Good description of the problems with Microsoft Viva. I usually just say it's not helpful, obnoxious, and angering. Your description…
The Apple-IBM partnership releases four healthcare-related apps in IBM’s MobileFirst for iOS series, although IBM is holding back the formal announcement until the HIMSS conference. The apps include an iPhone communication system for hospital nurses, an iPad workload app for hospital charge nurses, a notification and lab status app for hospital techs, and an app that allows home care nurses to upload information to an EHR.
From Mobile Gas: “Re: IBM’s MobileFirst for iOS Healthcare. It seems like smoke and mirrors since they didn’t provide a list of customers and looks like they just built a series of applications without considering apps already deployed. The hospital nurse needs tight integration with the hospital EMR and Epic and Cerner both offer point-of-care applications. They also need connections to secure messaging and alarm notification from companies like Voalte and Vocera. This will lead to further market confusion as Apple and IBM build products in the ivory tower and expect customers to figure out the integration. I think this is another sign that Apple doesn’t understand the healthcare enterprise – they could have addressed enterprise issues, such as iOS management and WiFi connectivity, and instead are building generic applications that will be hard to integrate with hospital core systems.” Most surprising to me is that IBM didn’t announce integration partnerships with Allscripts, Epic, Cerner, or Meditech and didn’t mention working with health systems to design and test their apps or to validate that they offer something important that EHR vendors don’t. I’m skeptical. Just because health systems run applications on IBM systems doesn’t mean IBM can grab EHR data indiscriminately and use it intelligently, although maybe the announcements that are being held for HIMSS contain more vendor-specific details.
From John: “Re: gender bias. Have you counted how many interviews you’ve done with men vs. women?” I haven’t counted, but it’s probably proportional to the gender ratio within the specific job roles (CEO, CMIO, etc.) If your point is that men are disproportionately represented in those roles, then I obviously agree, although it’s a slippery slope to then propose fixing what is perceived as a societal problem based on the single factor of gender. I like to think I’m gender-blind since most of the people I’ve chosen to work with are female and some of the better interviews I’ve done were with women. I’ll interview anyone who has the potential to be interesting and who is willing to do it my way — don’t underestimate that second factor since it takes guts to be interviewed for a full transcript without knowing in advance what questions I’ll ask and not having the chance to review the answers before I publish them.
From Kopecky: “Re: Mark Cuban. Getting flamed on Twitter for urging quarterly blood tests ‘for everything available’ as a baseline.” He’s well-intentioned even though he’s wrong. He assumes that frequent testing will create a personal baseline that will be more useful than population-based normal ranges when something changes. Here’s the problem: the more results doctors see, the more pressure they feel to do something about them because that’s how they are trained and they don’t want to get sued. Things start going wrong when patients get roped into the healthcare system … medical errors, polypharmacy, and compounded drug side effects. That’s the same problem with apps that create a continuous stream of questionably valuable medical data that someone has to review and react to. I suspect we harm far more people by providing unnecessary knee-jerk treatment than we do by not collecting enough data to support an early diagnosis. It would be great if “health” was a simple as automatically applying harm-free interventions in response to well-defined physiologic inputs or genetic analysis, but it’s not. Healthcare is often dangerous to your health.
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor MedCPU. The tagline of the New York City-based clinical decision support company is “Accuracy is not optional.” Its MedCPU Advisor analyzes the complete electronic clinical picture (including both structured and free-text data) in real time against an algorithm matrix, providing case-specific prompting with minimal false alarms. No change in user worfklow is required since the system runs in the background with no separate logon or additional data entry required. The company’s experts build, configure, and maintain best-practice rules from its library of specialty modules with minimal client resources required. On the technology side, the company provides integration via reader technology that requires no IT resources and includes a patented Context Engine to process free text information. Founder and CEO Eyal Ephrat, MD is an obstetrician and previously founded E&C Medical Intelligence (now PeriGen). Thanks to MedCPU for supporting HIStalk.
My YouTube search turned up a new explainer video for MedCPU Advisor.
This week on HIStalk Practice: Iora Health takes on primary care nationally with a homegrown EHR. Community Health Center serves as a model for a new telehealth program in Colorado. Australian physicians get no respect from their EHRs. Health information exchange in Georgia moves forward, as does telemedicine in Delaware. Spruce raises $15M from headline-making Kleiner Perkins. Health Informatics Director Karen Schogel, MD weighs in on MU3 at Genesis Medical Associates. Thanks for reading.
This week on HIStalk Connect: Google partners with Johnson & Johnson to co-develop a surgical robot that will integrate real-time image analysis and decision support into the surgeons workflow. In England, students with the Royal College of Art and the Imperial College London have created a self-stabilizing pen designed to help patients with Parkinson’s disease maintain legible handwriting. Apple and IBM unveil their newest batch of co-developed enterprise apps, including four apps designed for nurses. Fitbit finalizes its $18 million acquisition of Fitstar, a paid app that develops personalized workouts based on user’s fitness goals.
If you want one of these pins, stop by our HIMSS booth # 5371 on next Monday since we intentionally ordered few enough of them to make them collectible (actually it was mostly to avoid the risk of lugging them back home). We suggested that our sponsors design their own buttons, although I don’t know which ones actually did.
HIStalkapalooza Sponsor Profile
Visit Sagacious Consultants at HIMSS Booth # 1690 for a chat with some of the EHR industry’s smartest leaders, including founder and CEO Shane Adams and principal consultants Gordon Lashmett, George Evans, and Dr. Ron Jimenez. With experience as Epic CIOs and directors of clinical informatics, they will be available to dish out advice about your most pressing technical and operational challenges.
Sagacious Consultants will be rocking HIStalkapalooza as a Gold Sponsor. Guests can strut like rock stars on a red carpet at the House of Blues, grab a guitar or banjo prop, and strike a pose. Don’t leave without taking home a Sagacious rock poster commemorating this star-studded night for HIT.
April 8 (Wednesday) noon ET. “Leveraging Evidence and Mobile Collaboration to Improve Patient Care Transitions.” Sponsored by Zynx Health. Presenter: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health. With mounting regulatory requirements focused on readmission prevention and the growing complexity of care delivery, ACOs, hospitals, and community-based organizations are under pressure to effectively and efficiently manage patient transitions. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.
VistA vendor Medsphere and IT solutions provider Phoenix Health Systems merge. The Medsphere name wins, adding consulting and outsourcing services from Phoenix.
Healthland acquires revenue cycle solutions firm Rycan.
Cedars-Sinai Health System (CA) chooses HealthLoop for automating patient follow-up.
MultiCare Connected Care (WA) selects Sandlot Solutions to create a community-wide electronic information exchange.
Xerox will incorporate SyTrue’s natural language processing and medical terminology platform into its Midas+ analytics to generate diagnostic and procedure codes from clinical documentation in real time to calculate risk and outcomes for case management.
Kindred Healthcare’s hospital division chooses transcription, front-end speech recognition, and clinical documentation improvement from MModal.
Dave Levin, MD (Nordic) joins PeraHealth as physician executive.
Ed Marx resigns as SVP/CIO of Texas Health Resources.
Chuck Christian (St. Francis Hospital) is named VP of technology and engagement of the Indiana HIE.
Mike Waldrum, MD, MSc, MBA, president and CEO of the University of Arizona Health network, leaves quickly after the system’s acquisition by Banner Health to become CEO of Vidant Health (NC). He was CIO at UAB Health System from 1999 to 2004.
CognitiveScale launches a healthcare business unit that will apply cognitive computing to chronic care management and names Charles Barnett (Seton Family Healthcare) as the healthcare group’s president.
Announcements and Implementations
Joining the CommonWell Health Alliance are Meditech, Merge, and Kareo as contributing members and PointClickCare and Surgical Information Systems as general members.
The Chicago business paper profiles MedDocLive, started by a former Epic project manager turned medical student, which provides medical students and residents to help hospitals with their EHR go-lives.
The New Mexico HIE goes live with technology provided by Orion Health.
Here’s an interesting graphic tweeted out by KLAS as a teaser to buy its latest $15,980 health analytics report, which according to the graphic, involved only 77 respondents of which 28 said no vendors offer emerging capabilities. Health Catalyst and Truven are at the bottom with just three votes each? I’d have to see the methodology before I’d believe that.
Practice Fusion enables doctors to print drug coupons right from its free EHR, no doubt charging the drug companies that provide them. Patients like prescription drug samples and coupons, not usually realizing the indirect cost to themselves or those paying for their care.
MModal announces that transcription employment at its Coimbatore, India office has reached 1,000.
Vocera announces integration of its communications system with Epic for bed cleaning and availability updates, with similar integration with other EHRs planned.
Summit Healthcare partners with S&P Consultants to offer Cerner solutions that include domain compare and synchronization, blood bank validation, and a scripting toolkit for workflow automation.
CVS Caremark announces new affiliations with Rush University Medical Center (IL) and Tucson Medical Center (AZ) that includes sending CVS prescription and visit information to the EHRs of participating providers and offering patients services via its in-store MinuteClinics. Meanwhile, CVS filings show that its CEO earned $32 million in 2014 and added another $11 million in stock value. CVS share price increased 38 percent in the past year.
Non-profit health information provider Healthwise offers a course on shared decision-making.
Government and Politics
Texas lawmakers are considering a bill that would prevent providers from recording a patient’s gun ownership status in their medical records. The office of Rep Stuart Spitzer, who is a surgeon, says consumers are alarmed at being asked gun-related questions during visits and that he doesn’t trust the National Security Agency and other government agencies.
Athenahealth CEO Jonathan Bush will host a $10,000 per person fundraiser at his Massachusetts home for his cousin, presidential contender Jeb Bush.
Bob Wachter, MD is ubiquitous in plugging his new book (which I haven’t read), publishing endless excerpts all over the place including a series titled “The Overdose; Harm in a Wired Hospital.” It describes a single incident at UCSF Medical Center, his employer. It should be noted that despite the manufactured drama and hype-laden headlines (such as “How Medical Tech Gave a Patient a Massive Overdose”), the patient ended up being fine with no permanent harm from UCSF’s mistakes, although the salacious if inaccurate headlines might move a few more copies than just admitting institutional errors. Stripping away the novel-like prose leaves these facts:
- A pediatric patient (16 years old) was given 38.5 Septra DS tablets due to a series of errors resulting from the resident’s botched attempt to re-order a home med of one tablet twice daily.
- The incident happened in July 2013, just over a year after UCSF’s Epic go-live, but Bob doesn’t say if the resident had just started her rotation on July 1.
- The hospital had decided to require clinicians to dose medications by weight for children under 40 kg without exception.
- UCSF had elected not to turn on Epic’s overdose limits because teaching hospitals use research protocols that don’t always follow published standards.
- The pediatrics resident entered the order correctly, but then had to adjust it to match the available tablet strength per UCSF policy. She then re-entered the same order incorrectly, apparently failing to notice the mg/kg dosing that, according to hospital policy, should have been present on every single order she had ever entered into Epic, including the same order she had just entered for that same patient. She entered the dose as “160” in trying to enter the milligrams of trimethoprim instead and then ignored the resulting overdose message. The resident blames UCSF’s Epic setup for issuing too many alerts and for failing to highlight the most important ones.
- The UCSF pharmacist accepted the resident’s order after ignoring his own dose warnings.
- The hospital had floated a a newly-licensed night shift nurse from her normal PICU assignment to the general pediatrics floor because of short staffing, She didn’t question the dose and didn’t ask the charge nurse because she “didn’t want to sound dumb,” so she helped the patient swallow 38.5 oversized tablets.
The article series isn’t finished yet, but my conclusions so far are:
- Bob’s working the author angle of being the technology-wary guy to consumers. He writes well, but his lay audience probably won’t understand that hospitals make mistakes constantly even without technology. Paper orders were no picnic, believe me, and UCSF has some obvious people problems in putting newbies on the front line with questionable supervision. If your kid driving on a learner’s permit wrecks the family car while speeding, don’t blame the car manufacturer for not making the speedometer bigger.
- This is a classic example of the “Swiss cheese effect,” where an event occurred only because a normally reliable system of checks and balances fell apart due to alignment of failed links in the chain (new resident, new nurse working off her normal unit, nobody caught the mistakes made by others).
- The Epic screen is busy and doesn’t highlight the magnitude of the alert very well. UCSF’s decision not to hard-stop overdoses (in my experience, that’s probably because they don’t want to annoy easily angered doctors, although their research rationale is valid) would have prevented this mistake.
- UCSF’s “mg/kg dosing only” rule is commendable for most but maybe not all medications. They apparently decided to make this change universally when putting in Epic. It would be interesting to see what training was offered to prescribers before this change was made and how many of them were in favor of it.
- IT systems often lull people into a false sense of security since the screen always looks calm and rational. The alerts don’t, as Bob suggests, throw up a big skull-and-crossbones graphic – system designers assume that it’s the human’s job to understand the situation and not to cry wolf constantly.
- I would be interested to know what steps UCSF took to reduce insignificant drug warnings both before and after the event since Bob thinks the number is excessive. How does UCSF compare with comparable users?
- Epic could certainly redesign its screens to call more forceful attention to the biggest error outliers (or at least those it can detect with certainty), just like your PC says “Do you really want to do this?” before allowing you to accidentally format your hard drive. Perhaps Epic’s setup could (or should) require resident-entered orders that have seemingly big problems to be verified by an attending or chief resident before shooting them off to the pharmacy for immediate dispensing. IT-reduced turnaround time is not your friend when you make a mistake.
- Professionals have to be responsible for their actions and their judgment in using software, whether they’re doctors, accountants, or stockbrokers. UCSF put a lot of very green people on the front lines and they screwed up in ways that would have been equally horrifying with or without a computer (38.5 oversized adult tablets for a kid? Come on, just-graduated nurse, use your critical thinking skills).
- Errors usually happen when clinical employees are overworked, interrupted, or afraid of getting chewed out and all of these issues were reported by those involved.
- Don’t go to an academic medical center unless you really need one (and I say that having worked a long time in both academic and community hospitals). The July 1 new resident screw-up phenomenon has been well documented. Huge size and specialization means that when they float nurses as in this case, they’re dumped into a complex environment where they don’t know the people or processes. Academic attending physicians often possess big egos and make anyone who questions them (including the software analysts who configure clinical alerts) feel shamed, so nobody challenges them. Doctors and staff see so many complex, throw-out-the-rulebook cases that questionable orders are overlooked. Handoffs and intra-department communications aren’t always efficient since so many people are involved and they don’t always even know each other. Bring someone to sit by your side the whole time and question everything. I doubt the mom would have allowed her child to choke down 38.5 pills knowing it’s supposed to be a single one like she’d been giving at home.
What do you think? Clinical folks, how would your system and your people handle a potential mistake like this? Here’s a challenge for you: enter the same order for a similar patient in your test environment and send me a screenshot of what the ordering physician would see (I’ll de-identify the image). Let’s see how other hospitals and other IT systems work.
Quite a few companies observed April 1 with phony commercials and news items. This one from Microsoft announcing “MS-DOS Mobile” is pretty good. Epic had its usual home page makeover.
The teen whose parents publicly shamed an Atlanta hospital into giving him a free heart transplant in 2013 despite his history of not complying with prescribed therapy crashes a stolen car following a crime spree and dies.
- Arcadia Healthcare Solutions client Yakima Valley Farm Workers Clinic will receive an IT innovator award at the HIMSS conference.
- ESD posts 25 days of its history as it commemorates its 25th anniversary. Check out Day 7, where you’ll see its video of HIStalkapalooza 2012 in Las Vegas, which it did a great job of sponsoring. I still watch that video every couple of months because it’s fun and full of familiar faces, maybe even yours.
- Extension Healthcare releases version 5.0 of its clinical alarm safety platform.
- Hayes Management Consulting posts “Patient Portals: How to Balance Privacy and Engagement.
- Healthcare Data Solutions is named Concur’s App Center Partner of the Year for the third year in a row.
- Healthfinch asks “Is Primary Care in Rural America at Risk?”
- QPID Health President and CEO Mike Doyle will present on maximizing technology’s value to patients and providers at the ACHE Massachusetts Spring Conference on April 15 in Needham, MA.
- Healthgrades offers “5 Lessons I Learned from 10.10.10 in Denver.”
- Impact Advisors offers “Population Health Management Vendor Selection.”
- Liaison Technologies offers “Winning Lab Information Strategies for Value-Based Care.”
- Healthwise shares “The Secret Behind Serving Up the Right Information Every Time.”
- Holon Solutions will exhibit at the Texas Organization of Rural & Community Hospitals Annual Conference April 7-9 in Dallas.
- Intellect Resources offers tips on “Networking at HIMSS.”
- Galen Healthcare Solutions wraps up its experience at the InterSystems Global Summit.
- InterSystems recaps its annual conference, Global Summit 2015.