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July 31, 2012 News 15 Comments

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7-31-2012 9-55-13 PM

Accretive Health will pay $2.5 million to settle charges by Minnesota’s attorney general’s office over its aggressive patient collection tactics in hospitals (including those of Fairview Health Services) and lax security controls involving a stolen PHI-containing laptop. The company will cease all business operations in Minnesota, is banned from returning for the next two years, and can re-enter the state within the following four years only with the attorney general’s approval. Accretive is also required to return all patient information to the hospitals that provided it. The attorney general says she will turn over the patient affidavits her office collected to CMS, suggesting that Accretive’s hospital clients may have violated EMTALA laws that require them to treat emergency patients before trying to collect payment. The $2.5 million settlement will be added to a fund to compensate patients. Chicago Mayor Rahm Emanuel, who had previously inserted himself into the proceedings by trying to use his Democratic Party influence to get AG Lori Swanson to back off, declined to answer questions about his involvement.

Reader Comments

From Yesterdays: “Re: Community Health Systems. Contractor friends tell me they were part of the nearly 600 IT contractors laid off by CHS recently.” Unverified. I didn’t bother trying to confirm since I recently e-mailed someone at the for-profit hospital operator about a rumor that they were switching EMRs, but didn’t hear back.

7-31-2012 6-44-11 PM

From Wildcat Well: “Re: Practice Fusion. They have discontinued their affiliate program, which pays websites to promote signups for their ‘free’ EHR.” Unverified. They’re still taking signups on their Web page from what I can tell.

From Carolyn: “Re: National HIT Week. Are you involved in any of the activities?” No. To be honest, I’ve hated that concept from the day HIMSS started pitching the idea that provider IT people should stand shoulder to shoulder with their vendor brethren in trying to persuade politicians to throw taxpayer money at products sold by the vendor members of HIMSS (or as HIMSS nobly rephrases it, “public and private healthcare constituents will work in partnership to educate industry and policy stakeholders on the value of health IT for the US healthcare system.”) I don’t blame vendors for trying to influence the DC crew, but I am totally mystified how hospitals can justify spending the time and money required to send their IT people traipsing around Capitol Hill for the benefit of for-profit companies.

7-31-2012 9-57-01 PM

From Safety Paradocs: “Re: Wyckoff Heights. Wired for safety ‘well before ARRA’ as reported by the newsroom of Meditech, yet the young patient was not safe. How can we prevent such striking deaths?” Wyckoff Heights Medical Center in New York, which The New York Times politely calls “one of the most troubled hospitals in the city” because of mismanagement and its hiring of political cronies, admits a 22-year-old student who had consumed a diet drug and beer while pulling an all-nighter for her college Latin course. The hospital gives her IV lorazepam, ties her arms to her bed, and makes no notations in her chart (all documentation was on paper) that anyone was checking on her. Nobody notifies her family. She dies. A few weeks ago, the hospital’s own 83-year-old former chairman, who had been forced to resign and was then admitted for fainting spells, was found in his hospital room with a broken neck. Despite its problems (check out its reviews on Yelp), the hospital earned HIMSS EMRAM Stage 6 and $4.9 million in federal taxpayer dollars for its Meditech MAGIC implementation. To be fair, the incident occurred in 2007, which I assume was long before all of its EMR accomplishments. My takeaways are as follows: (a) while it’s true that better hospitals use more technology, it’s also true that technology didn’t make them substantially better – its use is correlated, but not causative, and plenty of crappy hospitals are using cool systems; (b) all the IT systems in the world won’t help if you have unskilled or uncaring caregivers, so choose your hospital based on quality and reputation, not what they’re packing down in the data center; (c) never, ever go to a hospital for anything serious without having an intelligent and alert advocate sitting by you at close to around the clock as possible, because having worked in several hospitals for most of my adult life, I can say that every one of them screwed up regularly due to inattentive or poorly trained staff, overworked doctors, unwashed hands, failure to notice when patients start to slip, overly aggressive treatment just because it’s possible, and lack of care coordination by all the one-trick specialists running around treating their particular body part of interest. Bring along a friend or family member to check your meds, personally challenge each major decision to make sure it’s based on conviction and science rather than lack of objection, and ask nurses whether your doctor and treatment plan are any good because they know but won’t say unless you press them. I think most hospital employees would agree that you need a wingman.

7-31-2012 10-00-14 PM

From Westie: “Re: cancer patient whose costs exceeded insurance cap. Wins a victory via Twitter.” Treatment of a 31-year-old’s colon cancer exceeds the lifetime dollar limit of his Aetna student insurance plan, leaving him with no insurance. He gets into a Twitter debate with Aetna CEO Mark Bertolini, who decides to cover the $118K in bills the patient racked up before was able to sign up for a different insurance plan. The tweets are fascinating as observers jumped on Aetna, blaming the company for selling insurance with low caps, questioning what would have happened had the patient not drummed up his own social network, ridiculing the CEO’s $10.6 million salary, and questioning how the Affordable Care Act will or won’t help. I’m glad he’s getting help, but we’re back to the original issue that patients can easily run up more expenses than the insurance they voluntarily signed up for will cover, and unlike every other kind of insurance, everybody expects someone else to pay without objection even though they met their legal obligation. I’d be interested to see who charged what of the $118K University of Arizona Cancer Center bill since those folks aren’t sharing Aetna’s financial sacrifice on the patient’s behalf as far as I know.

7-31-2012 10-01-30 PM

From Frank Fontana: “Re: paid endorsement programs such as those from AHA Solutions and the HFMA Peer Review Program. What do readers think about those programs?” I said years ago that they were pay-to-play, but they do still require products to be vetted, leaving me neutral on their value (I don’t see the benefit, but if they help connect vendors with prospects, then I see no harm.) Your opinions, please.

From EMR User: “Re: downtime penalty terms in contracts. We negotiated that any issue that we deem adversely affects our access or system usability allows us to subtract 5% of our monthly fee. We can do this daily up to five times per month.” I’ve said it before, but maybe it bears repeating. List the top handful of items that would be worst-case to you once you’re live on a vendor’s system (downtime, vendor acquisition, hardware failure, lack of acceptable implementation people, poor support) and insist on a penalty if any of them occur. Or, if you’re a glass-half-full type, reduce your fixed payment amount and offer a bonus if none of the events happen (same result, but it sounds nicer.) That makes sure your vendor has a vested interest in not allowing your worst dreams to come true, and at least if they do, you get the slight satisfaction that you’re getting paid for your trouble.

From Laboratorian: “Re: Epic. Could you opine to the extent to which MUMPS is constraining the growth of Epic? Everyone suggests this is a limiting factor, but so far it hasn’t been. How and when would they hit the proverbial wall?” It’s armchair quarterbacks, not customers, that keep trying to create a non-existent Epic Achilles’ heel out of MUMPS and Cache’. Most of that hot air comes from competitors Epic is killing, self-proclaimed experts who’ve never worked a day in IT or in a hospital, and cool technology fanboys who can’t stand the idea that Epic doesn’t care what they think. Despite the use of some ancient underpinnings, Epic’s product is apparently almost infinitely scalable, it does everything customers need it to do, and it works reliably. Nobody cares what it’s written in except their programmers – customers just want solutions, and the decision-makers when Epic is purchased are usually end users and operational executives, not IT geeks who salivate over source code. The only walls Epic could hit would be if InterSystems decided to go out of business (that’s not happening – they were absolutely printing money even before all those thousands of new Epic Cache’ user licenses dropped into their lap); if InterSystems decides to get greedy and either raise their Cache’ licensing fees or stop developing it (doubtful); or if Epic can’t get programmers willing to learn MUMPS (which has never been a problem because they do all of their training in-house and new UW psychology grads aren’t exactly swimming in job offers from Microsoft or Cisco). Anyone who claims Epic is about to hit the technical wall is just trying to plant fear, uncertainty, and doubt in the market. If there’s an Epic wall to be hit, it will be high costs that hospitals can no longer afford with reduced reimbursement, lack of ability to scale as it tries to extend its dominance outside of the US, some kind of meltdown like Judy stepping down and creating a vacuum of power, or perhaps some major and heretofore unfelt shift toward open systems that would put its rather closed model at risk. You’ll know that’s happening when you see the KLAS scores move from green to yellow. The only opinions that count are those expressed by customers with their dollars.

From Infrastructure Manager: “Re: downtime. I used to work with McKesson Horizon Clinicals, which didn’t have a great downtime report system. We scripted a routine that generated a PDF on a different server than Horizon and also copied it to a few PCs. It’s not a fast system to begin with, and you can’t help but feel the system drag when running those reports every hour, even with a huge Oracle server farm run by skilled DBAs. Also, the database design is poor and the tables are not indexed properly – you’ll see 4000 IOPS on a table/storage location and wonder that the hell is going on. If you’re hosted, who cares? Chew up those servers in a data center you don’t run and hope they’ve scaled to the appropriate size. If you aren’t hosted, take these reports very seriously.”

HIStalk Announcements and Requests

7-31-2012 9-34-41 PM

inga_small Unlike the curmudgeon Mr. H, I have watched a good deal of the Olympics. Who knew team handball was even a sport, much less an Olympic one? Yep, that’s what’s on at 5:00 a.m. on Sunday (don’t ask why I was up so early.) Go Iceland, by the way. So far my biggest complaint is that the men beach volleyball players don’t wear uniforms that are nearly as hot as the women’s. Thank goodness for men’s synchronized diving, however. I have decided that someone ingenious needs to develop an app that blocks all spoilers on Twitter and Facebook so that I will be totally surprised when Michael Phelps becomes the most decorated Olympian of all time (thanks all you expats in England who just had to share the news on Facebook.) Finally, good thing Rio is only one hour ahead of Eastern time so we’ll all see more live coverage in 2016.

7-31-2012 10-03-51 PM

Just  to prove to Inga that I’m not totally Olympics ignorant even though I haven’t watched the tape-delayed spectacle, here’s an interesting fact: the 300 hospitals beds used in the producer’s opening ceremonies tribute to NHS will be donated to hospitals in Tunisia.

Listening: reader-recommended Son Volt, music for driving or moping in smoky bars. Born of the remnants of 1990s minor stars Uncle Tupelo, somewhere between alt-country and roots rock. REM meets Neil Young.

Acquisitions, Funding, Business, and Stock

7-31-2012 10-04-53 PM

CommVault beats Wall Street expectations with its Q1 performance: net income of $10.1 million ($0.21/share) compared to $3.1 million last year on revenues of $111.3 million, up from $91.5 million.

7-31-2012 10-05-36 PM

Merge Healthcare announces Q2 numbers: revenue up 13%, adjusted EPS $.02 vs. $0.06, beating earnings estimates by a penny.


7-31-2012 10-08-02 PM

The Canadian Centre for Addiction and Mental Health selects Cerner Millennium as its clinical information system.

North Carolina HIE expands its relationship with Orion Health with the implementation of the company’s Health Direct Secure Messaging. The HIE went live in April 2012 and 70 providers have signed up, with the next phase being rollout of Orion’s EMR Lite. NC Direct is free for NC HIE participants and $100 per year per mailbox otherwise.

St. Louis-based Mercy chooses Humedica MinedShare as the Epic-integrated clinical intelligence solution it will use to manage population health for its 31 hospitals and 200 hospitals.


7-31-2012 5-41-41 PM

Lifespan (RI) names Eric Alper MD (UMass) as information systems medical director, charged with overseeing the development and implementation of clinical applications for the health system.

7-31-2012 5-44-37 PM

Amanda LeBlanc (Encore Health Resources) joins CTG Health Solutions as managing director of marketing and communications.

Announcements and Implementations

7-31-2012 10-09-46 PM

Yavapai Regional Medical Center (AZ) implements Cerner.

Christus St. Vincent Regional Medical Center (NM) goes live on the second phase of its Cerner implementation with the addition of CPOE and documentation for physicians, nurses, and ancillary care providers.

The VA system in western New York announces its participation in the HEALTHeLINK HIE as part of the VA’s Virtual Lifetime Electronic Record Health Communities Program.

Vocera announces the availability of its B3000 Communication system in France and introduces the Vocera Secure Messaging application for tracking messaging communications.

7-31-2012 10-10-57 PM

Jacksonville Medical Center (AL) goes live on CPSI.

E-prescribing system vendor NewCrop will incorporate interactive drug services from PDR Network into its platform, allowing its users to receive updated drug information, safety alerts, and regulatory and liability messages at the point of prescribing.

Caradigm (the GE-Microsoft joint venture) announces GA of Vergence 5, the latest release of its single sign-on and context management platform for healthcare.

Iowa Medicaid says its integrity program saved the state $30 million in its second year of operation, bringing the total to more than $50 million. Optum administers the program that analyzes provider claims for overcharges due to upcoding, unnoticed private insurance coverage, fraud, and simple math errors in bills.


The FDA clears Proteus Digital Health’s ingestible sensor, which works with a companion wearable patch and mobile app to monitor medication adherence.

7-31-2012 10-15-08 PM

The DoD and VA release PE (for prolonged exposure) Coach, a free smart phone app to assist service members and veterans with PTSD.


Minnesota achieves the highest rate of e-prescribing use in 2011, with 61% of prescribers routing prescriptions electronically. Massachusetts and New Hampshire had the highest physician adoption rate at 86%.

The New Orleans paper reveals that two-thirds of the full-time physicians working in Louisiana state prisons have been disciplined by the state medical board for issues that include pedophilia, substance abuse, and dealing methamphetamines.

7-31-2012 9-43-15 PM

Hartford Hospital (CT) and a home care group announce that information about 10,000 patients was contained on a laptop stolen from an employee of Greenplum, a “big data analytics” vendor and division of EMC that was doing readmission analysis for the organizations. The laptop was not encrypted.

I’m always skeptical of the Meaningful Use attestation numbers, so here’s an example that Meditech sent over in response to some of our recent posts. Inga’s analysis of numbers provided by CMS showed Meditech with around 120 hospital customers attested through May 2012. Meditech’s official number is 431, and even if mega-customer HCA is counted as only one hospital, they’re still at 271. That would place Meditech at #1, far above CMS’s #1 Epic, except that maybe CMS has their numbers wrong, too. I personally don’t think the number of attesting customers means much and this makes me even less interested in the vendor totals.

Physicians and experts testify to a House subcommittee that small practices are dropping like flies, with physicians moving to employed positions because of declining payments and increased reporting requirements. An orthopedist said his group shut down and took hospital jobs after spending $500K on an EMR hoping to reduce cost and improve quality, but the initial savings were eaten up by increased IT labor costs, upgrade fees, and the work required to document Meaningful Use.

Weird News Andy dubs New York Mayor Michael Bloomberg as “Dr. Bloomberg” after his push for hospitals to discourage new mothers from using canned baby formula instead of breast-feeding. WNA adds that he assumes the newborns won’t be allowed to have 32 ounce Big Gulps, either.

Sponsor Updates

  • Wolters Kluwers executive board member Jack Lynch discusses the emergence of “compliance clouds” during the company’s Half Year Media Roundtable meeting in Amsterdam.
  • Informatica gains partner support for its latest release of Informatica Cloud.
  • Impact Advisors earns the highest ranking in KLAS’s HIE consulting report, specifically identified as the only fully rated vendor providing HIE advisory and technical work.
  • DrFirst Chief Strategy and Privacy Officer Thomas Sullivan testifies at an ONC hearing on identity-proofing solutions for the electronic prescribing of controlled substances.
  • HIStalk sponsors earning a spot on Modern Healthcare’s Best Places to Work in Healthcare in 2012 include Aspen Advisors, DIVURGENT, Encore Health Resources, ESD, Hayes Management Group, Iatric Systems, Impact Advisors, Imprivata, Intellect Resources, Intelligent InSites, maxIT Healthcare, Santa Rosa Consulting, and The Advisory Board Company.
  • Allscripts, Beacon Partners, Cumberland Consulting Group, ESD, Merge Healthcare, and The Advisory Board Company receive the Healthcare’s Hottest companies designation by Modern Healthcare.
  • eClinicalWorks and Intelligent Medical Objects host webinars to introduce eCW IMO Problem IT Smart Search for ICD-10 coding.
  • United Hospital System of Kenosha (WI) renews its licensing agreement for Streamline Health’s Enterprise Content Management Solution.
  • MED3OOO customer Family Healthcare Network (CA) receives over $500,000 in EHR incentive payments.


Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Mobile.

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Currently there are "15 comments" on this Article:

  1. re: From Laboratorian: “Re: Epic. Could you opine to the extent to which MUMPS is constraining the growth of Epic?

    I am sure anyone who has used/implemented or paid for a Cerner/McKesson install has felt the Oracle sting either in their wallet or in their availability. I believe based on years of Epic experience that InterSystems is the underdog purely because they are not the “norm”. One would argue a few years ago that Epic was in the same boat. Together they will do just fine. As Laboratorian points out, no shortage of smart people to develop or maintain it and the scalability seems to be holding up just fine. If Epic was to convert to Oracle or SQL we would likely see the monies paid just shift to other vendors (Oracle and Microsoft) and the skillset would become a commodity service that would ultimate result in more downtimes and less reliability.

    Cheers to being the un-norm and requiring special (brilliant) people to run the most critical system in the hospitals that choose to run Epic!

    [From Mr. H] Just so new readers don’t get confused, reader comments are in blue and my responses (including the scalability comment) are in black.

  2. I liked your advice about keeping patients safe at hospitals. Do you think that EHRs will mitigate your view, or increase the need for vigilance, actually? The one point I wish to make is that you suggested that the Wyckoff Hospital did not have an EHR at the time of the death, but the article stated that they had become wired long before ARRA, which would mean that there was some degree of EHR in 2007 at the time of the death.

  3. Re: AHA endorsement, hospitals need to understand that this is the For-profit side of the AHA,and the endorsement goes to the company that will make the most money for the AHA. Vendors pay the AHA a large annual fee, plus a percentage of all sales during the 3 year endorsement period. As a CIO in a AHA member hospital the AHA endorsement I meaningless to me.

  4. Mr. H if you didn’t mention music and other tidbits it wouldn’t be nearly as much fun. Thanks for the random recommendations.

  5. Interesting that it is “Laboratorian” that is questioning MUMPS…since most of the big mega labs use systems with some MUMPS derivative…and last I knew Sunquest – the most widely installed best of breed lab system, uses Cache.

  6. The premise that it is simply a collection of ivy tower wonks and Epic haters that have concerns with a MUMPS platform fails to understand that healthcare information systems are no longer about simply capturing data from clinical encounters.

    Epic has done a great job of mimicking historical clinical workflows in a highly reliable manner. Medical records were initially kept to remind a clinician of what THEY did in prior encounters. When I sat for my oral boards, when posed a hypothetical scenario that required assistance from another specialty, the examiner told me to behave as if I were the only physician available. I had access only to my records and my skill set. This is the mindset that allows individuals to receive great healthcare in individual encounters, but as a population, we have great opportunities for improvement. We need to get beyond allowing individual clinicians to become single points of failure, who, when subject to fatigue, forgetfulness, overwhelming workload and other foibles of the human condition lead to poor individual or collective outcomes. That is where the concerns about MUMPS come in.

    While Epic’s database may be proving to be “infinitely scalable” from a transactional perspective, the nature of any object-oriented database severely limits its scalability in terms of building complex, real-time queries, and hence, analytics. Indeed, in order to perform queries for retrospective report generation Epic requires an export to Oracle which is ostensibly relational, more than object-oriented in nature, allowing those relational queries to be performed. Has any Epic client not noticed that they must purchase Oracle licenses in addition to Cache licenses when signing with Epic?

    For healthcare to improve as a whole, we need to help clinicians at the point of care with the ability to provide patient-specific decision support in real-time, and not only when the clinician requests it, but when it’s timely. Imagine a scenario whereupon a physician properly performs cultures for an infection and then treats the patient with an appropriate empiric antibiotic. We want the decision support to alert the physician that the antibiogram says that organism is resistant to the prescribed antibiotic in real-time, not when requested by physician after the patient fails to respond. Now consider more complex cases.

    There are petabytes of data out the that can help, but they will only help if the data can be aggregated in a discrete manner (a concept Epic wholeheartedly resists for non-Epic platforms) and we are able to examine the relationships between data elements in a mathematically logical fashion. A platform that cannot support these requirements cannot reasonably be presumed to be a winning strategy in healthcare. We have to be prepared for the day when massive parallel processing is used to crunch the data to impact outcomes in real-time. The encapsulation native to an object-oriented database restricts the ability to manage the data with the timeliness necessary to support such advances in care processes. While “big-data” companies clearly focus on scalability, they require mathematical foundations for their analyses, and hence do not utilize object-oriented databases. By not using database systems such as MUMPS, big data analysis has to compensate for speed issues with distributed architecture, parallel processing and computing muscle but they are not subject to MUMPS functional limitations such as the lack of a formal mathematical base which cannot be overcome.

    So, we can continue to move off “ancient” (Mr. H’s word, not mine) technology and approaches and become a better, safer, more effective healthcare system, or we can continue to simply focus on digitizing the historical approach to clinical data and hope that those single points of failure are always infallible.

  7. Real time alerting/decision support is not only possible with a cache/MUMPS database, what you suggest is easily accomplished today in Epic using simple BPAs assuming the ancient/antiquated Lab Information Systems can send micro results discretely. I’m not saying Epic’s lab software is any good but Sunquest, Labcorp, Quest and even Cerner/Meditech are a nightmare to interface with.

    Also, Cache has absolutely no limitation when you want real-time data/alerting – the only need for Clarity/Oricle is for statistical queries over large data sets e.g. all visits for all patients for the past year.

    We want the decision support to alert the physician that the antibiogram says that organism is resistant to the prescribed antibiotic in real-time

  8. To Real time alerting:

    It is the statistical queries of large data sets that will be the key to better outcomes, population health management, chronic disease management and the like. I get that Epic can handle the simple clinical decision support. It’s the complex ones that require querying a current patient profile against a population data set or, at least, an EDW that will advance care.


  9. Re: Sal Mavet’s response about Epic.

    This response seems to perfectly demonstrate Mr. HIStalk’s comments about the only critics of Epic using Cache being people who don’t really understand it. Epic does not use the object oriented parts of Cache (or any object oriented language). The data is not restricted by object-orientation and parallel processing is possible.

    As other readers have pointed out, Epic is also capable of many types of the real-time alerting the Sal complains are not possible in Epic. Many of these require the hospital organization to build/set-up the appropriate alerting but this is a function of the customizability of Epic, not a limit to what Cache and/or Epic are capable of.

    Just as with other EMRs, there are things that Epic does not do well and could improve but I think that focusing on Epic’s use of Cache is a waste of energy that could be better spent focusing on solving the actual problems. Until I see/hear of an actual example of a limitation created by the use of Cache, I will continue to believe that criticism of the “ancient technology” on which Epic is based is a red herring, marketing ploy used by those who either don’t understand or who want to distract from real issues.

  10. By the way, to say Epic is on 30 year old technology is just as silly as saying Cerner is on 30 year old technology. Or that AllScripts is on a 1980 technology.

    All major database environments were created in that era and all of them, yes including Cache, have been under aggressive development since then.

    And, at this point, while Larry Ellison is flying his own F15 jet, InterSystems founder is toiling away making his system faster and faster (and yes, FASTER).

    Cache had a 2012 release and before that a 2010 release. I believe Epic customers are most likely on that 2010 release.

    That would place them on approximately 1.5 year old technology.

  11. It’s not just “cool technology fanboys” who are underwhelmed by Epic’s technology. It’s not only MUMPS, but there is literally nothing innovative or cutting edge about Epic’s technology across the board. The people who dream of Silicon Valley swooping in to build the next of health IT undermine their own dream every time another Epic purchase or install takes place. Frankly, very few innovative computer scientists want to work in health IT because it’s boring and antiquated. I don’t blame Epic – after all, they simply make what they make, they don’t force anyone to buy it. To give Epic credit, they have created something reliable in an industry that values reliability. Epic’s customers, and the whole industry, need to realize that every dollar spent on Epic is one less dollar that could go to a truly innovative startup company using all the latest technology tools available. Healthcare as an industry has to really decide – does it want to be cutting edge or does it want to be safe? It’s a little sad to see people throw out terms like “disruptive” and “cloud” in regards to healthcare while turning around and buying/espousing Epic. In this case, it really is one or the other. If safe and comfortable is the way to go, leave Silicon Valley alone, because they’re not interested.

  12. @Sal: MUMPS/Cache’ is no better nor worse at doing the kind of data aggregation compared to any other platform. If anything, it would have a (slight) performance edge, since you have a higher degree of control over the exact sequence of steps that constitute the search so you can optimize based on knowledge of what the expected data will look like.

    There are also many good pattern matching strategies that are not performance intensive for real-time queries, made possible by doing a lot of the work offline. For example, matching a patient profile using an ANN would be a simple calculation; the computational complexity went into training the ANN with the data set to begin with.

    Personally, I think the largest obstacle to using advanced statistical methods is getting the specificity to be good enough that alert fatigue and the false positive paradox aren’t going to render your results useless.

  13. Re: Counting Says

    Do you have any examples of things you consider innovative or cutting edge in health IT? (Or even in other industries). I am trying to understand your definition. Also, there are a huge number of health IT startup companies… a lot of which are doing quite well despite or even because of Epic. Are you saying that none of them have innovative technology either?

  14. Re: Counting Says and the following assessment:

    “Epic’s customers, and the whole industry, need to realize that every dollar spent on Epic is one less dollar that could go to a truly innovative startup company using all the latest technology tools available. Healthcare as an industry has to really decide – does it want to be cutting edge or does it want to be safe? It’s a little sad to see people throw out terms like “disruptive” and “cloud” in regards to healthcare while turning around and buying/espousing Epic.”

    I find this to be a stretch. I don’t see my decision to install Epic as a vote against innovation. You seem to trivialize reliability as if it was a “nice to have” feature. I don’t think that’s how most of us empowered to make these platform decisions see it.

    Your stance also seems to discount the notion of incremental innovation–as if only some disruptive “revolution” will fix HIT. Maybe you are right, but from where I sit incremental will be much more realistic than disruptive.

    Lastly, if you ask any vendor (Epic included) what has most stifled innovation, you are very unlikely to hear a technology-driven answer. You will hear about a sprint to meet meaningful use and a host of other regulatory requirements and a type of least-common-denominator feature set required for certification.

    Do I wish Epic’s pace of incremental innovation was faster?

    Do I think that my decision to use Epic is stunting HIT innovation?
    Give me a break…

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  1. Part of my attitude relates to an experience I had. And this was within a single HIS. I wanted to…

  2. For what it's worth, the VA currently releases C-CDA (or HITSP C-32...my memory fails me) via eHealth Exchange and has…

  3. Unfortunately, I can't disagree with anything you wrote. It is important that they get this right for so many reasons,…

  4. Going out on a limb here. Wouldn't Oracle's (apparent) interoperability strategy, have a better chance of success, than the VA's?…

  5. Dr Jayne is noticing one of the more egregious but trivial instance of bad behavior by allegedly non-profit organizations. I…

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