Monday Morning Update 6/18/12

From Pathological: “Re: Epic. How do they handle blood product orders (type and screen, specifically) that go to LISs? FDA requires 510(k) approval of any CPOE module that electronically touches a regulated, FDA-cleared transfusion medicine module and Epic doesn’t have that approval. What do they tell new clients?” I could use some reader help here, so please add a comment if this is your area of expertise.

From Neighbor Ned: “Re: Lahey and Allscripts. They’ve had problems and haven’t seen the post-acquisition synergies. Bruce Metz came on board as CIO and wants a ‘unified architecture,’ which sounds like Epic. Decision to come within a month.” Unverified, but from a non-anonymous second-hand source, which is the best I have since Bruce hasn’t responded to my e-mail.

Welcome to new HIStalk Platinum Sponsor Park Place International. The company offers cloud-based technologies and consulting services that give Meditech customers a stable, optimized, and sustainable reference architecture. OpSus|Live is the company’s cloud-based hosting service that provides customers with a solutions and services package tailored to their unique needs. Its OpSus|Recover cloud-based disaster recovery service offers several service level plans based on recovery point and time objectives. They can design a certified infrastructure solution for new customers, or for existing Meditech customers experiencing performance problems, their technical consultants can provide rapid remediation and intervention. Hospitals interested in storage virtualization, thin provisioning, data encryption, vendor-neutral image archiving, secure virtual desktops, single sign-on, or hybrid cloud integration can get all the help they need from a focused company whose experienced consultants offering fresh approaches. Thanks to Park Place International for supporting HIStalk.

A slight majority of respondents said that opening up government healthcare data could provide health improvement. New poll to your right, in honor of Dr. Jayne’s recent rant: should HHS (and ONC specifically) back up new provider measures of quality or Meaningful Use with evidence proving that they work to improve patient outcomes?

Listening: new from one of my favorites, Metric. I’m also enjoying the new Beach Boys album, which thankfully is (a) all of the surviving members together other than in a courtroom; (b) mostly Brian Wilson and not much Mike Love; (c) not a bunch of rehashed old demos and laurels-resting, but new music; and (d) full of amazing harmonies that sound like the 1960s, but with the wisdom and wistfulness inherent with band members now in their 70s. Live video here. How they still hit those high notes is beyond me. The final track, “Summer’s Gone,” might bring up a tear if you’re sentimental or worried that this might be their last hurrah after 52 years. The new album is #3 on Billboard’s chart, “That’s Why God Made the Radio” is their highest-charting single since 1965, and the ironically named ‘Boys have broken the record of the Beatles by having over 49 years of Top 10 records.

Michigan-based hospital users of Epic form the EHR Michigan User Group, with 150 attendees from all 11 Epic-using hospitals gathering at Beaumont Health System for their first meeting. An Epic developer gave a preview of future Epic versions, warning the group not to share details with the media or competitors, with the TV station’s summary being, “Suffice it to say the software basically tracks patients in the hospital like the screens over the patients in Star Trek’s sickbay – only you can get the information anywhere, securely, on a tablet or smart phone.” That same TV station, loathe to run a picture-free online story since nobody can read without pictures these days and the user group apparently didn’t send over a photo, lazily headed over to Wikipedia for a startlingly irrelevant screen shot of the VA’s VistA as “as an example of an electronic medical record.”

Speaking of Epic, it drives me up a wall when people insist on spelling it as EPIC for some strange reason, apparently missing the point that even though it’s a short word, it’s still not an acronym (and the fact that Epic itself clearly does not capitalize it). Confounding the issue is Mount Sinai Medical Center (NY), which is installing Epic but calling its project EPIC in a highly contrived acronym (Efficiency, Patient safety, In/outpatient communication, Care.) Given Epic’s legendary and legally enforced paranoia about its intellectual property (as in the story above that warns about loose lips), I’d be careful. 

A CareFusion site from which medical equipment firmware updates are distributed is found to be loaded with malware, triggering a Department of Homeland Security investigation. Google’s Safe Browsing program flagged several pages related to CareFusion’s ventilators as being infected with 48 separate Trojan Horse programs and two scripting exploits (the screenshot above is from when I ran it.) Kevin Fu of the Medical Device Security Center discovered the problem when downloading an update for AVEA ventilators. He reported the problem to the FDA, adding that CareFusion’s instructions advise users to just ignore the usual security warnings. Fu also points out that vendor people and hospitals have gotten lax about running updates for pacemakers or other critical medical devices from the Internet or from someone’s USB key without thinking twice about it. Homeland Security’s analysis found that some of CareFusion’s sites were running six-year-old versions of ASP.NET and IIS 6.0.

Congresswoman (and Nurse) Renee Ellmers (R-NC) sends a letter asking HHS Secretary Kathleen Sebelius if HHS has adopted recommendations from the IOM’s November report involving the safety of healthcare IT. She wants to see a plan to minimize patient safety risk, a list of HIT-related errors that have caused harm or introduced risk, and a plan for a mechanism to allow users and vendors to report HIT-related deaths. She sent Sebelius a letter in August 2011 asking for a study of healthcare IT adopt, benefits, cost effectiveness, and medical error rates.

A June 14 power outage at an Amazon Web Services data center in Virginia takes down several cloud-based businesses, including Pinterest, for up to eight hours.

This makes me cheer given that the “site errors” people complain to me about that nearly always involve bugs in Internet Explorer, the worst browser ever written, and 90% of the time it’s an old version they’re running (because hospitals are stuck in a Microsoft time warp, often standardizing on IE6 from 2001 or IE7 from 2006 paired with their 2001-vintage Windows XP). An Australian retailer slaps a surcharge on orders placed by customers using IE7 since his company spends a ton of development time “rendering the website into an antique browser.” The company says only 3% of users run IE7, but most of his Web development team’s time is spent trying to code around its abundant flaws. I’ve had to pay people several times to do the same for HIStalk “problems” that don’t exist in Chrome, Safari, Firefox, or Opera.

Vince’s topic this week is more about Dairyland, but he’s got some fascinating pricing information from a number of vendors that will shock industry noobs (a five-year total cost of ownership for a full-line financial system of $400K? Yes, please.)

Discussion at a summit organized by the Association for Pathology Informatics on June 8 addressed the push for enterprise-wide systems that creates headaches for lab managers. Bruce Friedman MD said hospital administrators and IT people don’t appreciate the complexity and criticality of what he calls T-LISF — total lab information system functionality — that includes the LIS itself, middleware, outreach support, and firmware. Consultant Dennis Winsten said he has worked with several clients whose labs were being pushed into switching to Epic’s work-in-progress Beaker LIS by the offer of a free site license, requiring the lab people to perform an assessment of whether Beaker could meet their needs. Interesting: Cerner, McKesson, SCC Soft Computer, and Sunquest had speakers or attendees at the conference, but Epic passed on its invitation. 

Steve Larsen, the federal government’s most powerful health insurance regulator responsible for consumer protection and insurance exchanges, quits to become EVP of Optum, part of insurance company UnitedHealth Group.

Strange: a nurse in a hospital in Scotland streams so much porn from his NHS-provided laptop that he drags down the entire hospital network, with noticeable problems in radiology and videoconferencing as he is enjoying “Busty Japanese Girls” and “German Lesbians, Very Hot.” Officials inspecting his office found dozens of unopened referrals for his services going back to 2004. He was fired and his RN license was revoked this week, ironically denying patients his services as a member of the addictions team.

Eric Topol MD lists five technology devices that physicians should know about:

The smartphone-powered ECG, which he used on a flight to diagnose a passenger experiencing a heart attack, resulting in an unplanned stop to rush the passenger to the hospital.

The smartphone-powered continuous blood glucose monitor.

The iRhythm patch for Holter-like monitoring of cardiac arrhythmias for up to two weeks.

The AirStrip Patient Monitoring system for remotely monitoring ICU or other critical patients.

GE Healthcare’s Vscan ultrasound device that he says has entirely replaced his use of a stethoscope for listening to a patient’s heart.

E-mail Mr. H.