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Monday Morning Update 9/15/14

September 13, 2014 News 6 Comments

Top News


Illinois-based Advocate Health Care and NorthShore University HealthSystem will merge to form the state’s largest health system with 16 hospitals, 45,000 employees, and $6.5 billion in annual revenue. The CEOs of both systems say more mergers or acquisitions are likely as hospital consolidation continues. They also touted the benefit of shared electronic medical records and future plans to roll out more patient-facing technologies. I would bet that NorthShore’s Epic will eventually become the new standard, replacing Advocate’s Cerner system.

Reader Comments


From Core Consumer: “Re: Apple and Epic. Apple used Epic screen shots in their HealthKit presentation. There’s no doubt that the companies signed a partnership agreement. Just because details weren’t announced doesn’t mean it didn’t happen.”

From The PACS Designer: “Re: Office 365 Garage Series. With the focus these days on security, Microsoft in their Garage Series wants everyone to know where the Office 365 improvements will be to enhance user performance, collaboration, and connectivity.” I’m surprised Microsoft hasn’t crowed more loudly about Apple’s iCloud breach.


From Smooth Operator: “Re: Kaiser CIO Phil Fasano. Kaiser confirms that Phil has resigned. There’s all sorts of internal discussion on who will be named interim CIO.”

HIStalk Announcements and Requests


HIMSS and CHIME are the organizations most often joined by poll respondents. New poll to your right or here: what influence will Apple have on health and healthcare? Vote and then click the Comments link on the poll to elaborate further.


September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

We ran a couple of great, well-attended webinars in the last few days. Here’s “Meaningful Use Stage 2 Veterans Speak Out: Implementing Direct Secure Messaging for Success.”

This is last week’s “Electronic Health Record Divorce Rates on the Rise- The Four Factors that Predict Long-term Success.”



The Amerigroup Texas Medicaid health plan will use analytics from Treo Solutions, which was recently acquired by 3M Health Information Systems.

Announcements and Implementations


Australia’s leading interactive patient care vendor, Hills Health Solutions, will distribute patient engagement technology from Lincor Solutions. The agreement was signed during a trade mission visit to Australia by officials from Ireland, where Lincor is based. The company’s touch-screen offerings for both wall-mounted and mobile devices include clinician EMR access, audio and video patient calling, entertainment, patient education, surveys, and meal ordering.


Visage Imaging is sponsoring the full-day New York Medical Imaging Informatics Symposium this Thursday, September 18 at New York City’s Marriott Marquis. The $70 registration fee includes a sushi lunch and up to 6 AMA PRA Category 1 credits.


National Decision Support Company releases an Epic version of its ACR Select evidence-based imaging appropriateness module that includes not only the decision support rules, but also recording utilization data that can be reported from Clarity and Reporting Workbench.

Government and Politics


Nevada votes to shut down its Nevada Health Link health insurance exchange and move to Healthcare.gov after a problematic rollout and the firing of contractor Xerox, who had a $75 million contract to build the site. The state announced plans in May to use Healthcare.gov for at least a year, but decided last week to make the switch permanent.



The weather this week in Verona, WI for Epic UGM attendees: highs in the mid-60s, lows in the low 40s, sunny all week other than a chance of rain Monday morning.  The local paper and TV stations are warning commuters of significant traffic delays through Thursday. The folks at Madison-based Nordic wrote up “10 ways to make the most of your 2014 Epic UGM experience.”

The Yakima, WA paper covers EMR use by doctors who aren’t thrilled by it. One is the chief medical officer of Community Health of Central Washington, who says doctors are using up to half of the already-brief patient encounter to work on the computer and complains that EHRs weren’t designed by doctors. Another doctor says EHRs can improve care and patient relationships if doctors stop their foot-dragging and give patients the benefit of real-time lab results and e-prescribing. 


Bonds of SoutheastHEALTH (MO) are downgraded with a negative outlook after the hospital loses $39 million in 2013 because of revenue cycle problems caused by its Siemens Soarian implementation.


”The Onion” covers telehealth.


The Permanente Medical Group CEO Robert Pearl, MD lists five reasons healthcare IT isn’t widely embraced:

  1. Developers focus on doing something with a technology they like rather than trying to solve user problems, such as jumping on the wearables bandwagon despite a lack of evidence that they affect outcomes.
  2. Doctors, hospitals, insurance companies, and patients all feel that someone else should pay for technology they use.
  3. Poorly designed or implemented technology gets in the way of the physician-patient encounter.
  4. EHRs provide clinical value, but slow physicians down.
  5. Doctors don’t understand the healthcare consumerism movement and see technology as impersonal rather than empowering.

My list might instead be:

  1. People embrace technology that helps them do what they want to do. Most healthcare technology helps users do things they hate doing, like recording pointless documentation and providing information that someone else thinks is important.
  2. Technologists assume every activity can be improved by the use of technology. Medicine is part science, part art, and technology doesn’t always have a positive influence on the “art” part.
  3. Healthcare IT people are not good at user interface design and vendors don’t challenge each other to make the user experience better. Insensitive vendors can be as patronizing to their physician users as insensitive physicians can be to their patients.
  4. Technology decisions are often made by non-clinicians who are more interested in system architecture (reliability, supportability, affordability, robustness, interoperability) than the user experience, especially when those users don’t really have a choice anyway.
  5. Hospital technology is built to enforce rules and impose authority rather than to allow exploration and individual choice. Every IT implementation is chartered with the intention of increasing corporate control and enforcing rules created by non-clinicians. That’s not exactly a formula for delighting users.


California HealthCare Foundation covers the Cerner implementation of Los Angeles County’s Department of Health Services, which will replace several siloed systems that require photocopying paper charts to transfer a patient from one of the county’s hospitals to another. Harbor-UCLA Medical Center goes live first on November 1.


Tampa General Hospital (FL) fires an employee who it identified from audit logs as having printed the facesheets of several hundred surgery patients without authorization.


An oral surgeon in Pennsylvania creates a public outcry when he lays off an employee of 12 years because he says her cancer (ovaries, liver, and pancreas) will leave her unable “to function in my office at the level required while battling for your life.” The doctor claims his intentions were noble: he laid her off so she could collect unemployment during treatment, he says, after which time she’s welcome to come back to work.

A hospital in England bans use of the term “computer on wheels” or “CoW,” fearing that patients might be insulted in hearing a nurse ask a colleague to “bring that CoW over here.” They like “workstation on wheels” better. A cynical employee said patients weren’t the problem, but rather hospital executives tired of hearing employees complain that the computer system is a “right cow” to use.

Here’s another example, along with bathroom scales in the homes of obese people, that having health data is not the same as using it: McDonald’s admirably posts calorie counts for every menu item and offers low-calorie choices like salads, apple slices, yogurt parfaits, and bottled water, but nobody buys the healthy items – they’re lining up for 600-calorie milkshakes masquerading as coffee and the 1,200-calorie feed trough known as the Big Breakfast. It would be interesting to calculate the annual death toll from both kinds of malnutrition – over and under.

Weird News Andy declares this story to be “efficient drug operation.” Federal agents arrest two employees of the Bronx VA hospital for using its mailroom to receive packages of cocaine mailed from Puerto Rico.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

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Currently there are "6 comments" on this Article:

  1. Jees, Mr. H, who knew that HIT was not embraced by the users?

    Your list is much better than that of the CEO of Permante Medical Group. It is obvious that he has not ever used one to enter orders and to manage the care of a case of multi organ failure.

    However, did you ever think that doctors do not embrace them because they lead to new errors and create impediments to the narrative of the case?

  2. I know you are a big fan of Epic but you may not want to throw Cerner under the Advocate/Northshore bus just yet as Advocate and Cerner have been close development partners for a number of yrs now.

    [From Mr H] Per Modern Healthcare, “Advocate uses a Cerner Corp. EHR for its hospitals and several systems on the ambulatory side. However, Skogsbergh and Neaman said Advocate will move to Epic for its physicians, and they are going to evaluate whether they should convert all of their hospitals to one vendor.” It’s possible they would install Epic just for the physician practices, but I doubt that’s the case.

  3. Robbie Pearl’s article is much broader and I think is referring much more to non-EMR development. It’s the lack of specificity I think that makes his list seem ignorant. I find his articles in general quite uninformative owing to his trying to make them applicable to everyone and every situation. I’ve stopped reading them entirely. I do find Mr. H’s list very insightful as well. I think it’s true that many user complaints are not even about the technology so much as complaints about the sheer amount of work that seems to come with an EMR implementation.

    I do think there’s a certain amount of complaining just because it feels good though. I recently helped some specialists implement some discrete data for research. They can’t stop complaining about how they have to document it. I keep having to remind them that if they want it someone has to document it. They’re still waiting for the day when the system reads their mind.

  4. As much time as Keith has to comment on this blog, his EMR must be fantastic at freeing up time and making him efficient. Some people are just grumpy I guess…

  5. Mr. H,
    Why would you think Advocate would scrap its years of work with Cerner and its huge investment with them in population health solutions and deploy Epic? Advocate has a long history and has been very successful with Cerner, and Advocate (12 hospitals) is much larger than NorthShore (4) . You’re usually pretty good, but not sure I agree with this one.

  6. Advocate replace Cerner with Epic down the road? Not likely.

    I know someone there. Advocate is singing Cerner’s praises on pop health – and Epic has nothing to compete. The Epic narrative is laughable and must be part of Northshore saving face in the deal. Not strategic. Epic is a classic stovepipe system, and C already has E systems integrated into their platform.

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  1. I share your concerns about a lot of similar projects, but I think this one's an outcomes comparison thing, not…

  2. "Ascension Via Christi sent several ICU nurses home after they raised concerns about inadequate staffing." Nice. That'll show em.

  3. Thank you for sharing the full HIStory file. What a great tribute to Mr. Ciotti. “Those who cannot remember the…

  4. "Epic will roll out a “patients like this one” type tool to its users in Indiana this summer. It will…

  5. I don't see Cerner winning employee satisfaction surveys. I can't see VHA pivoting to Epic. It's going to be some…

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