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Monday Morning Update 11/4/13

November 2, 2013 News 20 Comments

From SNOMED Junkie: “Re: IHTSDO. Don Sweete, executive regional director of the Atlanta Region of Canada Health Infoway, has been named CEO of IHTSDO, the Denmark-based non-profit that manages SNOMED.” Verified. Don must have a graven image-like avoidance of being photographed since despite having held all these high-profile jobs, I can’t find a picture of him anywhere to include here (even on his LinkedIn profile, which is essential these days.)

11-2-2013 11-36-18 AM

From AthenAscendant: “Re: athenahealth. As a former employee, I heard from a colleague that some giddiness has been building regarding recent KLAS performance. She tells me that athenaCollector has established a lead on the score for Epic’s practice management suite and that athenaClinicals is within a fraction of a point of closing the gap with Epic’s Ambulatory EMR.” Unverified. I don’t know that athenahealth stands to gain a lot of Epic business in any case since it’s usually hospitals making those Epic decisions and they won’t give up integration to chase KLAS EMR scores.

From Nila: “Re: unstructured content. I’m curious what the HIStalk audience thinks when they hear that term.” Readers are welcome to leave a comment. What comes to mind for me is clinical documentation, discharge summaries, images, and scanned reports (internal or external). However, I’m not a fan of the term – a programmer would consider Shakespeare’s works “unstructured,” a somewhat derogatory label (i.e. structure is good, so anything that isn’t is bad) that in no way diminishes their usefulness or desirability to everybody else. Some parts of the unstructured information could be structured for portability and searching, but there’s nothing like seeing an actual picture or reading (or hearing) a clinician’s nuanced expression when trying to understand a patient rather than trying to understand a patient’s chart.

11-2-2013 11-29-12 AM

From Brandi: “Re: Health Tech Holdings. Rebranding all of their companies under the Medhost name.” Unverified, but it makes sense. The companies include HMS, Medhost, and Patient Logic. If they are changing, it’s a good time to stop writing MEDHOST in all capital letters. Overzealous marketing people convince companies to capitalize their names (and those of their products) for no reason, which sites like HIStalk ignore because it’s not proper journalism style and it’s also annoying. I’ll leave the all-caps version of the company name if it’s clearly an acronym (like HMS), but I’m going mixed case otherwise (Meditech, Medseek, etc.) Journalism style is also to strip off all of the copyright and trademark symbols the marketeers plaster on everything.

From David Copperfield: “Re: Siemens. Changing leadership in sales, marketing, services, cloud, and legal. This misdirection should keep the German brass looking for the pea for at least another year.” Unverified.

From Opie: “Re: funding rounds. We’re seeing some big numbers in HIT. Some of the recipient companies seem iffy.” The worst thing about big funding rounds is that they lock companies into their specifically stated strategies because that’s what the funders backed. Young companies need to learn from their inevitable early mistakes in strategy or vision as their customers tell them what they should really be doing and push the company into a different business than the ones they planned. If those companies are financially struggling but smart, they will figure it out over time and be better for it as Darwinism weeds out their less-capable competitors who don’t react to the realities of the marketplace. Companies flush with fresh VC money (along with the mandatory loss of control that comes with it) use the cash to charge hard and fast blindly down a path that is very likely not the best one, locking themselves into a strategies and products that were developed before the leaders have had the chance to figure out what they are doing. They can’t just change the plan since that would require telling the investors that they were wrong in the first place. The time value of money dictates finding hares rather than tortoises, but you can bet that the VC guys will deal themselves out within a few years either way. As a prospect, I’d be wary about doing business with a heavily funded but inexperienced company – their major motivator may be to sell the company rather than the product and you don’t really know what kind of company they’ll be when (and if) they grow up. I like what Steve Jobs had to say: “I hate it when people call themselves ‘entrepreneurs’ when what they are really trying to do is launch a startup and then sell or go public, so they can cash in and move on. They are unwilling to do the work it takes to build a real company, which is the hardest work in business. That’s how you really make a contribution and add the legacy of those who went before. You build a company that will still stand for something a generation of two from now.”

11-2-2013 5-38-19 AM

Poll results suggest keeping your expectations somewhere between modest and nonexistent if you’re a company with a hot new application but minimal experience working with hospitals. New poll to your right: which company’s stock would you buy if you had to invest in a healthcare IT vendor?

Listening: The Wrens, an amazingly literate but hard-luck New Jersey day jobber band that hasn’t released anything since 2002 but still has a reputation as one of the best live bands around. I’m playing this song a lot.

I’m changing the rules on the reader-contributed pieces I run as “Readers Write.” I’ve previously run just about any article as long as wasn’t commercial in nature so that any reader, regardless of employer, could express their point of view. I figured the potential negative reaction to lower quality submissions would set the bar to an adequate height. Unfortunately a lot of what gets submitted is PR-ghostwritten, company-friendly fluff pieces that are painfully basic for the HIStalk audience. I’m going to start politely rejecting those articles that don’t contain anything that the the average CIO wouldn’t already know or care about, Articles with personality and humor have a better chance of running, and I’ll always give special consideration to those submitted by providers, which unfortunately are rare.

Talk about scalability issues: only six people were able to successfully sign up for insurance via Healthcare.gov in its first full day of operation in which the administration claimed 4.7 million attempts.

I’m posting this on Saturday, so Monday morning readers will think I’ve erred in wishing luck to the hospital IT and vendor crews managing tonight’s fall-back to standard time. Setting the clocks ahead in the spring doesn’t usually cause as many problems as setting them back in the fall – it’s just not logical for time-dependent software applications to see an hour repeated, as I learned years ago when programming a repeat lab orders routine for my hospital’s order entry system (it mostly worked, but I did miss something that I shouldn’t have when the clocks fell back.) I like having daylight hours artificially manipulated to match the clock-bound schedules of most Americans, but it is a bizarre practice and it causes a lot of confusion if you live in Arizona or Hawaii or try to connect with someone there since they don’t observe DST and the rest of us are supposed to recall that fact.

11-2-2013 6-19-01 AM

Ray Murray (maxIT Healthcare) joins ESD as regional VP.

11-2-2013 6-35-32 AM 11-2-2013 6-36-42 AM

Todd MacCallum (TUC Managed IT Solutions) and Peter Schermerhorn (HealthMEDX) join Beacon Partners as regional directors.

ONC will convene a December 16 meeting of vendors interested in electronic patient identification and matching, with further details forthcoming. UPDATE: Per Lee Stevens, director of ONC’s State HIE Policy Office, the meeting isn’t just for vendors – also invited are HIE experts, state HIE leaders performing patient matching activities, HIE/HIT stakeholder associations, and privacy advocates.

11-2-2013 12-31-36 PM

Standard & Poor’s becomes the second financial rating firm to downgrade the bonds of Wake Forest Baptist Medical Center (NC), announcing its decision the day after the hospital reported a wider than expected $57 million operating loss following a disastrous implementation of Epic.

11-2-2013 12-32-37 PM

I mentioned that Travis from HIStalk Connect and I will be reporting from the mHealth Summit December 8-11 at the Gaylord National Resort just outside of Washington, DC. The folks there are offering HIStalk readers a $75 discount on the full access pass price ($675 general, $215 government, $200 student) if you register using discount code HISTalk (their spelling, not mine).

Here’s a decent SNL sketch skewering Kathleen Sebelius and Healthcare.gov from last week’s show.

11-2-2013 8-26-02 AM

It’s hard to fathom that a healthcare-related website (Healthcare.gov) can attract so much national and political attention, but it will make the November 11 cover of The New Yorker.

An interesting analysis of Healthcare.gov says the problem isn’t the Obama administration, which has successfully launched similarly complex sites under newer government agencies that were willing to fight to get the job done right. The problem, the author concludes, is HHS, which doesn’t have the competition that finally mercy-killed similarly walking dead organizations like Polaroid and Eastman Kodak:

Old organizations definitionally have a lot of longtime stakeholders. And in a sort of ecological process, those stakeholders have been selected for a certain amount of fitness for their environment, which is to say that they are good at doing things the way they have always been done, and they like things the way they are. They are averse to any sort of big change, and they will fight you with every tool at their disposal, from open warfare to passive-aggressively going through the motions on everything you ask them to do. That’s why organizations in crisis frequently need to fire the majority of their staffs to turn things around — and, more than once, an organization that has done so has found that it’s still stuck with the same corporate culture that wasn’t working before.

11-2-2013 11-47-08 AM

Lawyers file a class action lawsuit against Johns Hopkins Hospital over a gynecologist who is accused of wearing a pen-shaped video camera during his examinations, claiming that the doctor recorded up to 9,000 exams and stored them on 10 file servers. The doctor committed suicide earlier this year as investigators reviewed claims involving a variety of inappropriate behaviors. I was curious where you’d get a camera like that and the answer of course is Amazon, which offers the above 30 frames per second, HD-quality model with an 8GB memory card for $70. I saw YouTube video from it and the quality is not bad, although I can’t vouch for its use as alleged. You would think that the last thing a gynecologist would want to watch is movies of his own exams.

11-2-2013 10-42-27 AM

JD Power takes heat for awarding Samsung the #1 rating for customer satisfaction among tablet manufacturers even though Apple beat Samsung in every category except cost.

This is both depressing and uplifting. The California Department of Social Services orders closure of a filthy, unsafe residential care facility whose license had been suspended, so its employees simply walked out after the notice was posted on the door on Thursday and left 14 residents to fend for themselves. The uplifting part is that a cook, a janitor, and two caretakers stayed out of a sense of responsibility even knowing they wouldn’t be paid, finally calling 911 when they realized they couldn’t manage the residents until the Monday deadline for the residents to make new arrangements.

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Vince uncovers more great information about HBOC in this week’s HIS-tory. I was curious about former HBOC President and CEO John Lawless and I found that he’s retired in the mountains of North Carolina. I don’t know of anyone who has captured the kind of information Vince has, and the more time that passes since the industry’s early glory days of the 1970s and 1980s, the less chance it will ever be documented.


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

More news: HIStalk Practice, HIStalk Connect.



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Currently there are "20 comments" on this Article:

  1. We have all talked at great length on the Healthcare.gov website. I’m making a stink about the turnkey state exchange models that both Oracle and Microsoft advertised in 2011 and I never go along with Issa but this time I hope he does some good with digging in to see what technologies were used. Nobody mentioned these two “turnkey” products and I use that term loosely as we all know you still have to code and create some apps but if the 834 integration was already built in for payers, did anyone look at the two of these is one question?

    I think Oracle got a kick out of it as on my stats I saw my blog post on the posts being read at the same time they were having their shareholder meeting:) Maybe they were not any good or maybe they were? Did anyone look? Was CMS spending money writing code from the bottom up when there was a lot of code already done? I read another article where CMS decided to do their own 834 mapping and decided against a committee of standards…why…one more good question to think about. I know we get into licensing too but with the numbers on the dollar spent I think there was a little bit to cover this part, and on the Oracle side Fusion Middleware is right in there as part of the their Exchange platform solution which is the backbone that connects everything with a lot of Oracle technologies today and CGI did purchase the Oracle Access and ID platform…so questions..


    I don’t know how well Issa will do but hopefully he may dig in here. Now as a contrast we have CMS using a real up to date and fast appliance from Cray to audit insurer payments…very interesting as the government pretty much has supported the fast computers of Cray which are making a come back with big data and DOe has tons of them at their big data center where they award “computing space” every year. So CMS has this YarcData appliance from Cray they are using and Cray is consulting with them as well.


    The contrast one has to say is astounding:) It runs 512 TB in memory too…oh well by the time this all shuffles out it will be interesting to say the least.

  2. In my observation, the term “structured data” is being used as a hammer by EMR vendors to try to convince their potential customers that the only way to meet Meaningful Use requirements is by using clunky and time-consuming point-and-click, drop-down menu-laden systems to create that precious “structured data.” With natural language processing technology becoming more and more ubiquitous and affordable, this sales pitch simply is not true. Using NLP to process transcribed or speech-recognized dictation and utilizing HL7 and/or XML, it is not particularly difficult to parse narrative text into sections and even specific words and phrases and import that information into an EMR, and voila! Structured data! And as you mentioned, there is value in having access to the providers’ actual words, not just a sterile, possibly-accurate-but-not-necessarily-true electronic version of the encounter record.

    The truth is, right now it is entirely possible to create one system providing dictation capture, speech recognition, a transcription platform, provider-entry tools, NLP, computer-assisted coding (CAC), an encoder/grouper, and an EMR with a patient portal and analytics capability. Such a system would provide access to INFORMATION, not just data. All the goodies would be there: the original dictation audio, the full transcript, the “structured data,” the diagnostic/billing codes, aggregated population health statistics, you name it.

    I know why such a system hasn’t been built yet, but it should be, and it would be the mother of all healthcare documentation tools.

  3. Re: Baptist bond rating, this will be the first of dozens of hospitals who will crater under the pressure of the enormous cost burden placed upon them by their ridiculously irresponsible Epic implementations. If the initial costs weren’t absurd enough, the ongoing costs required to support that archaic technology will be their final undoing.

    Shame on any hospital that increases fees or cuts back on easential services to offset their irresponsible Epic implementation.

  4. That’s BS and you know it. All the vendors TCOs come out very close. These are big and complicated projects being pushed at an incredible pace.

    The cost of maintaining an integrated Epic system are much lower than the AllScripts cobble jobs.

  5. In regards to the New Yorker article. Sorry, Obama is the President, this is his plan so the blame is on his shoulders. He can wear this like a boat anchor around his neck, but somehow the media will allow him to avoid blame again. This would be funny if it weren’t so tragic.

  6. @Jay Vance. Then create, compress, archive and audit (prn) AVI files from actual patient care episodes (physician, surgeons, nursing, therapists) and peg reimbursement to actual time spent on clinical care, case-relevant research, treatment planning/synthesis, care coordination and documentation (same way we pays the lawyers who make the rules) and health care system fixed.

  7. I like the Saturday posts. Keep em coming.

    Obama is using a brickphone circa 1990. That is revealing and incongruous with his religious faith in IT to magically solve the country’s health care woes. What I glean from the Obamacare sign-up IT fiasco is that the communication was defective to non existent, exacerbated by the IT they were all using.

    It would appear that no one talks to eachother anymore, as IT expands.

    This is just like in hospitals where HIT systems have altered the thinking and destroyed the creative clinical thought and communication of the best clinicians who are forced to slow their brains down as they click in orders on poorly usable EHR ordering gizmos.

    Sad and pathetic.

  8. RE: unstructured data: As a ‘trench-worker’ doc, I have tried to dabble in some standards orgs with the voice that free text dictation is absolutely critical for appropriate clinical care of the patient. This is usually met with the tech/ ivory tower view that ‘all information must (and will eventually) fit into a relational database’, which I think is hogwash. After seeing some of the fairly recent research on NLP outperforming traditional data-mining tools(with such things as claims data), I have great hope that NLP will evolve as described as in #3 above. In addition, I am impressed with the technology of players like A2iA in even recognizing handwriting. Unfortunately, due to the glacial pace of advances in US HIT, combined with the innovation killing MU program, healthcare administrators will probably continue to force me to waste my time sitting in front of computers entering data instead of taking care of patients.

  9. Hey Ex-Epic. Leave poor Brain alone. If you can’t read the following paragraph, take a tip from Cee Lo Green, “thin fuku.”

    Cna yuo raed tihs? Olny 55 plepoe out of 100 can.

    i cdnuolt blveiee taht I cluod aulaclty uesdnatnrd waht I was rdanieg. The phaonmneal pweor of the hmuan mnid, aoccdrnig to a rscheearch at Cmabrigde Uinervtisy, it dseno’t mtaetr in waht oerdr the ltteres in a wrod are, the olny iproamtnt tihng is taht the frsit and lsat ltteer be in the rghit pclae.. The rset can be a taotl mses and you can sitll raed it whotuit a pboerlm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Azanmig huh? yaeh and I awlyas tghuhot slpeling was ipmorantt! if you can raed tihs forward it

  10. RE: Ex-Epic and No Brainer — EPIC TCO

    The TCOs that I put together based on HIMSS Analytics data show similar upfront costs of software between Epic, Cerner and MEDITECH but much higher ongoing cost of ownership for Epic. Epic hospitals come out at 4.55% (N=23) of operating expenses for IT, Cerner is around 3.1% (N=45) and MEDITECH is at 2.24% (N=103).

    If you have data which is different please present it and cite an industry standard source.

  11. Yup, Epic has a higher cost- more configureable, more frequent updates, more functionality. I’ve seen that dynamic at several customers- the IT department comes off a very sedentary product that hasn’t changed in years, not configurable, they hit Epic and end users want changes that are possible, just need building. Epic customers actually were threatening Epic at points to reduce the number of changes coming through the system, mainly major versions.

  12. TCO and old tech – Cerner still uses it’s own programming language: http://en.wikipedia.org/wiki/Cerner_CCL

    Funny to listen to them suggest others are old or hard to maintain. Cerner has a reputation for complex and expensive upgrades as do other vendors. Meditech rises above all of them as simple and easy to maintain, but as suggested by FHB – you don’t get a whole bunch of new features either.

    Actually, all these systems are of the same vintage, as are the companies themselves.

  13. Unstructured content-I think the examples are all correct, but it is important to note that unstructured content/data, is and will be the fastest growing type of data in healthcare as most other businesses. It includes images/DICOM files, scanned documents, dictated files, EEG videos, digital pathology files, EKG’s, and the list goes on. It also includes internet data. Unstructured data is critical for future data analytics and it appears the federal government will look to the exchange of unstrcutured data, just as they require exchange of structured data now. It is currently an area in healthcare that is growing exponentially, is often siloed in a multitidue of sytems and areas and will become more and more difficult to manage unless strategies are put in place now to centralize it, as well as search it.

  14. Probably too late, but here’s my reply to Nila re: “unstructured content. I’m curious what the HIStalk audience thinks when they hear that term.”

    Nila inquired about “unstructured CONTENT”. In the enterprise content management (ECM) world, with players such as Hyland Software, Perceptive Software, EMC (Documentum), and OpenText, whose products historically began as document capture systems (a.k.a., document imaging) and / or document management systems and evolved into ECM systems, CONTENT is defined as the intellectual substance of a document, which includes both structured DATA as well as unstructured DATA.

    As a programmer from the early COBOL and FORTRAN days, I learned that structured DATA are binary, computer-readable, and discrete data, typically stored in relational databases or custom applications with pre-defined fields. Also I learned that unstructured DATA are non-binary and human-readable, such as the data contained in analog documents, text-based reports, analog photos, drawings, vector / raster graphics, videos, audios, emails, web pages. GenesRFree and Chris, above, were correct in their definitions of unstructured DATA.

    According to my college profs, technically, unstructured CONTENT would be considered a misnomer, like so many words and definitions that get tossed around these days.

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