Readers Write 6/11/08

HIStalk will feature articles written by its readers in a weekly issue.

I encourage submission of articles of up to 500 words in length, subject to editing for clarity and brevity. Opinion pieces, issues summaries, or humor are welcome, provided they would interest a primarily healthcare and healthcare IT oriented audience. Submissions are subject to approval. For copyright protection, authors must indicate that the material has not been published elsewhere, that it contains no copyrighted material, and that published submissions become the property of HIStalk (to keep intellectual property lawyers at bay). Authors must include their real or fictitious name for purposes of attribution. All opinions are those of the respective author.

Send your article (as e-mail text or in Word) and become famous! Thanks to our authors, who voluntarily share their time and expertise with the readers of HIStalk.

A Pharmacy Perspective About CPOE+CDS
By augurPharmacist

Here is a pharmacy perspective about CPOE+CDS. I have worked as a staff pharmacist with three different CPOE+CDS systems over many years.

In my role, I am “catching” the order output from these computerized order entry systems. Basically, I review incoming med orders for appropriateness (a pharmacists’ term that involves checks for safety, likely efficacy and concordance with established guidelines). I then seek modification of errant med orders as necessary. Finally, I oversee order fulfillment.

I suspect that the mixed messages in the medical informatics literature about how CPOE+CDS seemingly improves med safety (Kaushal, Bates) yet also facilitates new types of med errors (Koppel, Campbell) might be explained by a closer examination of three things: available functionality, deployed functionality, and scope of implementation.

CPOE+CDS systems have been engineered differently and therefore they offer dissimilar functionality. Some functionality differences are important and obvious to staff pharmacist users. For example, a CPOE function that can calculate, round, and automatically cap weight-based doses using predetermined, safe maxima is an important function from the pharmacists’ point of view. Not all CPOE systems can do that.

To be fair to our vendor colleagues, it is also true that certain CPOE functions may be available but underutilized. In this case, the client may not have implemented the most recent software version or they may have made strategic decisions not to enable particular functionality due to a variety of organizational, socio-technical constraints.

Finally, the scope of implementation is important to consider. For example, where chemotherapy is concerned, many CPOE+CDS systems are presently unable to provide the chemotherapy cycle and regimen management tools necessary to order and manage these high risk, multi-drug therapies. If CPOE+CDS is deployed in particular areas without functionality to support identifiable unique or rapidly changing medical practice requirements, one has to ask if the scope of implementation is appropriate. In such specialized areas, perhaps it would be advisable to remain with the status quo of written orders until CPOE+CDS systems are further developed.

In terms of medication safety, the availability and deployment of particular functions and the scope of use for CPOE+CDS may help explain divergent reports about the ROI and patient value of CPOE+CDS.

Never Underestimate the Determination of Your Customers
By Nick Khruschev

After an eight-year absence from any MUSE event, for reasons too political to articulate in less than 500 words, I finally attended a MUSE conference again last month in Dallas. Considering that I’d attended and participated in the 10 consecutive international conferences prior to Atlanta Y2K, I wasn’t exactly sure what kind of event I’d find in the post MEDITECH MUSE era. I’m happy to report that I found a first-class event run by an organization that is absolutely flourishing.

Aside from the opportunity to connect with many former acquaintances and colleagues, I felt free to explore the myriad of offerings from the many vendors who may overlap, but mostly fill a gap. There was no apparent threat to MEDITECH’s prominence as the centerpiece to all of these services and products which mainly serve to add value to that primary core system which all customers in attendance share.

It was evident to MEDITECH customers in attendance that they are or will be approaching a major technology cross-road. And they’re right, there will be a lot of change in the next few years, much more than most of MEDITECH’s customers have ever experienced during their time as a MEDITECH shop. Currently, information related to this significant change is trickling out into the consciousness of the customer base through inconsistent and sometimes inaccurate sources. It was clear from my personal observations that there was much confusion and mis-information circulating among the nearly 2,000 attendees at MUSE. Significant change can be a scary thing, particularly when it is not well managed or communicated. People know it’s coming, but excusing the "Clintonese" for a moment, many don’t know just what the definition of "it" is.

At this year’s conference, the vendor which best communicated MEDITECH’s new technology to MEDITECH’s customers was Iatric Systems. In my opinion, the vendor which should take that accolade in Vancouver next year should be MEDITECH. If there were ever a time to re-think the position on this eight-year cold war, it’s now.

The PACS Designer’s NPfIT Software Review
By The PACS Designer

The UK’s National Audit Office has released its 2008 progress report on the National Programme for IT. While some aspects of the program are performing well, other parts are lagging behind because of slow adoption by system users.

The NAO states "delivering the National Programme for IT in the NHS is proving to be an enormous challenge. All elements of the Programme are advancing and some are complete, but the original timescales for the electronic Care Records Service, one of the central elements of the Programme, turned out to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk."

The progress report concludes that the original vision remains intact and still appears feasible. It now looks like one part of the program will take much longer to install at the various trusts and that is the Care Record System. They are now forecasting the CRS to be fully installed everywhere by 2015, four years later than originally planned.

The Picture Archiving and Communications System has fared much better than everything else with all the 127 trusts now using PACS. The PACS has reduced waiting times for diagnostic radiology and also increased the IT skill set of the PACS users. PACS up-times have generally met the 99.87% up-time goal but there has been some under performance in some of the trusts sectors. The Philips/Sectra team has had the best performance over the 18 month period that was measured starting in 2006. The Philips/Sectra team only had one month that did nor meet the 99.87% up-time goal. GE and Agfa fared much worse with GE missing the goal in six out of the 18 months and Agfa coming in last with seven months of misses out of eighteen months.

The Department’s latest survey, conducted in spring 2007, showed that 67 per cent of nurses and 62 per cent of doctors expected the new systems to improve patient care. As far as the electronic Care Records Service is concerned, it appears to be a lack of proper planning that has slowed adoption from TPD’s viewpoint. The blame can be shared by all, since a massive roll-out needs to be carefully planned in phases to insure the users get the proper training at the most convenient time. TPD’s not sure if it was used, but the use of a "Train the Trainer" program will make it more palatable for early adoption of new concepts in record keeping and could bring in the expected 2015 completion date for the Care Record System.

While much more needs to be done to complete the entire roll-out, it appears that the negative sentiment towards the implementation of IT solutions is dissipating. This change to a better attitude towards IT should be used to encourage all participants to put in a maximum effort to help each other to adapt to these new concepts for the betterment of the NPfIT,its patients, and providers.

Readers Write 6/4/08

HIStalk will feature articles written by its readers in a weekly issue.

I encourage submission of articles of up to 500 words in length, subject to editing for clarity and brevity. Opinion pieces, issues summaries, or humor are welcome, provided they would interest a primarily healthcare and healthcare IT oriented audience. Submissions are subject to approval. For copyright protection, authors must indicate that the material has not been published elsewhere, that it contains no copyrighted material, and that published submissions become the property of HIStalk (to keep intellectual property lawyers at bay). Authors must include their real or fictitious name for purposes of attribution. All opinions are those of the the respective author.

Send your article (as e-mail text or in Word) and become famous! Thanks to our authors, who voluntarily share their time and expertise with the readers of HIStalk.

HIStalk vs. Trade Magazines
By MrDan

I’m sure that trade magazine has never made a mistake. No wrong facts, no bad sources, no mistakes. Unlike you anonymous bloggers who write whatever you want, despite being rated by thousands of readers as their primary source, the most reliable, and better then all the rags.

Or, gosh … maybe they feel threatened?  That you produce better content in less time for free and threaten their institution? 

The publisher could have e-mailed you, identified the issue, and requested a correction. You know, the exact process they want people to follow for their publication. But apparently he thinks that, since bloggers are inferior people who can never rise to the level, caliber, and pure nobility of him and his colleagues, it’s a better idea to throw a bitch-fit and smash you in your own forum. And you STILL issue a clarification (much faster than the rags do, I might add – within days, not months), and take his criticism in stride, answering without insulting.

Have I seen his publication? Yep. Been curious?  Yep. Am I someone they want as a reader, as a senior at a major vendor? Probably.

After this, will I ever subscribe or read a copy? Nope. The bias and lack of foresight and careful thought reflected by the publisher has tainted the entire organization for me.

Sorry, I feel very defensive of you and that just pissed me off. Hope all is well, and keep it up!

M.U.S.E Conference
By Green Tea

The independent MEDITECH users group (M.U.S.E.) met May 27-30th in Dallas, TX for their 2008 International conference. I understand that there were approximately 1,900 in attendance, including vendors. I am surprised that there have been no postings, so I thought I would provide one user’s view.

If you haven’t been to a MUSE conference, this may be one of the few conferences that keeps a strong focus on user networking with limited interference by vendors. Most of the sessions are presented by users and vendor education sessions are clearly identified. MUSE has also done a pretty good job trying to screen out user education sessions that have been sponsored by vendors. The user sessions may not be as polished as some conferences, but you typically get the straight story without any spin.

The hot topic was MEDITECH’s new platform – FOCUS. Doylestown Hospital (MEDITECH’s first conversion from Magic to FOCUS) presented about their journey. It was an interesting presentation considering they just went live a couple of weeks ago (I smell a HIStalk interview!) They kept it very objective and educational. 

It was interesting to hear CIO comments on FOCUS. Some are embracing it, others are questioning it. Unofficially, I would score it 25/75 right now. Of course, the rumor mill was at work that MEDITECH will lock out third-party vendors such as Iatric Systems, I-People, Shams, etc. It seems like a bad idea to me since these vendors often take the heat off MEDITECH when MEDITECH can’t deliver niche solutions.

The vendor hall was modest compared to many other HIT conferences. Iatric Systems had some of the biggest crowds, at least when I was looking. JJ Wild (Now "A Perot Systems Company") had a much larger contingent than years past. I-People brought in a couple of Dallas Cowboy Cheerleaders if you are into that sort of thing. Best give-away goes to Valco for the cowboy hats — they were everywhere. 

One prominent vendor was missing again– MEDITECH. 

Well, that just scratches the surface of some of the conference highlights. It might be interesting to hear from a few other readers to get their interpretations/opinions.

Personal Health Records
By Tommy Callahan

You agree with Carol Wayne and Neil Patterson that patient-entered data can not be trusted, yet you reference an article that states that data entered by young patients into a tablet PC vs. paper is more valuable to a physician in providing care. 

The bottom line: when physicians see new patients, they must "trust something typed in by the patient for medical-legal reasons" (or written) in order to provide care.

As a consumer, at a minimum, I would find value in a PHR that would auto-populate my history data into a physician’s PM and EMR, if for no other reason than my memory stinks and I have kids that get sick and get hurt, particularly while on vacation, and I have had to complete too many histories to count. There is also a bit of value to the provider if his staff does not need to read my usually awful handwriting to enter my demographics into the PM/ADT system.

I attended a conference in DC last year that included a dozen or so PHR vendors. I can’t recall the name of one of the vendors that maintained the form formats for most doctors and/or interfaces to most of the PM/EMR systems. The concept was that you simply indicate the doctor or clinic that you will be visiting as a new patient and the company will provide your data to the office in a usable format in advance of your visit. Pretty valuable to me as a consumer.

Open Source Software Review – caGRID 1.2
By The PACS Designer

caGrid is the service oriented architecture for the cancer Biomedical Informatics Grid (caBIG), whose goal is to develop applications and the underlying systems architecture that connects data, tools, scientists, and organizations in an open federated environment. To meet this goal, caBIG will bring together data from many and diverse data sources.

caGrid enables numerous complex usage scenarios, but its basic technical goals are to:

(1) enable universal mechanisms for providing interoperable programmatic access to data and analytics in caBIG
(2) create a self-described infrastructure wherein the structure and semantics of data can be determined through programming efforts
(3) provide a powerful means by which services available in caBIG can be discovered and leveraged.

caGrid implements grid technologies and methodologies that enable local organizations to have ultimate control over access and management.

With caGrid’s support by some of the most prestigious universities, the user of caGrid is getting a first-class operating environment as a tool in fighting cancer. Since caGrid uses the service oriented architecture approach, it leverages many legacy cancer databases. Support is broad through a membership of well-regarded universities such as Ohio State University and also the National Cancer Institute.

TPD Usefulness Rating:  9.