News 5/13/09

From Louis Crabb: “Re: acronyms. This site is useful.” Link. It sure is. I tried some fairly obscure healthcare IT acronyms and they were all there. Some cool tools are bundled with the search, too. Industry noobs should look there for starters when facing an unfamiliar acronym. Good find.

From Dean Sittig: “Re: tagging articles by vendor. Why not just have them use the Google site search option, or go to Google and enter: topic site:histalk2.com. I’m a big fan of search, not a big fan of human-curated site indexes. That is what killed Yahoo.” I agree, but I’m not quite sure why Google doesn’t seem to index everything on the site. It also doesn’t separate interesting stuff from trivial mentions. I suppose it would be like indexing the newspaper – technically correct, but still only somewhat useful in trying to locate useful content.

From The PACS Designer: “Re: CCR. Since the Continuity of Care Record (CCR) created by the ASTM International E31 Healthcare Informatics Committee has been out for awhile, it was great to read that Microsoft has incorporated the CCR into their Amalga Unified Intelligence System offering. TPD was a member of the E31.28 Technical Subcommittee for Electronic Health Records that created the CCR document for caregivers and patients.” Link.

From Stifler’s Mom: “Re: Wal-Mart. I thought you’d appreciate this article about a reluctant Wal-Mart clinic visit.” Link. It’s a fun story by an admitted anti-Wal-Mart bigot who left its contracted retail clinic impressed. “As I head out into the brightly lit parking lot, I realize that this has been the easiest, most gratifying (and sociologically fascinating) trip to the doctor I’ve ever experienced. I realize that when it comes down to it—it being my thin wallet, of course, and, well, my health—there is really no way of getting around the truth. Wal-Mart did not save my life. But damn if it didn’t give me what every hard-working American deserves. And damn if I didn’t feel, dare I even say it, lucky.”

Pretty good Q3 numbers for Mediware: revenue up 4%, EPS $0.06 vs. $0.04, which the company attributes to its Hann’s On acquisition and its partnership with IntraNexus.

Welcome to new HIStalk Platinum Sponsor e-MDs of Austin, TX. They’re new to HIStalk, but are also a Platinum Sponsor of HIStalk Practice, which we appreciate. They have the coolest-looking Web site I’ve seen, which includes an EHR Discussions blog with a lot of ARRA information. Here’s Dr. Eric Fishman’s interview with founder David Winn, MD, FAAP, who says he wrote his initial product in Paradox and PAL (we old-timers know about that). Thanks to e-MDs for supporting HIStalk.

Four hospitals and 15 clinics in UAE are live on Cerner Millennium.

In Australia, the New South Wales Department of Health announces a $74 million statewide health information exchange.

This is a good interview (in six parts) with Omnicell CEO Randy Lipps. Talking about his experience with his hospitalized child: “I was looking at a nurse who was highly paid and highly trained, and it seemed like 75% of her work was what a clerk would do. Because my daughter was on a ventilator there were a lot of disposables. My daughter had dedicated nurses, and I saw the entire cycle. When the next nurse came in she would start fumbling around the drawers, looking for stuff. I would tell her where the previous nurse had stored her stuff. The each had their own secret stash of supplies because the supply chain within the walls of the hospital was so broken. They all had their own system to make sure they had the materials they needed for their jobs.” And speaking of competitor Pyxis: “Pyxis was a Street darling before they were acquired by our big competitor. They are a division of Cardinal now. They are a great company and I wanted to mimic them so much. When they got taken over by a large company, they stopped investing in R&D, and they stopped investing in customer service. In healthcare, especially with hospitals, it is not about selling product but creating a partnership.”

OK, so the big healthcare lobbying groups offered to cut healthcare costs. Sort of. Or, maybe cut the rate of rise a little (like me saying I’ll take less of an annual increase if you’ll let me keep goofing off as an employee). They agreed to everything, but nothing. They offered self-serving reform to make sure real reform doesn’t flare up. Remember Medicare Part D, the drug company windfall profit assurance act, that was pushed through by Congressman Billy Tauzin, who immediately quit to become the president of PhRMA, the drug company lobbying group that benefitted most from his political maneuvering? Those reform-minded folks are at the table, of course, with newfound heartfelt concerns about Joe Sixpack. There’s a long history of scumbaggery by some of those groups and the politicians who take their money. Want real reform? Impose it without their involvement. If they offered $2 trillion, $20 trillion should be about right for starters.

Massachusetts tried and failed to curb medically unnecessary ED visits, apparently, as the 47% rate of inappropriate utilization hasn’t changed, but costs have spiked 17% over two years.

Don’t forget that you can see recent comments on this page I created.

Jobs: Cerner CPOE Activation Support, IMPAC Mosaiq Consultant, SVP of Sales.

Michael William Freeman, son of Medicity RVP of sales Bill Freeman, has a role as Morgan Gutherie in the season finale of The Mentalist. Check him out next Tuesday at 9 Eastern.

McKesson is interested in acquiring more medical device companies from Israel, saying that country has companies that excel at linking medical devices with information technology.

A Cerner software guy invents Web Bootstrapper, a technology used in Cerner’s PHR that tailors a Web site’s display based on the speed of the device connecting to it, such as smart phones.

McKesson’s practice management people are staying in Dubuque, the GM says, now that the company’s office has moved to a technology park after leaving downtown Dubuque and laying employees off.

Famous neurosurgeon Ben Carson of Johns Hopkins (mentioned by Hopkins CIO Stephanie Reel when I interviewed her and holder of an amazing 50 honorary doctorates) is on the board of Physician Capital Group, started by a friend of his. Doctors input their fee-based activities into a BlackBerry or iPhone and the company pays immediately, but takes 12% as a commission while it waits on its own check from the insurance company.

Open source software is touted as a good solution at the first Philippine eHealth and Telemedicine conference. I tracked down the company of one speaker, myCare2x, an Germany-based open source system (PHP, Apache, MySQL) that has a fully online live demo.

Nuance Communications files its Q2 report: revenue up 13%, EPS $0.03 vs. -$0.13 (and $0.24 not counting asset amortization).

You knew it was coming: the husband of the first US resident to die of H1N1 is suing pork producer Smithfield Foods, whose Mexican farm is where “some believe” is where the virus originated.

E-mail me.

HERtalk by Inga

Johns Hopkins Hospital is the latest medical facility to warn patients of potential data theft. The hospital sent a letter (warning: PDF) dated April 4 to the Maryland attorney general’s office alerting them that a former employee was suspected of fraud involving fake Virginia drivers’ licenses. The hospital first learned of potential problems on January 20 and notified 10,000 patients of their suspicions April 3.

Kathleen Sebelius names nine staffers to the Office of Health Reform. This is the office tasked with spearheading HHS’s efforts to pass health reform this year. A quick glance at the list suggests the staffers are mostly political appointees (former Obama campaign staffers and the like) along with one doctor.

Our HIStalk Hero of the Week is Medicity, which donated $5,600 worth of IKEA furniture to help Ronald McDonald House Charities furnish a new wing at Cincinnati Children’s Hospital Medical Center. The sofa and assorted tables and chairs were originally acquired and used to furnish Medicity’s booth at HIMSS.

Even in a recession, vanity prevails. The number one surgical procedure nationwide last year was breast augmentation and the top non-surgical procedure was Botox injections. Over 355,000 breast augmentations were performed in 2008 at an average cost of $3,900. That’s a lot of implants.

Shareholders of HealthSouth file a civil lawsuit against founder Richard Scrushy, asking him to pay $2.6 billion for his alleged role in a HealthSouth fraud scheme. Shareholders are asking Scrushy to repay salary, bonuses, and stock deals, as well as personal plane flights and breast implants for a singer he was promoting. Regardless of how the suit is settled, it’s unlikely Scrushy still has much money of his own. He’s in prison on a state bribery charge.

Merge Healthcare aligns with Shanghaie Kingstar Winning Co, a Chinese healthcare IT company serving over 800 hospitals. The arrangement allows Kingstar to offer its clients Merge’s document imaging solutions.

UNC Hospitals (NC) select MediClick to provide its Contracts & Analysis solution to manage supply contracts and purchased services agreements.

The LA Times releases an interview with Farrah Fawcett, which includes plenty of criticism for UCLA Medical Center’s failure to protect her privacy. When details of her cancer appeared in the National Enquirer, Fawcett was convinced the leaks originated from UCLA. She and her doctor eventually set up a sting operation, which led to an investigation by UCLA officials, who tracked the leaks to one particular employee. At the same time, UCLA repeatedly asked Fawcett to donate money to the hospital for a foundation to be set up in her name.

AMICAS posts $11.3 million in revenues for the first quarter, compared to $12.8 million the first quarter of 2008. Net loss for the quarter was $1.2 million, or $(.03) per share, compared to last year’s loss of $467,000 ($.01) per share.

An English plumber visits his GP’s office after experiencing tremendous pain and bleeding from his belly button. The GP removes a 4 cm fetus, which was determined to be his parasitic twin – an identical twin brother that had died in their mother’s womb. Here’s the really icky part. The plumber had his brother’s fetus placed into a jar and took him home.

E-mail Inga.

2009 Reader Survey Results

Thanks for participating in my reader survey. Here are some high points that I took from it.

• A little less than half of readers have ever posted a comment to an article. (Try it! Everybody has something to say or share.)
• The most important elements of HIStalk are news (4.61 on a 5.0 scale), rumors (4.44), humor (4.31), and Inga (4.30).
• 95% of readers say HIStalk influences their perception of products and companies.
• 77% of readers say they have a higher interest in companies mentioned in HIStalk.
• 79% of readers say HIStalk helped them perform their job better in the past year.
• 99% say HIStalk has influence on the industry.
• 92% said the HIStalk’s posting frequency is “about right”.

Here are some specific comments and suggestions I pulled out as representative of what readers provided. The most common comment was “don’t change a thing,” which I appreciate as well. Your feedback on any of these is welcome.

• It’s more important about NOT changing your basic tenets: provide an accurate, concise summary of what’s happening in the industry, sorting out the rumor mill facts, letting us hear from interesting people in the industry and the new ideas and people in the industry. You are the only one providing this unbiased service and I really appreciate it. Thank you.
• The site is pretty ugly and difficult to read. Us vendor folks could mentor you in design if you ever asked 🙂 I know, but I like it amateurish because, well, I’m an amateur. I admit to having zero aesthetic ability.
• Too many Flash ads. Several readers mentioned that the animated ads are distracting. The immediate solution was to offer the View/Print Text Only link at the bottom of every article that shows only the article itself. I will also pass the suggestion of static-only ads along to the sponsors, although it’s their call.
• More writing about smaller companies. I would love to, but it’s hard to separate the PR from reality sometimes. I’ve been burned before about what I hoped would be an honest appraisal of a technology or company only to have the marketing people swoop in to spin the facts.
• Don’t run unsubstantiated rumors. I like the dichotomy that a few readers made the same comment, yet rumors are the second most popular feature. I try to get confirmation and often do, but not always. I don’t run all the rumors I get, so I have to walk a line between what sounds likely but with the understanding that sometimes the rumor is wrong. The good thing is that if it really is wrong, someone in the know will usually correct me quickly and I always run those corrections.
• I would like to change HIStalk discussion forum. I’d like to see it used more, but I’ve learned to live with the fact that HIStalk readers just don’t like posting to a discussion board. They are doing better in posting article comments, though.
• HIStalk is Mr. HIStalk’s unique thing; don’t change anything because I trust Mr. HIStalk’s judgment. Thank you.
• Paragraph headings with vendor/site/technology/main-topic keyword, to allow skimming. That’s really hard since we cover a lot of ground in one posting (that would be a ton of headlines). Other readers suggested some kind of online compendium of items grouped by vendor, provider, or product, which would be pretty cool but a big of a pain to maintain. Thoughts? I’m sure I could find some cheap labor to pick through each HIStalk post, cull out items by company or person, and then add them to a specific page for that company or person. Would anyone find this useful enough to be worth the expense?
• Have scheduled online chats. I’ve tried those and participation wasn’t very good. I’m not sure people like chats in general, plus their synchronous nature requires being in front of a PC at a specific time.
• Don’t let your "interviews" be PR spots for their products or companies. I try, but it’s sometimes hard to derail the subject from their agenda.
• Do a podcast version, e.g., interviews with actual HIS users with experiences to share. I’m not a fan of podcasts, but I’m looking at recorded Webinars as a good alternative. Stay tuned.
• Make it your full time job as it should be netting you around $2 million a year by my estimates if you were charging what it is worth. This would allow you to do a better job building your portfolio by extending your brand. Of course you would have to ‘out’ yourself which won’t be a bad thing. OK, I admit I included this reader’s comment here just because it flatters me.
• This is a hard question because you do such an incredible job. The only change I can think of to more strongly encourage people to do reporting ("it takes a village to make a great blog even greater"), especially from conferences that everyone does not have time to attend, and coach people on how to develop pithy content vs. vague comments, "here’s three things I hadn’t heard before" vs. "the conference was ok, but fewer vendors were there.” That would be great, although I’m always wary (from experience) of assuming that good readers will happily transition into good writers. I respect the fact that some folks just want to read and leave, but having a few more readers who are more involved would be super.
• If you comment on someone else’s dialogue, make your comments a different color, or make there’s different all of the time so it is easy to tell who is "speaking." Man, I have struggled with this one. I post reader comments in blue, but that still leaves quotes from articles. I’m open to ideas.
• I would look for success stories in healthcare delivery (the real stuff, you know, when a doc/nurse and a patient interact, and that interaction is enhanced by technology); we all need to see them and remind ourselves why we do what we do. That would be great. I wish I got more of those stories.
• Resolve the HIStalk-HIStalk Practice weirdness. They seem to repeat some information, and they don’t apparently link to one another. HIStalk covers everything, while HIStalk Practice covers physician practice technology. Sometimes the same item appears in both, but only when it’s appropriate. The idea was that HIStalk Practice would cultivate a new audience interested in ambulatory topics and not the more hospital-centric topics that appear on HIStalk. We interviewed individual doctors about their EMRs, for example, for HIStalk Practice, something we probably wouldn’t have run in HIStalk. While some readers follow both, we expect each to have a majority of readers who don’t look at the other. It will take some time to figure out if that’s indeed the case.
• Give yourself a break–you must work enormous hours. I do. I need to quit my day job one of these days, but I would need to find something that would offset the income I would lose using the time I would gain. And, some activity that would keep me in the industry since there are plenty of bystander writers out there, but not as many participant ones.
• Might be interesting to profile healthcare providers and hospitals more to get a feel for what’s happening out where systems are used. You’ve done it occasionally, but most of your interviews and profiles are from vendors. That would be great, assuming provider people would participate. We will try to get more of those.
• Do more for job placement or available positions. Maybe by region? I’ll consider that.
• Still don’t understand the difference between Inga’s section and Mr. HIStalk, except for the footwear comments. It’s only to let you know who is writing, especially if we express an opinion. Inga often writes first, so if she covers an item, it goes in her section. Since we’re kind of chatty and personal, there would be “weirdness” (to use the reader’s word above) if you didn’t know who was “talking”.
• I use IE6 w/ virtually no security, but I still never see any "…on your right" columns/content. Vendor ads are on the left, your editorial paragraphs are in the middle, blank space on the right. How about a "setup your browser for this site" FAQ link? I’m always the last to know about IE problems because I don’t use it. Readers e-mail fairly often saying that something is wrong with HIStalk’s layout, ads, or signup forms. Invariably they are using IE. If someone readers HIStalk on IE6 or 7 and everything works like it does in Firefox, let me know what settings you’re using (screen shots?) and I’ll pass it on.
• HIStalk is a fantastic contribution to the industry – someone should write a "good guy" story about you! Please keep it coming!! That one was me preening again. I’d rather be anonymous, though. As the very few people who have known me for years as Mr. HIStalk will attest, I’m uncomfortable talking about it.
• Having Deb Peel pose as Inga in Chicago was a scream. I agree. She was fun, as were our other sash-wearers.
• You’re a game-changer… many people I know don’t pick up the trade rags anymore. Thank you. I haven’t read any of the glossies for years, so it isn’t just me.
• Because I am new to this site and HIT but interested in learning as I go (you are my tutorial) I would love a decode area where I can find out exactly what acronyms like CCHIT and HIMSS stand for, etc. I figure I can start with a glossary and then take it from there. It would help me if users would provide some of the definitions.
• Since I am new to healthcare (vendor side), HIStalk has been VERY instrumental in helping me learn both sides of the industry and issues. I would like an occasional "101 learning piece" for the newbies- maybe in the form of a subject and the Seasoned folks can comment. "What I wish I knew when I was new…" or something like that. HIStalk has been like being the new kid in school but the cool kids still let you hang out with them. Thanks SO much! Best of luck! That’s a fun idea. If I could ever get people to read and post to a discussion form, that would be a perfect vehicle. Maybe I need a redesigned forum, although you wouldn’t believe how hard it is to keep spammers out.
• Do you have a day job (I assume the answer is yes), a family, hobbies? Yes, yes, and yes. Well, OK, I really don’t have any hobbies other than HIStalk.
• Thank you for including peer-review journal articles in your analysis and not limiting your reporting to just the commercial press. Happy to do it. If you see something interesting that I can get full text for, I’m happy to critique it.
• You can get started on vendor-independent Webinars – specifically to cover new technology usage in real hospitals/practices, and provide business cases that others could emulate. These would have to be done by healthcare providers. Working on that. I agree completely.
• The work you guys do has been invaluable to my career. I reference your work often (and give much deserved credit), and you have provided keen insight into the industry’s inherent complexity and overarching issues. My time as a journalist taught me a lot about the value of curating and meaningful dispensing content, and I can recognize editorial value when I see it. You guys nail it. Thank you.
• Some of the questions in this survey seem more commercial than the tone you have historically taken with this blog. Please don’t tell me you are being seduced by the money available for more directly pushing sponsors or others products! It’s the same old survey. I have plenty of sponsors and make zero effort to get more, other than writing HIStalk as usual. I’ll be honest: it’s great to not have to worry about that.
• Brilliant job, don’t know how you do it, but so glad you do, I am completely your fan! Keep going and add more contributors to write guest columns like "Being John Glaser". Expert judgment is one of our best assets. The washout rate for guest columnists is high, but I would like to have more of them since I enjoy what they have to say as well.
• Make links easier to see in Firefox. Working on that now.
• Put up an industry events page or calendar. Working on that now.
• You provide the conscience to this crazy business. If you’ve made one person in power a more honest person, then you’ve done a great service to us all. Thank you.
• A great job. I’ve gotten our CMIO and our CIO to read it. Of course, when his name appears in a report he’s not too happy, but hey, at least the stuff is usually accurate, even if we can’t figure out who named names.

Monday Morning Update 5/11/09

From Stan van Man: “Re: Sage. I just got an e-mail from one of the people who was cut at Sage who told me that Sage Healthcare RIF (don’t you love that acronym) was 500.” My company contact tells me that Sage North America reduced headcount (employees plus open positions) by 500, but that’s throughout all of Sage, not just Healthcare (which took a relatively minor hit).

From Dr. Lyle: “Re: Cerner MPages. I’m a long-time Cerner user and have many bruises to show for it. However, I am cautiously optimistic about MPages as it appears to be what many of us have been asking for: a Web-like front end to the data and functionality in the system. At the very least, it allows users to use HTML and similar programming to create a user interface which displays disparate data in the way they want, such as creating a diabetes screen that brings together meds, labs, physical exam findings, and evidence-based findings. At the very most, there may be some opportunity for interactivity via data input (e.g. change a variable to see how it affects the data) and ordering (e.g. meds, tests) on that very screen. In other words, they are beginning to go down the road of separating the data from the application and interface and allowing end-users to create the displays and customized functionality we believe will work best for us. While this might seem like common sense, most EMR vendors continue to work in a closed, three-tier system (data, application, and interface) that does not allow for this level or ease of customization. It could lead a new paradigm of what an EMR is and does, shifting EMRs to become a platform that holds the data and applications, but allowing interfaces to be in the hands of the users.” Dr. Lyle refers to his blog entry on EMR usability. I liked that idea going back to the mid-1990s, when vendors or users of character-based systems turned them into something that looked slick and brand new by using screen-scraping tools like Attachmate or Seagull to create GUIs that could even tie multiple applications together under the covers. It would be cool if a vendor app could provide functions and tags that would work like ColdFusion or PHP, giving users control of the display and maybe extending its functionality by doing lookups into other systems, links to Web content, or databases or running self-developed functions. Customizing screens, screen flow, and reports is most of what users want to change, not the underlying database or internals, so that would be powerful.

Speaking of MPages, I found this site, run by techies at UW, Stanford, and UAB, which is trying to build an open community of MPages developers.

From Josh: “Re: reusable components. I thought it was worth reiterating a point in your 5/6 update: ‘What healthcare needs are small, specialized systems that interact.’ This diametrically opposes the notion of ALL of the major HIS vendors to date. The idea of small, standards-based reusable components rather than monolithic, interconnected systems is called Service Oriented Architecture (SOA). There are a number of successes in other industries and the core notions (Enterprise Service Bus, Agile development, composite views, etc.) are readily understood in the software development community. What seems not to have been done is the transformation of provider requirements to force deconstruction of these systems. I’ve long been flabbergasted at the interface inflexibility in most commercial HIS offerings and the uselessness of data we generate in applications not intended by the designer. It’s time that the providers start dictating detailed requirements to our vendors – and SOA may be the mechanism to do that.” That is an interesting paradigm – CIOs have pushed the “off the shelf” idea to the point that prospects rarely put system design issues into their contracts, either accepting the product as-is or choosing a different one. When I worked for a vendor, I hated the idea that we couldn’t do something specific for a customer unless we rolled it into the base product, which either meant we had unhappy customers or a Frankensteinized product with a bunch of jerry-rigged bolt-ons added just to make some weird customer happy (usually one of our biggest customers, no surprise there, who bring both unreasonable influence and illogical processes to the table). I like where this discussion (and the one above) are going. If software could be customizable while remaining supportable, everyone wins.

I just posted a summary of the 2009 HIStalk reader survey. I didn’t e-mail blast it since not everyone cares about it, but if you’d like to know what readers suggested and what I think I can accomplish, check it out.

England’s Department of Health gives BT $150 million in advance payments despite what the Guardian says is “years of delays, system failures, and overspending …” and a temporary government ban on Cerner rollouts because of system problems.

I’ve hosted a visit by Traveling HIT Man, my new BFF (that’s him, helping me edit today’s post). He’s looking for the next stop on his HIT tour (see the pics of where he’s been), so if you’d like to have him come to your place, let me know and I’ll send him your way. 

HHS announces members chosen for the Health IT Policy Committee (advises ONCHIT on interoperability) and Health IT Standards Committee (advises ONCHIT on standards and certification). Both committees hold their first meetings this week in Washington.

Odd: two motorcycle riders in India, one of them a Dell software engineer, ride around pulling the scarves of girls for some reason. Locals caught them and beat up one of them, but the Dell guy escaped, only to be arrested later and charged with criminal intimidation and assault with the intent to outrage modesty. His punishment is to sweep the floors of a local hospital for one hour per day for a month.

Patient Safety Technologies, the sponge counting system company, names board chair Steven Kane as CEO following the pursuing of other interests of David Bruce, former president and CEO.

Cooper University Hospital (NJ) gets a local newspaper mention for going live on its $30 million Epic project.

The swine flu is coming and humanity will be wiped out! Old-timers have heard this before, in 1976, and we even had a vaccine then (although it had a couple of minor problems: it didn’t work and people who got it sometimes died. But hey, some people died who didn’t get it, so evidence is inconclusive.) Concerned Americans who heard about today’s crisis on celebrity gossip sites have responded to this serious risk to their health by drinking, speeding, smoking, having unprotected sex, chowing down on superhuman junk food portions, and taking a bottomless pharmacopeia of dangerous prescription and illicit drugs. 

President Ford — uhh, Obama — has a great health care plan, other than it will cost $1.5 trillion. I’ll let Sen. Ron Wyden of Oregon speak for me: “You go to a town meeting and people are talking about bailout fatigue. They like the president. They think he’s a straight shooter. But they are concerned about the amount of money that is heading out the door, and the debts their kids are going to have to absorb." The article wisely observes that “one person’s wasteful spending is someone else’s bread and butter,” saying that doctors, hospitals, and drug companies are going to raise holy hell about any attempt to pay them less, even for good reason.

Chinese hackers break into Cal-Berkeley’s health sciences servers, giving them access to the health data of 160,000 students and relatives. Nobody noticed for six months.

The UCLA Medical Center employee who pleaded guilty to selling celebrity medical records to the National Enquirer has died of breast cancer.

A university does the “buy some old drives from eBay and see what’s on them” test. What they found: Lockheed Martin ground-to-air missile plans and its personnel records, medical records, pictures of nursing home patients, correspondence from a Federal Reserve Board member about a $50 billion currency exchange, and security logs from the German Embassy in Paris.

Speaking of which, thanks to the reader who reminded Inga about the need for offsite PC backups (since my trusty USB hard drive sits two feet from the PC, giving it little chance of selective survival in a fire or disaster). I’m doing a 15-day free trial of Carbonite.

Here’s what I love about hospitals: a 17-year-old high school athlete goes to the ED of Kadlec Medical Center (WA) with a shortness of breath. She is correctly diagnosed by the ED staff as having a pulmonary embolism, almost unheard of in young, healthy patients. The next night was prom night, so the peds staff brought in her dressed-up boyfriend and classmates, made her up in her prom dress, took pictures, set up a CD player and disco ball in her prom-decorated room, and provided a candlelit dinner for the couple (with Jello for dessert, of course, since it’s a hospital). “We are totally blown away by what they did,” the mother said.

E-mail me.

Being John Glaser 5/5/09

One of the greatest inventions of all time is the three-by-five card. Compact. Sturdy. Lightweight. Portable. Blank on one side. Lines on the other side. The three-by-five card has many uses.

The three-by-five card is at the core of my efforts to organize my work life. This card lists those things that I need to pay attention to, or ask about, or do in the next one to two weeks. If you were to look at my three-by-five card today, what would you see?

• Budget. I think this entry is permanently on the card since it seems we are always dealing with the budget – putting it together or monitoring it. Our operating and capital budgets have to be flat next year. At this time, our managers are making good progress on achieving this target. But our hospitals are not finished with their budgets, so they may cycle back in the next couple of weeks and ask us to make further cuts. Terrific.
• COMPASS. COMPASS is the name for our major revenue cycle initiative. We are working with Siemens and Accenture to standardize our revenue cycle processes and data and implement the systems needed to support that standardization and improvements. Like the budget entry, COMPASS will be on my card for years to come. We are moving well. Good progress is being made on the Newton Wellesley Hospital (our first implementation) plans. Progress continues on developing the governance and new management models that are integral to the project and are a big change for our hospitals that are used to autonomy. And outreach efforts are doing a nice job of helping people understand the capabilities of the Soarian system and the new processes. As is true for any large project, there are always issues and challenges that need attention from time to time.
• NWT Frm. I have no idea what this means. I apparently had something in mind when I wrote this, but I have forgotten what it was. If I haven’t figured it out in two weeks, I will presume that I took care of it and cross it off the list.
• Clin Ops Agenda. Clinical Systems Operations is a meeting of several IT leaders who discuss major clinical systems issues and strategies. We have a meeting in a couple of weeks and I’m trying to line up the agenda. While still in flux, it looks like we’ll have discussions about (a) the effort required to close the gap between our current clinical system features and the features we think we will need to qualify for Stimulus financial incentives; (b) an overview of our strategy to enable medical record coders to code entirely from the EHR and not need to pull the paper record; and (c) a discussion of the project demands for our Clinical Data Repository team – we need to help them prioritize.
• Common clinicals. It is time to return to the strategic conversation of how common should our clinical systems be and, given whatever degree of commonness we choose, how should we go about making that plan happen? We last had this conversation three years ago. In many ways we are making good progress towards that goal of commonality – our EMR implementation will be completed this calendar year, progressive adoption of services (in the SOA sense) continues, and the Brigham and Mass General are working together on Acute Care Documentation (ACD). However, we need to step back and broadly consider our current approach, which is best characterized as incremental and progressive homogeneity. We need to frame some overarching questions that need to be addressed, e.g., should we view this as a catalyst for broad transformation of care at Partners or will we focus largely on reducing the complexity of our portfolio of clinical systems? And we need to define the process for answering those questions. While we need to return to this discussion, we have to moderate the pace. The Brigham and Mass General will be consumed by the ACD and Medication Administration projects for a couple of years and we need to be careful that we don’t unnecessarily distract those efforts. And in many ways, the COMPASS project is plowing the ground for are still under developed organizational prowess at broad standardization of data and processes.I expect that FY10 will be spent developing and revisiting our common clinical systems plans with execution of the resulting plans beginning in FY11.
• Staff e-mail. Every month I write an e-mail to the IS department. This e-mail is a combination of news, strategic outlook, and overview of major initiatives. I have been doing this for nine years. I need to write this month’s e-mail. I haven’t figured out a topic. Presumably having this entry on the card will lead to a burst of inspiration at some point.
• Agility. We had an IS team look at improving our agility. They did a great job and I want to implement a number of their recommendations and advance the work that they started. But I haven’t gotten to it. This line has been on my three-by-five card for a long time. I need to get off my butt and do something about it.
• Jess – yard. Our middle kid Jessica lives in a condo (two units total) with two buddies in South Boston. My wife and I own the condo – rent more or less equals mortgage payment. But this does mean we are landlords, and as landlords, we need to deal with the tiny back yard. The plan is to turn the back yard from a sea of mud and weeds into somewhere young ladies and their boyfriends (assuming they pass the background checks) can hang out. Some yard plans have been developed. I need to let Jessica know which one we will go with. I’m OK with putting in a patio. The water fountain that spouts a 20-foot tall “geyser” every hour on the hour will get wacked from the plan.

There are other items on the three-by-five card, but I have probably bored you by now.

For those of you who have yet to discover the three-by-five card, I encourage you to check it out. No batteries. No worries about an operating system crash. Easy to read. You can drop it down the stairs and it doesn’t break. And you don’t need to stay in the lines when you write on it.

John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

Monday Morning Update 5/4/09

From Deborah Kohn: “Re: Kaiser’s PDF formatted PHR. PDF Healthcare is a Best Practices Guide (BPG) and Implementation Guide (IG), published in 2008 by two standards development organizations (ASTM and AIIM). PDF Healthcare is not a vendor, product, or service, nor is it another standard. PDF Healthcare describes little known attributes of the Portable Document Format, an international, open, ISO-ratified and published standard that is freely viewable on almost every laptop/desktop around the world, to facilitate the capture, exchange, preservation, and protection of health information, including but not limited to personal, handwritten documents, structured or unstructured clinical notes, structured laboratory test result reports, (unstructured) word processed reports, electronic forms, scanned document images, digital diagnostic images, photographs, and signal tracings. Until members of the PDF Healthcare Committee were told by HIMSS09 staff members that as an ‘unsanctioned HIMSS09 event’ our PDF Healthcare demonstration in the Hyatt Hotel McCormick Place had to ‘cease and desist’, PDF Healthcare was successfully demonstrated to an enthusiastic audience. One demonstration showed how clinicians in Southern California securely exchange patient health information with only a 3G phone, encrypted USB drive, and a printer.” I found the above participant slide on the AIIM site, so maybe someone can chime in as to whether it’s going anywhere.

It really bugs me that HIMSS locks up every possible meeting venue so that nobody can do anything without HIMSS approval anywhere near the conference site, the one time a year where people can connect without add-on travel costs (I’m pretty sure the most interesting events would be unsanctioned). I still say there needs to be a conference designed for the benefit of attendees, not exhibitors, with more and better educational sessions that are cutting edge, not submitted a year in advance with occasional unvetted conflicts of interest. A non-profit or small company shouldn’t have to spend GE-like dollars just to get a once-a-year audience in Neon Gulch.

From Curiously Underfunded: “Re: stimulus. Does anyone know how the physicians will go about collecting the stimulus funds? I keep reading about the qualifications, etc. but have not been able to find anything about how to apply!”

Jon Manis, CIO of Sutter Health, posted a comment in the HIStalk Forum about its Epic project. Not to be outdone, Neal Patterson (or so he says) posted the full text of Jon’s e-mail to staff (thanks to the readers who sent a copy of the e-mail to me as well). The original post by Francisco Respighi was a bit more speculative, inferring mass layoffs, which may or may not be the case. None of this is to cast judgment on Sutter, of course, but to call attention to what’s going on in the industry in general. Sutter has to run like a business, so if they are forced to make tough decisions that change long-term plans, then they probably aren’t the only one.

Speaking of Sutter, it signs a contract for Ingenix Impact Intelligence, giving doctors in the Sutter network access to metrics, utilization, and disease management information.

EHRtv posts its HIMSS interview with Jonathan Bush, conducted at the HIStalk reception. I’m really impressed with the video quality of what Dr. Eric Fishman has put together – it’s like watching TV, complete with high-quality titles, transitions, and great audio. Many people think YouTube is the standard for Internet video, not realizing how bad their proprietary compression and streaming technologies are (great for putting up cell phone video of a dog chasing its tail, but not great for anything you want to watch or listen to for more than 60 seconds). Some others of the many interviews he’s posted: David Winn of e-MDs, Tee Green of Greenway, and former Congressman Richard Gephardt. It’s really interesting to see and hear these folks directly. I saw Dr. Eric and he was working his butt off at HIMSS, seemingly everywhere with his camera crew. I think EHRtv is brilliant. I keep bugging him about how it works technically, so he’s probably pegged me as a fanboy stalker.

Thanks to everyone who completed my reader survey. I’ve already got a to-do list of reader-stimulated ideas that I’ll be putting in place. One expressed concern that the survey implied big HIStalk changes, even though it’s the same old survey I’ve been using for years. Not so — I’m not looking for new sponsors, planning to make any part of HIStalk a fee-based subscription, or adding new kinds of advertising (to answer specific speculation). I’ve been extremely fortunate that companies e-mail me saying they are interested in sponsoring, I e-mail back a rather primitive information sheet on page views and all that, and they either sign up or I never hear from them again. Probably 90% of those who get involved do so simply because they derive value from reading HIStalk and want to give something back (I know that sounds hokey, but I’m happy to report it’s absolutely true). Anyway, if you like HIStalk in its decidedly amateurish form, you will be pleased to know it’s not going to get any slicker (but you will like a few tweaks that were suggested, I think). I sent Inga the results Friday evening and got her “wow, they really like me!” reply minutes later, so she’s happy she scored well in the “what parts of HIStalk do you like” question (I rated her highly myself). And the question that had us both preening: “Over the past year, reading HIStalk has helped me perform my job better.” Those answering yes: 79%. That’s the ultimate metric and I’m really proud of it.

One other item from the survey. I’m surprised at how many industry newcomers read HIStalk to learn about healthcare IT (a third of readers have been in HIT for less than 10 years). I’m going to do whatever I can to better serve that audience. Some folks said they are ashamed to admit that they don’t know some of the acronyms or products I mention, while others said they would find great value in having HIStalk content segregated by topic (so if you wanted to see everything about Cerner, for instance, you could look in one place). I don’t know where I’ll find the time, but I may try to put together something like that in some kind of encyclopedic format, maybe with reader contributions (that screams Wiki, doesn’t it?)

People have asked about being able to view article comments easier. Options:

1. Click the Show Comments link at the bottom of an article to display the comments posted for it.
2. The Recent Comments list in the right column shows the most recent commenters and which post they commented on.
3. I just added a new Comments Page that shows the first few lines of the 30 most recently posted comments. If you see one you like, you can click the title to jump to the article, or click the commenter’s name (below the blue box) to jump directly to that comment (this is a new WordPress plugin that I installed to try to address the reader’s comment question).

Picis is offering a free Webinar called Best Practices to Help Improve Clinical and Financial Performance in the ED on May 12.

The local paper covers the ED computerization of A.O. Fox Memorial Hospital (NY). It’s McKesson, I believe.

Most of you (60%) don’t know or don’t care about Oracle’s acquisition of Sun, according to the last poll I ran. It will be a good thing for HIT, said 22% of respondents, while 18% said it will be bad. New poll to your right: if you are in hospital management, is the financial mood better or worse than it was in early winter when both the economy and the weather were bleak? Some say it’s looking up in general, so I’m interested in what’s going on at your place.

Someone posted a YouTube video of a demo of Cerner PowerChart using MPages at Lucile Packard Children’s Hospital at Stanford. MPages allow creating scripts or Web pages (including AJAX apps) that launch from tabs on the Millennium application screens. It’s pretty cool to see information widgets being dragged and dropped to create a custom Web page like iGoogle.

On HIStalk Practice: Dr. Lyle on information overload, Dr. Gregg Alexander on the creatively maladjusted, and our usual medical practice-related news and snark. If you want to be a guest author, either one-time or ongoing, let me know.

Markle Foundation releases its report (warning: PDF) on “meaningful use” and “certified or qualified” EHRs. Its seven principles: clear metrics are needed; use of information and not software alone should be the goal; use of existing electronic information such as medication lists and lab results should be rewarded first; ambitious goals should be phased in; EHR certification must include capability to achieve meaningful use and to also address security and privacy; ARRA support should include lightweight, network-enabled systems and not just big iron EMRs; and patients and families should be able to put their EHR information in whatever personal health record system they like. A bit different from the HIMSS “buy more stuff” approach, although both emphasized outcome metrics. The gripe with both: representation was heaviest from vendors and high-profile nonprofits whose people have the time to spend on non-revenue generating activities (unlike the average small-practice doc who’s trying to survive and, despite the preponderance of healthcare they deliver, who is also minimally represented by all these thought leader think tanks proposing their future).

Jay Parkinson gets more press than anybody else who’s running a three-doctor practice for primarily healthy, young, cash-paying patients, so it’s not surprising that Newsweek picks up his story, complete with the requisite hipster fawning (although at least omitting the usual GQ-like stubble-and-black-pants photo shoot), but also pointing out that his radical model benefits himself as a capitalist more than society in general. He follows the usual script, bashing insurance companies, EMR vendors, “old people” (meaning anyone on the wrong side of 40, apparently), and anyone who doesn’t spend their day on Facebook (“We’re starting with those who get it. Facebook started in 2004 at Harvard. It wouldn’t have started with old people. But you know what sucks? Now your mom is friending you.”) You know what sucks? Having a problem like a heart attack or chronic illness and learning that your franchised 2.0 photogenic IM-and-Facebook doctor doesn’t want anything to do with you. That’s where most of the value (and expense) of the healthcare system exists, not in having someone willing to bike over to your loft to prescribe sore throat ampicillin before your midnight poetry reading.

Hospital layoffs: Metrohealth Medical Center (OH), 270, Reading Hospital (PA), 106.

The former IT director of a Houston non-profit organ donation center pleads guilty to deleting its electronic data (including backups) after she was fired in 2005. She’s facing up to 10 years in jail.

Where will this fit in the PHR and financial responsibility market? Quicken Health Expense Tracker, a free, Web-based tool available for customers of a few insurance companies.

Number of hits Googling “swine flu”: 263 million. Number of deaths of US citizens from it: zero. Value to TV stations, newspapers, and J&J, the makers of Purell: priceless.

EMR vendor MedLink International says it has signed a deal with CBS Radio to develop what it seems to think will be a WebMD competitor, a revenue sharing portal tied to six New York affiliates of CBS (formerly Infinity Broadcasting, currently in near-collapse after Howard Stern left for Sirius). Unlikely. In the mean time, the one to beat might be Everyday Health, a mashup of several other sites that bought Revolution Health’s old site and draws more traffic than WebMD.

Odd: an illegal alien who gave up custody of her severely brain-damaged four-year-old daughter while fighting a drug charge and being evicted for not paying rent is fighting deportation and trying to regain custody. The daughter is a citizen since she was born here; at stake is the potential multi-million dollar proceeds of a lawsuit against Vanderbilt University Medical Center, which the mother claims caused her daughter’s problems by puncturing a vein.

E-mail me.

CIO Unplugged – 5/1/09

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Do You Have What it Takes?
By Ed Marx

I landed on the bottom of the ocean, staring up at the surface. Before I could process what happened to me, I was ripped out into the watery abyss. I paddled toward the light, broke through, and gasped for breath. Only seconds before, I’d been standing high upon a rocky outcropping along Kauai’s Na Pali coast

Spring Break of ’88 began well. Free tickets to Kauai to visit my in-laws and introduce them to our baby boy. During his grandparent cuddle time, my wife and I made our way down Kauai’s north shore to get an intimate look at the magnificent Pacific. We took advantage of a photo op before heading back up the lone path. I stood at the edge of the rock several meters above the ocean surf. I smiled, said “cheese,” and a second later, we were both overcome by a wave that took me out to sea.

Bloody knees, winter surf, rocky shoreline, I was in danger. Swimming parallel to the shore while outmaneuvering the breakers was not easy. Pummeling waves and the force of the undertow zapped my energy. I was scared. Gradually working my way closer to shore, I prayed the waves would not crush me against a wall of boulders lining the island. Three to four people met death that way every winter on Kauai. After much prayer, my feet touched solid ground. I scrambled up cliffs before the tide reclaimed me.

Although I’m an active tri-athlete, I’ve purposefully avoided the ocean. I’ve tackled lakes and rivers but never the open sea. I’m still afraid. Then an opportunity opened up for me to race in one of the sports foremost events, Escape from Alcatraz. I considered passing it up but instead said yes. If I didn’t face my fear, it would own me. On June 16, I hope to make swim way across the San Francisco Bay, avoiding all sharks and undertows.

I once feared public speaking, too. Now I love it. Despite a familiar nervousness that arises before each gig, I press on. To practice and hone the skill, I now look for speaking opportunities.

I feared challenging business peers, respectfully, of course. After I overcame that, I conquered a fear of challenging my managers. Iron sharpens iron, as they say. We experience growth by pushing each other onward toward a greater purpose.

Many who feel “stuck” in their careers are likely limiting themselves out of fear. Are you afraid to rock the boat? Do you comply dutifully with every request even though you know a better way? One way to accelerate your career is to continually pursue growth; second, is a willingness to combat fears—not letting the own you.

Do you fear getting fired for speaking up? How about being wrong or laughed at? I’ve been there, too. Others fear success and the additional performance expectations that come with it. Embrace your fears. Confront them. Then experience freedom.

One of my present fears is dancing an entire song with our Argentine Tango instructor. I can handle learning an individual move, but the pressure of a complete dance with an expert just kills me. I sweat. I forget how to speak. I even forget the move we just learned. But I’m smart enough to understand that unless I tackle this head on, my skills will not grow beyond what I know today. And that is unacceptable. I won’t tolerate complacency. You shouldn’t either.

Reflect and write down your fears. Be brutally honest with yourself. Then attack them one-by-one, with purpose. You will be amazed at the results. And I’ll bet you’ll find you’re not alone. Not only will you grow, but so will your family and employer.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

Readers Write 4/30/09

Submit your article of up to 500 words in length, subject to editing for clarity and brevity. I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Note to the US Healthcare System: Treat Me Like a Dog
By Peter Longo

I think everyone knows the US healthcare delivery system seems to have more challenges than solutions. From my vantage point, working in healthcare technology,I sometimes wonder if we can ever put all the crazy puzzle pieces together. I never thought that one day, soon after a long overdue physical and a trip to my dog’s vet, I would deem it in so need of repair that I begged to be treated like a dog.

Recently my beloved dog Hamlin’s digestive system grew tired of his “Cowboy Chow” dog food. Without a moment’s notice, my wife quickly went out and purchased him three other kinds to choose from. (I wonder if tonight I complain about dinner, will my wife run out to three different restaurants and find me something I prefer?)

Even the newly purveyed dog food did not settle Hamlin’s stomach. My wife, busy escorting three kids about town, informed me I had to take him to the vet. Since I work for a healthcare technology firm, I assumed going to a doggy doctor would be fun and enlightening; a respite from seeing human hospitals and doctor offices.

Hamlin and I eagerly pranced into the office with me ready for the inevitable “doctor wait”. Interestingly enough, I was greeted at the counter by a smiling receptionist calling out Hamlin’s name. But of course, they were expecting him because he had an appointment! Wow, novel concept here I thought.

Next I had my wallet out, ready to be accosted for money before I could even get a quick question in. Before I could eject my credit card, the side door opened and a smiling “nurse” asked Hamlin to come this way. (I assumed they were smiling because they were going to make a fortune out of me). Guarding my wallet, I followed our escort down the hall. I was still dazed from the fact they were expecting us and recognized Hamlin.

As we entered our exam room, I was perplexed to see a shiny new notebook computer on display. Before I could gasp in shock, the vet walked up behind me, introduced himself to Hamlin (the patient) first, then to me. Casually, he turned toward his shiny new laptop and within two key strokes had Hamlin’s medical record on the screen. My dog’s entire record. Looking like the complete geek that I am, I jumped at the vet asking to see everything on the system.

Eyeing me as though I might be in need of medical help myself, he leaned back to show me Hamlin’s electronic medical record. His life history, his owners, where he was born, any past medications he had, everything. Even his lab results were in there. The polite but guarded vet then showed me three other exam rooms, all equipped with shiny new laptops, all with Hamlin’s record available on them.

After a quick and thorough exam, the vet punched a few more keystrokes. He electronically ordered various lab tests — right then and there! I asked him about the firm that performs the tests and he told me the lab he uses provides great service and is top notch. He said the lab results will be sent back electronically and into Hamlin’s file directly! (In a moment of serendipity, I later discovered it was my company’s software providing the lab with the tools to accomplish this small miracle).

As I left the room and approached the front counter, a nurse had a prescription waiting for me along with three cans of super special dog food. Now I was really confused — is it not the patient’s job to walk the prescription and files to the front counter? Did my paper shuffling job just get outsourced to a computer? Adding to staff’s perception of my total geekiness, I asked how she did that. With a slight chuckle, she showed me the computer screen where the doctor requested it from the exam room. It just angered me to see such efficiency. I know my kids feel Hamlin deserves only the best, but better healthcare service than me? Adding injury to insult, I paid only $55 for the visit.

Hamlin’s enlightening experience really made me think of my own recent medical episode. A few weeks earlier, I went to my annual check-up. I scheduled the appointment and diligently showed up on time. As I checked in to see my doctor, one hand shoved a clipboard in my face, while a second hand went for my wallet. No verbal communication yet. Even though Hamlin theoretically can’t speak, he was treated to verbal communication and a custom greeting. I then proceeded to brush up on pop culture in a six-month-old People Magazine (I did not know Britney had a second baby and broke up with K-Fed?) while waiting 27 minutes for my appointment. If only someone told me how long my wait would be — but hey, that would take the fun out of guessing when I would be home.

I finally entered my exam room to be greeted by a nurse,a sheet of blank paper and a $.25 pen. She took my vitals. Later, my doctor sashayed in with that same high tech paper but a more expensive pen (with a drug company’s name on it) to drill me further. As all checked out fine, he indicated he needed some lab work to complete the exam. Amongst some forms floating on a table (uncomfortably near my half-clothed rear end) he found an order sheet. He checked a few things here and a couple things there then gave me the nod to transport the paper across the hall; then my lab orders and I waited some 18 minutes more.

A couple of weeks after my exam, I received my lab results “in the mail.” Next to each test result, the doc was kind enough to scribble an “OK.” Then a nice hand-written note claiming, “All looks OK, see you next year.” I put that report in a sophisticated manila folder and filed it. Why did I have to have this manual, impersonal, medical experience right before my vet visit?

Dazed and confused after leaving the vet, I wandered back to our house. Upon opening the door, my three kids showered Hamlin with love. They rubbed his back, gave him endless kisses and asked him easy softball questions. “Have you been a good boy?” My wife brought over doggie treats and “king” Hamlin relaxed on his back as the kids indulged him full of treats. My life quickly went to the store to find him “the best food money can buy.”

I was left standing at the door waiting to even be recognized. I sure did not get any kisses, let alone a back rub. I put myself on the couch and wondered if anyone was going to fetch me a treat. I would have been happy if one of my three kids just pushed the remote closer. As I stared at a blank TV screen, it dawned on me … I really need to be treated more like a dog.

News 4/29/09

From Ralph Curmudgeon: “Re: Kaiser’s flash drive PHR. Kaiser’s offer of the flash drive has the same inherent problems as shoving a stack of papers and an x-ray folder in the patient’s hands. Unless the drive is encrypted and the patients have the computer skills to use it, it’s effectively worthless. Besides, I’ll wager >50% of them end up getting lost – just like the paper records. The average Joe and Jane out there – particularly the elder ones – aren’t ready to haul around electronic records in the pocket or purse – heck, they can hardly understand their treatment bill. Now injecting them with a re-programmable chip in their upper back – like Rover – that’ll work.”

From The PACS Designer: “Re: Seesmic/TweetDeck. As Twitter gains more popularity, there are enhanced free applications that will manage all your Twitter favorites and also allow you to manage photos and videos to give you a ‘video Twitter’. One of them is Seesmic, created by a French company, which competes with another application called TweetDeck. TweetDeck has had some memory leak problems that are now supposedly fixed according to Adobe, so Seesmic appears to be the better choice to track Mr. H’s, the Candid CIO’s, and Labsoftnews’s Twitter posts along with others.” Link. At the risk of sounding tragically un-hip, I have to admit that I’m already sick of Twitter even though I do basically nothing with it. At least blogs required minimal effort to actually write and post the usual vapid, dull comments. Twitter makes it easy for Twits to expel a never-ending, 140-character flatus stream of “what I’m doing right now” self-indulgent babbling (as long as the activity allows keeping at least one hand on the keyboard) that puzzlingly finds an audience of people willing to read it. People complain that they have no free time, yet they apparently use what they do have screwing around with World Wide Waste of Time applications that provide the illusion of usefulness.

From Leon Poncey: “Re: cyber-attack. Thought this might be interesting to HIStalk readers.” Link. An interesting recap of an incident in California where unidentified individuals crawled into several manholes (they’re never locked, of course) and cut eight fiber cables, causing a loss of 911 service, cell signal, landline telephone, broadband, alarms, ATMs, credit card terminals, utility monitoring applications, and the hospital’s internal network (which apparently had some unexpected dependencies). Repercussions were fascinating: the hospital went to paper, stores accepted only cash, and employees were sent home. The only technology that worked was one of the oldest and least sexy: ham radio (I can say that because, being a nerd, I will admit that I was once a ham radio operator, at least until I noticed that it was like Twitter: the technology was ample to interconnect people from all over the world, but the people using it invalidated the entire premise because they had nothing interesting to say).
 
From Alter Ego: “Re: Halamka’s blog. I think he’s getting a bit egocentric, kind of full of himself. Does anyone really need to know about the details of his work spaces?” I already assumed he was full of himself, although I don’t know him. I actually kind of enjoyed the post that has pics of his digs at Harvard, BIDMC, and his home office, which is just a chair and a MacBook Air (I certainly enjoyed that post more than those Zen ones where he gets all moist talking about some bizarre flute he has dedicated his life to playing, his tea ceremonies, or climbing rocks). And, I have to defend us bloggers since there’s always some reader who launches ballistically when a couple of sentences didn’t hit his or her interests precisely. I get an e-mail something like this: “Oh my GOD I don’t read HIStalk to get (humor, music recommendations, guest articles, etc.) and I want the time back that it took me to read (the three sentences out of hundreds). Stick to the facts and leave that to the professionals (comedians, music critics, professional writers, etc.)” Apparently just skipping over those few words is too much of a challenge compared to writing out a complaint, so I have no idea how those folks can read a newspaper (“Oh my GOD I don’t follow stocks so please stop running that crap and stick with the sports and leave the investment talk to stockbrokers”). If Halamka wants to write about tooting his flute, then that’s his right, and anyone who can’t stand that should probably just read the personality-free trade rags.

From Deborah Kohn: “Re: HIPAA. I completely agree with your reply. Just a history reminder of this complex law. Prior to 1996, the public was demanding two things: 1) greater portability of health insurance between jobs, and 2) confidentiality protection of personal information and privacy protection of the individual – with a focus on health information. Consequently, the 1996 Kennedy Kassebaum Bill (K-2) or Public Law 104-191 or the Health Insurance Portability and Accountability Act (HIPAA) (and, given the 2009 ARRA HITECH Act, this 1996 law could be viewed as version 1.0 or 1.a), was introduced with the following legislative goals: Title I – Portability, which contains only one major component — ensuring that individuals between jobs are able to carry their health coverage forward or obtain similar coverage. Title II – Administrative Simplification, which contains four major components, which are the most publicized: 1) Unique Identifiers (for Employers, Health Plans, Health Providers, and Individuals); 2) Electronic Data Interchange and Coding Standards (the Transaction Set and the Code Set); 3) the Confidentiality and Privacy Standards for analog and digital records / documents (the Minimal Disclosure of Individually-Identifiable Health Information, the Control Over Sharing this Information with Outside Entities, and the Ability of Patients to View Their Information and Receive a Record of Access to Their Information); and 4) the Security Standards for digital records / documents (the Administrative, Physical and Technical Safeguards).”

The last plea of this particular telethon: if you haven’t completed my reader survey, would you? I’m already making my to-do list from the responses so far, but it’s not too late to register yours.

Not willing to take the chance that the government will define “meaningful use” of EHRs in a way it doesn’t like, HIMSS goes ahead and preemptively makes up its own definition and sends it off to CMS and ONCHIT for what they hope is rubber stamping. Its recommendations:

• Name CCHIT to be the EHR certifying body (no surprise there).
• Adopt interoperability per the specs of HITSP and IHE.
• Implement increasingly stringent metrics. For hospital systems, HIMSS wants metrics to be ratcheted down no less often than every two years to allow “health IT companies to make necessary modifications to their products, including the rewrite of legacy enterprise EMRs as necessary.” (Question 1: what enterprise EMRs are not legacy? Question 2: does anyone really expect products to be rewritten?)
• Evaluate best-of-breed and open source technologies fairly in their demonstration of meaningful use (note that HIMSS throws in a half-hearted but still eyebrow-raising acknowledgment that free software that competes with the products of its vendor members, saying “use of open source options can be cost-effective for some hospitals.”)
• For the first two-year phase (FY11), measures include use of lab, pharmacy, and radiology systems, along with a CDR (interfaced to “the patient accounting system” for some reason). Discrete clinical observations (allergies, problem list, vitals, I&O, flowsheets, meds) are recorded electronically, but electronic physician documentation is not required. Auto-capture of NQF quality measures is required. Hospitals exchange electronic information, but it can be in the form of scanned documents.
• For the second phase (FY13), 51% of orders must be entered by CPOE, e-prescribing to outside pharmacies must be in place, and systems follow whatever data output standards HITSP and IHE devise.
• For the third phase (FY15), CPOE goes to 85%, bedside eMAR/barcode verification is in place, evidence-based order sets and reminders are in use, and information exchange is underway with public health organizations and subunits of a statewide or national exchange. There’s a line about analyzing “pharmacokinetic outcomes resulting from patient medication interaction” that makes no sense to me.
• Most of the practice-based EMR recommendations are similar: clinical data display with CPOE capability and doctors entering their own orders, e-prescribing, and quality measures, followed by clinical decision support and interoperability.

My opinion: a pretty nice job. The standards are straightforward and measurable, although the practice EMR document doesn’t get specific about physician usage percentages like the hospital one does. It looks to me like they basically took the HIMSS Analytics EMR Adoption Model and made Stage 3 (minus the diagnostic imaging requirement) the first phase and Stage 5 the second (along with part of Stage 7 – capturing data in CCD format). Fairly ambitious, but it may go back to Obama’s early question about “what would it cost to get all hospitals to Stage 4”.

Microsoft creates a version of its Amalga data analysis tool for life sciences. They claim it connects information in ways that allow researchers to make new discoveries.

Cerner just announced Q1 numbers: revenue up 2%, adjusted EPS $0.52 vs. $0.47, beating estimates of $0.51 by the usual Cerner penny (but light on revenue, so shares are pricing down). Nobody I know is buying Cerner systems, but they are managing their business with great skill, working the recurring revenue stream and managing expenses to keep Wall Street happy. 

UK’s NHS threatens to give BT and CSC the boot if they can’t get their Cerner and iSoft systems, respectively, up and running in at least one large hospital by November.

Joel Selanikio of Georgetown University (and of his own company, DataDyne) wins a $100,000 Lemelson-MIT Award for Sustainability for developing the open source EpiSurveyor mobile healthcare survey software.

Continua Health Alliance wins the American Telemedicine Association’s award for innovation. The ubiquitous John Halamka’s quoted congratulations on behalf of HITSP are included for some reason.

Palomar Pomerado Health is offering, without a prescription, the personal genetic testing kits of Google-backed 23andMe.

Southeastern Regional Medical Center (NC) promotes Eric Harper to CIO.

Sutter Health is reluctantly turning Marin General Hospital (CA) back over to the county next summer, so that means it will need new information systems. ACS gets a $55 million contract to install McKesson Paragon and support it through 2017. Former El Camino Hospital CEO Lee Domanico is running the transition team that will take over. The hospital originally said it couldn’t afford to pay him more than $264K, but he will make up to $779K a year under his two-year contract signed in January, a large pile of money for running a 235-bed hospital.

The University of Nebraska and the technology transfer organization of its medical center are suing Siemens Healthcare Diagnostics for patent infringement, claiming that Dade Behring knowingly sold laboratory testing systems that used technology the university had patented and licensed exclusively to Abbott Laboratories. Siemens AG bought Dade Behring in 2007.

Kathleen Sebelius is confirmed to become HHS secretary, but none of HHS’s 18 other key positions have been filled. I want Obama to succeed, but so far he’s just a cooler version of Jimmy Carter – lots of lofty goals, but incompetent when it comes to execution (how many times has he apologized for one gaffe or another in just his first 100 days or so?) Anyway, she’s in, but without a team.

A new study published in Archives of Internal Medicine found that computerized medication reconciliation reduced medication errors by 28%.

Total margins for Pennsylvania’s hospitals have dropped 12% in the past two years to –6.3% due to portfolio losses and more uninsured patients.

E-mail me.

HERtalk by Inga

From Old Coot: “Re: John Wennberg. ‘Too much acute care today/wasted money spent at end of life – need to redirect those resources to community health initiatives.’ In other words, let the old folks die off peacefully – and quickly – and spend more money handing out condoms to kids who won’t use them. Wennberg, who is no spring chicken, better watch out. His kids will be slipping that potassium chloride mickey into his Metamucil one evening. I wonder how Wennberg’s parents are doing these days . . ."

From Hair on Fire: "Re: insecurity. Glad you got back at Mr. HIStalk for his snarky comments about your insecurity (or was it his?) with your comment about the Code Blue band :> We chicks need to stick up for ourselves – and one another!” Thanks for the chick support. However, Mr. H created his comments  after mine, so I didn’t really have a chance to get back to him, although I did chastise him for letting the world know I was insecure (am I insecure about that?) The secret is now out. Will the adoring fans be disillusioned?

From John d’Glasier: "Re: Twitter. Doonesbury says it all: Tweets for twits. Twitter is adolescent narcissism.You can’t possibly said anything worth reading in 140 characters unless you believe American Idol, Survivor, and Are You Smarter Than a 5th Grader? represents the zenith of American entertainment – preparing you well for pop culture acceptance of anything without meaning, gravity, or importance." Here’s the strip. I was totally with you, John, right until the subtle slam on American Idol, which happens to represent the most entertaining three hours of my week (after reading Mr. H’s posts, of course.)

From Lucy Padovan: "Re: shoes. At the height of the dot-com era, some well-meaning but alcohol-befuddled colleagues thought I should be nicknamed e-babe, odd since I’ve never bought or sold anything on eBay in my life. Nonetheless, a friend sent this link to me and I wanted to pass it on. This is just shoe lover to shoe lover." What is there not to love about sexy crocodile pumps that retail for $2,650 that you can steal for a mere $630?

Clara Maass Medical Center (NH) successfully implements Axolotl’s Elysium Exchange, enabling ER, inpatient, and outpatient records to be shared electronically across the health system.

I have enjoyed reading the various posts about fancy hospital building, bloated budgets, etc. Here is my two cents. I visited a friend once who was at MD Anderson. If one day (God forbid) I wind up with cancer, MD Anderson is where I want to go. It felt comforting, current, and everyone was efficient, friendly, and supportive. The pretty building made a difference. Another time during my traveling days, I had the unlucky chance to spend the night at a hospital in a major city. At the time I didn’t know this, but it this hospital is considered one of the best in the country for the type of emergency I was experiencing. While the staff was great, the hospital itself was old and tired-looking and my room was dreary. I actually knew enough about healthcare to understand that such things don’t affect the quality of care, but, the lack of aesthetics didn’t aid my overall comfort level. So I am of the mindset that if someone wants to donate millions on pretty buildings, I’d like to say "thank you" on behalf of all of us average patients who rather be sick in an attractive facility.

United Hospital System (WI) selects Eclipsys Sunrise Enterprise clinical solutions for its multiple hospitals and clinics.

Medfusion names Bill Loconzolo chief technology officer. Medfusion provides online communication tools for healthcare practices.

A Nobel Prize winner finds the top five mood-lifting activities for women are: sex, socializing, relaxing, praying or meditating, and eating. (No mention here if the Nobel Prize person is a man who believes in the power of suggestion, but it’s not a bad guess.) Exercising and watching television followed closely. Near the bottom of the list were cooking, “(day-to-day) taking care of my children,” and housework. If you are in need of advice on how to be happy, Dr. Lobe has some tips for you. And if you are a woman, let me know how well these these five activities are working to increase the joy in your life.

Hard to miss finding information on swine flu, especially with all the tweets, podcasts, and up to the minute postings by the CDC/HHS, WHO, and every news agency out there. Personally I prefer the Google map that displays confirmed outbreaks by location (helpful for planning my next vacation.)

MED3000 gets a mention in a Wall Street Journal article that looks at various tactics by employers and insurers to motivate people to make healthier choices. Money, by the way, seems to be a good incentive.

Picis announces that the VA has selected Picis Critical Care Manager for its Veterans Integrated Service Network 12, aka the Great Lakes Health Care System.

Let’s hope that the US health crisis never gets this bad. A Japanese woman with headaches during labor is turned down by 18 hospitals that refused to accept her due to overcrowding or overly busy doctors. She had a brain hemorrhage and went into a coma, but a hospital that finally accepted her delivered the baby by Caesarean before she died eight days later. The Japanese ER crisis is blamed on a number of factors, including the aging of the population, economics pressures, and professional and legal issues. ER doctors are overworked, poorly compensated, and risk criminal prosecution (not civil) over malpractice issues. The government estimates that currently Japan has half the number of ER doctors required to serve the population (about 2,500 to serve 127 million people.)

E-mail Inga.

Monday Morning Update 4/27/09

From 13th Floor Elevators: “Re: traffic tickets covered by HIPAA. The clerk must have consulted our hospital’s HIPAA officer, who says employees who have babies can’t use hospital e-mail to tell their colleagues as it would be a HIPAA violation. This HIPAA thing needs a lot of rework. And, when was the last time you heard anything about the ‘portability’ in HIPAA?” HIPAA was a pretty good 1.0 effort, but it’s hopelessly outdated, seldom enforced, and watered down by special interests. Pre-Internet privacy laws and information systems are relics that really should be rewritten. As for portability, I don’t see much improvement, especially if you have a pre-existing condition (does “pre-existing” mean before you were born?)

From KitKat: “Re: MD Anderson Cancer Center. Layoffs Monday, with 16 anesthesiologists getting the pink slip.” MDA is looking for $280 million in budget cuts and will start cutting employees within a month. The best thing about the article was this reader comment: “I’m STILL trying to figure out why the new buildings at MD Anderson had to be so over the top lavish; almost like a shrine to cancer.” It’s not just MD Anderson. Lots of hospital executives I’ve known love building fancy structures as a substitute for the imaginary careers they gave up in private industry, always daydreaming that they would be running big for-profit businesses and flying around in corporate jets if they weren’t so selfless. It’s always rationalized that the community wants those magnificent edifices, despite the evidence that suggests what the community really wants is easier hospital parking, reasonable rates, a chance to get in and out of the ED without taking six hours, and interacting with employees who at least pretend to be empathetic. Unfortunately, those big buildings seem to make all of those attributes worse. I would trade all that architecture for a couple of good nurses (especially since you can’t see that imposing facade from your room anyway). Like financial institutions, when you’re selling an intangible, you have to convince customers that it’s real by spiffing up the storefront.

That reminds me of that consumer survey early in the stimulus talks about where they wanted to see healthcare money spent. IT was dead last. Fancy buildings would probably have been there, too, if respondents were asked to rate their importance. So why don’t we give our customers what they want instead of what we think is good for them? Maybe that’s more of that good old paternalism, where you just tell the patient not to worry their pretty little heads because the doctor knows best. You and I are healthcare consumers and patients, so if asked what we would really like to see changed, I bet it would be the easy stuff like what I mentioned above and not buying new IT systems. We want to be respected, informed, consulted. We don’t want to be inconvenienced, harmed by medical error, or infected. We would like to be able to afford the care we need. If IT (and those fancy buildings) can do any or all of those things, consumers will love it, but just having the IT without delivering the results won’t impress anyone except nerds.

 

I think I need to write a novel since I have this great story idea stuck in my head. Here it is. A fictional foreign industrial conglomerate, despite a generations-long history of shameful behavior (using death camp labor, bribing prospects to get business going back 100 years) wins a huge government contract. Champagne corks are popped back in the home office, stiff executives clumsily attempt fist bumps. Now comes the key scene: at that moment, dozens of unsmiling federal agents crash through the office door, armed with search warrants and evidence boxes. The big government contract had been a sting operation! The conglomerate has been caught red-handed after decades of improper government contracting! I’m trying to decide whether to portray the company’s competitors has having set up the sting, but I need to give that more thought. I’m picturing Dennis Quaid as the humorless government agency head, Maureen McCormick as his love interest, and maybe Rod Blagojevich in his big-screen debut as the conglomerate’s ranking executive. I dunno … not very believable, I guess.

The new BusinessWeek says EMRs may be a waste of government money in The Dubious Promise of Digital Medicine. Points: evidence that EMRs improve patient safety is scant, vendors like selling off-the-shelf systems that are hard to implement and maintain, and HIT special interests have kept government oversight to a minimum. Individuals are called out: Newt Gingrich for playing a heartfelt futurist when he’s getting paid by vendors, Nancy DeParle for having high-dollar Cerner connections, Glen Tullman for working his Obama connection, and McKesson’s lobbyists pushing policy ideas on members of Congress and of the Administration to reward clients for using their aging systems. Several negative hospital EMR experiences are cited. Also mentioned: vendors are pushing for CCHIT as the certifying body, knowing that a group led by a former vendor executive and started by HIMSS will provide a friendlier audience than FDA. OK, the article is all over the place and certainly sought out whatever high-profile negative stories it could come up with, quoting only those who had a bad EMR experience (who never blame their own organizations for choosing or implementing it poorly, of course – everything is the vendor’s fault). Worth a read, but only because lots of people will see it. Its conclusion, however, is entirely reasonable: we’re spending billions on systems developed even before the Bush administration (HW, not Shrub) that haven’t exactly lit healthcare on fire so far. As a taxpayer, you’re taking a bet with billions that a prudent gambler wouldn’t. Water under the bridge, though, so there’s no point pontificating about it now.

Is Apple developing a Mac Tablet and would it be a great platform for EMRs? Good article, good reader comments.

An interesting article on 12-employee Precept Health, a New Zealand startup struggling financially but winning big business over companies like Philips for ICU monitoring.

New poll to your right: what’s the impact of Oracle’s acquiring Sun? From my cheap seat, it looks like the showdown to be king of the technology world will be between Oracle and Google. The worst aspect is that Oracle gets MySQL, Oracle’s main (free) competitor that powers much of the Internet (including HIStalk). Oracle hates Microsoft, which is already wheezing, and can inflict serious damage on it by attacking its Office and SQL cash cows with Sun’s free alternatives. Since Oracle is still buying everything in sight, what if it picks up Red Hat? (IBM better strike fast if it still wants to be a playa). Microsoft hasn’t made a good acquisition in years. Proclarity in 2006, maybe, but that’s niche; I can’t think of anything else other than Visio in 2000 since the Great Plains deal didn’t make sense to me. Everything else seems to be add-ons to fix holes in existing products, not anything innovative.

Interesting in the definition of “meaningful use” of EHRs? The VA will provide a live audio broadcast of Tuesday’s NCVHS meeting, which will attempt to create one.

Fujitsu announces its new EMR in Japan: HOME/EGMAIN-GX V2  (don’t they have marketing people over there who could come up with a name that might actually be remembered?) The only Web pages I could find were in Japanese, but it appears to do orders, meds, bed management, and diagnostic imaging.

Reader survey. Important. Complete, please. Thanks.

The economy may be wearing you down a little, but at least nobody’s moving you to a desert and planting bombs in your front yard. Major Patrick Baker is a citizen-soldier and chief nursing officer at Madison County Hospital in London, Ohio, deployed since January to Balad, Iraq as Flight Commander, Flight Clinical Coordinator Team of the 332nd Expeditionary Medical Group, the largest trauma center in Iraq. He organized a charity marathon in Iraq to coincide with one in his hometown, recruiting 400 airmen, soldiers, and sailors to help raise $8,400 for the American Heart Association in honor of his six-year-old daughter Ellie, who was born with multiple heart problems. Tired of manufactured “heroes” like shallow TV stars and exorbitantly paid athletes? You can e-mail a real one. HIStalk Practice contributor Dr. Gregg Alexander knows him and sent me a link to the video.

Senator Jay Rockefeller (D-WV), chairman of the Senate Finance Subcommittee on Health Care, introduces legislation that would create an HIT Public Utility Model that would provide grants to safety net providers that would cover the cost of implementing open source systems plus five years’ maintenance. It would also create a HIT Public Utility Board within ONCHIT to over see the program. He says, “Open source software is a cost-effective, proven way to advance health information technology – particularly among small, rural providers. This legislation does not replace commercial software; instead, it complements the private industry in this field – by making health information technology a realistic option for all providers.” I like it. Jay’s kind of doing his own thing here without being steered by lobbyists and HIMSS, proposing a solution that could put more HIT in the field without just dropping big dollars on private companies. I just wish that, when we talk about open source, it covered more application ground than VistA. It’s good, but not exactly cutting edge, and the number of potential community members is limited to those who happen to know MUMPS programming. 

Kaiser Permanente offers members a $5 USB flash drive containing their basic medical information and recent encounter data. A secretary downloads the patient’s data while they wait. But, they have to show up in person to get it. The article omits the most important fact: how do doctors access that data in case of emergency, which is the whole point of getting the USB drive in the first place? Hopefully it is easy, does not require loading anything on the doctor’s PC, and doesn’t require a password if the patient is brought in unconscious. Maybe someone should invent a hardware or software token that would positively identify a PC user as a doctor so they could be given elevated privileges to open the medical files of patients.

Forbes profiles Steve Schelhammer, a former teacher and yearbook salesman who formed disease management company Accordant Health Services, sold it for $100 million, and is now CEO of Phytel, which analyzes EMR data to find non-compliant patients and sends them messages asking them to schedule a visit. Practices pay for the service, but benefit from increased visits.

E-mail me.

Federal Agents Raid Siemens Medical Solutions Offices in Malvern, PA

Federal agents from the Defense Criminal Investigations Service raided the offices of Siemens Medical Solutions in Malvern, PA today, according to a Philadephia TV station. Agents armed with search warrants secured employee workstations, seeking documents related to the company’s military contracts.

UPDATE: Inga contacted Siemens and received this response:

Statement Regarding Government Inspection at Malvern Facility of Siemens Medical Solutions USA, Inc.

Malvern, Penn., April 22, 2009 — Siemens Medical Solutions USA, Inc., the U.S. operation of Siemens Healthcare, has been served with a search warrant. Siemens Medical Solutions USA, Inc. has and will continue to cooperate fully with the Government’s investigation.

Readers Write 4/22/09

Sense of Reality
By Greg Weinstein

I have been working on clinical systems and integration in an academic medical center for 20 years now and I am watching with growing concern the frenzy of the standards writers. Prior to going to HIMSS, I took the time to read some of the HITSP specs – specifically. the C32 document sections related to medications. Everyone has a problem with sharing medication lists and everyone wants to do it right. But while C32 has over 30 data elements for each medication record (down to the lot# and bottle cap style) the only thing required was the text of the drug name. When I asked people how they could build a data sharing system (NHIN, RHIO, HIE) with only that requirement, they answer that, within each exchange, the “details need to be agreed on”. This sounds a lot like the failure of HL7 v2, though with a lot more baggage.

I visited the IHE Connectathon at HIMSS. What I saw was not encouraging, but entirely predictable. The scenario demonstrated a patient moving through a series of care facilities with CCDs used to transfer the patient’s record. Naturally one site included only the medication names (actually they stuffed long strings with the names, routes, frequencies, dose all together into the name field) and embedded this in their CCD. The next site expected to receive the medication name, route, dose, etc. as separate fields and was unable to import the data. The demonstrator began manually re-entering the data by reading the long multi-element strings and using the data entry form of his own system. This might have allowed entry of the data into his system, but almost certainly lost the data “provenance” (that it arrived via a specific signed CCD). 

After a few minutes, the crowd became restless and he gave up, skipping the last four medications. He then generated his CCD and transferred it to the next system in the scenario, which, amazingly, only saw the medications from the last CCD, where four medications had been omitted. In fact, the contents of the multiple CCDs reflected the system limitations of the various systems more than they did the actual patient state being represented in the scenario.

Against this background of non-success, we see CCHIT certification scenarios of ever-increasing complexity and new HITSP requirements to include every data function ever conceived. And then we see published research stating that no one has proven that any of this actually improves outcomes.

Regarding CCHIT, the entire focus of application certification is wrong. We ought to be asking providers to support certain functions. The CCHIT approach of application certification implies that a single system needs to do everything. Why couldn’t a provider choose to use more than one piece of software so long as their practice did what was needed?

I sincerely hope that someone will be able to calm the waters, make rational decisions on what data is most valuable to share (medications, allergies, problems, labs, images, and “documents”), and how to go about it.  Without some focus and reasonable expectations, we may waste an entire generation of software development activity, kill innovation, and crush smaller companies, all without tangible benefit.

MUMPS to Java … Caveat Emptor
By Richie O’Flaherty

I couldn’t let this pass un-commented, having had some direct experience in language translations many years back in which the organization I was a part of translated a number of applications (mostly in-house developed) from Meditech MIIS and MaxiMUMPS. While most of the pain occurred in the MaxiMUMPS translations due to extensive non-ANSI standard extensions in the language implementation, a common theme (pronounced "fly in the ointment") became apparent in the implementation of the resulting application.

This was the shocking performance impact of the translated code. Differences between how language components are coded in the source and destination languages can have crippling effect on the translated application. A primitive operator in the source language may or may not exist in the target language. If it doesn’t exist, an equivalent piece of code must be written and invoked everywhere it occurs in the source application code. That may involve many instructions or even many lines of instructions as well as overhead to invoke and clean up every time it is used. 

The difference in the number of machine cycles to execute these "equivalent" components can (and did) bring the translated application to its knees, requiring rethinking of hardware configurations as well as targeted application redesign in the resulting language to salvage the very life of the system which was the principal IT solution for a major outpatient clinic.

I am not a Java programmer so I cannot offer perspective on speed and efficiencies that Java may bring to the table, only that this is and was the massive piece of the iceberg in our translation efforts involving MUMPS. It should be noted however, that MUMPS (and MaxiMUMPS) cut their teeth supporting an impressive number of simultaneous users on hardware that had but fractional MIPS ratings. That these outmoded dinosaurs are yet running applications anywhere is a sure sign that the possess a level of efficiency that should be at minimum respected, but more advisedly investigated when seeking to translate them to anything. Iron is certainly cheap(er) these days, but I reiterate — caveat emptor.

Do You Know What’s In Your Medical Record?
By Deborah Kohn, Principal, Dak Systems Consulting

One must go back to ePatient Dave’s main point (albeit difficult to find given all the exchanges and text): "Do you know what’s in your medical record? THAT is the question worth answering."

It doesn’t matter if the data are stored on paper, on analog photographic film, or on a digital storage medium. The only way one will be truly responsible for one’s health is to get copies (analog or digital) of one’s complete, episodic medical record, review the record with one’s provider(s) if necessary, and if errors are are found, correct them. Because one deals with people, processes, and technologies, data inaccuracies occur all the time!

However, since the 1970s, patients have been allowed to access the information contained in their medical records, and since HIPAA "I", patients have been allowed to add addenda to their records. Similar to obtaining and correcting the data contained in one’s credit report, one must ask to do this.

As a health information management professional for over thirty years and long-time member of the American Health Information Management Association (AHIMA) whose banner remains "Quality Information for Quality Healthcare", I never NOT obtain copies of my episodic medical record for review, archive, and information exchange purposes. Hopefully your readership will do same.

For example, as a health information management professional (fortunately or unfortunately) I knew only too well that when I was hospitalized five years ago my clinical records (created and stored in both analog and digital formats) would contain inaccuracies. One operative report contained my correct demographic information in the report header but described me as male (I’m a female) with inoperable colon cancer in the report body. (Either the surgeon or the transcriptionist had mistakenly switched the dictation based on another case that day). Subsequently, these data were coded as such for billing /reimbursement purposes (ICD/CPT) and clinical purposes (SNOMED), making no difference had the data populated a Google or Microsoft or other PHR.

In summary, to answer another question asked in one of the blogs, " Who’s going to validate and correct the data?", the good news is that health information management professionals working in all types of healthcare provider organizations are not only trained but tasked to validate these data. The not-so-good news is that given staffing constraints and other similar issues, it is not and never will be possible to audit 100% of the medical record content in 100% of the cases. Therefore, only YOU, the patient, can and must review and correct the data.

Monday Morning Update 4/20/09

From Leonard Smalls: “Re: CIOs. The selection of the HIMSS chair best highlights all that is wrong with healthcare IT. He was an X-ray technician, went to work for a healthcare IT vendor, and then to his hospital, where he is now CIO. He was groomed by vendors and HIMSS with little information technology education and experience other than vendor applications. This is what is wrong with healthcare IT. You can’t be just a good manager and join the right organizations to be an effective CIO. You must have information technology education and real-world experience in the layers below the application layer in order to make effective decisions about systems and how to integrate them. If not, you become a vendor-whore (pardon the language). I see this repeated often in healthcare organizations. Those in the industry need to stand up and shout when the emperor has no clothes.  Otherwise, sit down, be quiet, and quit complaining about crappy software in the healthcare IT space.” This is the “CIO as the technician in charge vs. generalist change leader” argument that never seems to end. One camp says hospital CIOs should be doctors and nurses, another says they should be the same kind of person you’d want for COO or even CFO, while the old-schoolers says the CIO should know the bits and bytes. I’ve yet to see a convincing correlation between CIO effectiveness and their background since so much depends on leadership style and the organization they work for. I do believe that hospital CIOs are too cozy with the idea that everything revolves around vendor software, often because that’s all they know. Look at how chummy CIOs are with vendors with HIMSS and CHIME – is that an admirable win-win position or is it an incestuous relationship? Either way, that’s why it’s an uphill battle for open source applications, internal development, or simply optimizing the use of what’s already been bought. Those less-sexy efforts rarely get you on the A-list of advisory boards, speaking engagements, and rah-rah magazines. Plus, lemming hospital executives are swayed by vendorspeak, too (“vision centers” are for non-IT execs looking through a gauzy and deceiving lens, for the most part, not CIOs) and not encouraging their CIOs to blaze any trails.

From Svetlana Stalin: “Re: two million visitors. This very intelligent and sometimes bizarre Web comic strip relates to your recent achievement. Congratulations!” Link.

From Bashkirian: “Re: the data model that nearly killed Joe. Heard the vendor was Epic. Can anyone confirm?” I believe ample clues were provided to draw a conclusion about the vendor, although the conclusions about the magnitude of the problem and who’s to blame for it could certainly vary.

From Speedo: “Re: MED3OOO. Heard Tom Skelton has inked a big deal with Tenet.”

From IT Manager: “Re: Carilion. Carilion Clinic’s EMR implementation is going as smoothly as any I have seen at several other health systems. I think we are rolling out Epic at all of our hospitals and ambulatory sites faster than anywhere else in the US. Carilion’s 140-bed hospital implemented Epic smoothly on all applications just a few months after the 800-bed Carilion Medical Center went live.”

President Obama names 36-year-old Aneesh Chopra as chief technology officer of the United States in his Saturday morning radio address. Chopra is Virginia’s secretary of technology, but more relevant to healthcare, was previously managing director of The Advisory Board Company, the publicly traded healthcare consulting and advisory firm, where he led the CFO group. His LinkedIn profile shows no technology experience or education whatsoever (that should drive Leonard Smalls, whose comment about CIOs is above, crazy), although his Democratic party participation is impeccable. Jeff Bezos, Bill Gates, Eric Schmidt, and other big-name visionaries had been touted for the job, so many are scratching their heads as to why he was chosen and what he brings to the table. HIMSS gave him a state advocacy award in 2007, so I’m sure a fawning press release applauding his selection is imminent. I wouldn’t get too stoked: he’s not a member.

Interesting: Gibson General Hospital finds a Russian hacker’s exploit on its e-mail servers that allowed them to be used to forward spam all over the world. Palisade Systems, whose packet management technology was used to detect and fix the problem, ran the press release. One case study involved using the company’s PacketSure Procotol Management Appliance to limit peer-to-peer traffic for a university.

The latest newsletter (warning: PDF) from Intellect Resources has thoughts on how to tell your kids that you’re out of work (advice you’ll hopefully never need). Check in, too, with Traveling HIT Man (their version of Flat Stanley) to see where he’s been. He may find his way to HIStalk Intergalactic Headquarters someday.

Would you please complete my reader survey? I do it every year to help me keep HIStalk on track. Thanks.

A pharmacy technician whose job was the subject of layoff rumors kills the pharmacy manager, a co-worker, and himself at Long Beach Memorial Medical Center (CA).

Anonymous whistle-blowers claim (and press-obtained documents seem to confirm) that the Australian government is rushing its Cerner systems into production without any medication functions working, presumably to get something live to avoid embarrassment in next year’s elections. The $70 million system was ripped by an unnamed health IT expert, who predicts hospitals won’t use it: “No one likes using it because it’s shit. It’s totally inflexible.”

The folks at Digital Healthcare Conference (May 6-7 in Madison, WI) are offering a special $295 registration rate (use code HISDC) for provider readers of HIStalk. It’s a pretty high-powered speaker list and a nice facility (Fluno Center for Executive Education, above). I’d go if I could get off from work.

Those pink-pantsed boys at Voalte have got their marketing on despite being a start-up. This funny video makes fun of an unnamed competitor that should be obvious to everyone, a la Apple vs. IBM (Voalte isn’t a sponsor or anyone I know, by the way, for those who may think I have a hidden agenda – I just find their product interesting and their approach fresh).

BIDMC CIO John Halamka says sending clinically unreliable administrative data to Google Health for PHR use was a mistake in retrospect, as evidenced by the head-scratching conclusions e-Patient Dave found when he viewed his own records there and found a long list of medical conditions that he mostly didn’t have (but had been tested for). BIDMC is shutting down the ICD9 feed and trying to map their homegrown software’s data to SNOMED-CT instead of sending free text. e-Patient Dave, who is the public face of the problem, is advising Google and BIDMC. Not to minimize his contributions, but couldn’t Google have spent a few of its gazillion dollars to actually talk to one of the many informatics experts in the industry instead of just happily blowing in whatever data BIDMC said it could send and calling it mission accomplished? Honest to God, we’ve got real-life doctors, nurses, informatics PhDs, and nomenclature and taxonomy experts everywhere and nobody ever asks them, instead just sending off a bunch of marketing types and programmers to hack out something that looks cool even if it is somewhere between medically useless and medically wrong. Show of hands: who out there would have told Google that it was a fantastic idea to use claims data as a clinical tool? (like, “The doctor tested you for cancer once, ergo, you must have cancer.”)

If top dogs Google and Harvard’s BIDMC (and Uncle Sam, who’s putting a lot of faith in aggregating data from iffy and undocumented sources) can’t figure out this data quality issue, what does that say about an industry that’s about to spend billions on a national data exchange? Who’s going to validate and correct EMR data that’s being whisked electronically all over the country? (or, more importantly, who will use it knowing its limitations, which is the reason that PHRs are of limited value today?) Here’s what e-Patient Dave wisely said about the fiasco: “I suspect processes for data integrity in healthcare are largely absent, by ordinary business standards. I suspect there are few, if any, processes in place to prevent wrong data from entering the system, or tracking down the cause when things do go awry. And here’s the real kicker: my hospital is one of the more advanced in the US in the use of electronic medical records. So I suspect that most healthcare institutions don’t even know what it means to have processes in place to ensure that data doesn’t get screwed up in the system, or if it does, to trace how it happened.” I was talking to Robert Connely of Medicity (formerly Novo Innovations) and we agreed that interoperability is a piece of cake compared to the next mountain to climb: semantic interoperability (I’m getting this data element from you, but tell me what it really means). Vendors don’t always document that even in their own databases (see the healthcare data model critique that I wrote about earlier).

The Australian Business Journal profiles the resurrection of IBA Health, parent of British software company and NPfIT vendor iSoft. Some fun talk from IBA’s chairman about that iSoft acquisition, which initially was going the other way as the much larger iSoft was to acquire IBA, but then iSoft’s market cap dropped from $3 billion to $300 million. “It had lost 90 per cent of shareholder value and its management team and we ended up as the underdog bidder — the pissy little Australian company — wanting to take over a British institution. They did not treat us seriously. I guess there was a bit of colonialism involved. They had hoped an American company would take them over. Instead, I came back with a slingshot and we took it over.”

Speaking of IBA, it acquires Hatrix, an Australian vendor of eMAR systems.

Alaska, already the most pork-heavy state, zips through a bill pushing electronic medical records, hoping to grab some stimulus money.

A Huffington Post article by Deane Waldman (a doctor) decries poor usability in clinical systems. “I can access my Excel spreadsheets on either MAC or PC but I cannot see a chest X-ray and lab results using the same program. Inpatient files are coded (and secured) separately from outpatient records making it impossible easily to compare them … The Obama administration is encouraging the development of EMR and that is wonderful. The scary part is that I know they will do it wrong. They will do ‘business as usual’ … As a colleague on Twitter wrote recently, ‘IT tends to focus on back-end programming and loses sight of the front-end [the users]. Without usability, software is [and EMR will be] useless’ … the screen in the hospital on which I am supposed to electronically sign my letters: it has 74 icons! Talk about incomprehensible. The needs of the end-users must drive the design.”

CCHIT takes the first step toward its expansion to certify long term care systems, putting together a LTCS Advisory Task Force. The CCHIT apple didn’t fall far from the HIMSS tree: keep the paid headcount down, use volunteers to do all the real work, keep expanding, and figure out multiple revenue streams. None of that is bad, necessarily.

GE’s Q1 earnings sucked less than expected: EPS $0.26 vs. $0.43, but the GE Capital news just keeps getting worse: its earnings dropped 58% to $1.12 billion, but without a favorable, one-time tax treatment, it would have lost $153 million. GE Healthcare wasn’t exactly a bright spot, with revenue down 9% and profits off 22%.

Reading Hospital (PA) will lay off 250 employees.

Turns out the cure for the nursing shortage was a recession. The RN position vacancy rate in Massachusetts is only 4%, with new grads scrambling to try to find jobs. Mass General has a 2% vacancy rate, BIDMC is laying off some nurses, and Children’s has nothing for new grads.

Top military doctors in Iraq aren’t happy with its new tracking system for wounded soldiers. The new system, Theater Medical Data Store (TMDS) replaced Joint Patient Tracking Application (JPAT). I wrote about JPAT awhile back, citing this article and others. Lt. Col. Mike Fravell was a Landstuhl Regional Army Medical Center CIO and VA fellow who built JPAT himself, where it found a wide and appreciative user audience, but his initiative annoyed top brass determined to spend big money on the TMDS replacement system. He was transferred out to his own Siberia. The main complaints about TMDS involve data loading time (it’s run from servers in Virginia) and multiple information links for each patient, making easy interpretation difficult. An army vascular surgeon sounds like his civilian counterparts: “I know JPTA is dead, but our current system is not functional. As we do more with less putting the administrative burdens on the doctors is ludicrous.”

Odd lawsuit: a woman is suing Boulder Community Hospital (CO) and nearly a dozen doctors, claiming that the hot water bottle placed underneath her while she was in labor exactly two years ago left third-degree burns on her buttocks.

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CIO Unplugged – 4/15/09

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Health Information Exchange Begins at Home
By Ed Marx

To date, I’ve had the privilege of holding three CIO positions. First, for a physician managed services organization. Second, in an academic-based multi-hospital system. And currently, as CIO for a large faith-based community hospital system. In my first C-suite gig, we talked about CHINs, which morphed into talks of RHIOs, while today we discuss HIEs. All of these have had the big, hairy, audacious goal to exchange information on increasing quality and decreasing costs.

Clinical, financial and now federal incentives generate a noble rush to participate. As I dug into details of certain opportunities at current and former organizations, I discovered that neither technology nor the sustainable business model posed the greatest challenges. Instead, the information exchange within the walls of my own institutions verged on nonexistence or lacked vision. We talked at high levels about exchange while knowing full-well we had not yet achieved this nirvana internally. Much work needed to be done at home, and we had to act with purpose to prepare for HIE.

In 1995, at Parkview Episcopal Medical Center, we reached advanced stages of interoperability. First, we implemented strong inpatient clinical systems and practice EMRs. We began sending electronic scripts to the local pharmacies. Participating physicians received a 10 percent discount on their malpractice insurance. We stopped printing and sent all reports to our medical staff electronically. Only after getting our own house in order could we achieve this exchange.

At University Hospitals, our team was awarded the very first NHIN grants. We freely exchanged data with other sites across the country. We exchanged clinical information with our joint-venture hospitals, with federally qualified health centers, and with others. We achieved our increased quality and reduced costs objectives. Our success came after we laid a firm internal foundation and developed our own portal.

At Texas Health, we’ve used a similar approach. Because we had disparate applications early on, we built a portal that essentially mimics an HIE but fits our health system. We exchange externally but on a limited basis. We’re just now completing our overall HIE strategy that might be as simple as plug-and-play going forward. Despite the years of futile conversations regarding data exchange taking place in the region, we would not have been ready without the current portal.

HIE is a critical component of our American health care landscape. It’s the right thing to do. Caution! First look in the mirror and ensure that you’re exchanging data internally before placing your expectations externally. We don’t want to find ourselves saying "do you remember the word HIE," just like we do today with CHIN.

Take action now.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

Being John Glaser 4/14/09

The foundation of any high-performing organization is talented, experienced, and motivated staff. Attracting and retaining these staff members requires that the IT organization be seen as a great place to work. Over the years, I have learned that six factors form the foundation of an organization that people want to work for.

1. For any organization to function and for its staff to get work done, it must be organized. Departments must be formed. Processes are needed for making decisions and performing recurring activities such developing applications. People want to work for well-managed organizations.
2. The IT organization must hire well, bringing in the talent, skills, and experience that it needs. If a person turns out to be a less than satisfactory addition to the team, the organization has to handle the situation quickly and with humanity.
3. The IT organization has to help its staff grow and learn. Training and professional growth opportunities are needed and staff must be given time to pursue them.
4. There should be ongoing efforts to improve the work setting. These efforts can range from events such as social functions to tele-work programs to improving space.
5. Organizational problems need to be fixed. Process redesign efforts that streamline requests for new applications. Changes to the organization structure to reduce confusion over accountabilities. At any point in time, the organization is not firing on all cylinders across all functions. Problems need to be assessed and fixed.
6. And finally, a tone must be set. I am not sure that I have a good definition of tone other than it is the climate of the organization. Tone results from the daily actions (or inactions) of IT management and IT staff. It seems to me that the tone of a great IT organization has several characteristics. The actions:

• Inspire and motivate. The work is interesting. We believe that the work is important and we know that each of us is needed if the work is to happen well.
• Exhibit integrity. The actions and words of individuals are true to their values and beliefs. There is little tolerance for dishonesty and “games.”
• Demonstrate courage. There is a willingness to make hard decisions and stand by them. There is a realization that you may personally have to absorb the blame and anger of others.
• Show caring. We reach out to those who need personal or professional help. Disagreements and debates avoid personal attacks. We take the time to give someone a heads-up.
• Are demanding, but tolerant. The organization sets high standards for the work that it does. However, it recognizes that even the best people screw it up from time to time (sometimes in very big ways) and the organization does not eviscerate those who make mistakes.
• Exhibit accessibility. Those who need us can get to us. One may or may not be able to help or help right away, but one is not sitting behind a moat.
• Are comfortable with personal limitations. All of us have strengths and weaknesses. It is important to know yourself and be comfortable with the fact that, in some ways, you are limited. And it is a sign of personal and management strength to surround yourself with colleagues who have the strengths that you do not.
• Being a great place to work is important. While making sure that the necessary factors are in place is a key responsibility of IT leadership, this responsibility is shared by everyone in the organization.

Of all of the factors, tone is the most important. If the tone is a good one, the climate will exist that enables all of the other factors to happen well. And tone is set by everyone.

Making sure that the IT organization is a great place to work is something that each of us does every day.

John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

Monday Morning Update 4/13/09

From Ben Mehling: "Re: open source. I can state emphatically that Medsphere is ‘truly open source’. This fact is easily verifiable with a quick visit to http://medsphere.org where anyone can download copies of our software and use them within the provisions of OSI (http://opensource.org/) and FSF (http://www.fsf.org/) approved licenses under which we release software. Medsphere.org is also our community’s central hub for discussion, support and development activities — anyone interested in open source and healthcare is welcome. We’re happy to discuss this with anyone that still has concerns, either publicly or privately." Ben is director of advanced technology at Medsphere.

From MiamiRocksters: "Re: Satyam. Looks like IBM is still in the running." The company will be sold off by the end of the month, with bids due Monday. IBM said it was pulling out because of Satyam’s exposure to US class action lawsuits for accounting fraud, but I bet they’re still in the hunt (building the net present value of the lawsuit risk into the offering price, of course). Two Indian companies have been bandied about as front runners to buy Satyam, but Cognizant, HP, and CSC are also said to be interested. And why not? The accounting scandal was limited to a few hands and the business should still be sound, at least once the bad PR can be soothed. The Pricewaterhousecoopers auditors are still in jail, as should be whomever thought up that ridiculous company name.

From Kenneth Parcell: "Re: HIMSS. It was OK. The traffic seemed lighter, but the transportation was reliable and convenient. My only beef was that the shuttle service to the airport took over one hour. Chicago is a wonderful city and I would definitely enjoy it if HIMSS decided to return. Most interesting technology was Google’s PHR suppository repository. Wish I had a picture, but it looks like a little white capsule with Google written on the side. I assume it is placed in the appropriate orifice where it seeks all health information from the source. When finished, the collected data is linked to your PHR and you can Google search clinical information about yourself, such as ‘Find abnormal growths’ and ‘Am I getting enough fiber?’ Not sure why I saw others rubbing the repository on their lips … perhaps they were salesmen and were confused about where to stick it." So far, the poll to your right is running 2:1 for a Chicago return.

From Being John Doe: "Re: Cerner’s answer to HIMSS?" Link. It’s a Cerner YouTube video about its Second Life world or whatever the fantasy-nerds call it. I have to think all those companies that hired hipsters to create Second Life sites are regretting that decision. I didn’t see or hear Second Life mentioned even once during the entire HIMSS conference.

A New York Times article profiles the use of an EMR (from e-MDs) of a rural doctor, who summarizes as follows: "I’ll never go back to the old system. I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.” This is what I’ve been saying here for years: the main value of electronic records is being able to review and create electronic data from anywhere. Just getting data into an electronic form is where the payoff lives. I’ve argued that HITECH should have rewarded providers for sharing data on a national framework such as NHIN, paying them per patient (or, even better, per record type). Using technology is one form of "meaningful use," but making data available to other providers is more so. The power is in the network, not the desktop.

And in that regard, Dale Sanders, CIO of Northwestern Medical Faculty Foundation (thanks to Dr. Lyle for the link) might change your EMR perception with his phony news article about an EMR created by Amazon.com. It’s a deceptively simple and light-hearted piece, but think about what he’s saying about software personalization, analytics, architecture, and social networking, a contrast of pre-Internet EMRs to what could be given what we know today.

C-Span has video coverage of a White House discussion on healthcare reform led by Nancy-Ann DeParle this past Wednesday. She seems fun.

The AMICAS-Emageon headcount reduction, according to one very informed source, is over 100.

Global nonprofit IntraHealth International launches IntraHealth Open, offering free downloads of celebrity remixes of "Wake Up (It’s Africa Calling)" and accepting donations to support open health software solutions for the developing world.

CCHIT musings: everybody wants CCHIT to "certify" EMRs on everything from usability to the financial stability of the vendor. Is that really necessary? Stimulus payments will be tied to using a product certified by CCHIT (or some other group), so it doesn’t make sense for users of already-certified systems to lose money because their vendor can’t meet new usability standards (even though that provider is actually using the product without complaint). CCHIT was formed to evaluate interoperability and reduce physician risk, back when its certification had little impact on the income of either vendors or providers. We need to be careful about wanting CCHIT to turn into KLAS, churning out a "Top X" ranking instead of certifying minimum requirements and letting the market decide which vendor is doing all the non-essential stuff better. Surely doctors are smart enough to buy wisely.

Ivo Nelson e-mailed to say his ongoing pub event HIMSS was so popular that Encore might do it next year in Atlanta. That’s the home base of the Fado’s chain, about which he mentioned that his deal with a more authentic Chicago pub fell through at the last minute because it decided to close for the weekend (hey, if they’ve got Guinness and a green flag or two, who cares?) I’m also interested in ideas for the HIStalk bash there, assuming I can get sponsors and all that. I have thoughts on just about everything except location since I don’t know Atlanta very well.

A note to all you supposedly expert media people covering Dennis Quaid’s speech: please stop capitalizing heparin. It’s a generic name, not a brand name. Thank you.

Some open source people believe they saw the beginning of mainstreaming of open source at the HIMSS conference. I don’t see that happening. Reason: hospital CIOs were raised under the influence of application vendors, often have worked for them in the past, and even more often hoping to work for them in the future, and overseeing Epic or Cerner shops is a resume builder. CIOs, like the hospitals they work for, don’t like to be the first in their area or size range to do something different. Most importantly, healthcare is driven by special interests, lobbyists, vendor people volunteering for influential committees, and job-creating potential. Open source doesn’t have any of those (not to mention a non-government track record). Even the VA seems to be itching to dump VistA in favor of commercial products (again, rightly or wrongly). When you talk about hospitals using open source, that’s mostly VistA, which would be fantastically lucky to get 1% market penetration. Not a rosy opinion, I know, but I promise to update it when any open source clinician application hits 50 hospital clients. If hospitals aren’t interested even when starved for capital as they are today, they never will be.

Since the President is promising everything to everybody and printing whatever amount of current those promises require, he goes ahead and adds "give all veterans a new electronic medical records system" to his Santa list.

New York offers $60 million in financing for HIT projects, this time targeted to medical home applications.

I see the e-mail update signups have been going like gangbusters, so that box to your upper right is calling your name, at least if you want to be among the first to know important stuff. Inga pores over the stats like a CPA, so it makes her happy.

Odd lawsuit: the patient of a plastic surgeon who claims her face-lift surgery was botched has posted an ongoing stream of nasty comments and videos all over the Web, blaming the doctor. He sued her for defamation for doing so and then, according to the patient, called the mental health department claiming she had e-mailed him saying that she planned to commit suicide live on the Internet, getting her Baker Acted. The doctor says she is psychotic and hurting business for his $5,999 Tax Time Special breast augmentation surgery. Here is her site, with a ton of documentation (seems convincing to me, but I’m not taking sides because both parties sound litigious).

The Conficker worm hits University of Utah’s health sciences schools and its hospitals.

Harris Corp. gets a $14 million, one-year contract to provide an imaging system for 65 DoD hospitals, announced at HIMSS. Also announced: Harris donated $10,000 to the Wounded Warrior Project.

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An HIT Moment with … Judy Kirby

An HIT Moment with ... is a quick interview with someone we find interesting. Judy Kirby is president of Kirby Partners of Altamonte Springs, FL (formerly Snelling Executive Search).

How would you characterize the healthcare IT job market and how do you it see changing over the next 1-2 years?

The healthcare IT job market is different than I have ever seen. I entered healthcare IT recruiting during the recession of 1992 and have witnessed its peaks and valleys. With the current economic crisis this country is experiencing, healthcare seems to be relatively stable, compared to other industries such as finance or automotive.

That being said, healthcare organizations have investments that have diminished and are struggling with shrinking reimbursement rates. According to Thompson Reuters, the median profit margin of U.S. hospitals has fallen to zero percent. There is a lot of financial pressure on hospitals and nearly half are operating in the red. Many see hope in the stimulus money that will be available for electronic health records. Right now, there is caution and uncertainty in most organizations. They have needs in their IT departments, but are being very, very cautious in hiring and we have seen the hiring time increase.

If the stimulus money for EHRs has the effect that some like Dave Garets from HIMSS Analytics predicts, there will be a shortage of implementation talent in the future. But that being said, as always, there will be positions that are “hot” and those skills that will be in abundance. Two years ago, we encountered many senior healthcare IT managers and CIOs who were approaching retirement age. They are now saying they will remain in the workforce longer and postpone retirement due to their dismal retirement portfolio performance. Healthcare IT positions, especially higher level positions, that were to open by the retirement of baby boomers will open up later rather than sooner.

There is good news, however. We recently did a survey of healthcare CIOs that showed 31% expect their organization’s IT departments will grow in the next year. 50% said their department numbers would remain the same, and only 19% predicted a decrease in their department staff levels. The survey also indicated that 39% of the respondent’s IT departments are currently actively hiring, 6% will hire in the next three months, and 4% will hire in the next 3-6 months. There are always numerous opportunities out there no matter what the current economic conditions.

The biggest effect the economy has had on our business is the number of possible candidates for positions who cannot relocate because they are upside down in their current homes or live in such a down real estate market that they can not sell their home.

You might think a firm such as ours would have experienced a downturn in the current economy. Just the opposite is true. We are as busy now as we were three years ago. 

What advice would you have for employees to both keep their current jobs and prepare for their next one just in case?

We actually are presenting at HIMSS on this same topic, “Know when to hold them and know when to fold them”, with Jon Manis, CIO of Sutter Health System. The advice for keeping your job is the same for preparing for your next move up on the rungs in your career ladder – you have to be invaluable to your organization and not just taking up space. We have heard from many CIOs they are using this recession as a way to “clean house”, so to speak. All things being equal, they will keep the employees who are doing the best job and have the best attitude. You can train skill sets, but you cannot train attitude, enthusiasm, or a desire to be successful. Those are the traits you need to exhibit.

This is also the time to update your resume. Do it before you are in need of a new position. Don’t list what you have done, but describe what you have actually accomplished in your position. It is much easier to keep track of these accomplishments on a regular basis rather than having to go back and try to remember after the fact. Quantify your results as much as possible. Plus, when having conversations with your boss, it is always nice to be able to talk about your successes.

How is the role of the CIO changing? What should CIOs be doing now?

The CIO role has really changed over the years from a “bits and bytes” individual to a true C-level leader. John Glaser, CIO of Partners HealthCare, and I did a presentation at the CHIME Fall Forum on this very topic entitled “Where are we going? Evolution of the CIO”. Put succinctly, the CIO has to be a true leader, just like any other C level position in the organization. It goes beyond just keeping the systems up and running. That is part of it and a crucial part that can get a CIO fired. But, the role is starting to go way beyond that as CIOs acquire additional departments and different responsibilities.

The CIO of today and tomorrow needs to be reaching out within their organization. They need to learn what leadership “looks like” and become more involved in working on business issues and contribute more than technology. They need to work with colleagues as peers and focus on understanding them and solving their problems. They need to fill domain knowledge gaps and skill gaps. And as we already stated, they never need to rest on their laurels, but focus on future accomplishments and how those accomplishments benefit their organization.

Management of a healthcare IT department requires the same skills as management of any other department. As more and more in the hospital domain becomes “application driven”, CIOs will shoulder more and more responsibilities. We have heard several CIOs mention recently that they have picked up oversight for other departments – even departments such as HR or marketing. You need to know your limitations, and know when and where to find true specialists to handle things you cannot. 

What will the effect of the stimulus package be on the job market?

It will be interesting to see just how the stimulus money does affect the job market. As you reported recently, Wal-Mart is entering the EHR market, and others will jump on the bandwagon to get those funds. The money will have some positive impact on those with strong implementation knowledge and for those in consulting. What the real impact of the stimulus package is will be difficult to predict until all the rules and regulations are ironed out. Any time the government is involved, your guess is as good as mine, but I do see it as a positive for those in healthcare IT.

We have talked with healthcare IT organizations that are already looking ahead to the stimulus monies and planning for the talent they need to embark on the projects that will attract these dollars. 

What kinds of roles and training are available for clinicians who want to get more involved with IT and informatics?

The roles are many and varied, depending on the clinical background. With EHR, lab, radiology, pharmacy, and informatics, depending on the background, there are lots of opportunities for the clinician who wants to be involved in technology. These include everything from a CMIO to nursing informaticist to builder and implementer. The individual needs to look at where they would like their career to take them long term, and then decide the best route to reach that career goal.

We are seeing more physicians and nurses in the CIO role. We are seeing a new position, CNIO (Chief Nursing Information Officer) develop in larger organizations. Consulting firms and vendors are utilizing these skill sets in their business models. As far as training, there are numerous masters’ programs out there and they provide a good education. If at all possible, while pursuing book learning, try to balance that out with hands-on experience. The two paired make a much better skill set than just a degree and no real technical experience. The employment world is a competitive place: degrees, experience, certifications, and a broad range of experiences do make a huge difference in how fast and how far you can move up the career ladder.

On a side note, we would like to mention we will have a name change this month from Snelling Executive Search to Kirby Partners. We feel this name will not create confusion as Snelling has. There are other Snelling personnel offices out there that focus strictly on administrative and temporary employment. Our people remain the same, and our niche remains the same. All we do is healthcare IT recruitment.

From HIMSS 4/7/09

From Evil Knavel: "Re: HIMSS. Do you get special treatment from companies at HIMSS, especially sponsors like athenahealth that seem to get a lot of PR? It seems like it." Guess you missed the part about eating burgers in the hotel and at McDonalds. Only one sponsor knows who I am, so the answer is absolutely not. I am an anonymous peon at the conference, so I’m seeing it just like everyone else (intentionally – I don’t want favors, but yes, I’m sure I could milk the heck out of it if that interested me). In fact, anybody with CIO in their title is going to get treated a lot better than me since they have their own off-limits meetings, vendor giveaways, and fancy event invitations that I don’t get (disclosure: I went to the Cerner CIO event as an anonymous guest of someone, which was cool to a day-jobber like me). FYI, athenahealth is not a sponsor (and disclosure there: they don’t do much marketing, but decided to be an HIStalk sponsor about a year ago just to be nice. I turned them down because that was right after the HISsies and it would have looked suspicious, which we both agreed was the right decision).

From Christi: "Re: reception. I’m ever so grateful to Ingenix for hosting the party. The Trump Towers staff was over the top on customer service – every single staff person was incredible! When I’d ask for directions to something they’d not only tell me where it was, they’d walk me all or part way to it! And the ballroom we were in was gorgeous. What a lovely site and lovely party – thanks for being so cool as to have someone who wants to throw money into doing this." Thanks to Tom for sending over the pictures.

That’s it for me – I’ll be heading home first thing Wednesday morning. I saw quite a few people with suitcases in the hotel lobby today, so I’ll guess that the exodus already started. That astronaut doing the closing keynote tomorrow afternoon may have had more people in his Mir space station than will be in the audience.

My verdict on the conference: nicely done. I actually didn’t mind the weather as much as I thought, but the Saturday start in April really threw me off. The logistics were as good as ever and Chicago and the convention center were fine. My only remaining gripe the cost of hotels. I really wish I had bypassed the Ambassador people and just used Priceline since I paid too much, but couldn’t cancel and re-book without a penalty. 

My favorite giveaway (other than the foam slippers): the tee shirt above from Solution Q, vendors of the Eclipse project portfolio management system. It’s not new humor, but I hadn’t heard it in a while and never from a tee shirt.

VC firm Psilos Group will raise a $450 million healthcare IT fund.

It’s probably just as well that Cerner opted to stay out of town this week since an ugly PR episode might have resulted. This article says that four Chicago mental health centers closed today as a result of billing glitches in the Chicago Department of Public Health’s Cerner system caused it to lose more than $1 million in state funding when bills backed up for over six months.

Someone asked me about ARRA and innovation. They are mutually exclusive terms. ARRA was designed to dump a lot of taxpayer dollars into private hands quickly and forcefully, yet it requires CCHIT-certified products that would take years to develop from scratch. For that reason, it will just boost sales of the same old stuff. If anything, it stifles innovation because all the prospects who might have decided to sit tight and hope for better products will have to spend sooner to get their cut. The most valuable asset any company can have right now is a CCHIT certification, whose value went up multiples with ARRA.

I was chatting with someone earlier this week and he said he hated Citrix. I made my usual comment that it’s like a Denny’s restaurant – always a compromise from what you really wanted. His theory is that the availability of Citrix allowed old, primitive applications live on, providing another layer of workaround that gave vendors an easy out for bad system performance, difficult maintenance, poor security, and lack of a true thin client or Web strategy. The healthcare-only combo of Citrix-MUMPS-Cache is everywhere, of course, and there’s no customer indignation to replace it because it works.

Some guys talking on the escalator this morning said that Rob Kolodner got a standing ovation in his final HIMSS appearance as ONCHIT (and deservedly so). I would be shocked if he isn’t in Atlanta next year, but in the booth of a consulting firm or vendor instead. He confirmed that he’s retiring, but looking for other opportunities. By all accounts I heard, he’s a good guy, humble and fun.

I want to get the autograph of Gay Madden, CIO of The Hospice of the Florida Suncoast, since she’s on the shuttle bus TV every morning (in a Sprint commercial, I think).

I went to a session this morning on digital pathology that was pretty cool. It’s interesting that systems exist to convert slides to massive images that can then be manipulated and studied in a cockpit of monitors rather than through a microscope. The speaker said his company had licensed satellite image processing technology since it works about the same on the cellular landscape as it does the terrestrial one.

UPMC chooses chooses the clinical research management system from mdlogix (the annoying all-lowercase name is their doing, not mine).

Ingenix announces its Care Tracker EMR, priced at $5,000 per year for a solo practitioner. Also announced: RAC software and services that help hospitals comply with the Medicare Recovery Audit Contractor (RAC) program by providing alerts of claims likely to be audited.

Someone told me of an overhead conversation this week in which national drug chain VP said his company hoped to cobble together a simple EMR (enough to claim minimal use) just to get stimulus money.

Jonathan Bush was on FoxBusiness this morning after a late night at the Trump (I don’t know how he does it). The site doesn’t support a direct link, but you can search on athenahealth and look for today’s video. The host opens with a HISsies mention, although not by name: "Jonathan was honored last night as the industry’s figure of the year in healthcare technology." He talks about HIMSS and HIT. The company also announced that its eRX module has received Surescripts certification.

Someone mentioned that it’s ironic that Sun is pitching its NHIN capabilities even as its IBM acquisition went up in smoke, implying that maybe it’s not stable enough to hang the NHIN hat on.

A HIMSS location name that sounds like 1999: "Surf the Net".

The digital pathology session talked about IT as a barrier because of locked down PCs. That reminded me of editorials I’ve written lambasting the lazy IT socialism of treating all users equally (badly) in assuming they are all too stupid and irresponsible to have any control over their PCs. Their ought to be a way to gain responsibility points based on need and ability, allowing higher level users with a defined need to perform simple software installations or OS changes.

Seen on Epic’s booth: every EMRAM Stage 7 hospital uses EpicCare. For a company that says it doesn’t market, that sure kicks the competition where it hurts.

I took a look at iMedica’s new/not new Transition product. It’s the existing product with the knowledge base turned off at a 20% discount, giving an easier and cheaper start. If you want the knowledge base later, you just pay the difference.

The last of the booth observations:

• iMDsoft has a Visicu-like ICU monitoring. I tried to learn more, but the reps were too enamored with each other’s company to want any of mine.
• Corepoint Health (the former Neotool) had a nice booth and seems to have grown considerably in capability and ambition.
• iSoft was demonstrating Lorenzo, which isn’t sold in the US. One rep was, anyway. The others were sitting on the demo station stools playing around with their cell phones.
• AT&T/Cisco Telepresence had a conference room setup in the booth with the big monitors in place, which actually looks like have a conference room since the one side of the table is for virtual participants.
• Medicity had a good crowd.
• I chatted briefly with the ICA person, who explained the company’s CDR and clinical portal that can also be used as an in-house clinical workstation to add capability to existing systems.
• I checked out Bistro HIMSS: $23 (including tax and drink) gets you a paper plate on which to load up pedestrian-looking heat lamp Chinese.
• I miss the blue nametags that distinguished vendors from providers, but that was in a simpler, black and white HIMSS world.
• PatientKeeper had a big rack of smart phones and PDAs running their software to show its versatility.
• I don’t know much about Orchard Software, which had some KLAS information on a booth sign that suggested it’s the highest rated lab system. I’d tell more, but nobody there was paying much attention to my eye-catching glances.
• eClinicalWorks had a bunch of people in the booth.
• There was a good crowd at the Sentry Data Systems booth.
• EDIMS had a nice booth and crowd. Apparently they have a EDIS Lite kind of system with knowledge management, but nobody made an effort to talk to me.

I apologize if you e-mailed an invitation for me or Inga to visit your booth or meet you personally and it didn’t happen. We stayed very busy getting information to write each day’s HIStalk, so we ran out of time.

HISsies 2009 Winners

It’s time now to announce the winners of the 2009 HISsies, the Brutally Honest HIT Awards, as voted by the readers of HIStalk. We don’t claim the results are scientific, but they are always interesting.

• Smartest vendor strategic move: Medicity-Novo Innovations merger.
• Stupidest vendor strategic move: GE Healthcare losing unsatisfied clients.
• Worst healthcare IT vendor: GE Healthcare.
• Best healthcare IT vendor: Picis.
• Best provider healthcare IT organization: Cleveland Clinic.
• Hospital you’d want to go to if facing a life-threatening illness: Mayo Clinic.
• Most promising technology development: Software as a Service.
• Organization you’d most like to work for: Picis.
• Company in which you’d most like to be given $100,000 in stock options: Picis.
• Most overrated technology: speech recognition.
• Biggest healthcare IT related news story of the year: Obama’s position on healthcare IT.
• Most overused buzzword: interoperability.
• “When _(blank)___ talks, people listen,” the person who influences healthcare IT the most: President Obama.
• Best CEO of a vendor or consulting firm: Todd Cozzens, Picis.
• Most effective CIO in a healthcare provider organization: Lynn Vogel, Ph.D., associate professor of bioinformatics and computational biology, vice president, and chief information officer, University of Texas M.D. Anderson Cancer Center.
• HIS industry figure with whom you’d most like to have a few beers: Tom Daschle.
• HIS industry figure in whose face you’d most like to throw a pie: Neal Patterson, Cerner.
• Healthcare IT industry figure of the year: Jonathan Bush, CEO, president, and chairman of athenahealth.

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