Bill Stead on the National Research Council’s Report

Full text of the report is available here.

The report calls for a change in approach to health care IT.

This conclusion does not reflect negatively on the sites visited. To the contrary, their pioneering work and suggestions let the committee see the way forward. It does not contradict calls for increased investment in health care IT. Better management and use of information are essential to improving the health care system.

The report suggests that a larger dose of today’s health care IT will result in both improvement and harm. It will cost more and take longer than people expect. Collectively, the result will fall far short of what is needed.

For example, today’s clinical applications tend to be monolithic and complex. Rather than enabling small improvements in practice, the many information system interdependencies actually slow down improvement! Instead, clinical applications should reduce barriers to clinicians and patients doing what is best for care – even if doing what is best requires rapid cycle, iterative change in clinical behaviors and work flows.

A different outcome is possible. We do not need to wait for better IT before we move aggressively forward. However, near-term success will require a fresh approach to managing the investment by health care organizations, our health care IT vendors, and the government.

The report lays out five principles for use of IT to support evolutionary change in health care that are actionable in the near term. With a longer view, it identifies four principles to support revolutionary change and several research challenge problems.

It includes six recommendations directed at the senior management of health care organizations and, through them, to their vendors. Let me highlight a couple.

Organize incentives, roles, workflow process and supporting infrastructure to encourage, support and respond to opportunities for clinical performance gains.

In other words, the IT infrastructure should evolve with the improvement process, not lead it.

For example, if your goal is to reduce medication administration errors, start with incentives and infrastructure for blame-free reporting. Next, identify the situations with a high rate of "wrong patient, wrong dose" errors. Then, target deployment of technology support like bar code medication administration to those situations. Finally, continue to monitor performance, refining the combination of process and technology if needed, or extending to the next highest problem area.

In this way, you guarantee improvement. Use the technology only where needed and correct unintended consequences early.

Balance the institution’s IT portfolio among the four domains of automation, connectivity, decision support, and data mining capabilities.

The majority of today’s health care IT is designed to support automation, with some investment in supporting connectivity and little support of decision making or data mining. Yet the IOM’s vision for 21st century health care expects support for cognitive activities (helping providers and patients think about complex choices as they make decisions) and a learning health care system (mining related bodies of data to recognize and respond to patterns).

These activities are much more about connectivity, decision support, and data mining than about automation. The required shift in focus is large. Technology exists to support movement in these directions, but it is outside the comfort zone of many health care organizations and the established health care IT vendors.

Finally, read the report! It is short. It reflects careful study and review. With complex issues, one sentence may balance another. Hearing one sound bite without the others can mislead.

Health care organizations and health care IT vendors should read section 3 (rebalancing the portfolio), section 4 (principles for success), and section 6.3 (recommendations for health care organizations. They add up to only 12 pages.

In addition, I would point vendors to Appendix C, which summarizes the committee’s observations, the consequences, and opportunities for action, with the latter tagged as short term or research. Check your current offering and product direction against the ones tagged as short term.

William W. Stead, MD is associate vice chancellor for strategy/transformation, director of the Informatics Center (which includes the Department of Biomedical Informatics of the School of Medicine, the Eskind Biomedical Library, and the Center for Better Health), and CIO at Vanderbilt University Medical Center; and chief information architect for Vanderbilt University. He is chair of the Committee on Engaging the Computer Science Research Community in Health Care Informatics, which produced Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions under the auspices of the National Research Council.

Monday Morning Update 1/12/09

From You Missed This: "Re: another e-mail blunder from an HIT CEO." Eclipsys CEO Andy Eckert accidentally copies an equities analyst from Thomas Weisel Partners on what was supposed to be a private e-mail to CFO Bob Colletti and EVP Jay Deady, in which he remarked that a Weisel research note questioning the company’s growth rates, "certainly zeroed in on our organic growth rate." Andy told the analyst that what he was saying is that organic growth is a focus, not admitting that Weisel had uncovered a weakness. Still, the analyst’s generally positive opinion didn’t change.

From oneHITwonder: "Re: Sutter. My father was recently a patient at Sutter General Hospital in Sacramento (he’s home and doing well now). While visiting, I watched a nurse enter his room and pull down a wall-type desk, which revealed a keyboard and monitor. I was very impressed, but the nurse did not use the computer — she just pushed the keyboard out of the way and used the desk for a writing surface. I later asked another nurse if she uses the computer in the room and she said only if all the workstations at the nurses’ station are being used. Another nurse joined in, saying they were put in the room for ‘e-charting’ that never materialized, assuming ‘it must not be going well at other Sutter hospitals’ (I believe the reference here was to Epic). They occasionally look up lab orders, but that is about it. Sutter General uses Eclipsys for CPOE."

From The PACS Designer: "Re: Palm phone. Palm has released its challenge to the iPhone and it created quite a stir at the Consumer Electronics Show. Perhaps there’s a place in healthcare for the new Palm Pre to support user requests to add it to existing systems." Link.

This sounds interesting: Infirmary West (AL) launches an Internet system that lets patients self-register (for a $25 fee) for non-life threatening ED appointments, then come in at the appointed time instead of sitting around watching Judge Judy amidst the mayhem. They take it seriously: if the patient isn’t seen within 15 minutes of their appointed time, their visit is free. The nurse who runs the ED came up with the idea. An employee checks each registration as it comes in to make sure the patient’s condition doesn’t require immediate evaluation. Notice that the registration screen also provides an estimate of when you’ll be seen even before you sign up. The system provider is InQuickER, which runs the same service for several hospitals, but I can’t find out anything about the company.

A reader sent over a local article about December layoffs at North Memorial and Park Nicollet in Minnesota that were to affect over 600 positions.

Medfusion, the Raleigh, NC vendor of consumer-facing technologies for physician practices (like patient messaging, online registration, online payments, etc.) buys the former A4 and Allscripts office building in nearby Cary for $7.25 million, citing strong sales and the need to add up to 50 employees to join the current 70 in 2009.

Tennessee RHIO Shared Health hires Adnane Khalil, formerly of MedAvant, as VP of technology.

I’m doing some tentative experimentation with Twitter, so if you want to follow me, I’ve put an icon over in the right column. You won’t get much except updates when I publish something new, at least until I make it part of my routine. I might use it from HIMSS.

The CFO of Misys PLC resigns "by mutual consent."

Last chance for HISsies nominations. When the voting starts, you’ll say, "Why didn’t that idiot include these obvious nominees?" and I will smugly respond, "Because you and your passive ilk couldn’t be bothered to click a simple link to nominate them." To avoid all that unpleasantness between us, you might as well cast your nominations.

Nobody likes it when welfare recipients complain about the free money they get from the rest of us, so maybe HIMSS should be careful about how it characterizes its EMR Welfare Program. In Modern Healthcare, its director of congressional affairs is quoted as saying, "Our minimum is $25 billion."

I’ve never heard of Leap of Faith Technologies of Crystal Lake, IL, but the eHealth technology vendor is looking for testers for its "virtual pillbox" for smart phones. The eMedmobile application extracts information "smart labels" on pharmacy containers to issue medication reminders and to notify someone if the patient misses doses. Grants to help cover its development cost came from NIH, the National Cancer Institute, and the National Institute on Aging. Check out the demo – it’s cooler than it sounds. 

Interesting: medical students at University of Washington practice surgical technique in a mocked-up OR that includes a computerized patient. What’s different is that they’re also using simulations like these for nurses, dentists, and pharmacists and will combine the programs to teach the professionals communicate better, not just to practice their technique. A good line from the executive director of UW’s Institute for Simulation and Interprofessional Studies on the traditional surgeon’s training of learning on live patients: "I’d rather be able to tell some surgical resident, after 25 unsuccessful tries on a simulated patient, that maybe he ought to consider going into pathology.” UW is is also trying to get Microsoft to adapt the Xbox to allow training students at remote locations, but apparently hasn’t had much luck.

Reports suggest that troubled Satyam Computer Services is looking for a buyer. The CEO was arrested and the board dissolved this week after admitting that revenue was overstated and $1 billion of cash assets did not exist. Law firms are lining up to get a shot at the lawsuit coming against auditors PricewaterhouseCoopers, about which one big equity firm’s head said, "If you’re an auditing company and your client says they have $1 billion in cash, you do check with the bank." The company’s interim CEO was formerly president of its commercial and healthcare businesses.

Cardinal Health cuts its fiscal year outlook, citing hospital cutbacks in capital spending.

I’m guessing Bush and Obama don’t agree on much (thank goodness), but here’s one goal both think is important: having electronic health records for all Americans by 2014 (and that you can deficit-spend your way out of a depression, apparently). In a speech Thursday, Obama said the government will make "immediate investments" on IT, which will not only save money, but "reduce the deadly but preventable medical errors that pervade our health-care system." With that in mind, Gerson Lehrman Group predicts a 14.1% annual growth in the EMR market, although they oddly list Google and Microsoft as big potential winners (and also GE and Siemens, whose products I sure wouldn’t want my taxpayer dollars to fund if it’s innovation that’s needed). It’s funny that the Republican pushed free open source solutions like VistA, while the Democrat seems to be in favor of just buying commercial products with federal money. You’d think it would be the other way around, although not when the goal is just to spend a bunch of government money.

With that in mind, new poll to your right: where should the billions be spent?

Hospital layoffs: Good Samaritan (NE), 32; St. Francis (NE), 22; Blue Hill Memorial Hospital (ME), no number given; University of Chicago Medical Center (IL), up to 1,000; St. John’s Regional Medical Center (CA), 33; Los Robles Hospital & Medical Center (CA), 8; Ventura County Medical Center (CA), 30; Central Kansas Medical Center (KS), 50; Carson Tahoe Regional Healthcare (NV), 30; Erlanger Medical Center (TN), 80. Tenet Healthcare announces cuts in vacation time, sick time, and 401k contributions for its 50,000 employees. CGH Medical Center (IL) shuts down its free nurse hotline that gets over 550 calls a week.

West Penn Hospital says it fixed a patient-reported problem in which its online bill payment application that allowed users to see information about other patients. The hospital blamed a billing partner, but didn’t explain why the patient e-mailed the hospital twice and didn’t get a response until she called the local TV station.

More on the National Research Council’s Report on Healthcare IT

I worked late Friday night to get a summary of the report out because I think it’s important. I’m already getting some thoughts back from folks in the industry, so I think we’ll have a good dialog about what it means.

Much of what I’ve written in the past aligns with what the report says. In 2005, I cited an excellent report from The Advisory Board Company as the basis for an editorial on the shortcomings of clinical systems like CPOE, which the report said fails to improve practitioner performance 87% of the time. I said, "Several years after the IOM report that supposedly opened our eyes, clinical systems really haven’t delivered on the expectations. They haven’t made us much better … Everyone is buying and implementing and improving, but the patient doesn’t seem to get much benefit from all this clinical system churning. We’re still plagued with poor integration, sloppily designed bolt-ons to old products, and outdated architecture. We’re also not good at changing business processes on the provider side, so let’s take a few lumps along with our vendors. We’re equally guilty."

The logical question people might ask themselves: I agree with the report to some extent, so what happens next? Will the conclusions cause years of sustained activity and industry self-reflection like IOM’s "To Err is Human"? Some thoughts:

• Who’s going to pay for all this clinical and IT improvement?
• Is the IOM’s vision of patient care a reality or a pipe dream? Will hospitals commit to it? If not, there’s no reason to build automation that won’t be used – we already have that problem.
• Show the numbers that justify the cost. Did UPMC’s cost or outcomes improve after they spent tons on IT? Are they better than less-automated facilities? So far, the link between IT investment and excellence (of any kind) seems iffy, especially when held to the standard that IT caused the improvement, not just co-existed with it.
• The report suggests that a complete shift in systems development, implementation, and use is needed. So how do you put that into play, especially in a competitive IT market where vendors can’t just scrap what they have and start over? And in a competitive provider market that’s struggling with low margins and entrenched inefficiency?
• Were conservative CIOs part of the problem, happy to ditch best-of-breed systems in order to gain integrated mediocrity that’s easier to support? And is that still necessary with more modern integration technologies? All of those systems were designed even before the Internet caught on.
• Maybe the next step would be to create specific standards from those goals that could be used to assess specific systems and their use. I’ve often said that a big problem with clinical systems is "having them" vs. "using them to improve care."
• The challenge will be the lack of standards in hospitals, even the lack of repeatable processes within a given hospital. Hospitals are notoriously unwilling or unable to get employees and physicians to follow even obviously important rules (like "wash your hands"). Systems are hard to support and enhance because hospitals resist change, forcing vendors to build in an infinite number of configuration options.
• The committee intends to follow this report with others, although in the case of "To Err is Human," most of the reaction came from the shock and public shame of the first one (Googling "98,000 medical errors" gives 83,000 hits).
• It will be interesting to see how HIMSS reacts. My first thought was that it would rush out a vindictive, clearly vendor-serving defense like it did with Ross Koppel’s articles, where he studied the unintended consequences of a clinical system implementation that actually increased patient harm, and HIMSS took offense. I think they’re smarter now, though, and will simply suggest more research while staying the course, i.e. still insist that the government should subsidize the purchase of today’s EMR systems, which is diametrically opposite to what the report concludes. HIMSS sees itself as the voice of healthcare IT, so it will surely recommend actions in which it (and organizations it influences) will be a prominent player.
• With that in mind, the last organization that I would want at the table when discussing healthcare IT changes is HIMSS. No offense to them, but their world is high-paying vendor members and flashy exhibit halls, not upsetting the gravy train. The approaches IOM says are wrong are the ones HIMSS pushed us into: RHIOs, CPOE, and "clinical transformation" that rarely had any impact.
• Nothing in the report should be interpreted as blaming vendors for anything. It merely says, "We’re here and we need to change direction to go to there." The job of vendors is to sell what customers will buy, so I take the conclusions as more of a criticism of providers who not only don’t demand systems that might work differently, they don’t even use the ones they have optimally. Providers should be setting the vision, not vendors, but have shown a remarkable inability to do so. Still, current products were based on old paradigms and old technologies, so it’s a good time for vendors to take stock.
• Despite the long list of problems in the report, it should be noticed that some hospitals have had success (quiet or otherwise) using off-the-shelf systems. I see it like this: today’s systems have taken us about as far as they can, hopefully providing value and benefit along with way. Now we’re ready to envision the second generation of systems (I’m arguing that we’re still in the first generation, but you may disagree), assuming that providers are simultaneously ready to embrace the changes that these new systems will support.
• Software vendors and hospitals dedicate a huge chunk of resources to billing and malpractice avoidance. If you want to reform healthcare and healthcare IT, simplify payment and free up all those people working on billing and  other administrivia to do something that actually benefits patients.
• If you want to know what a given person or organization will excel at, look at what they’re paid to do. If you want someone to change their behaviors, make sure you’re rewarding the behaviors you want. If you’re paying someone to paint your house, don’t base their pay on what they spend for paint.
• The bottom line: the goal is measurable quality improvement and reduced cost, not conspicuous consumption of IT. If you pay people to deliver better and cheaper outcomes, they’ll figure out what tools they need.

E-mail me.

A Summary of the National Research Council Report on Healthcare IT

The full text of the report is available free here.

I’ve gone through the report and will summarize it loosely below (the most interesting parts, anyway). A couple of industry experts have volunteered to provide their interpretation. Bill Stead, chair of the group, told me he will write up a short statement on the implications for hospitals and vendors for HIStalk. I’d like your thoughts, too.

Make no mistake, this report is important. The IOM has clout and is generally not seen as biased or influenced by industry. Anyone working on the front lines of patient care will identify with nearly every one of the observations and recommendations, although there’s no easy fix for most of them. The most important thought as you read, I think, is this: what traditional wisdom does the report challenge and who will be upset by that?

• HIMSS won’t like it because they didn’t think of it and it is somewhat critical of today’s systems (I expect a quick rebuttal). It’s quite a contrast to the exhibit hall.
• Not all vendors will like it because it may not align with their architecture or products and it questions today’s concept of integrated systems (note the line about monolithic, integrated systems that can’t support changing ideas – you know a couple of vendors and probably even some CIOs are shooting out of their chairs).
• HIMSS, rah-rah press, and anything Most Wired will hate it because it concludes that, despite big investments and painful implementations, today’s IT is not really helping patient care as much as it could and maybe we’re going further in the wrong direction.
• Users will like the observation that vendors don’t often take human factors design into account, resulting in systems that are hard to learn and use.
• Hospitals will take some offense because it holds them accountable for not using what they’ve bought and using automation mostly for purposes that have minimal patient care value.
• Not everybody in the government will like it because it emphasizes that healthcare needs drastic changes, not just more of the same systems, especially when it come to complicated government payment for services that aren’t necessarily in the patient’s best interest.
• Even the big hospitals that served as the site visits may not like it because, despite the mind-boggling sums all of them have spent on IT, the report doesn’t suggest impressive results. It mentioned one unnamed site (almost certainly UPMC) that has spend $500 million on IT in the past 10 years, but still isn’t where it should be.

For me, the most impactful statement echoed one I’ve made here several times recently: the government should not be in the business of funding IT systems, whether they’re archaic or state of the art. It should reward quality and let providers use whatever tools, IT or otherwise, that will help meet them.

In fact, nearly every conclusion in the report has been covered in HIStalk at one time or another (I’m not bragging on that, just pointing out that for a bunch of academics, their conclusions resonate way down here where Mr. HIStalk plies his IT trade by day and sees what they saw, which I think means they hit the target squarely).

Here’s the summary:

This report was produced by the National Academies, of which the Institute of Medicine is one division (along with the National Academy of Sciences, National Academy of Engineering, and National Research Council). Members of these groups work without compensation to advise the government and the public on science and technology issues.

Members of the Committee on Engaging the Computer Science Research Community in Health Care Informatics are:

William W. Stead, Vanderbilt University, Chair (CIO and information architect)
G. Octo Barnett, Massachusetts General Hospital (Harvard professor and research informatics)
Susan B. Davidson, University of Pennsylvania (computer science chair)
Eric Dishman, Intel (general manager of Intel’s Health Research and Innovation Group)
Deborah L. Estrin, UCLA (computer science professor)
Alon Halevy, Google (research scientist)
Donald Norman, Northwestern University (design professor)
Ida Sim, UCSF School of Medicine (associate professor of medicine and informatics director)
Alfred Spector, Google (VP of research)
Peter Szolovits, MIT (computer science professor)
Andries Van Dam, Brown University (technology and education professor)
Dio Wiederhold, Stanford University (professor emeritus of computer science)

This is an interesting group: mostly computer experts who could bring an objective viewpoint to the table (no vendors, no advocacy people, no caregivers). Some bias was obviously introduced upfront when choosing the committee members, the site visits, and the guests providing briefings (the "smart table" and Azyxxi-like analytical tools obviously were inspired by Microsoft, which did one briefing).

The committee disclaimed upfront that it did not look at all care sites and roles, particularly the 1-2 physician practice where much of the medical care is delivered in the US. It is hospital-centric.

The committee’s charter was to determine how well providers (hospitals, for the most part) are using technology support to strive towards the IOM’s vision. The tenets of that vision and visionary examples of how computers might support them are (from my interpretation and their examples):

• Comprehensive patient data. Computers could identify and count home meds, then using RFID-encoded prescription information to assess patient compliance.
• Patient-specific clinical decision support. Instead of looking at paper EKG strips, the doctor sees them overlaid with an animated electronic model of the patient’s heart. Historical information is presented in a consistent format for easy comparison.
• Application of evidence-based practice guidelines and research into practice. Doctors can subscribe to medical literature alerts, download new clinical guidelines into their systems, and use them to construct a series of patient flowcharts to choose from, when will then update disease management dashboards, order sets, and pre-programmed reminders.
• Tools that can highlight patient and population problems. A doctor can review a dashboard of all their diabetic patients, with all measures of disease color-coded so that all patients can be quickly assessed visually and interventions planned. During the patient’s visit, the system chooses drugs based on their therapeutic class and insurance coverage.
• Rapid integration of devices and historical patient information as a "learning" system. Patients run applications on their smart phones that measure activity and post it to their Facebook page widget. Inhalers are Bluetooth-enabled to monitor compliance and provide alerts tied to activity and environmental factors.
• Integration of information from alternate care sites, such as the home. Diabetics wear continuous blood glucose sensors that suggest action and dial an emergency number on their cell phone if readings advance to dangerous levels.
• Empowerment of patients and families with personal health records, education, and provider communication. EHRs allow patient access via the Internet and have an interpretation function that gives a lay explanation comparable to what a physician would provide.

What’s wrong with today’s use of IT

• There’s a big disconnect between systems and clinical practice.
• Systems place too much emphasis on clinician data entry without giving them value in return.
• Implementation cycles are too long, often measured in decades.
• Clinicians spend too much time digging through raw data that systems dump in their laps, leaving them to figure out how to use it in thinking about the patient.
• Today’s systems are build on a transaction-heavy foundation, with minimal context or grading the importance of information.
• Decision support should provide cost analysis, grade the quality of information, and allow clinicians to simulate interventions before doing them for real.
• Systems should be designed as thinking systems with transactions built in, not as transaction systems with decision support bolted on.
• Caregivers should not have to manually enter data that is being collected by electronic sensors – systems should be self-documenting.
• Users should be able to pose questions and have retrievals query multiple databases without requiring data in them to be standardized.
• Physician-patient interactions should be captured by real-time transcription and camera/microphone recording with suitable privacy consideration.
• The government’s role should be to embrace quality improvement, not to promote specific technologies that lock users into inefficient workflows. Incentives should be aimed at infrastructure, hardware, and data mining.
• IT should not be promoted en masse to clinicians until it helps them do their jobs better.
• A wide variety of payers with their own rules wastes a lot of clinician time trying to get paid.
• Clinical systems require extensive training, unlike PC applications that follow standard UI design and require no training.
• When clinicians round, applications add little value to the discussion and its results aren’t recorded anywhere for later use.
• Provider IT investments should be evaluated within four IT domains: automation, connectivity, decision support, and data mining.
• Organizations should at least scan their paper documents to make them available electronically.

Observations from the committee’s site visits

• Hospitals have a mix of paper and computer records, so users have to learn where to look.
• Work lists are usually managed on paper.
• Clinical systems were simply built to look like the paper they were supposed to replace, such as flowsheets.
• Documentation is after the fact.
• Clinical roles and responsibilities are not explicit.
• Clinical users value speed over everything else, but they don’t understand the systems that are supposed to support them.
• Legacy systems predominate, each with their own setup parameters and content, implemented with the goal of getting up and running rather than doing anything useful.
• Change management in hospitals means nobody moves ahead until the slowest party is ready.
• Biomedical devices were universally poorly integrated.
• Semantic interoperability is almost non-existent. Systems weren’t designed to guide users through the process of completing common fields with standard terminologies.

Recommendations

Evolution

• Focus on improving care, not on the technology.
• Seek incremental gain for incremental effort, rather than huge IT projects that take forever.
• Capture all the data you can.
• Design systems around human factors principles.
• Support the cognitive function of caregivers.

Revolution

• Design systems with disruptive change in mind, i.e. genomics, which are more easily supported with connected systems rather than monolithic, integrated, all-encompassing systems.
• Archive data in ways that future interpretation and analysis can yield new knowledge.
• Design technologies to eliminate ineffective work processes.
• Design systems that can put data into context.

IOM Report: Today’s IT Systems and Implementation Efforts Aren’t Good Enough to Support IOM’s Quality Standards

A new report published today by the IOM’s research council concludes that today’s hospital systems "fall far short … of what is needed to support the IOM’s vision of quality health care."

In its summary, the report says, "IT related activities of health professionals observed by the committee in these institutions were rarely integrated into clinical practice. Health care IT was rarely used to provide clinicians with evidence-based decision support and feedback; to support data-driven process improvement; or to link clinical care and research. Health care IT rarely provided an integrative view of patient data. Care providers spent a great deal of time electronically documenting what they did for patients, but these providers often said they were entering the information to comply with regulations or to defend against lawsuits, rather than because they expected someone to use it to improve clinical care. Health care IT implementation time lines were often measured in decades, and most systems were poorly or incompletely integrated into practice. Although the use of health care IT is an integral element of health care in the 21st century, the current focus of the health care IT efforts that the committee observer is not sufficient to drive the kind of change in health care that is truly needed. The nation faces a health care IT chasm that is analogous to the quality chasm highlighted by the IOM over the past decade."

Free access to the full text of the report is available here.

Bill Stead of Vanderbilt chaired the group, which conducted site visits at UPMC; the VA Medical Center in Washington, DC; HCA TriStar; Vanderbilt University Medical Center; Partners HealthCare; Intermountain Healthcare; UCSF; and Palo Alto Medical Foundation.

Given that the facilities observed have what is considered comparatively advanced IT systems and massive budgets compared to the average hospital, the report is sure to have far-ranging implications to the industry, especially as debate continues over whether the best use of federal stimulus money is to fund purchase current systems instead of revisiting whether they are adequate to deliver the changes needed in healthcare. 

News 1/9/09

From Peter Marshall: "Re: layoffs. Here’s another one: Cabell Huntington Hospital (WV)." Link. The hospital laid off 40 people on Tuesday. Like everybody else jettisoning employees, the CEO says the goal is to flatten the organization, making you wonder why he let it get un-flat in the first place (and whether the managers who hired them should be left unscathed). Also in WV, Weirton Medical Center forcibly parts ways with 36 FTEs. Other layoffs: Crozer-Keystone Health (PA), up to 400 employees; Uniontown Hospital (PA), 50 FTEs; Wilkes Regional Medical Center (NC), 45 employees; Noble Hospital (MA), nine employees; Mercy Health Systems (KS), 44 employees; Baptist St. Anthony’s Hospital (TX), 47 employees; Meridian Health (NJ), 65 positions. Erlanger Medical Center (TN) announces plans for a hiring freeze, layoffs, and renegotiation with suppliers. In case it’s not obvious, hospitals were waiting until after the holidays to cut staff, but the plans were in place long before Christmas.

From djk: "Re: Swedish Covenant Hospital, Chicago, is named a HIMSS Analytics Stage 6 EMR hospital." Their congratulatory letter from Mike Davis says 25 hospitals have now hit the Stage 6 mark.

From Boutros Boutros-Ghali: "Re: Web 2.0 and social networking. I’m interested in what role it will play in healthcare." I’d like to hear some opinions on this. I have to say I’m skeptical because some of the ideas seem obviously lame and the folks behind them are often light on track record, with a singular fixation on selling out their fledgling enterprises to the first willing party, so I’ll say that lots of the "companies" (more like "Web sites") will sink without a whimper without accomplishing much of anything. I’m always suspicious, too, that they tout fresh thinking only because that’s all they’ve got. Still, some will likely survive. The question is whether patients really have enough clout to matter in the grand scheme of things. Patients paying out of their own pockets could band together via social networking, but healthcare is mostly divided as those with insurance or those unable to pay — there’s not much middle ground because of absurd hospital policies on pricing and non-discounting.

Allscripts-Misys just announced Q2 numbers: revenue up 33%, EPS -$0.05 vs. $.07, slightly missing expectations on revenue but beating earnings estimates. The stock is up nicely after hours (3.5%), probably because the recent Leerink downgrades already took the wind out of its sails (not a bad thing, maybe, since reaction to the news will appear more optimistic and maybe rightfully so). And, surely the combining of the two companies made the numbers sketchy until that settles out. No matter how you look at it, the jury’s still out.

I should mention that I’m way behind on e-mail, so if you’ve sent me something, I’ll try to catch up over the weekend. Between the day job and HIStalk, I’m tied up from before daylight until bedtime.

The AHIC Successor organization is finally announced as the National eHealth Collaborative, hoping to get face time with Obama’s underlings in the next day or two. Our esteemed contributor John Glaser is on it, so I’m trying to twist his arm to explain the organization’s role and its plans going forward.

Clinical trials imaging services vendor Bio-Imaging Technologies sells its CapMed personal health records division to Metavante Technologies, a $1.5 billion annual sales banking and payment technology vendor whose healthcare offerings include benefit payment cards, eligibility and claims processing, ID cards, and (here’s the tie-in, I’m guessing) health savings accounts. CapMed and its icePHR was an early HealthVault partner, won TEPR’s "Best PHR" in 2008, and was supposed to be the medication PHR provider for IBM’s NHIN prototype, although I don’t know how that turned out.

I played around with Twitter once (for about 30 seconds) and lost interest, but I see several folks have signed up to follow me. Coincidentally, Bruce Friedman tells me he finds it useful for short thoughts and reminders about news items (he’s a lot smarter than I am). Question: what would I do with it? I can see that it might be fun to Twitter from HIMSS (since I could use the Bold instead of waiting to get the laptop online). Otherwise, am I missing something that would be valuable to readers?

HIMSS says it will work collaboratively COCIR, a European medical equipment trade association (its words, not retracted like HIMSS did) for "public policy activities" and conference production. Being psychic, I’ll predict that HIMSS will just buy it outright before long. One of its main activities, according to its site, is helping push the products of its vendor members (sound familiar?): "COCIR sees a negative trend in the age of the EU equipment base and is extremely concerned about this lack of investment. Continual investment in state of the art electromedical equipment is essential for the comfort of patients and medical staff." Not to mention profits.

California bars ED doctors from billing patients directly when their HMOs won’t pay the full bill. The California Medical Association complains that the ruling lets HMOs pay ED doctors whatever they want.

CHIME’s advocacy people mail (warning: PDF) Tom Daschle to let him know how much it supports EMR adoption (notice the letter manages to slightly botch the full name of HIMSS, leaving out the "and"). At least CHIME wasn’t as blatant as HIMSS in snaking a long tongue in the general direction of the federal feed trough, mentioning only incentives ("necessary funds") for EMR adoption. Still, they’ve got advocacy people.

Rick Peters, like me, is critical of the HIMSS EMR Welfare Program. He’s unhappy that HIMSS doesn’t talk more about its HITSP and CCHIT affiliations (I don’t see that as a problem and they haven’t tried to hide that fact, but maybe it’s less obvious than it seems). There’s a lot of dense and less interesting stuff in the middle, but the conclusions are interesting: that HIPAA was subverted by EDI claims clearinghouses who convinced Congress that they already had the best solution available, which killed all the positive possibilities of bringing in new approaches. The EMR tie-in: "Federal funding should go to fund research and innovation in health care IT along the lines of the NIH, NSF, and DARPA, not the status quo. Direct purchase of products and their subsidy should be avoided. There is a market (finally) for EHRs after all these years and the market should figure itself out without artificial influence. If vendors or institutions seek funding from the Federal government they should have to compete openly with academic institutions, independent contractors, start-ups, and all their competitors, without unfair and anti-competitive artificial constraints." That’s not to say that the current vendors may not be the best electronic medical records solution, only that nobody’s opened up the competition to see if the money might be better spent elsewhere or in having those same vendors take a different direction.

Jobs: Senior Network Analysts – Cisco Wireless, Cloverleaf Integration Consultant, Soarian Consultants, Revenue Cycle Consultant.

I’ll be winding down the HISsies nominations shortly, so if you haven’t voted yet, now’s a great time. Some of them gave me a chuckle, I’ll say that, and some of the serious ones (best CIO, CEO, and hospital) have some good nominees to choose from. That will lead up to the HIMSS conference, of course, so if you have suggestions on what Inga and I can do there to make it more fun for everybody, then let’s hear them. I thought about doing a live Internet radio broadcast from Chicago, or maybe a nightly recap with call-ins, but that sounds like a lot more work than my typically lame brainstorms involving Fake Ingas and free drinks.

American Sentinel University adds new members to its healthcare advisory board, including Roy Simpson of Cerner. It’s not regionally accredited, instead holding the less-accepted DETC accreditation that online-only schools often earn (meaning you can’t always transfer credits to a regionally accredited school). That’s at least better than the highly iffy Kennedy-Western University that’s popular with healthcare people, which just changed its name and fled from California when the state cracked down on diploma mills. I used to link to the bios of vendor and hospital executives whose degrees came from phony schools, but I got tired of the nasty e-mails demanding that I not mention that their "schools" were complete shams. Let’s just say there are a lot of those folks, some even double-appending "Dr." before and "PhD" after their names (usually a sign of stupidity or vanity) with only a mail order credential.

Dumb press release headline: "Solos Endoscopy, Inc. Receives Purchase Order from Cleveland Clinic." I can’t wait for the follow-up ones announcing shipment, receipt, and payment.

How does this happen? Police reports say Christ Hospital (NJ) threw out a newborn baby’s body in the trash, leading to search of garbage dumps in two states. The mother and the hospital can’t agree on whether the baby was born alive, a key point in the inevitable lawsuit to come.

The chairman of Indian outsourcing company Satyam Computer Services, in a story being called India’s Enron or India’s Madoff, admits that the company falsified its earnings and assets for years, saying specifically that over $1 billion of cash on its most recent financial report doesn’t exist and revenue was 20% less than reported. Shares were down an astounding 91% before trading was halted Wednesday, dropping from $9.35 to $0.88. You’re doing a heckuva job there, PricewaterhouseCoopers, auditors for the company. Enron took down Arthur Anderson, so PwC has got a heap of trouble on its hands. Anybody want to buy PwC Healthcare cheap? You may get the chance. The lawsuits will still be flying by the time you would graduate from law school in case you’re considering a career change.

Ohio passes a law requiring that pharmacy technicians register with the state board of pharmacy and pass a competency exam even though the state (like all others) already required held pharmacists accountable for checking their work. It came after a two-year-old died from an incorrectly compounded IV. That’s great for the techs, of course, since the now-limited supply will raise wages.

The Jerry Seinfeld commercials couldn’t save Vista (although they won lots of "stupidest waste of money" awards), so Microsoft moves right to the Windows 7 beta and hopes everybody forgets the debacle of dysfunctional drivers and wildly underestimated system requirements intended to keep its PC partners happy while burning its own customers.

Loma Linda University opens a new hospital with all the latest sexy stuff: robotic surgery, private rooms with balconies, room service, and flat screen TVs. The cost: $4 million per bed. The impact on local health: we’ll see.

The local business paper writes up Polymap Wireless, a Tucson company that makes Bluetooth-enabling technologies for scales, blood pressure cuffs, and glucometers so they can transmit results over the Internet to providers.

Iatric Systems creates an endowment to provide one hospital in need with its Security Audit Manager and related services.

Someone steals $60,000 worth of nurse call center hardware from Bear River Valley Hospital (UT), which was storing it in an unsecured storage until a new hospital opens up next month.

Creighton University (NE) is losing $10 million a year on its faculty practice organization, blaming a lack of patients and computer problems that delayed billing. The plan: hire 50 or more new doctors to bring in more patients. The impact on local health: we’ll see (I know I said that before, but I’m now fixated in Don Berwick’s statement that all this increased supply of medical horsepower just raises costs). I suppose it’s unthinkable to simply scale back the services to match the income. That’s like asking the government to live within its means.

The family of a toddler killed in an Illinois medical helicopter crash sues the company that operated the helicopter, its parent company, and the estate of the pilot killed in the crash. The former chair of the National Transportation praised the family for bringing the case forward "to push the industry for tighter rules," but he’s hardly unbiased: he’s one of the lawyers hired by the family.

E-mail me.

HERtalk by Inga

From Frank Sinatra: “Re: MyWay product. I hear that the Allscripts-Misys MyWay sales are strong. Results are well above goal. MyWay is the repackaged iMedica product that is now being sold strictly through resellers to 1-3 doctor practices.” Good news for Allscripts, though I still can’t figure out why they would choose to sell this seemingly popular product through resellers only. Aren’t the majority of the country’s physicians in 1-3 doctor practices?

Summa Health Network utilizes new technology from MDdatacor to use data from physician systems to determine compliance with evidence-based guidelines.

Tufts Medical Center warns thousands of BCBS HMO patients that providers will not accept its insurance as of February 1. Tufts is not happy that BCBS is paying them 20-40% less than other Boston-area teaching hospitals. BCBS admits an imbalance in rates “that can be because of market clout.” Tufts does not want to sign up for a new payment system that includes per-patient payments, plus additional payments for meeting quality targets.

Merge Healthcare cancels plans to sell its China-based operations. Inqgen Technology intended to purchase Merge’s Cedara Software Shanghai, but Merge’s new management wants to focus on growing its business internationally.

Just two weeks after raising $6 million for expansion, Motion Computing CEO Scott Eckert resigns. The company also laid off 25% of its workforce, or about 30 people, following its previous layoffs of 55 employees in April and July.

This could be a fun lawsuit to track. A San Francisco chiropractor sues a former patient for libel and invasion of privacy after the patient posts a negative review on Yelp. The patient disliked the doctor’s billing practice and felt he was being dishonest with insurance companies.

Parkview Medical Center (CO) takes top honors in a national patient safety contest sponsored by Patient Safety & Quality Healthcare magazine and Precision Dynamics Corp. Parkview implemented a new barcode technology system that reduced medication administration errors from 20% to 8%.

The executive director of Maine’s HIE initiative HealthInfoNet expresses concern the project will run out of money before it’s operational. It has relied on grants, but the director hopes to receive additional dollars from a possible federal HIT economic stimulus package. After all, federal bailouts are all the rage.

This sounds like one nice guy. A New York surgeon demands that his estranged wife either give him back the kidney he donated to her in 2001 or pay him $1.5 million. He’s a little miffed that she had an extramarital affair.

Back in 2003, People Magazine named Sanjay Gupta one of the “Sexiest Men Alive.” You would think that once you get that title, there isn’t too much more a guy could aspire to. Yet, now he is being considered for the Surgeon General post despite skimpy public health experience and a cozy relationship with the drug companies that sponsor his TV career. Kind of makes you wonder what might be in store for Brad Pitt.

Vendor Deals and Announcements

• Diversified Radiology of Colorado streamlines its billing operations with its new AMICAS partnership. Diversified will utilized the AMICAS financials, dashboards, and claims processing solutions.
• CareTech Solutions signs a five-year agreement to provide IT outsourcing to Central Maine Medical Family (ME).
• The 49-bed Cogdell Memorial Hospital (TX) implements an integrated clinical and financial system from Healthcare Management Systems.
• Newton Memorial Hospital (NJ) signs a six-year agreement outsourcing IT to PHNS.
• Axolotl integrates M*Modal’s Speech Understanding engine into its Elysium medical transcription workflow solution.
• Cancer care provider OnCare (HI) selects IntelliDose for chemotherapy treatment management to integrate with its Allscripts EHR/PM system.
• Novo Innovations announces a record year in 2008 that included 17 new customers, more than double the previous year.
• Press Ganey Associates acquires PatientFlow Technology, hoping to increase its clinical and operational presence while broadening its consulting services.

E-mail Inga.

Being John Glaser 1/8/09

A byproduct of the implementation of an electronic health record is the creation of a relatively large clinical database. The core value of this data is supporting the provision of care. There are other uses — secondary uses — which are important.

Perhaps the most important secondary use is assessing the quality, efficiency, and safety of care. Care patterns can be contrasted with national guidelines; a physician’s practice can be compared to that of other physicians; and the health of a population of people with a chronic disease can be assessed.

However, several organizations have begun to look at additional secondary uses of this data. Two areas show great promise.

One area is post-market surveillance of medications. The graph above (Brownstein, PLoS ONE, 2007) was developed using data from Partners HealthCare. It shows a dramatic increase in admissions due to heart attack. The arrows indicate when our physicians began to prescribe Vioxx and when they stopped prescribing Vioxx. This example raises some interesting possibilities — could we begin to monitor a medication soon after it is introduced and do a much better job of detecting problems earlier?

Another area is leveraging EHR data for clinical research. An area Partners is working on centers on genome association studies (www.i2b2.org), e.g., are there genes associated with depression treatment success? The graph above (Kohane, Internal Partners Analysis, 2008) is a bit complicated, but it shows that studies that leverage EHR data (the lowest set of lines) can cost five times less than studies that rely on manual chart extraction (the top set of lines). In addition, it appears that EHR-based studies can be done in one-tenth the time. These gains in efficiency and speed could dramatically alter clinical research.z

There is still much work that remains, e.g., developing sound methods for dealing with the often poor quality of EHR data. However, both of these examples show very compelling potential secondary uses of clinical data.

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

News 1/7/09

From Inside Outsider: "Re: Sunquest. Hearing from Sunquest insiders that the New Year layoff axe has begun and folks with close to 20 years of time served have been shown the door." Unverified, but I’ll invite the company to respond.

From Health Care Consumer: "Re: video. This video made me laugh — you should watch it." Loved it — Red Sickle Red Armor Insurance. The tag line: "This is what health insurance corporate videos would look like if they told the truth. And, if they hired crappy animators." They make fun of "non-profit" RSRA (wonder what insurance company that could be?) "As a non-profit, we don’t have stockholders. No, we don’t have to answer to Wall Street when we’re meeting your healthcare needs. And we don’t have to share the money we make with anybody else. We’re free to stockpile it and use it to build the infrastructure that keeps our company running properly. For example, did you know that we have 4,000 corporate vice presidents?" 

From Andy: "Re: errors in the UK." Link. NHS records show that 3,645 people died in one year due to "patient safety incidents" that included surgical errors, incorrect diagnosis, staff or employee abuse, falls, medication errors, and equipment errors. Those are the errors that were reported and proven to cause death, of course, so the real number is almost certainly a lot higher (only 54 died from medication errors, the reports say, which is only a little higher than the number of fatal equipment errors, so that’s probably a too-low number for meds). Still, deaths (or, more accurately, reported deaths) were up 60% in two years.

From The PACS Designer: "Re: Cloudo. If you want to have an online PC to collaborate and share files with with others, there is a new application called Cloudo, or a PC in the cloud. It does just about anything a physical PC does with the added benefit of easier sharing of documents, photos, etc. and also includes the ability to do cell phone file sharing and retrieval." Link. Looks pretty cool, "a computer that lived on the Internet, instantly accessible from any computer or mobile phone."

From Ted Peters: "Re: ThedaCare’s lean program. They use lean events to streamline work flows. Epic is flexible enough to accommodate the new work flows and Epic’s done quite a bit of development to enable the stuff Theda wants to do, making life easier for other customers as well. ROI doesn’t come to those who wait, it comes to those who are going out and using a good EMR as a tool to get there." Link.

Listening: Interpol, post-punk indie rock out of NYC. And watching (rare since I almost never watch TV): Psych.

I’m not exactly sure why HIMSS needed to acquire a privately published magazine, but it’s the new owner of Government Health IT. I don’t like that for several reasons: (a) it was the only magazine I actually read and sometimes referenced here other than Computerworld, so I have this feeling that it’s about to become a lot less interesting and objective; (b) HIMSS will surely use it to beat readers over the head with its pro-vendor advocacy agenda even more than it already does through other channels; (c) only one employee is coming over in the deal; (d) it was one of very few HIT publications out there whose original, independent reporting didn’t sound like some fresh-faced 2.5 GPA state school journalism grad trying hard not to sound clueless about both the subject matter and the audience; and (e) it was already free anyway, so it’s not much of a HIMSS member benefit. I got the internal memo sent out by the selling media company to its employees, which said "we were made a very attractive, unsolicited offer," so the HIMSS salivation over possible HIT lollipops from Obama must have set off a fierce desire to get even closer to the feds.

Allen Tien MD, president of Medical Decision Logic (mdlogix), e-mailed to let me know that Washington University School of Medicine and BJC (MO) have signed a 10-year license for the mdlogix Clinical Research Management System.

Someone just sent me a LinkedIn connection request, which reminds me: Inga and I will approve any we get because we’re enablers in your quest to dominate other LinkedIners with your impressive connection list. The HIStalk Fan Club is up to a startling 461 members, outdoing some of the magazines that started their own groups since readers didn’t do it spontaneously.

Army doctors at Landstuhl Regional Medical Center in Germany report excellent experience using Nuance’s Dragon Medical with the AHLTA clinical system. The Surgeon General says the 10,000 copies bought for world-wide use will pay for themselves in less than a year with transcription savings.

Medicity reports 81% revenue growth in 2008, its tenth anniversary, with strong sales and the hiring of 51 new employees focused on R&D and customer support.

A non-profit organization created to raise money for the University of Hawaii medical school is deep in the red, owing the school $7 million. The organization was supposed to generate revenue, manage grants, and provide billing services. The dean sounds like he’s running GM: "We have collectively inherited an entity undercapitalized at the beginning that has limped along and has required a re-infusion of capital to upgrade its operations."

Inteoperability vendor dbMotion brings on new executives: Marty McKenna (Allscripts) as VP of commercial operations and marketing; John Jordan (Insite One) as east VP of sales; and Steve House (Cardinal Health) as west VP of sales.

Children’s National Medical Center (DC) chooses eClinicalWorks PM, EHR, and community health record for its employed, clinic-based physicians.

A New York Times article covers personalized medicine, tailoring drug selection and doses based on individual patient genetic makeup with the strong possibility of choosing more effective treatments, reducing cost, reducing side effects, and speeding up response. EMRs are going to be a key, of course, which is why smart vendors like Cerner, Epic, and others are building genetic data capabilities into their products. Not that you care, but here’s how I’ve explained it to people: it’s like the vastly increased accuracy in weather forecasting that happened once meteorologists discovered air mass behavior and the effects of barometric pressure instead of looking at old weather charts and basing today’s forecast on last year’s weather.

Don’t forget to make your nominations for the HISsies awards. The actual voting will start in a few days, but the only choices you’ll have are those that have been nominated (you’ll feel guilty if Neal isn’t on the ballot for The Pie, won’t you?) The winners will be announced at the HIStalk event at HIMSS, assuming there is one, of course (stay tuned).

Eclipsys completes its acquisition of Premise.

Ray Beerman, former CIO of Jackson Memorial Medical Center (FL) and healthcare IT pioneer, died last week at 73.

Hospitals in Yemen’s capital city go on strike after a doctor is killed by a man who said his father died from the doctor’s medical error.

Odd lawsuit: a rheumatologist’s patient claims she asked him repeatedly to provide a sign language interpreter during her office visits. He declined, saying as a a solo practitioner that he couldn’t afford the $150-200 per visit cost when Medicare was paying him only $49. The woman’s visits were routine and she had no complications, but she sued the doctor, claiming he violated federal and state anti-discrimination laws by depriving her of the opportunity to fully participate in her care. The jury awarded the woman $200,000 and another $200,000 in punitive damages, all of which comes from the doctor’s pocket since it wasn’t a medical liability issue (and in fact, he wasn’t allowed to bring up her satisfactory medical outcome as part of his defense).

Hospital layoffs: Lee Memorial Hospital (NY), Merrimack Valley Hospital (MA).

Here’s why healthcare costs keep going up: Grand Rapids, MI, reluctant to allow growth and tax revenues to slow, bets the farm on a Medical Mile of new hospitals and healthcare vendors to create high-paying jobs. As Don Berwick says, will that really improve health, or will it just increase cost?

The owner of several defunct medical software companies in Tennessee is charged with fraud in an alleged $17 million scheme to obtain loans based on bogus software sales.

Memorial Hermann claims its "quick look" ED program, where nurses give patients a quick check within five minutes of ED arrival to get the really sick ones to a doctor faster, says the wait time to see a doctor has dropped from 93 minutes to 20. It’s amazing that we still haven’t figured out an acceptable way to keep routine patients from clogging up the ED.

E-mail me.

HERtalk by Inga

From Jon Bon Jovi: “Re: CD sales. Yes, CD sales continue to plummet, but downloads continue to grow (whether or not anyone is paying for those downloads is another issue!) Quite a few of my musician friends are now moving to the idea of not even pressing indie CDs anymore, and just offering new recordings online. Amazing.” The article I referenced last time indicated that one reason vinyl sales were up is that they were cheaper than CDs or downloads.

From Clement Clarke Moore: “Re: poem. Loved the Night Before Christmas poem.” Thanks to everyone who said they enjoyed the HIStalk version, which I presented to Mr. H as a Christmas present. IMHO, I thought it was kind of clever.

I’ve been a little behind on my news and my e-mails with the holidays, but I think I’m almost caught up. My apologies to "Lindsey,” who I e-mailed back at 2:00 a.m. New Year’s Eve morning (note to self: try that new Mail Goggles feature).

Wells Fargo Insurance Services donates $25,000 to Cabell Huntington Hospital (WV) to help purchase a GE Healthcare OmniBed.

A Leerink Swann analyst predicts that Obama’s plans for funding healthcare technology will not help the sector for at least 12-18 months. Bret Jones downgraded several HIT stocks, sending HIT stocks down in Tuesday’s trading.

Virtual Radiologic names Mike Kolar VP, general counselor, and secretary.

Gwen Darling with Healthcare IT Jobs has been telling me I need a Twitter account, so I finally set one up this weekend. I am not sure that I need something else to keep up, but I’ll try it for awhile. If you care to tweet (twit?) me, look up IngaHIStalk.

INTEGRIS Health extends its deployment of Allscripts Care Management from two hospitals to all 13 of its Oklahoma facilities.

A VA study of 35,000 patients finds that telehealth programs help patients to better manage their health. Hospitalization days dropped 25% for patients using home telehealth and hospital stays fell 19%. The services cost an average of $1,600 a year.

IBM CEO Sam Palmisano predicts that more than 900,000 jobs will be created if the government invests $30 billion in HIT.

I’m predicting we’ll see stories similar to this one in coming months. MRI operator Metiscan Technologies negotiates $1.97 million in debt forgiveness with its largest creditor.

And more stories like this: Baptist Health of Pensacola fails to obtain financing for the $245 million purchase of West Florida Healthcare, a unit of HCA. Baptist has always received recognition for its quality and patient services programs, but it never seems to make money despite that (apparently there’s no profit in either one, which is a pretty sad commentary in itself).

Like Mr. H, British physiotherapists (aka physical therapists in Yank-talk) enjoy the Wii Fit and even incorporating it into rehab routines.

Faithful readers will recall that my background is more in the ambulatory world, unlike Mr. H, who lives and breathes hospital stuff. I finally convinced him it would be cool to have a HIStalk site that focused on the physician world and he finally gave in. Please check out HIStalkPractice if you are interested in technology for the doctor’s office. If you like it, sign up and tell all your friends (we have 208 subscribers so far on our second day – thanks! and also a couple of sponsors to announce shortly). I feel like I used to when I sold a brand new version of software … kind of like, now that I have made the sale, will it really work?

Alaska launches a new Web-based database designed to track immunization history.

Partners HealthCare, Pfizer, the Clinical Research Information eXchange, and the Clinical Data Interchange Standards Consortium form a coalition to test ways to improve electronic reporting of adverse drug events. The group will study how standards, technology, and a new business model can improve drug safety by helping physicians better recognize and report adverse events.

The Wall Street Journal reports that in 2007, healthcare spending grew at its lowest rate in almost a decade, although the 6.1% increase is still a faster rate than the overall economy. Interesting statistic: we spend $7,421 a person for healthcare ($2.2 trillion overall).

Iowa institutes a new computer system designed to track purchases of most prescription drugs. The database is expected to help doctors and pharmacists track drug seekers.

E-mail Inga.

Being John Glaser 1/6/09

I travel. Not all of the time, but enough of the time. Like many of you, I attend conferences, sit on various external committees/association boards, and visit vendor headquarters.

Air travel has become a sport. A sport that has millions of participants and seems to be growing.

Any sport that has a broad participation and is experiencing growth eventually sets its sights on becoming an Olympic sport. Admission to the Olympics requires that the sport has events, in particular, events that require displays of cunning, physical prowess, and human drama.

A small group of experienced healthcare industry travelers from across the globe has developed the following set of initial events.

Security Sprints

The sprints involve heats, semi-finals, and finals. The fastest traveler-sprinter wins.

Event 1
Sprint through security with only a briefcase.

Event 2
Sprint through security with a two large bags, toiletries, laptop, overcoat, and shoes with laces that are all tangled.

Event 3
Same as Events 1 and 2 with the following obstacles:

• Family of six with four misbehaving children
• Young person who can’t understand why they have to surrender their bottle of water
• Older man who seems to not understand that you have to remove the metal from your pockets
• TSA screener who wants to make sure, double sure that he misses nothing on the x-ray

Baggage Stowing

Winners have the fastest times. Contestants can be disqualified per the constraints below.

Event 1
Fitting a bag that is two inches too long into the overhead without breaking the overhead door or using duct tape to secure the door.

Event 2
Placing a 4x4x3 foot duffle bag under the seat in front of you without breaking the crystal goblets in the bag.

Event 3
Placing a 150-pound bag in the overhead without dropping it on the head of the passenger in the aisle seat.

Seat Defense

These events are scored on “technical skill” in which points are gained or loss based on execution of the maneuver.

Event 1
Silencing a chatty seat mate (Using “Talk to me again and I’ll kill you” costs the contestant 5 technical skill points. Using “I’m on the verge of developing the formula to cure cancer — could I have a moment or two to concentrate?” earns the contestant 5 points.)

Event 2
Preventing the person in front of you from reclining their seat (Spilling soda on their head is minus 5 points. Pointing the air vent so that it blows on their head is plus 5 points.)

Event 3
Stopping the person next to you from reading over your shoulder. (Saying “Read my stuff again and I’ll kill you” is minus 5 points. Turning the book/newspaper upside down and continue reading earns the contestant 5 points.)

These events are preliminary. And there is work that remains in refining the events, e.g., some European nations are not in complete agreement with the US/Japan proposed Seat Defense point schema. However, the International Olympic Committee has given initial approval of several Air Travel events making their debut in the 2012 Olympics. It is not too early to begin training.

I expect to see many of you training on upcoming flights.

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

Monday Morning Update 1/5/09

From SQL Goddess: "Re: American CareSource. I thought this was interesting, having never heard of the ancillary care networking business." Link. The Dallas-based American CareSource (warning: the horrid white-on-puke-green color scheme will give you an instant migraine) had the best performing stock of North Texas companies in 2008 with 120% appreciation and a $105 million market cap. It contracts with labs, dialysis centers, and imaging centers to offer their packaged services to small insurance companies and employers. The CEO says it deals with the best and cheapest ancillary providers. "Do you really need 15 imaging centers in North Dallas? How about five that offer the best quality and best prices?" Somebody’s buying it (literally): the company handled 500 claims annually three years ago and is doing 550,000 now, with good prospects in a cost-cutting healthcare environment.

From Topexecit: "Re: Microsoft getting ready to lay off 17% of staff." Link. Rumors are flying that Microsoft will have massive layoffs on January 15, with up to 15,000 employees getting the axe. I don’t doubt that layoffs could be imminent with Q2 reports due on January 22, but despite a plethora of gaffes, MSFT is still doing OK in some markets. And, a number that high would surely have triggered firmer and more numerous leaks of what’s about to happen, not just one guy posting on an obscure tech site that starts ping-ponging around. On the other hand, as I’ve always said, terrible market conditions are a great time to get rid of deadwood, announce all the previously hidden bad news, and make all the tough but unpopular decisions.

From Garrnut: "Re: Partners. Getting skewered by the Boston Globe. This is the third article in a series." Link. The opening sentence about the Partners-Blue Cross insurance cost agreement gives the conclusion away: "It was the gentleman’s agreement that accelerated a health cost crisis." The article claims that Partners got a 75% increase in insurance rates since 2000, forcing other insurers to give it similar increases and encouraging competing hospitals to to seek the same rate, creating inequity, delivering only a tiny percentage of expected cost savings, and leaving duplicative services intact between the two formerly competing hospitals. Deeper into the article, however, is a key fact: Partners has never had a margin greater than 2% and makes a good bit from investments, so its prices aren’t out of line. Here’s some cold water on that, though, from none other than IHI’s Don Berwick, who worries about the inarguable fact that medical oversupply creates its own demand: "When Partners decides to expand . . . the prediction would be it will not add to the well-being of the population. It will add to cost." My opinion: we’re back to the "exactly how well do we want our hospitals to do financially" argument, where everybody’s proud of the the local hospital, its highly compensated executives, and its fancy buildings as long as they’re not the ones directly paying for them. All of that was probably inevitable when the industry turned to the "business model" instead of the "charity model" of yesteryear, encouraging hospitals to run like businesses instead of charitable and religious missions.

From Lupe Velez: "Re: Blueware. A quick check of LinkedIn reveals the CEO is Rose Harr, formerly with IBM. Businessweek.com confirms that and lists David G Holland, formerly with Genesys Health Systems, is COO. I can’t figure out what they offer either." Someone sent over another announcement from them, but I’ve lost interest.

Several people have told us we should write more for the physician office audience, so we’ve started an HIStalk-like site for them called HIStalk Practice. Coverage here won’t change a bit, so for the majority of HIStalk readers who find its ambulatory EMR and related coverage deep enough, then don’t worry about reading it. Otherwise, check it out, sign up for the e-mail updates on that page, and watch for some new contributors who will be helping us write about medical practice IT topics (and let me know if you’d like to contribute).

Most folks are back to work, so I’m ready for your submissions for Wednesday’s Readers Write and suggestions for "An HIT Moment with …" subjects. HIMSS is coming up before you know it, which means (thankfully) that lots of folks will be asking about HIStalk sponsorship, HIStech Reports, text ads, etc., so time is running short for prospective sponsors who want to get on board (that’s not a sales pitch, just a statement of reality that, if it’s like past years, we won’t be able to accommodate the laggards).

I put in some significant Wii time over the holidays, with this conclusion: if all-but-canonized Saint Barack Obama really wants to spend $25 billion of taxpayer money to buy EMRs for doctors who don’t really want them, he should nationalize the Wii Fit programming team to write a free EMR (it’s nearly a PHR already). I didn’t get the Wii thing until I tried it. No wonder they can hardly give away the Playstation and Xbox. As to the first part of my conclusion, my upcoming Inside Healthcare Computing guest editorial is called Buying Doctors Systems They Don’t Want: Why Even Detroit’s Bailout is More Progressive than the HIMSS EMR Welfare Program.

Speaking of sponsors, the last couple of weeks have seen two of them involved in what should be great acquisitions: Novo Innovations was picked up by Medicity and Premise will become part of Eclipsys. It’s really surprising how many HIStalk sponsors have been involved in rewarding acquisitions over the years (that’s not always good for me, of course, since one sponsor acquiring another means I lose one). Inga brought up the fact that a disproportionate number of our sponsors are top ranked in KLAS as well. I don’t understand it, but it’s interesting.

It’s HISsies time! (for either the fifth or sixth year — I can’t remember). Since the voting covers all of 2008, it makes sense to open up the nominations now while that generally awful year is still fresh in your mind. Please fill out the 20-category nomination form. Everybody has fun with the final voting, which will follow in a couple of weeks, but it’s the nominations that make it interesting. As always, I’ve thrown out a few of the less-interesting categories and replaced them with some fun new ones. Which vendor will be acquired in 2009? Who’s the best healthcare CIO? Who will get The Pie? You tell me.

Listening: Elf Power, Athens-based psychedelic indie rock. For all you Misys-Allscripts folks in Raleigh, they’re kicking off their US tour in Chapel Hill on January 21.

It appears that predictions were correct: Obama names healthcare IT as one of the key elements of his economic recovery plan.

The York VA Medical Center (TN) found that it had performed colonoscopies using possibly contaminated equipment, so it used its EMR to identify affected patients to offer them follow-up care (hopefully not a free repeat colonoscopy).

Jackson-Madison County General Hospital (TN) avoids layoffs by cutting back on discretionary spending, including "software packages."

I’ve chided "free EMR" vendor PracticeFusion for what sounded like wildly inflated marketing claims, but I have to admit that its 2.0 screen shots look pretty good. Lots of docs have signed up, although I haven’t seen proof that they’re actually using it fully.

Newspapers love "first baby of the New Year" stories, which I’ve previously observed always seem to involve young, unmarried, and unemployed parents (often just one) who get a bunch of promotional samples from local businesses hoping for free PR. My local paper didn’t let me down this year and neither did most of the newspapers I checked – how about yours?

I mentioned a fascinating profile a few months ago about Kaiser informatics pioneer Morris Collen, MD, who’s 95 and still working. Here’s an even better article from the LA Times. He works on clinical decision support and is writing a book to be called The History of Medical Informatics: The Clinical Support Systems.

Hospital layoffs: Albemarle Hospital (NC); Cambridge Health Alliance (MA); Also: University of Maryland Medical Center asks employees to take unpaid time off to avert a budget crisis.

Healthcare Association of New York State, which pays its CEO $500K according to tax records, launches a "Help Your Hospital" Web site to enlist public support for "vital funding" as the governor tries to cut costs (emphasizing lost jobs more than anything else). It also offers a HIMSS-like closed loop in which vendors are encouraged to buy corporate sponsorships or host the ever-present golf tournament in return for access to its members: "What value does your organization place on networking with more than 550 not-for-profit health care providers? How can you establish a powerful presence and make critical connections with these key decision-makers?" One of its surveys claims that New Yorkers would overwhelmingly rather see their taxes increased than to cut healthcare costs of any kinds, which would be a lot more believable if it were on a ballot and not on a special interest group’s survey.

Odd hospital lawsuit: a Pennsylvania woman is suing a local hospital for allegedly using her image in commercials without her approval, claiming invasion of privacy and being "deprived the value of the exclusive use of her likeness."

And another: a prostate surgery patient sues Shawnee Mission Medical Center, claiming the operating table malfunctioned during the procedure and permanently injured him when it dumped him to the floor. The hospital was previously sued by a patient who claims he was paralyzed and his neck broken when an X-ray table dropped him on the floor while he was sedated.

Ed McMahon files papers against Cedars-Sinai, demanding a protective order for the privacy of his medical records as part of his lawsuit for what he claims is medical malpractice.

Memorial Hermann yanks the name of its $3 million donor Roger Clemens off its sports medicine institute, citing reasons other than the obvious one that he’s been irreparably linked to his denied steroid use (or the claims by a woman that the married Clemens had a longstanding affair with her starting when she was 15).

E-mail me.

HERtalk by Inga

Parents magazine names The Children’s Hospital of Philadelphia the nation’s best pediatric hospital.

A Juarez hospital opens a sales office in El Paso to recruit patients and help them navigate medical tourism issues.

John C. Lincoln Health Network and Mayo Clinic (AZ) end their family-practice training programs due to funding issues. Lincoln Health estimates 2007 losses from the program were $650,000.

Hershey Medical Center monitors infection outbreaks via a computerized system. The software provides staff with quick charts and graphs illustrating how many patients within a particular unit are infected and which lab specimen contained the germs.

Good news from Allscripts-Misys. The company revises its Q1 non-GAAP net income to $15.4 million from $13.4 million.

The Detroit News cites CareTech Solutions as one of the bright spots for Michigan’s tech industry. Though the state has lost 6,100 positions over the last year, CareTech has added almost 150.

Music purist Mr. H claims he has done nothing to contribute to this trend, but I’m not so sure. Vinyl record sales double from 2007 to 2008, while CD sales fell. I actually still have a record player, though it’s been 10 years since I touched it (obviously I am not an audiophile). Now I’m wondering if I still have that REO Speedwagon album somewhere.

In Tennessee, e-prescribing increases 127% over the previous year.

E-mail Inga.

Eclipsys To Acquire Premise for $38.5 Million

Eclipsys announced this morning that it will acquire patient flow systems vendor Premise of Farmington, CT for $38.5 million in cash. Closing is expected within 15 days.

News 12/31/08

From The PACS Designer: "Re: 2008. TPD is blown away by the success in 2008 for HIStalk! Never did I expect the famous healthcare luminaries that agreed to be interviewed! Wishing HIStalk and everyone else a better and more prosperous 2009. Happy New Year!" Thanks to TPD for his regular-as-clockwork, bite-sized educational postings. Keep in mind that he and I have never met or spoken – he posts just to help educate HIStalk’s readers. Thanks, TPD!

This will be a little short since I’m just getting back in after a short trip to KCMO. The barbeque at the couple of places I tried was good, even if the sauce they bury it in is jaw-clenchingly sweet and heavy, more like ice cream sundae topping than anything you should put on meat (like KC Masterpiece or what they put on barbeque down south at the Sonny’s chain – mostly corn syrup, molasses, and fake liquid smoke). Once you scrape that off, it’s pretty good. By state, I’d rank the barbeque as TX, NC, MO, GA, and TN (OK, AL, and AR should be in there somewhere, but my experience is limited).

Andy sent a link to a story about struggling hospitals, with the focal point being Shands AGH in Gainesville, FL, the town’s first community hospital that will be shut down in 2009 to save money, 12 years after it was bought by Shands Healthcare. The CEO of Shands blames bad debt and reduced Medicaid payments.

I found Greg Hall’s analysis of the crippling effect of institutional debt in healthcare fascinating, the idea that industries that created phantom wealth in the form of leveraged debt and tax advantages. "Examine the notion of ‘capacity utilization.’ Without debt, excess capacity is not viewed as a problem. Consider the local fire department. Paid staff resides at stations 100% of the time, regardless of emergency conditions. 100% state of readiness. Imagine if the fire station had to pay a mortgage: it would then be forced to convert its unused (excess) capacity to a cost, and in turn focus on raising revenues to support its excess capacity. This is exactly the case with hospitals (and many other large U.S. businesses)." It’s dead-on for hospitals. Every one I’ve worked for, including those that showed a huge ‘surplus’ (non-profitese for ‘profit’) still could not finance even predictable costs through operational profits; they were always going to the bond market. And, I’ll throw in my psychological theory that supports Greg’s concept: the hotshot MBA CEOs who now run many/most hospitals instead of the previous crop of MHA-trained ‘administrators’ aren’t satisfied with just keeping a hospital running efficiently and serving the community; they have to show their for-profit counterparts that they’re business sharpies, so the preferred outlet is community dominance and building massive Taj Mahospitals. That’s the coin of the realm when it comes to community hospitals: beating your competition and erecting awe-inspiring buildings that generate obvious community pride, but with highly questionable community value. One might postulate that much of today’s economic ills were caused by B-school grads, many of them who found their way into healthcare as their widget of choice, who were taught that growth is everything when it comes to businesses, stocks, and assets. Just making a nice profit is not sexy enough. As a result, the churn of leverage and acquisitions and vertical integration caused a mess that will not be easy to get out of, even with those $1 million and up hospital CEO salaries. Hospitals, unfortunately, were just as greedy, just less honest about it in claiming it was all for their communities, large chunks of which already couldn’t afford their services.

A reader sent over a BlueCross BlueShield of North Carolina memo that asks doctors to support elimination of "highly problematic privacy provisions" that it claims could be included in the economic stimulus package. I mentioned the Confidentiality Coalition’s similar demands last week (BCBS Association is a member of that group and that’s mentioned in the memo). Some items they don’t like: requiring patient authorization for disclosing PHI for treatment or payment purposes; requiring EMR users to keep records of non-verbal PHI disclosures; and allowing individuals to opt out of interoperability projects like HIEs and RHIOs (!!). That’s about as arrogant as the sham that BCBS is "non-profit" while sucking in huge chunks of healthcare expense for administrative functions that seem to more often hinder it rather than help it. All I know is that BCBS makes a ton of money (nearly $200 million profit in one year not too long ago in NC alone), pays its executives ridiculously handsomely, and occupies buildings that are decidedly non-Spartan.

Hollywood will surely make a movie about this: Cigna refuses to pay for a liver transplant for a 17-year-old leukemia patient, saying the procedure is experimental, even after the patient’s doctors report a six-month survival rate of 65%. Nurses and local citizens picket the insurance company, after which Cigna grudgingly agrees to pay for the procedure "out of its own pocket." Hours after Cigna relents, the patient dies before the transplant can be done. The family is suing. This is where our American cultural view of death kicks in: from what I’ve read, other countries accept death when it’s inevitable, while here, no expense is too great to prolong life even for a short time. A liver transplant costs several hundred thousand dollars and uses a donor liver that someone else won’t get. I don’t know the case, but to an objective (i.e. non-family) observer, would that patient have been the best use of the limited resource of dollars and livers? It would be nice not to have to make that choice, but insurance requires balancing unlimited demand with limited resources, with the result of doing that poorly what we have today — huge costs for heroic but ultimately often unsuccessful interventions, especially in the elderly in the last few weeks of life.

North Mississippi Medical Center will replace its EMR system at a cost of $28 million, approved this month by the state.

The New York Times covers the city’s subsidized rollout of eClinical Works and its pay-for-performance project. "As for Dr. Benovitz, he said that if the city had not recruited him, he would still be using paper charts, which had a comforting tangibility, a record of life that could be held in his hand and paged through like a book. But he was happy to invest the roughly $40,000 over three years to implement the project in exchange for the city’s expert advice, though it has temporarily slowed him down, with two patients filling the time in which he used to see three." Unless somebody convinces medical schools to drop their income-protecting student enrollment quotas, let’s hope the 33% reduction in capacity really is temporary since the EMR won’t do much for patients who can’t get an appointment.

I might be the only person left who remembers the Atlanta-based technology company Healthdyne. The company’s founder, Pete Petit, is named board chair of Georgia State University, where he earned his MBA. 

An interesting test case may set a precedent for the practice of telemedicine. A doctor prescribes generic Prozac for a 19-year-old without examining him after the Stanford student requested the drug via an Indian Web site (now gone, but I found an image in an archive above), which forwarded the request to the doctor as its contractor. The student killed himself. The doctor will go on trial for practicing medicine in California without a license, but the prosecution has to prove that the student was in California when he requested the drug and that it’s illegal for an out-of-state doctor to write and fill prescriptions across state lines. With all the talk about how to streamline and nationalize healthcare (not what it’s being called, but what it is), you would think that someone would suggest removing all the state-specific regulations relating to privacy, patient care, prescriptions, state billing, etc. and replace them with a national standard. Nobody talks about the inefficiency they create and the questionable benefits they provide.

OK, I’m beginning to think everyone involved in the would-be Emageon-HSS deal is nuts. The fighting lovers are embracing again, with HSS saying the consummation will happen in February 11, financed by Stanford International Bank after all. Why did Stanford bail out last week, then? According to the CEO of HSS, "This extension will also allow us additional time to complete our integration plan for our technologies." Maybe I’m clueless, but I don’t see that the integration plan has anything to do with the legally binding agreement HSS made to do the acquisition by an already-passed date. Plan whenever you want, but when you sign to do a deal with a given set of terms, the negotiation is over. Blaming the bank seems ridiculous since it has the same parent company as HSS. At least Emageon will supposedly get $9 million of HSS’s escrowed money if the deal falls through again. Is this saga really going to give prospects a good feeling?

Have a good New Year’s. Fun stuff coming! (HISsies, HIMSS stuff, and so on). Thanks for reading.

E-mail me.

Monday Morning Update 12/29/08

From Blueware: "Re: promotion. Jyran Glucky was promoted from Lead Architect to Vice President of Application Development at BlueWare." I have to admit that I’ve never heard of the company and had to Google them. From its overly busy site, it’s hard to figure out exactly what they offer, but it has something to do with EMRs. And despite a press release about this promotion, there’s not a list of management anywhere I could find in the jumble, so I don’t know who else is involved.

From IntelliDOT: "Re: layoff. IntelliDOT in San Diego laid off 12 percent of its employees due to slow sales." Unverified. We’ll check it out.

Listening: Rachelle Ramm, a hard-rocking California beauty. Which reminded me of my old favorite, Swedish all-girl metal band Drain STH.

The New York Times writes up the Marshfield Clinic’s technology. A good quote from AHRQ’s Carolyn Clancy, who says the clinic "understands that it’s a system of improvement that technology makes possible that really matters, and the electronic health record itself is no silver bullet." That’s the positive, but the negative is this answer about the $50 million per year (!!) the clinic spends on systems: "People ask about return on investment, but that’s the wrong question. This requires the usual leap of faith that knowledge will yield good things — better care, doing things smarter and, yes, saving money in the long run." That’s a pretty big leap. Excellent article.

The Emageon saga continues, dragging the company’s name further in the mud. Would-be acquirer Health Systems Solutions, Inc. says its major shareholder, Antigua-based Stanford International Bank Ltd., won’t provide the funds for the acquisition to go through. Emageon CEO Charles Jett seems to be the outraged spokesperson, but he’s not a major player given that he was ousted from the board last summer after an ugly proxy fight with Oliver Press Partners. Now it could be that Stanford is just playing with the stock behind the scenes, safely tucked away in Antigua outside US jurisdiction, but it makes more sense that they’ve found something they don’t like about Emageon and their carefully created legal structure gives them an out that they’ve chosen to exercise. Or, that billionaire owner Allen Stanford and Oliver Press don’t get along, like Gordon Gekko and Sir Larry Wildman in Wall Street (Stanford really is a Sir, the first person knighted by Antigua, where he holds dual citizenship along with the USA).

Jobs: Cerner Millennium Senior Analyst (Healthcare Performance Group), Director of Clinical Information Systems (Snelling Executive Search), Director of Nursing Informatics (Johns Hopkins Medicine), PharmD (Parker Healthcare IT), CareVue Technical Specialist/Clinical Engineer (Cedars-Sinai Medical Center), C-Level Sales Executive (Company Confidential). Drop your e-mail address here and get a weekly jobs list.

West Virginia University Hospitals gets certificate of need approval from the state to spend $18 million on new hardware and a data center for its $90 million Epic project, although they’re short on capital and will delay the data center construction.

Odd: Mississippi lawmakers are considering increasing cigarette taxes to help support struggling hospitals, saying, ‘We have been leaving untold millions of dollars on the table." That’s what happens when politicians start seeing your money as theirs, although there’s no doubt smokers will cost the state a lot more than that.

The number of hospitals laying off in 2008 has already beaten the 2003 record, although the number of laid off employees is relatively modest at 9,700 who have filed for unemployment because of mass layoffs.

Kryptiq is awarded a patient on encryption of healthcare information in a way that prevents the servers it sits on from decrypting the data. Hopefully they’ll use it in products rather than as the subject line in nasty infringement lawyer letters.

Two employees of Samaritan North Health Center (OH) are indicted for identify theft and money laundering for getting names of the recently deceased from the newspaper obituaries, looking up their information in the hospital’s computer system, then taking out loans in their names.

The Bahrain Medical Journal will start publishing online with free access, even allowing readers to do whatever they want with the articles as long as they cite them properly. Leading the conversion to an open access journal was senior editor Dr. Mohammad Al-Ubaydli, author of the book Free Software for Busy People and author of an editorial (warning: PDF) in the current issue urging Bahrain to adopt open source instead of proprietary EMR systems.

UK patients, worried about NHS’s plan to store patient information in a national database, are choosing to instead carry their information on a smart card that doctors update via USB port after each visit. The card’s distributor pays doctors to download patient data, mention of which elicited this reader comment: "An other way for doctors to make a quick buck!! They are already been paid twice. Once by the taxpayer and the other by the drug companies. Its about time we patients had access to our own medical data."

The first 10 episodes of Children’s Hospital (inexplicably spelled Childrens’ Hospital) are now up on the WB, semi-entertaining in an Airplane kind of way. "A hospital is a place for smart people to take care of people who aren’t smart enough to keep themselves healthy."

Resident: You’re the attending physician and I need to get your permission. I need to cut this kid open.
Attending: Why? She’s got a broken arm.
Resident: Says who?
Attending: The X-ray.
Resident: Please. I don’t trust those – they’re not even in color.

Speaking of online series, Lisa Kudrow stars as an Internet-based psychologist who does three-minute Webcam sessions on the largely improvised Web Therapy.

Red Hat’s Q3 numbers: revenue up 22%, EPS $0.12 vs. $0.10.

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News 12/24/08

From Tom Tubow: "Re: blogs. I was thinking about why I read HIStalk instead of the other blogs and I realized: theirs feel like work, yours feels like fun." Thanks for noticing, but it’s by necessity. I have a short attention span, so you won’t get many long, weighty theoretical essays from the standard roster of self-anointed, frowning experts here. I’m more Howard Stern than William F. Buckley. If you leave here both informed and entertained after just a few minutes, Inga and I have done our jobs.

From Long-Time Reader: "Re: article. Here’s one from the Denver paper on local EMR integration." Link. It’s about the Colorado RHIO.

From Josh: "Re: McKinsey report. Puts 2/3 of what it believes is $650 billion excess cost on the backs of ‘specialty outpatient care’ providers, noting that ‘current outpatient reimbursement methods reward providers for delivering more care, or care that is higher intensity.’" Link. The conclusion is so obvious that it’s often missed: professionals will perform whatever services they can get paid for. If you’re paying for diagnostic imaging, expect a lot of diagnostic imaging to be done. Don’t expect providers to cut their own income just because it might be beneficial to a particular insurance company or society in general ("first do no harm, but second, make sure to bill what’s paying well this month.")

From The PACS Designer: "Re: file sharing. Another cool online application TPD recently found is drop.io, which gives online file-sharing possibilities to those who work in teams to accomplish tasks and goals." Link.  I was annoyed that the only "how to" help is by video, which I generally refuse to watch online unless it’s something stupid on YouTube, but theirs is by DemoGirl, of whom I’ve been a fan for years. The service looks cool … you can password protect files, e-mail them in, and share them selectively. Not the cheapest, starting at $20 a month, but pretty slick.

From He Hate Me: "Re: Microsoft. I hear they’re putting a presentation together for Daschle’s team. Maybe Amalga HIS isn’t as far away as people are saying." I hope Daschle’s smart enough to recognize that Microsoft’s healthcare toe-dipping hardly makes the company an expert (its Azyxxi acquisition and Visio add-ins aside). Lots of folks, including those who have actually worked in healthcare as something other than a recent growth target, could give him the unbiased scoop if that’s what he wants.

From kb: "Re: Epic. You’ll be happy to know Epic will be contesting another frivolous lawsuit from Acacia. Doesn’t sound like Epic was the only one named in the lawsuit either." I assume that was the one by Document Generation Corp. that I mentioned last week. I said then I was surprised that Acacia, if it’s really behind the suit, would want to tangle with Epic again. I was reading something the other day about how many corporate infringement lawsuits are filed by shell companies with zero to five employees and a no assets other than a patent, using the high cost of mounting an infringement defense as leverage to extort money from big companies. No wonder other countries are eating us alive in everything from manufacturing to science — we’re too busy suing each other to actually produce anything.

From Darth Tater: "Re: HIMSS. The HIMSS staffers must be deluding themselves – probably being from Chicago, they think they have some special ‘in’ with the administration. They need to learn what happens once people move inside the beltway. More to the point, HIMSS is hardly the only source of information. John Halamka mentioned during a HITSP meeting last week that he was testifying earlier in the week. I am aware of other projects where they are personally working with specific Senators – more directly than ‘staffers.’ And anyone that thinks IEEE, RSNA, AMA, etc. etc. aren’t in front of people also doesn’t know what they are talking about." I give credit to the incoming administration – they’ve got people believing that their vote and participation count, so thank goodness for that. The reality is, though, that not everybody will leave with a lollipop. Not everyone will be happy with the direction. Not all groups have the influence they think they do. Politicians are good at saying "maybe" when they really mean "no way." And despite the good work that a lot of people do in healthcare IT, HIMSS is, using its own words, a trade association of vendors, and those don’t typically carry a lot of weight. That’s where being vendor-heavy probably curtails their influence.

UPMC Presbyterian reaches Stage 6 of the HIMSS Analytics EMR adoption model, joining 23 others.

What do lobstermen, victims of ice storms, and potential users of electronic medical records have in common? Maine’s finance authority agrees to extend financial help to all three.

Motion Computing, maker of the C5 Mobile Clinical Assistant, gets $6 million in new funding. The press release says the C5 has been deployed to over 4,000 healthcare organizations, which is a lot more than I would have guessed. They must be selling lots of them in other countries since I’m pretty sure their hospital penetration is nowhere near 50% here and even that would only be 3,000.

Listening: Skarlet Blue, hard-rocking Aussies. Video here. Catchy and nicely done.

I had the HIStalk server upgraded again today, as I nearly forgot to mention. There were times, especially on weekday mornings between 9 and 11 Eastern, when you may have received a "page not found" error because the user load was redlining the Apache service, which means … well, that too many people beat you to HIStalk before the memory ran out. It’s hard to believe I could once get away with a little $4 a month shared Web hosting hosting account. Anyway, hopefully it will work better now.

EnovateIT partners with Metrologic to provide 800 bedside medication barcode scanners for Novant Health (NC).

AC/DC singer and local resident Brian Johnson dedicates a music room in his name at Sarasota Memorial Hospital (FL), paid for by the foundation of former Who bass player John Entwistle, who died of a cocaine-induced heart attack in 2002.

Deborah Peel’s Patient Privacy Rights is upset by a letter (warning: PDF) from Confidentiality Coalition to Congress. What it says (despite that group’s name): healthcare IT is so important to healthcare and the economy that principles like accounting of disclosures, consent for TPO, and "unnecessary" notification of a privacy breach should be scratched from any HIT plan the government undertakes. Don’t let patient privacy stand in the way of progress, in other words, kind of an eminent domain on PHI. The group behind it appears to be Healthcare Leadership Council, a self-described "business league" that spent $1.6 million on lobbying last year. Some of the members are predictable (drug and medical device companies, GPOs, and the Big Three drug distributors) but I don’t understand why a few non-profit hospitals have signed up (and Vanderbilt’s School of Nursing). Their main pitch seems to be that US healthcare is a great value because of all the "unparalleled improvements in the field" brought to you at high cost by the folks who would rather not have their gravy train derailed.

Forbes uses athenahealth’s payor ratings to determine The Worst Places to Be Sick and Poor. The bottom five states: Virginia, Florida, Georgia, Texas, and … drum roll … New York, which takes nearly 140 days to pay Medicaid claims despite billions spent on software. You know it’s going to get worse as states, especially those addicted to growth, find their coffers empty and, unlike Uncle Sam, they can’t just print more money.

RelayHealth wins a consumer engagement award for its connectivity offerings for consumers and providers, specifically its Results Distribution Service.

University Hospital in Dubai signs up with Epic. Judy is actually quoted. Come to think of it, that’s an opinion I’d like to hear: does Judy think the government should subsidize EMRs since she’s selling all she can without its help?

The Philadelphia paper debates the cost and benefit of electronic medical records, talking to Doylestown Hospital and Abington Memorial. It also invites the public to attend one of those local discussion groups that HIMSS is arranging to generate policy recommendations for the Obama administration. I would expect the lay people to suddenly be heavily in favor of healthcare IT investments they were unaware of previously since HIMSS is facilitating, but I’ll defer to anyone who was actually there.

A Kansas urologist develops cell phone software that protects highly unskilled and overconfident teen drivers from killing themselves and the rest of while yapping and texting while driving. It blocks the phone while the key is in the ignition. Ingenious.

A former Cedars-Sinai billing employee is charged with setting up a fake laboratory company and submitting patient bills that insurers paid via a post office box, using the identities of over 1,000 patients.

The British Medical Association fights a government plan to open up patient databases to researchers, including those from private companies. They say companies could harvest (or "hoover," as they say) patient names in order to market to them.

University of Wisconsin-Madison will put up signs warning patients that their doctors might be taking drug company money for research or consulting (without doing anything about it – kind of like those "unauthorized solicitors" signs in airports that let you know Moonies are around, but still leaving you on your own to deal with them. The medical school dean wants doctors to report the money they receive, with one example cited being an orthopedic surgeon who checked off the maximum amount — over $20,000 year — which in his case was actually $400,000 a year for eight days of work. Of course, patients still have to decide what to do even if they know Doc is pocketing drug company money, so it probably won’t amount to much.

Paul, an HIStalk reader in the UK, sent this message: "My current organisation is a New Zealand based Systems Integration Company, called Simpl, and they have been commissioned by 10 of the leading District Health Boards in NZ to procure a system which could potentially be a national standard across New Zealand. We would very much like to publicise the fact this procurement is underway and invite interest from any USA software providers that believes they have a solution that could fit. I suggested HIStalk may be a great way to alert the USA market to this potential. Up to 10 New Zealand District Health Boards are seeking to procure technology that will support the transformation of healthcare delivery by providing an individual-centric health management system that is health provider agnostic. Therefore the solution must address not only their hospital PAS requirements, but also enable seamless access to an individual’s health information by registered health practitioners / qualified health professionals wherever they work (hospitals, the community and primary care, rest homes etc) and even by the patients themselves. This procurement is being managed by Simpl, a New Zealand based Systems Integration company that specialises in Healthcare." The tender system is here and the reference number is 24585. I have the RFI, but I think you can get it there, or contact Paul.

The Nashville business paper reports that business is great at Brentwood-based 24-employee credentialing software vendor Sy.Med Development, on track for $3.2 million in sales this year. The piece has some interesting business pearls from the CEO, such as "You can change industries rather easily and hard work, belief and passion can make up for lack of knowledge."

A former Wachovia VP in the Miami area gets three years in jail for helping an accomplice with a $48 million Medicare fraud and money-laundering operation.

UnitedHealth Group launches its free public Web portal, myOptumHealth.com, run by its health and wellness subsidiary. The site run ads for United’s insurance products and will also sell advertising space (there’s already a Cymbalta ad running on the front page, I see). You can fill out a PHR online.

Oracle claims its DB Machine is the most successful launch in company history.

Emageon says its would-be acquirer, Health Systems Solutions, Inc., is taking too long to close the deal. Emageon says HSS is giving it the runaround by continuing to make due diligence requests despite a signed merger agreement, avoiding setting a closing date, and claiming Emageon misrepresentation. Emageon stock tanked on the news Monday, down $0.92 to $1.30. HSS is smaller than Emageon, so you never know if they’ve run into financing problems since that’s about the only valid excuse unless they’ve really found a skeleton in Emageon’s closet.

Enjoy your holiday(s), whatever they might be. I’ll be around if you want to e-mail me.

 

Twas the Night Before Christmas
By Inga

‘Twas the night before Christmas, when all through IT
Not a creature was stirring – not a single PC.
The charges were updated by users with care,
In hopes that more money would make its way there.

The doctors were finished, all smug in their heads,
While nurses were checking on every last bed.
And the CIO in his office, and I in my cube
Had cleaned up our e-mails (and watching YouTube).

When out from MS-Windows there ‘rose an odd chatter,
I switched off Minesweeper to check on the matter.
Away to the Internet I flew in a flash,
Launched open HIStalk and hoped nothing would crash.

The tune on Pandora was silenced at once
My laptop moved slowly – it seemed to take months.
When, what to my wondering eyes should appear
But a miniature Mr. H and Inga, that dear.

With my VGA driver, so lively and quick
I knew in a moment it must not be a trick.
More rapid than eagles, his rumors they came,
And he whistled, and grumbled, and called them by name.

“Now Neal! Now Vern! Now Hammergren and Judy!
Now Glen! Now JB! Now Pappalardo and Andy!
To the top of Web page! To the top of the crawl!
I know all your secrets! Yes I do know them all!”

With news and some gossip, those wild rumors fly
The leaders read closely, hoping they’ll not win The Pie.
So onto HIStalk the top dogs would click
To read Mr. H and his Inga, with all of their shtick.

And then, in a twinkling, I heard a new sound
My disk drive was churning and chugging around!
As I drew down my head to refresh the screen
Out popped Mr. H – an amazing sight to be seen!

He was dressed in polyester, from his head to his foot,
He had quite the old-fashioned programmer look.
A bundle of gadgets he had flung on his back,
As well as the Blackberry, still new from the pack.

His eyes – how they twinkled! His dimples how merry!
He looked ready to scribe a new fun commentary!
His droll little humor was clear from the start
This was man who made blogging an art!

The stump of a pipe he held tight in his teeth
And a light was encircled on his head like a wreath.
He had a kind face and pooch at his belly
So this was who turned vendors’ knees into jelly?

He was quiet and quick – the picture of stealth
As he checked out the tech things in our office of health.
A wink of his eye and a twist of his head
He noted our software and computers by beds.

He spoke not a thing as he took a keyboard,
I recalled how his words were stronger than swords.
Then touching his finger upon the word “send”
Today’s posting had clearly come to an end.

He sprang to my laptop and gave a short whistle
Then into cyberspace he went – as fast as a missile.
But I heard him exclaim as he slipped out of sight
“Happy Christmas to all, and to all a good-night!”

E-mail Inga.

Monday Morning Update 12/22/08

From HIMSS Staffer: "Re: conference call. On a Friday HIMSS conference call, HIMSS staffers bragged about being the sole source of information for congressional staffers and the new administration. Said that was something they had worked towards for the past couple of years. Not everyone is convinced that vendors that develop systems that don’t even talk to themselves (Epic at Stanford, Kaiser, and PAMG, for example, can’t share information) should be driving this discussion. Nor that EMRs are going to improve quality or cut costs."

From UKIE: "House calls. Pioneering company uses system built on Adobe LiveCycle ES to enable housecall physicians to provide care to patients anywhere." Link. Janus Health, a San Diego developer of technology for house call doctors, develops a Web portal for charting and communication that lets doctors work from anywhere. I’m a little suspicious, though, at the gigantic announcement on the site that the company has secured a "broad" patent for any kind of house call-related technology, its prominence and wording suggesting that infringement lawsuits against companies with even unrelated house call technology is possible.

Ingenix Consulting, of which the former Healthia Consulting is now a part, is doing a big project and needs up to 50 clinical implementation consultants. Check their job page (although this posting is fresh and may not be up for a couple of days). I know a lot of folks have been cut loose in the past couple of months, so this is one of few big-scale hiring efforts I’m aware of. Healthia, of course, sponsored the HIStalk event at HIMSS last year, which was chock full of cool, smart healthcare people (that’s the Healthia people above, who look quite happy even though they were not having spirituous beverages like everybody else). 

Lots of hospitals have been cutting back on travel and education. I’m not sure that’s a bad thing. It seems like having people constantly running around to conferences and hearing the same messages makes them all think alike. Healthcare is notoriously imitative, where nobody is willing to do anything original or risky unless they can find a handful of other hospitals that have already done something similar (meaning nobody’s doing anything original or risky, of course, since everybody is average by definition). Tough times may finally unleash some desperation-inspired creativity.

New poll to your right: do you agree with the HIMSS recommendations to the incoming administration?

Lisa Romano is promoted to VP and chief nursing office of TeleTracking Technologies.

Henry Schein Practice Solutions launches DDX, an application that connects dental practices to dental labs (or medical practices to medical labs). The requirements page recommends Schein’s Labnet system on the lab end, though, so it may not be all that useful unless everybody is running Schein apps.

CCHIT opens a 31-day public comment period on the 2009 certification criteria, including those for PHRs.

WSJ has a video interview with Microsoft’s Steve Shihadeh, which also featuring gratuitous shots of a Microsoft sign and flag. Nothing new.

The Picower Foundation, a big philanthropic organization with $1 billion in assets, shuts down after getting burned by Bernie Madoff’s $50 billion Ponzi scheme. The foundation was started by a big Alaris Medical Systems shareholder who pocketed $1 billion when the company sold out to Cardinal Health. On the other hand, Jeffrey Picower, the Alaris shareholder, has had his own business and charitable dealings questioned by the SEC, with the now-defunct foundation being one. You know economic news is grim when a $50 billion fraud case barely makes the front pages among all the bailout stories involving several additional zeroes.

Hospital layoffs: Piedmont Medical Center (SC), Monmouth Medical Center (NJ). At OHSU (OR), executives take a 20% pay cut and may forego bonuses that averaged nearly 40% of base pay, holiday parties are canceled, and salary freezes and layoffs are coming. Cleveland Clinic has implemented a hiring and salary freeze for non-patient care positions.

In happier news, congratulations to the information systems department of Southeast Georgia Health System, which wins the holiday door decorating contest ("holiday" being the bland but legally acceptable substitute for "Christmas" or "Hanukkah" or "Kwanzaa" or any other observances that might conveniently fall into the December/January timeframe when the vast majority of us celebrate Christmas but can’t call it that).

Technicians working on the computerized security system at a brand new New Jersey psych hospital inadvertently unlocked all the doors on at least two occasions, allowing at least one patient to elope (that’s the word that came to mind since I’ve heard it used to refer to psych patients getting out, but it probably sounds funny to non-healthcare people, kind of like the annoying, contrived use of "naive" to describe patients who aren’t big narcotics users, i.e. "opiate-naive").

Three VPs leave clinical trials software vendor Etrials as the company restructures. The new CEO is Denis Connaghan, who you may remember from his HIT days at IBAX under Jeff Goodman. The announced plan: "get as many of our people close to our customers, and, really, to remove layers from the organization and become really customer-focused." If that’s a new plan of action, then no wonder the old CEO got himself eloped.

I’ll be around writing here and there this week (maybe), but if you won’t, have a wonderful Christmas, Hanukkah, Kwanzaa, Festivus, New Year’s, or National Bicarbonate of Soda Day.

E-mail me.

HERtalk by Inga

A couple of former Misys execs find new homes. SciQuest names Gamble Heffernan VP of marketing and Charles Lambert accepts an interim post as finance director for Helphire. Hefferman was the Misys VP of Community Solutions and Labert served as CFO.

ACS names David Bywater managing director of the Healthcare Solutions unit.

Healthcare informatics company Med-Vantage appoints Peter Goldbach, MD its new president and CEO.

Mission Regional Medical Center (TX) selects the IntelliDOT Phlebotomy Specimen Collection system.

CHIME awards several educational scholarships to its members. The winners of the CIO Boot Camp Alumni Scholarships are Robert Eardley, associate CIO at University Hospitals in Cleveland; Diatta Harris, director of IT at Erickson Retirement Communities (MD); and Nanda Lahoud, administrative director of value realization at THR. CHIME also presented the Edge Scholarship to Carol Roosa, CIO at Monadnock Community Hospital (NH) and the CHIME Women’s CIO Scholarship to Bridget Haggery, VP/CIO at Oregon Health & Science University.

St. Agnes Hospital (MD) names Dr. Norman Dy as physician director of pay for performance and core measures. (that’s a title I’ve never heard)

A former ER nurse is named  president and CEO of Pocono Health System/Pocono Medical Center. The hospital board of directors chooses Kathleen E. Kuck, who has spent the last year serving as interim president and CEO. During the last year, her achievements include the implementation of an EMR.

WellPoint Foundation president Caroline S. “Caz” Matthews joins the Perot System board of directors.

IPC acquires North Florida Hospitalists and Orange Park Hospitalists (FL). IPC now has over 600 physicians on staff, serving over 300 facilities.

Ochsner Health System (LA) implements WebDefend software at its seven hospitals.

Presbyterian Healthcare Services (NM), Marin Medical Practices Concepts, Inc. (CA), and St. John’s Medical Group (MO) select Medical Present Value to automate the payor contract management process.

The CEOs of two California medical companies are charged with billing Medicare over $3 million for equipment not provided patients or for items they knew patients didn’t need.

St. Joseph’s Hospital and Medical Center (AZ) plans to add a videoconferencing system to connect hospital specialists with referring physicians in the community. The Clinical InfoNET system will also be used as a CME tool.

SAP announces that MetroSouth Medical Center (IL) has selected and implemented its enterprise applications solutions across its healthcare system. The SAP applications include financials and procurement tools.

E-mail Inga.

News 12/19/08

From Larry Fine: "Re: Philips is sunsetting the CareVue Classic product (formerly from Agilent, and before that, HP). We are looking for clinical systems engineers with CareVue, bedside devices, RDBMS, and HL-7 experience to help support our extensive CareVue Classic deployment (150 ICU beds) until our Epic inpatient go-live in about a year. I have placed ads on DICE and the HL-7 organization’s web site and even sent a message to the HP Alumni mailing list, but no bites so far (or no credible ones, anyway). I would be interested in hearing any other ideas from HIStalk readers about how to reach potential contractors or recruits that could provide this support and then transition to Epic device integration support." I didn’t use Larry’s real name because my policy is not to unless someone asks specifically, but he’s CTO of a big hospital. You can comment on the article with your suggestions. My suggestion is self-serving: run a highly cost-effective listing on HealthcareITJobs.com, which takes seconds. The CareVue sunsetting is leaving quite a few hospitals in a lurch, pushing some too quickly into clin doc systems that can’t match its ease of use.

From The Alchemist: "Re: new site. Well, healthcare advocates, why wait until 2010 for the World Health Organization to embarrass the United States Health System with a world ranking lower than our present 36th? Someone apparently has been concerned about the state of health for the United States to implement a new web site for quality health measures worthy of our national western lifestyles." Link.

From Chad Greer: "Re: TeleVox. oneHITwonder has unfortunately received incorrect information about TeleVox and the support of our popular HouseCalls reminder system. TeleVox will absolutely continue to support all customers utilizing HouseCalls, regardless of the version. Paying a subscription is not a requirement as of 1/1/09. For customers that want to utilize the advanced features and capabilities of the ASP version, they can elect to pay a subscription fee for the service upgrade. TeleVox prides itself on being High Tech with a Human Touch, over 16,000 customers respectfully deserve accurate information that only TeleVox delivers. We apologize to any customer who has been mislead by this information. Thanks in advance for helping clear the confusion about misleading information that can travel fast in this day and time." Chad is the VP of sales and marketing for TeleVox.

Document Generation Corp. files suit against Allscripts, Cerner, Sage, McKesson, Misys, Meditech, Epic, and Eclipsys for infringing on its patient for "computer-assisted document generation." A little homework suggests that patent troll Acacia Research has filed suits using the company’s patent before. Acacia makes a living filing ridiculous nuisance lawsuits against companies that claim infringement, but they rarely go to court because the company conveniently offers a "license" that costs a little less than mounting a legal defense against its eye-rolling claims. Acacia said it was the company’s only licensee in a 2007 suit against 19 EMR vendors, according to one source.

Jobs: SIS Project Manager, Product Design Engineer/Analyst, Manager of IT Technical Support, Eclipsys Clinical Consultants.

Sunquest will acquire the Outreach Advantage outreach lab package from Pathology Associates Medical Laboratories, a Providence Health and Services subsidiary in Spokane, WA.

Accentia, an India-based healthcare solutions provider, gets a $22 million contract to provide services to "a chain of hospitals in the US" that include transcription, coding, and billing. It will hire 5,000 employees. The chain was not named, but one might suspect HCA from timing and deal size. Obviously whatever hospital group it is doesn’t want its offshoring known.

New go-lives for Picis: Kennedy Memorial Hospitals (NJ), Edward Hospital (IL), California Pacific Medical Center (CA), Inova – Mt. Vernon (VA), Central Washington (WA), and Valley Baptist (TX).

A board member of troubled Canadian L&D software vendor LMS Medical System quits along with the president and CEO, that last one interesting because she’s threatening to sue the company. Another former employee is threatening legal action for improper termination. Two of what must be very few survivors start wearing all the hats between them: the interim CEO is the CFO and a board member; the interim COO and CTO keeps his old job as product development VP. Shares are at 2 1/2 cents in case you need some last-minute stocking stuffers or something cheaper than gift wrap.

Tobias Samo, formerly of The Methodist Hospital (TX), joins Eclipsys as CMO.

RIM turns in nice quarterly numbers on BlackBerry sales (and I’m not just saying that because I’m packin’ a Bold).

Standard & Poor’s threatens to cut GE’s credit rating over its GE Capital exposure.

Listening: Shinedown, radio-friendly hard rockers out of Jacksonville. You don’t have to be a drug-ingesting, illiterate loser to like it, but you’ll probably do the pigeon-necking thing because it’s melodic (try The Sound of Madness). The guitarist is quitting after tonight’s show in Flint, MI, although he’s not blaming Flint.

Something to consider as the government becomes the financier and partner of big chunks of what’s left of American industry: in Scotland, the government decides to impose a dress code on healthcare workers for infection control and cost saving reasons. White coats for doctors are out, as are ties. No pens in pockets, no long-sleeved shirts, all hair must be tied back.

Emanuel Medical Center (GA) suspends all employee benefit accruals for 2009 — vacation, holiday, and sick time — hoping to avoid layoffs.

BIDMC rolls out proximity security from Third Brigade. The company says its Deep Security system protected users from the IE zero-day vulnerability even before Microsoft sent out a patch.

Penang Adventist Hospital in Malaysia will use SAS for financial planning and budgeting.

Kimball Health Services (NE) chooses HMS. It’s impressive that the 20-bed critical access hospital is aiming for CPOE and bedside barcoding.

I’m pretty sure Dennis Quaid doesn’t really need the $750K settlement that Cedars-Sinai will pay for overdosing his twins with heparin, especially since they’re fine and apparently incurred no medical expense. Their suit against Baxter over what they said was confusing drug packaging has been dismissed, which I’m not sure I knew. And, it’s important to note that the settled suit was only on behalf of the twins; Quaid and his wife could still sue the hospital. It’s a shame it happened, of course, but untold numbers of people suffer far worse outcomes every day from medical mistakes. You can find and discipline everyone involved, but then you’ll have a big empty hospital since everybody working there is human. I wish I knew the answer or had confidence that anyone else does, but neither is the case. Suing the hospital got him a HIMSS opening keynote gig, of course (why?) Alan Greenspan will be there too, so maybe he can explain why he let the economy go to hell under his watch.

One thing that caught my eye in the HIMSS panhandling memo to the not-yet-President: a call for a higher profile HIT official (Senior Health IT Head? … interesting acronym). You can bet they’ve got someone in mind, a safe, vendor-friendly choice who’s on board with its CCHIT/HITSP agenda. But, their attempts to influence legislation in the past have been a bust, so hopefully cooler heads will prevail than to just shovel $25 billion at doctors to get them to use systems they may not want. I have to say that, as a provider-sider, I’m kind of embarrassed that HIMSS lined up for Uncle Sam’s dwindling trough like all the loser industries that failed due to their own stupidity, but now think it’s a good taxpayer investment to override the free market’s valuation of their services. It’s called free market Darwinism – let it work even if it hurts.

El Camino Hospital (CA) will buy the assets of Community Hospital of Los Gatos from HCP. Eric Pifer, MD, who joined El Camino as CMO/CMIO last year, will be president of the hospital when ECH gets it running.

Court documents suggest that Siemens Healthcare may have paid $15 million in bribes to five Chinese hospitals from 2003-2007 to get $295 million worth of business (great ROI, but illegal). One hospital’s radiology director supposedly got $65,000 to ensure the hospital bought a $1.5 million MRI from Siemens.

A group of dentists holds a teleconference to formulate recommendations for the new administration, which include cross-training medical and dentistry students on each other’s field, sharing computerized records, and addressing liability concerns related to sharing data. They think doctors and dentists need to talk more. What I didn’t know: Pitt has a dental informatics program, the only one in the country.

AED-SATELLIFE, a Watertown, MA nonprofit, provides solar powered PDAs to healthcare workers in Uganda for accessing medical information. It also runs HealthNet, a global communication network linking healthcare workers through its satellite (thus the SATELLIFE name). I see they’re looking for developers and users to join their open source data collection, analysis, and reporting platform. I couldn’t find their financials to decide if they’re a good charity.

Odd: a "medical marijuana club" in California (where else?) plans to add a new kitchen for its pastry chefs, who make pot brownies and other drug-laced goodies sold from deli-style cases (that’s really it above).

Bizarre lawsuit: Florida Hospital Ormond Memorial sues the descendants of the long-dead man who in 1962 donated the property the hospital sits on, trying to weasel around the donor’s stipulation that the land be used only for a hospital. The hospital wants to sell the land to whoever wants it for $16 million and move to a new location. The hospital didn’t bother to contact the descendants, so the lawsuit came out of nowhere and they’ve had to hire lawyers. Says the donor’s widow: "I don’t know anything about it. Nobody called me or anything." Stupid or cold? I can’t decide.

Another: California’s Supreme Court rules that Good Samaritans trying to help accident victims can be sued for damages if they injure the person. The case involves a 27-year-old woman, whose friend pulled her out of her wrecked car thinking she saw smoke and worrying it might explode, but allegedly causing paralyzing injuries. The victim’s lawsuit against her (former) friend can continue.

E-mail me.

HERtalk by Inga

The Joint Commission issues a Sentinel Event Alert discussing the possible safety risks related to medical devices and HIT implementations.

Boston Medical Center eliminates 250 jobs and cuts various clinical services in an attempt to address $114 million in funding cuts.

St. Joseph Health System selects Allscripts to provide Enterprise EHR and PM to 100 affiliated physicians.

BCBSA extends its relationship with AT&T Business Solutions, awarding its two multi-million dollar national contracts to serve as its primary networking services provider.

The Commonwealth Fund launches a new Web site that tracks performance data for hospitals. Unlike other rating sites, WhyNotTheBest.org is not providing rankings. In other words, KLAS-like information on hospitals, but without the rankings. I wonder if there is a need for something similar in the HIT world? Sometimes I wonder if the whole ranking process affects accuracy because I know it can cause vendor hysteria. For example, certain companies clearly push their happiest clients to the ratings site to assure a high rank. The vendors focus on that earning that #1 spot, and I bet some execs have bonuses tied to it. If you are a company without the time and money resources to monitor your KLAS ratings, does that make you a lesser company? Is the company with the #1 rating really that much better than #2? A #1 ranking certainly gives a company a great excuse to issue a press release. Too bad it’s considered lame to send a press release saying, “We were only .001 points behind #1, so we’re pretty great, too.” Perhaps if everyone weren’t so focused that top spot, we’d feel more comfortable that data is truly meaningful.

In a survey that seems to be financed by pharmaceutical companies, Manhattan Research finds that 40 million US adults have elected not to have a prescription filled because of the cost. Women and patients with neurological and mental health conditions were the ones most likely to skips their meds. Sildenafil citrate was not on the list of the most-missed medications.

A Miami physician receives a 30-year prison sentence and is ordered to pay $8.3 million for her part in an $11 million Medicare fraud scheme. Her medical assistance gets 14 years.

Dear Santa: You know I love my iPhone, even though I seem to drop it all the time and lose it in the bottom of my purse. I’m thinking this pretty pink case (or perhaps one of these) may be the answer. I’ve been good. Love, Inga.

E-mail Inga.

Being John Glaser 12/18/08

The National Alliance for Health Information Technology (www.nahit.org), an organization jointly sponsored by the American Hospital Association and CHIME, held a board meeting earlier this week. The organization discussed its strategy of working with providers and others to develop and disseminate “real practices.”

Real practices refers to practices that healthcare organizations have developed to help ensure that their system implementations are efficient, effective, and provide the value anticipated by the organization when they approved the project. These practices could surround applications such as CPOE, revenue cycle, and business intelligence. These practices could address project management, clinician engagement, vendor partnerships, and CIO-Board relationships.

For several reasons, the stakes have been raised for healthcare IT investments.

Increasing reimbursement and quality improvement pressures have put commensurate increasing pressure on successful electronic health record implementations. As their strategic importance and operational criticality increases, implementations that run too long, cost too much, or don’t deliver significant organizational gain will be less tolerated.

In addition, the credit and stock market challenges mean that there will be fewer IT investments. If the organization is going to fund, for example, one investment and not four others, that one investment had better deliver the goods.

The national healthcare IT agenda forms a parallel thread to the above.

The national agenda has been very focused on adoption. The low adoption rates of CPOE and outpatient electronic medical records have led to this agenda. But increasingly, it is understood that this focus is too narrow. Adoption isn’t the point. Effective use, improved care, and reduced costs of care are the point.

Hence the national agenda is evolving to augment adoption directed initiatives, e.g., financial incentives to implement an EHR, with initiatives directed to helping providers improve care using the technology.

These two threads converge to a materially heightened emphasis on execution.

Whether or not an organization is successful in implementing an application and realizing value is dependent on the vendor and implementation partner chosen. However, success is much more dependent on the organization’s skill in managing the implementation and realization of gain.

This skill can be greatly enhanced if a healthcare organization understands the “real practices” that other organizations have successfully used.

Sharing best practices is not a new idea. Association conferences are designed to share lessons learned. The value of consultants is often the experiences they bring from other organizations.

And while it is not a new idea, it is an idea that is becoming significantly more important. We might have gotten by with sub-optimal implementations in the past. We won’t be able to get by with them in the years ahead.

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

HIMSS Issues Healthcare IT Recommendations for the Obama Administration

HIMSS issued its healthcare IT recommendations for the Obama Administration and Congress this morning, stating that "2009 is the year for healthcare reform in the United States." The recommendations were assembled by a 100-volunteer work group that convened from September through December, led by the chairs of the HIMSS Advocacy & Public Policy Steering Committee and Government Relations Roundtable.

The themes of the recommendations are:

• Using at least $25 billion of federal money to get providers to a mid-level stage of EMR adoption
• Elevating the ONCHIT office with more authority and visibility
• Pushing CCHIT and HITSP standards as a condition of government assistance
• Expanding telehealth
• Reviewing privacy policies

HIMSS recommends:

• Spending at least $25 billion of federal money ($5 billion per year for the next five years) to help hospitals and practices adopt EMRs, not including additional money for federal and state providers.
• Paying providers to achieve Stage 4 of the HIMSS Analytics EMR adoption model by the end of 2014 in the form of grants, loan, and tax benefits.
• Making funding available only for purchase or upgrade of CCHIT-certified products that meet HITSP interoperability specifications, claiming that "CCHIT has help streamline the EHR market by serving as a trusted source to guide providers when adopting health IT product."
• Expanding Stark exemptions to cover "additional healthcare software and related devices" that are CCHIT certified and that meet HITSP interoperability specifications.
• Codifying and funding HITSP as the National Standards Harmonization Body for five years.
• Codifying a "Senior Level Health IT Leader" in the administration to oversee a national healthcare IT strategy, saying that "ONC has not been codified into law and does not have adequate authority to coordinate health IT activities through all federal departments and the US."
• Authorizing a coordinating body to advise the administration on healthcare IT and coordinate the standards work of HITSP and CCHIT.
• Conducting a White House summit specifically on reforming healthcare with IT to generate consensus and solutions within 90 days of the inauguration.
• Urging Congress and the Secretary of HHS to establish a "patient identify solution."
• Supporting "the routine updating of codes and coding systems for effective healthcare delivery and payment."
• Mandating that reimbursement by paper checks be prohibited for payors and providers of federally funded programs, replacing them with direct deposit by December 31, 2010.
• Expanding the FCC’s Rural Health Care Pilot for telehealth.
• Paying providers for telehealth services.
• Providing incentives for providers and payors to participate in HIEs and the Nationwide Health Information Network.
• Creating a roadmap for using PHI.