Monday Morning Update 9/19/11

September 17, 2011 News 5 Comments

From LongTimePharmacist: “Re: CPOE. A clever video done to YMCA. We all need some CPOE laughs now and then.” I like it. I always look for tiny glimpses of hospital reality: the nurse with charge stickers all over her top, the well-used Tabasco bottle on the table in the doctors’ lounge, and the drug shortage list taped to the pharmacy wall. The “everybody in the pool” finale is subtle and appropriate. They did a nice job.

9-17-2011 5-26-01 PM

From Cassie: “Re: hospital performance. The hospitals that have spent millions on EMRs and CPOE and have meaningfully mediocre outcomes to show for it.” A New York Times article contrasts hospitals on Joint Commission’s annual quality report (those who were 95% compliant with specific treatment standards) to reputation-based lists. Not even one of the hospitals listed on the US News & World Report Best Hospitals Honor Roll made the Joint Commission’s list, meaning tiny, no-name community hospitals and podunk VA hospitals beat Johns Hopkins, Cleveland Clinic, Mass General, and every hospital in New York City. That latter omission raised the ire of the president of the Greater New York Hospital Association, who said healthcare is complicated and any one list can’t be definitive. Which is correct, but it still illustrates the obvious: big academic medical centers excel in some areas (eye-popping architecture, richly compensated superior diagnostic and surgical talent, and excellent teaching and research capabilities) and lag in others (patient satisfaction, getting meds administered on time and rooms cleaned on schedule, and delivering solid outcomes cost effectively). I’ve worked in both small community hospitals and large academic medical centers and have concluded that for the latter, it’s tough to scare employees into rule-following when mediocre professors get jobs for life under the tenure system, service employees are paid market-excessive salaries to assuage organizational social guilt, and almost nobody gets fired or laid off even when they deserve it.

From Burnt Umber: “Re: new Epic hospitals. [Hospital A] and [Hospital B] are going with Epic.” I contacted the CIOs at the unrelated hospitals, who responded quickly and cordially that they are close to making a decision. They asked that I not run anything just yet since their final negotiations might be messed up as a result (as one of the CIOs said, “I am a dedicated reader and I know the impact that this could have.”) Both offered to talk to me afterward about who they chose and why, which will be a far more compelling read than me just quickly blurting out their rumored choice. I’ll have more in a few weeks.

From The PACS Designer: “Re: innovative IT solutions. TPD salutes Texas Health Resources for being recognized by InformationWeek for developing an innovative IT solution by integrating an automated risk-assessment tool with its electronic records system to cut down on blood clots, which are a leading cause of hospital deaths. Other healthcare IT solutions from Christiana Care Health System, Lehigh Valley Health Networks, and Kaiser Permanente were also recognized for using IT to innovate healthcare processes.“

My Time Capsule editorial from 2006 for this week: Few Threats to Healthcare IT’s Big Three. I named the Big Three inpatient vendors that were leaving competitors in the dust, which just wasn’t said in polite company back then.  A sample: “I don’t see anyone catching up to these Big Three, with the possible exception of dark horse McKesson. GE Healthcare, Siemens, Eclipsys, Misys, and others may get an occasional full-system sale, but they’re mostly fighting over crumbs.”

Vince’s HIStory this week covers Intermountain Healthcare (IHC), Part I of a two-parter. E-mail Vince if you can help him out with fun facts about upcoming historical HIT footnotes AR Mediquest and JS Data.

9-17-2011 3-24-42 PM

Most respondents don’t expect HHS to verify Meaningful Use attestation claims all that closely. New poll to your right: who will benefit most from WellPoint’s use of IBM Watson technology?

Dr. Travis covers the use of mHealth by pharmacies and health systems on HIStalk Mobile. 

9-17-2011 5-18-46 PM

An article in The Verona Press says that Epic’s user group meeting this week will draw 6,500 guests, with a total attendance of 11,500 counting the company’s 5,000+ employees. It must be like having Woodstock in your tiny farm town. Pictures and reports are welcome. The rain and mid-60s high should give way to sunnier and slightly warmer weather for the conference.

Ten transcriptionists at a Washington hospital, unhappy that their jobs have been outsourced to Webmedx on short notice, want the option to take severance with benefits instead of accepting what they say is a pay cut to to work for Webmedx. The hospital says its contract with Webmedx (the transcription company that was bought in July by Nuance and announced here in June) will save it up to $2 million over five years. The other gripes of the transcriptionists: the jobs they were offered involve sitting in front of a monitor at home waiting for assignments to pop up on the screen when the cheaper offshore transcriptionists aren’t available; they don’t all have broadband connections; some of the work involves editing the output of speech recognition systems instead of transcription (which pays less); and they will be required to transcribe for other hospitals whose doctors and accents are unfamiliar to them. Being squeezed by cheap offshore labor on one side and sophisticated speech recognition systems on the other is not exactly a position of power. That’s a national problem, of course – compared to the old labor-intensive and technology-unaffected factory jobs of yesteryear, we just don’t need as many employees as we have people who need a job.

Last week was the HIMSS Policy Summit, where HIMSS coaches its members to pester Congress to keep spending taxpayer dollars on healthcare technology (aka “advocacy”). Part of their pitch, predictably, was to not derail the HITECH gravy train. Members were also the Charlie McCarthy to the HIMSS Edgar Bergen in asking Congress to support a national patient identifier. You might think that Congress would have more important matters to deal with (a country rapidly circling the drain), as should providers (high costs and lackluster results that are helping cause the aforementioned drain-circling).

9-17-2011 5-48-14 PM

UAB Health System (AL) names Jorge Alsip MD as its first CMIO. He was a consultant with Cerner.

Hardly shocking: big organizations that profit from the sale of cancer drugs urge the Joint Committee on Deficit Reduction to reject a Medicare change recommended by the Congressional Budget Office that would save $3 billion (or from their dollar-sign viewpoint, would be a “$3 billion cut to cancer care” that would result in “weakening the nation’s cancer system.”) Like they always say about healthcare – one person’s excessive costs is another person’s livelihood, with every suggestion for eliminating excessive costs triggering cries of wounded anguish from the livelihood side of the same equation.

A British hospital moves a patient’s medical history to another hospital using Patients Know Best, a patient controlled health records system in which the patient uses a Facebook Friend-like function to add new doctors to the clinical team.

9-17-2011 6-16-06 PM

Piedmont Healthcare (GA) will spend $180 million on new IT systems that I assume includes Epic, reported here as an unconfirmed rumor in July but bolstered by the presence of a bunch of Piedmont job listings for inpatient Epic people. They’ve been an Eclipsys/Allscripts client for quite some time.

Nine Rite Aid drugstores in Michigan roll out OptumHealth’s NowClinic, which allows people to conduct a 10-minute IM or webcam-based chat with a doctor 24 hours a day for $45, the outcome of which can be a prescription filled by Rite Aid. 

A North Dakota clinic opts out of a Blue Cross Blue Shield medical home program called MedQHome, saying it violates the HIPAA rights of patients by sharing their information with MDdatacor, a third-party consultant, without their permission. BCBS North Dakota insists that patient permission is not required.

University of Michigan Medical School will start a Computational Medicine and Bioinformatics Department.

E-mail Mr. H.

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Currently there are "5 comments" on this Article:

  1. Your survey response on MU audits is most interesting. The bulk of responders are expecting minimal audits.

    That doesn’t square with what the feds have done with RAC audits that are going gangbusters in part because the feds pay the contractors a percent of what they save. Three things say to me MU-RACs are coming. 1)Big federal budget cutbacks are coming, 2)the new ONC structure of the AA separate from the ACTB, and 3)the frequent mention by ONC about the need for ‘surveillance’ in the final regs. And remember all an MU auditor needs to do is find one MU out of line and it’s bye-bye big bucks.

  2. Actually, to clarify Frank’s message a bit further about the RAC audits: when CMS/Medicare sends out its independent auditors, these auditors are paid completely by their “savings.” If no abuse is found, they don’t get paid. These auditors are thus paid on a contingency basis (a bounty for every found error). Medicare loses nothing; the chance of a provider ending up with a loss/fine are high, especially with such a complicated law s.a. MU.

    So in a way, the office that gets reviewed will be presumed guilty until found innocent… a perversion of what should really be occurring. Just another reason for practitioners not to participate in MU!

  3. Awesome work to the guys and gals at St. Francis – that CPOE video is awesome. Best one I’ve seen so far.

    Boo to the Epic-wanting CIOs who know they want it but are waiting til their “decision” is made before announcing. This farce of an RFP process is pretty much the way it works nowadays at hospitals wanting to buy Epic. It’s basically just a matter of wanting Epic, and then skewing the metrics and arguments to make sure you get it at any price – like $180 million for Piedmont. That’s ridiculous…hope the CFO there doesn’t have a heart attack when he writes the first bill, because the hospital will have to charge him double for his care to pay off its new EMR.

    Congrats to Dr. Alsip for the CMIO gig at UAB. UAB is an incredible organization top to bottom, and from reading his bio it looks like he’s going back to his alma mater.

  4. Agreement with Dr. Borges. Doctors should avoid deals with the government.

    It is a matter of liberty and independence (from their invasive meddling) v taking a few pennies from the Feds so that they can then dominate you with nasty audits and meaningfully useless computer generated requests for information on patients and their management.

    The best advice is offered By Dr. B. Don’t buy, don’t buy, don’t buy.

    One more point. The link between EMRs and the failure to achieve meaningful outcomes as deficed by the JC was avoided in your comments to Cassie.

  5. Cheers to your comments about the value of huge EMR investment without the institutional strength to use the tool. EMR is only technology unless it is combined with best practices, standards, and protocols. While we are on that point, how about the investment of millions in clinical databases which, with a few Intermountain-like exceptions, seem to produce little actual research or clinical improvement outcomes. We all know that we want that database, but are we prepared to do the work to make it clean data and will our physicians or researchers ever actually use the data?

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