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Monday Morning Update 4/29/13

April 27, 2013 News 18 Comments

From Healthcare Outsider: “Re: making decisions. I’m in corporate IT, but a recurring theme appears where healthcare IT leadership seems unable or unwilling to take meaningful actions that would benefit their organizations. They can’t seem to make decisions, and in a corporate world, leaders who don’t act on revenue opportunities or cost savings don’t last long. Is it asking too much for healthcare IT to make responsible decisions to avoid wasting money?” An interesting question that I will pose to readers – leave a comment with your thoughts about whether hospital IT leaders really are missing bottom-line opportunities simply because they can’t make a decision.

4-27-2013 3-43-24 PM

From The PACS Designer: “Re: iPad cancer app. UBM Medica LTD has just released Version 1.5 of their Cancer Management Handbook for the iPad. Now clinicians can get all of the great content from this popular reference tool as well as the latest care updates on their iPad. TPD will add this app to TPD’s List upon the next update release.”

4-27-2013 1-59-54 PM

More than two-thirds of poll respondents don’t like the idea of ONC charging vendors a fee to support its certification programs. New poll to your right, triggered by Bill Rieger’s recent Collective Action post about TEDMED: Should conferences focusing on health IT innovation de-emphasize the involvement of hospitals and physicians because they are part of the problem? There’s a “comments’ link on the poll once you have voted, so feel free to defend your argument.

Rural and community hospital systems vendor CPSI announces Q1 results: revenue up 11 percent, EPS $0.63 vs. $0.51. Chairman David Dye said in the earnings call that, “Several of our competitors are clearly struggling with failed EHR system implementations. As a result, the number of new prospects and contracts that our competitor replacement is increasing.” The company also says that it has been writing contracts that allow customers to defer paying maintenance and support until they achieve Meaningful Use and that is impacting revenue.

4-27-2013 5-00-15 PM

Texas Health Resources is featured in a subscription-only Wall Street Journal article about “exercise meeting rooms”  where employees can meet while using stationary bikes or treadmills. CIO Ed Marx is quoted. He tells me that they also have a meditation room as well as a stand-only meeting room that encourages ending on time.

4-27-2013 5-01-59 PM

New Mexico State Senator Tim Keller urges UNM Hospital to reconsider its decision to eliminate 57 transcriptionist jobs in outsourcing the transcription function to Nuance at an annual savings of $500,000. Nuance has offered jobs to the transcriptionists, but at what the employees claim is a 20 percent pay cut, reduced benefits, and a requirement of an unrealistic 99 percent accuracy rate. Keller says shipping the jobs out of New Mexico will reduce state income tax collections.

4-27-2013 5-03-10 PM

Hackers break into the Automated Clearing House account of seven-bed Cascade Medical Center (WA), diverting more than $1 million to 96 banks. The hospital, whose operating budget is $13 million, recently announced plans to seek affiliation, saying that the Affordable Care Act will require deliver care to more patients without increasing funding and that three of ACA’s cost-savings programs (results-based payments, EHRs, and ACOs) all require major investments.

Providence Health & Services announces plans to lay off 150 billing and medical records employees whose jobs it says will no longer be necessary when it moves to Epic. The system originally notified 687 employees in 2011 that their jobs would be secure for only 18 months, but most of those employees have already transferred to other jobs or quit.

4-27-2013 5-05-44 PM

A former patient registrar sues Integris Grove Hospital for violating her religious beliefs by requiring her to register patients using the identity-confirming PatientSecure palm vein biometric system. She told her supervisor the hospital is lying about the information it collects and that the system resembles Bible’s “mark of the beast” because only the right hands of patients are scanned. Integris says using the system is a job requirement but offered her a transfer to another facility, which she declined saying it wasn’t worth the one-hour commute.

4-27-2013 4-09-32 PM

Members of a Congressional panel hear testimony about physician misinterpretation of HIPAA requirements. Rep. Phil Gingrey, MD (R-GA) and others said they wonder if doctors don’t hide behind HIPAA to avoid answering awkward family questions or in their urgency to move on to the next patient,  whole Rep. Bill Cassidy (R-LA) said doctors aren’t HIPAA experts and simply remember colleagues “who have been grabbed by the law and not let loose until every one of their personal resources have been exhausted.” Also testifying was the widow of an Iowa high school football coach who was killed by a mentally ill man with a recent history of violence and animosity toward the victim who had been released from a hospital without notification to his parents or law enforcement officials because of HIPAA requirements. OCR later clarified that providers can disclose mental health information to families and law enforcement officials if such disclosure might be expected to prevent harm.

Weird News Andy says this woman was taking us for a ride. A TV investigative report finds that a 51-year-old South Carolina woman summoned EMS ambulances at least 100 times in the past seven years with vague 911 medical complaints just to get a free ride to downtown Charleston, where she would sign out AMA and then run errands. Upon being arrested, the woman said the rides, billed at $425 plus mileage, were part of her Medicaid benefits. Taxpayers are on the hook for at least $400,000.

A woman who failed a pre-employment drug screen sues her would-be employer, the hospital that administered the test, under the Americans With Disabilities Act. She says her “shy bladder” syndrome leaves her unable to urinate in public restrooms unless she runs the faucet, but the hospital forced her to provide her sample in a sink-less room.

Vince continues this week with his HIS-tory of GE Healthcare.

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Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

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Currently there are "18 comments" on this Article:

  1. To Healthcare outsider…”IT leadership seems unable or unwilling to take meaningful actions “.

    First let me say that healthcare IT and healthcare management are not without their failings, but on the other hand, how can you make sound /rational management decisions when the payors keep changing the rules and even the game. Take a look at the last HISTalk Readers write where Mr. Nerd talks about the feds Value Based Purchasing payment program. And also look at my comment.

    Tell me, in private industry if the feds kept changing the rules for how much your commercial business could bill for service (as opposed to IRS toying with taxe laws that only impact bottom line), how fast would you make rational and sound decisions?

    And also in your private business how would you mange if your sales staff could go to your Board and get you fired becasue they do not like your commission plan or management style?

    I bet you’d be cautious, very cautious making any significant operational change. I’ve worked in the private sector and the public /non-profit world and there is a difference. I do not believe that justifies incompetence, but it sure makes it a tougher row to hoe.

  2. Completely agree that frequently changing governmental and payor rules can paralyze decision making.

    Additionally, unlike the corporate world, where top-down leadership can make a decision and instruct employees to change, much of healthcare relies on independent groups and providers. Buy-in and consensus need to be achieved prior to major change. Otherwise, either practices will move their patients elsewhere (if local opportunities exist) or 1-2 recalcitrant doctors can still create a furor among staff.

  3. ”IT leadership seems unable or unwilling to take meaningful actions “
    I see not so much indecision, just dumb decisions. Million dollar pilots every quarter that never make it anywhere, deals made with vendors where there is a “special” relationship, and systems and hardware bought when any clinical user or analyst in a cubicle can point out why it will fail in one minute. Like the government, a large system’s IT budget could be cut by 10-25% and it would work out well if the purse strings are managed appropriately.

  4. To Healthcare outsider…”IT leadership seems unable or unwilling to take meaningful actions “..

    Amen. The incompetence in HIT leadership is staggering and a growing challenge. They lack leadership decision making skills, can not communicate to their senior management or the board what, why, and how, and spend most of their time at conferences supporting or justifying their their existence (lets just say its a forum!)

    Spare us the excuses of having to deal with CMS, HHS, payers, or providers, collaboration, consensus building. These words are code to mean HIT leaderships gets to procrastinate and make no decision and blame it on someone else. SOS. The dollars that are being spent today tells us that we have to raise the bar on HIT leadership competencies.

  5. Re: the employee and the palm reader – we had a similar issue with a hand reader time clock system we implemented in 1996 or so. Good to see people are still interpreting the Book of Revelation in wild and crazy ways!

  6. The more I read on this excellent blog, the truths leak out. This is all about money and not about patient care. Patients are simply grist for the cash registers. Wait, my friend, until you are critically ill in a “modern” hospital, where the nurse and doctors (as reported by the Hopkins) spend more time with the computer to your neglect..

  7. Regarding Healthcare Outsider’s comments… those are fairly offensive comments to start with, as the writer assumes it is al IT leaderships fault. I have witnessed many organizations that are loath to invest in certain parts of technology for several reasons. There is the constant struggle with CFO’s demanding measurable ROI when there are rarely clear ROI opportunities that the bean counters can ever agree on. But miss the agreed upon ROI or your budget using numbers you have never agreed to and they are looking to give you a haircut. Next, you will see the lack of project sponsors from the business OR the sponsors are just unwilling to step up and get engaged on a project to ensure its success. We have an opportunity to implement a technology that also requires changes in HR policy and the organization has tried three times to implement the base product and due to the lack of ownership from HR, Finance, and Nursing, it has failed to reap the benefits each time. You will also find a loss of appetite for IT investment after implementation of an EMR. For example, our company squandered two years to start BI due to a lack of understanding of the potential benefits AND indigestion over the price tag after spending north of $100m to implement Epic (and that was the right decision that is not being regretted). I would suggest that the issue is the never ending second guessing from the business when we try to lead them to water and they absolutely refuse to drink. And I would also suggest you see these examples way more than the success stories you read about from places like THR and Sharp.

  8. I find it odd that we think healthcare is run by idiots.

    Those “idiots” claim 16ish% of the US economy by GDP and are growing.

    You are all being duped. These guys are extraordinary business people. Their businesses make vendors look like novices. The larger vendors aren’t even midsized when compared to health systems.

  9. It simply comes down to, who is the industry visionary or thought leader? The “anointed” organization should pursue that strategic direction and reap the rewards just like any other industry.

  10. Re: Justa CIO

    I would say it’s the industry in general rather than healthcare IT that’s at fault. I’ve worked at literally dozens of Epic sites and the vast majority of them are systemically dysfunctional – whether it’s the ludicrous sense of entitlement from providers, the business model of “let’s hire the cheapest registrars we can find and hope claims doesn’t take a hit”, or no one in the IT department actually working 40 hours a week, there’s plenty of blame to go around. In any other industry they would have long gone bankrupt but fortunately for hospitals, healthcare isn’t like any other industry.

  11. I love the exercise meeting rooms, but find it interesting it is only men in slacks and comfortable shoes in the photo. This meeting style may be challenging for women in skirts and heels.

  12. So many good and interesting responses to Healthcare Outsider. In the on-going debate as to whether healthcare really is different from other industries or not, especially when it comes to IT, it reinforces that for good or bad, yes we are different.

  13. Ironic that someone ex-Epic would mock the idea of hiring the cheapest labor and hoping that it works out. Think unqualified registrars doing data entry is bad, try philosophy majors installing healthcare IT.

  14. Re: GlassHouse

    The issue isn’t with how much they’re getting paid, the issue is one of competence. When you have analysts at hospitals who get <60 on their exams, that's when you know the implementation is going to be much more interesting. These exams are not hard by the way – I've literally passed these exams without studying for them since they ask common sense questions and it's OPEN BOOK/SYSTEM. Who cares if you have 20 years of relevant experience when you can't pass a simple exam? All it tells me is that you spent 20 years being incompetent at your job.

  15. RE: Healthcare Outsider. It seems to be more or less all about timing. Working on the vendor side in HIT sales it is frustrating watching hospital/health system leadership delay moving forward with decisions/implementations; however, I empathize with how important measurable outcomes, ROI (please notice how these are listed separately), budget, increased/changing demands for larger investments in IT infrastructure to help support new systems – which always seems to be lost in the conversation, internal resource requirements to implement new systems, and then on-going maintenance considerations (i.e. who will carry the management responsibility for this new system going forward). These all play a huge role, and all while trying to manage/leverage the (existing) “moving parts” of a billion dollar organization. I am also only representing one solution and asking decision makers to make me their priority. Even when we offer compelling evidence for the benefits it can be difficult to “get on their radar”. I worry more about pissing off the leadership by pestering too much. Frankly, I would just like open and honest communication about if and when we should be speaking. I love pulling together deals both the client and the company feel are mutually beneficial. I didn’t get into HIT sales to act like a pushy “used car salesman”. Our clients remind me/us our product works and is changing the way they can deliver healthcare to their patients. That’s what helps motivate me: that I am not just selling a lousy gizmo, I am changing healthcare. I wish leadership would just be more honest with us as to where their heads are at and the plans they have for their organization. We’re all adults. There is plenty of sales opportunities. Just give it to me straight.

  16. There a big difference in how you hire. Epic hires for IQ and ability and truth be told, philosophy majors often have some logic classes behind them that can be useful. Whereas at hospital sites there’s been lots of self sorting where the competence has left. I’ve seen too many people with certifications who can’t perform even the most basic of end user functions let alone build. The registrar is more capable than the big money certified analyst after a few hours of training.

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Reader Comments

  • Sam Lawrence: Except in this case, coding = medical billing, not development. Though the same warning may be true...
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  • Tom Cornwell: Great stuff from Dr. Jayne as usual. One small typo, last sentence of second-to-last paragraph: should be 'who's' not 'w...
  • HIT Observer: What I find most interesting here, is people defending their common practices rather than truly taking this as invaluabl...
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  • Peppermint Patty: Veteran - can you clarify what was "fake "? Was something made up (definition of fake) or did you disagree with Vapo...
  • Pat Wolfram: Such a refreshing article. Thanks -- there really can be a simpler version of an acute HIT implementation. But I do ...
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