Readers Write 1/05/10

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

The Direction of Healthcare Industry Technology
By Steve Margolis, MD, MMed, FCS, BSIS, MBA

Regarding the recent John Gomez interview on the direction of healthcare industry technology:

“Interoperability is a huge one where the way that this industry’s worked, has been not embracing the ability to exchange or interoperate between systems. We’ve been kind of proprietary. I think that also creates a challenge and a barrier for hospitals to move.”

I agree that data system interoperability is key to moving the industry forward. The plans for standards of interoperability, privacy, and security will be finalized next year. It’s going to change the landscape and mandate exchange of “semantically interoperable” information among care providers and between providers and patients.

Beyond that, we all know many common applications in healthcare are not available from a single vendor and cannot be made to integrate easily. Supporting third-party integration is extremely helpful, allowing provider organizations access to the latest advances in knowledge and technology, especially when you consider that the fundamental focus of ARRA and other federal initiatives is to take costs out of the nation’s healthcare delivery system.

Content for evidence-based care is dynamic and federal regulations are changing too rapidly for a stagnant platform. I think our industry needs to take lessons from the iPhone app model, i.e., ease of ability to integrate new applications to meet the growing need to keep up with the latest information and technology advances in order to sustain quality and curb costs — especially when the provider’s core vendor is not ready to meet those particular needs.

In short, the right technology approach for the industry is an open technology platform that provides flexibility in both front- and back-end integration, together with the means to easily cater to constituent-specific workflow. This openness is necessary to allow for the cost-effective leveraging of existing and future technology investments.

That’s why we’ve been deeply involved with Eclipsys in developing a platform that provides a services-oriented architecture that allows for third-party integration and multiple applications in context of both the patient and the user. This app integration strategy will enable providers and other third parties to build applets that will enable easier integration between existing vendor solutions, legacy, and/or other in-house developments.

The key benefit for this design approach is that hospitals need not be concerned that prior technology investments will become obsolete if the vendor advances the platform. Conversely, it means that user innovation doesn’t have to cater to the vendor’s development timeline or direction. This type of openness will allow a hospital to integrate with any Web service with a similar open health platform for driving innovation and efficiency.

Another area of important technological development is in the area of visual workflow tools. Many healthcare workers prefer to design visually and iteratively. A visual workflow tool enables rapid prototyping. Examples of this need include the opening of new clinics or the development of a new protocol in response to a pandemic.

Working together, the clinical team can translate their thinking into a devised workflow in very short order and then upload and incorporate that workflow into the system. The beauty would be that the workflow could incorporate third-party systems, such as interacting with NIH or CDC systems and provide biosurveillance data and outcomes data that could help treat pandemics in real time across the country or globe.

This is just one example, but it exemplifies the possibilities we could leverage in open architecture design. To take the monumental steps needed to improve care delivery, we will need this type of open architecture to overcome the challenges we face in delivering quality healthcare in a rapidly changing and ever-demanding environment.

Steve Margolis, MD, MMed, FCS, BSIS, MBA is chief medical informatics officer at Orlando Health of Orlando, FL.

Interoperability 2009
By Jerry Sierra

I’m a nurse who has worked in healthcare IT for over 10 years; six (and counting) for two of the top vendors. However, I feel compelled to share a story that has absolutely nothing to do with my background.

I recently moved my family from Wisconsin to Cleveland. I know you won’t be able to concentrate on my story unless I add it was to be near family (but I also really like Cleveland). My 22-month-old decided months ago to stop the normal progression to solids and instead to stick with bottles. After extensive medical testing, I’ve come to the conclusion that he’s outgrown his reflux, and out of sheer stubbornness (inherited from my wife, of course), refuses to eat anything but M&Ms, goldfish, and yogurt. As much as I like these snacks, I have fears of having to pack these items and a bottle in his lunch box for the next 12 years. To prevent that, we took him in to see our Cleveland pediatrician for a referral to their feeding clinic.

During the visit, we filled out a records request for our Wisconsin hospital and prepared to wait a few months for our referral appointment. Being a cynic, I decided to call and make sure that the records had been sent to the Cleveland GI. They, of course, had no idea what I was talking about and suggested calling Medical Records. They, of course, assured me that the doctor had never sent the piece of paper to MR and that it was never scanned into the EMR. They promised to promptly send me out a new form.

After a few short weeks, I received the form, filled it out, and sent a copy to the hospital in Wisconsin. After waiting a few more weeks, we received a letter from the Wisconsin hospital letting us know that they would love to help us out but, because of HIPAA, they could only accept their own records request form (it’s been a while since I waded through the act, so I must have forgotten that section). So I copied the exact same information onto the form with the correct letterhead and sent it off. I called a few weeks later and was told that the records were mailed out.

We arrived at the specialist’s office and asked the doctor if he had received the records. Would anyone care to guess the response? Anyone? Anyone? Bueller? Of course, he had received nothing. So I took out my tattered copy of the Wisconsin EMR report and the doctor photocopied it so that it could be scanned and added as an attachment to the visit note in the Cleveland EMR (which coincidentally, enough is the SAME vendor). There you have it, a shining example of real-world interoperability.

Who was to blame for this mess? The hospitals, for having antiquated workflows and not turning on key features like the ability to e-mail physicians? The vendor for not making it easier to share information and not allowing patients to add to their own records? The government for not mandating the NHIN, CCD exchange, etc.?

As you can see, the interoperability bar is set depressingly low. Let’s hope 2010 is the year we start making some real progress.

A New Reality in Healthcare Systems – Automation, Agility, and Compliance
By Bruce Oliver

The ever-changing administration of healthcare, increased regulatory requirements, cost control demands, clinical quality, patient safety,and satisfaction issues challenge the US healthcare system. The volume of these challenges requires automation, agility, and compliance, plus relentless execution from healthcare organizations who expect to survive and prosper in the new US healthcare system.

The current HIPAA 5010, ICD-10, ARRA (American Recovery & Reinvestment Act), and HITECH Act of 2009 mandates, incentives, and requirements — and the penalties for noncompliance — are forcing all healthcare organizations to adopt new technologies, processes, and standards. Additionally, pending new health reform legislation will add more requirements to an already over-burdened healthcare delivery and administration system.

Making the changes necessary to achieve the mandated requirements should be viewed only as one of many steps. This first step should be a well thought out and comprehensive strategy designed to prepare healthcare administrative organizations to take full advantage of imminent changes, such as secure anytime-anywhere access to patient information and clinical data, improved patient quality, safety, and service standards and real-time processing of medical transactions and claims.

In addition to the new requirements, national healthcare reforms will require healthcare organizations to implement new business processes and workflows to be compliant while being cost effective. It requires foresight to establish corporate standards, project methodologies, and updated infrastructure to adapt to pending and future requirements for process automation, organizational agility, and operational excellence and compliance.

As healthcare provider and payer administrative organizations embark on compliance processes, they can build parallel paths toward business process improvement and operational excellence. This can happen because compliance is an organizational process that includes business process and technical reengineering for healthcare organizations. Therefore, an organization’s overall strategy should be centered on achieving operational excellence as well as implementing new regulations for compliance. This strategy would require the organization to:

• Establish standardized operational excellence as a corporate strategic priority that is parallel to the implementation of new regulatory mandates, incentives and compliance projects.
• Reassess how and why the organization conducts business to improve agility, especially in the area of manual business and clinical processing that may provide opportunities for online real-time processing and secure anytime-anywhere information availability for more effective decisions and reductions in operational costs.
• Define operational excellence as an enterprise wide initiative with measurable goals that extend beyond the regulatory compliance dates. Once initiated, this initiative should continue to scale up or down to improve, evolve and automate business processes to meet the ongoing healthcare mandates requirements as needed.
• Target compliance areas that can provide high degrees of success in shortest possible time to build momentum and demonstrate compliance. Foster the use of agile technologies and software tools for automation of processes to realize faster results and improved functionality.
• Create sustainable knowledge transfer processes, staff training infrastructure, and programs to develop the skills required for operational excellence as an extension to the HIPAA 5010, ICD-10, ARRA, and HITECH projects and new health care reform regulatory requirements.
• Link operational excellence goals to compensation and incentives to focus and reward program efforts.

Healthcare organizations that are able to accomplish this dual effort should be able to differentiate themselves in the marketplace. This differentiation will be evident not only in outcomes and operational performance, safety, and quality measures, but in financial performance as well.

An automation, agility, and compliance approach does not necessarily require an organization to do an enterprise “rip and replace” project and face the monumental risks associated with it. Instead, an operational excellence plan executed with incremental improvement in systems and infrastructures is a risk adverse and affordable approach toward the automation, agility, and compliance the organization is striving to achieve.

Bruce Oliver is the payer practice director at maxIT Healthcare, LLC.

Monday Morning Update 1/4/10

From Ned Flanders: “Re: remote ICU monitoring. Publication bias apparently runs both ways. JAMA rejected a study evaluating the clinical and financial impact of remote ICU monitoring last year because although the results were extremely impressive, they claimed the study had a weak design (before and after) and did not shed light on the actual reasons why remote ICU monitoring helped (since it had already been shown to help). Curious considering the recently published study had the same design and flaws, with the only difference being outcome.” This highlights a little-appreciated reason for not believing everything you read: the most powerful influence wielded by publishers isn’t how they spin a particular story, it’s their choice of which stories to include in the first place. That process has zero transparency to readers, so it’s the most dangerous. The second most powerful is where the piece appears if it is published. The third is how the headline (or abstract) is worded since many people will base their conclusion, consciously or subconsciously, on that alone.

From FinSoft: “Re: QuadraMed. Jim Klein is out – read the 8K from December 30.” This was actually reported by Misys_ex to me in early December, but I always hesitate to run rumors about named individuals unless it’s public knowledge since I’d hate to see my own name in “he’s been fired” speculation (no need to give the boss ideas). Jim was SVP of product management and CTO until his “involuntary termination”. Some degree of executive change is all but mandatory when a company is acquired. Companies don’t generally buy other companies because they don’t want to change a thing.

From Anne Onymous: “Re: HHS rules. For years, vendors charged a fortune for simple interfaces to the systems of other systems. Now, in order to get certified, they have to offer this interoperability. In addition, they may not be able to charge for it! There are no provisions for them to charge for receiving patient data, although there is no mention about sending patient data (I could have overlooked it). I predict that in the final rules, certified vendors will have to receive select patient data and respond to inquiries for it from other certified systems at little or no cost. This is reasonable and necessary for patient care. The impact of these rules will be very positive for vendors that provide niche applications.”

From Downtown: “Re: meaningful use. Awesome summary. Will anyone other than attorneys read the whole thing? With an unusual lack of fanfare, ONCHIT seems to have published a new Web site, StateHIEResources.org. It was registered on the 13th by some Canadians. Now I’m really confused!” I signed up for the listserv and it’s apparently a follow-up to (and the same domain registrant as) the State Health Information Exchange Leadership Forum, run by AHIMA “through a cooperative agreement with the Office of the National Coordinator for Health IT.” The new site has no AHIMA reference. ONCHIT apparently offshored its Web development to Canada.

From ChiSalesChick: “Re: a big EMR vendor I won’t name. They are ‘restructuring’ a lot of their sales people right out of a job.”

From Cleveland Brown: “Re: HIStalk. I was scrolling down the sponsor list yesterday and thinking about how far your little blog site has come in the years that I have been reading. All of your hard work and your integrity surely has brought you well-deserved respect and fame (if not fortune). Thank you so much for producing the one blog that I turn to daily! I do admit, however, that I do not share your site with many of my peers. It is important for my ego to always know more than anyone else and reading HIStalk makes it so.” Lots of readers have confidentially told me they keep their HIStalk reading habits secret for the same reason, which is flattering and amusing. I guess that does slow the word-of-mouth effect, although I note that December’s HIStalk visits were up nearly 40% year-over-year, which is closer to shocking than merely surprising since I keep figuring that anyone who cares has already found it.

Speaking of the remote ICU article, thanks to the reader who sent over the JAMA full text article. The article by a University of Texas Medical School associate professor looked at mortality, complications, and length of stay before and after implementation of Philips VISICU in six ICUs in five hospitals (in a single health system) from 2003 to 2006, using around 2,000 randomly selected patients (about half the total). Hospital mortality dropped a little, but that was not statistically significant after adjusting for severity. There was minimal effect on complications and length of stay. The big gotcha: two-thirds of the patients studied had doctors who allowed the intensivists to intervene only in life-threatening situations, i.e. they were not really letting the remote intensivists manage those patients. Also: the hospitals did not integrate their CPOE and progress notes into VISICU, so all the intensivists had to work from was a daily fax (note the irony that, among all that expensive technology, the only “interface” was a daily fax from one user to another). My conclusions (crediting Smalltown CIO for some thoughtful comments left on my original post about this article): (a) as is often the case, implementation decisions had more impact on outcomes than did the technology itself; (b) you could flip the conclusion around and say that, since tele-ICU had no negative impact, it provides opportunities to maximize use of scarce resources; (c) rural sites could use tele-ICU and keep the patient closer to family members without negatively impacting outcomes (and helping support those rural facilities instead of big academic medical centers); and (d) hospitals buying remote ICU monitoring technology should first see if local docs will support it by letting those remote intensivists do something more than just provide off-hours fire watch coverage.

Speaking of tele-ICUs, Advanced ICU Care, a St. Louis ICU monitoring service whose 60 intensivists and ICU nurses use VISICU, raises another $2 million of investor money, bringing its total to $12 million.

It’s a new year – time for parades, bowl games, and HISsies nominations. Tell me your thoughts about 2009’s best and worst vendors, the smartest and stupidest vendor moves, and of course the granddaddy of all HIT industry awards: your choice for “HIT industry figure in whose face you’d most like to throw a pie.”

Another New Year’s tradition: newspaper profiles of the local hospital’s first baby of the year, which as I annually note, seldom involves married parents.

Listening: Boston-based Lyres, which sounds like the Animals or Seeds time warped from a 1960s garage into the 1990s with their Farfisa organ in tow.

HHS didn’t make its proposed Meaningful Use standards easy to work with, scattering them over two verbose PDF files (they didn’t exactly lead by example when it comes to discrete data and interoperability). I pored over the documents again in my usual nerdy New Year’s Eve (while watching some guy doing an Evel Knievel-style car jump on TV and all three hours of Rush in Rio) and put the actual criteria and thresholds into a handy-dandy Excel worksheet (note: it looks crappy in the preview, but perfect once you download). It spells out the provider parts of the MU requirements in concise detail. Certification and payment specifics means nothing if you can’t look down this list and nod your head that, hey, we can do all this stuff on the computer. Let me know of any additions or changes. I numbered the criteria just for reference, but it’s a made-up number.

Some thoughts on the proposed Meaningful Use criteria:

• I’m trying to figure out who the big winners will be if these criteria are approved. Consultants for sure. Companies like RelayHealth that provide eligibility, claims, and information exchange services. Companies that can perform a security analysis. Vendors that offer a usable medication reconciliation function. Vendors with patient portals. Companies that can help put vital signs information directly into the EMR.
• Losers: EMR vendors already strapped to pay for CCHIT certification who now have to cough up another million or two to meet the additional requirements. That’s another blow to small and innovative vendors who aren’t raking in the cash, meaning the market tilts even more in favor of the older, bigger ones whose sales were so limited that the government decided to intervene in the free market in the first place. Market consolidation is probably good, but I expect the development agenda will now be even more driven by Uncle Sam, not users (especially since the HITECH sales window is small, so even sales-driven innovation may dry up once everybody has chosen their dance partner).
• Lots of folks, me included, expected the criteria to be a slam dunk for moderately tech-savvy hospitals and practices. Not so: considering the small percentages of them using CPOE and e-prescribing, the minority that can provide electronic copies of information to patients, and the small number of practices that can provide patients with fast access their online health information, the these are stretch goals. I bet those requirements will be dialed back in the final version for that reason.
• Good luck with providing the denominator number for the reimbursement measures. You will need to know the total number of prescriptions generated, the number of orders issued, and the number of episodes in which medication reconciliation should have been performed. The document indicates an estimated time to generate the denominator at one hour using the EMR’s capabilities, which is surely a mistake since the EMR doesn’t help you count paper orders.
• The CPOE requirement is generous to hospitals, which have been screwing around since the 1980s trying to get doctors to use CPOE with dismal results. They are required to hit only 10% CPOE usage since “CPOE is traditionally one of the last capabilities implemented at hospitals.” (like, decades after buying it?) Practices, most of them considering their first EMR in a quick ramp-up to earn HITECH money, need 80% usage right out of the gate. I expect changes here, too, with the hospital target raised and the practice one lowered.
• With the minimal CPOE usage required for hospitals, the five required (and undefined) clinical decision support rules won’t have much impact on patient outcomes.
• The report cites a pseudo-fact that, “Some vendors have estimated that EHRs could result in cost savings of between $100 and $200 per patient per year.” Vendors say a lot of things, but I believe only those that are enumerated in a contract, preferably with rewards or penalties to encourage backing up self-serving statements with risk. I’m not sure I would have included that stat.
• The report used the high estimate of EHR cost from a range of $25,000 to $54,000 per provider, stating that “we believe the cost of such technology will be increasing.” Why should software costs increase when user bases are increasing, which should allow vendors to spread their fixed software development costs over more users? The only one factor that would raise the price is the vendor cost of complying with certification requirements (government meddling in free markets never comes free).
• That higher upfront EMR cost makes the elusive $44K jackpot even less enticing. Doctors were already avoiding EMRs because of cost and negative workflow impact. Providers are questioning whether they can qualify for the incentives and whether they trust the government to pay them.
• Conclusion: if you like the idea of having the government use taxpayer money to encourage the use of specific products in the pursuit of lofty and possibly unrelated goals, this at least pushes some theoretical behavior change in the users who choose to participate. If you’re a provider trying to decide whether the government money has too many strings attached, this might convince you that it does. And if you asked me how the odds of high EMR utilization changed with the release of these proposed requirements, I’d say they got worse.

Apparently we are not collectively certain that Epic is a proven solution for acute treatment of seriously ill patients, at least based on the results of my last poll. A new one to your right (or lower left if your screen resolution is set low): are the initial Meaningful Use criteria too easy for providers to meet, too hard, or about right?

I love this newspaper article because it reminds me how shocked I was the first time I saw what it describes first hand: the person in scrubs assisting a surgeon performing an OR procedure is sometimes an unlicensed salesperson of the medical device being used. In addition to the skilled medical personnel in the OR, “at the foot of the operating table, there’s Chuck Bates, a guy who studied biology in college and always wanted to go to medical school but never did. Instead, he began his career selling hot dogs to grocery stores. As the surgeon prepares to make an incision, Bates stares at the X-ray monitor. Come up one centimeter and make your incision there, Bates tells the surgeon.”

This is what the lure of taxpayer-funded EMR Welfare has done. An Indiana group holds its first planning meeting about applying for $15 million in federal HIT money (the Beacon Community Program) even though the representative of the only hospital involved (and the main beneficiary of the grant) skips the meeting because he’s on vacation. Their application is due January 8, so they met without him. The county health department director figured the financial windfall would be nice, but low EMR provider usage makes the group a pretty poor EMR beacon for the country to follow: “It’s been a real struggle. The hospital’s computer system has been crap. I’m not sure it is even 15 percent, let alone 25 percent.”

E-mail me.

CIO Unplugged 1/1/10

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

Think with your Heart
By Ed Marx

Will it bust your view of me to know I cry at work? It’s true. Whenever I give a tour or visit staff on a floor, at some point I excuse myself and cry. I can’t help it, especially after talking with skilled clinicians who demonstrate sympathy. Seeing the patients overwhelms me, and starts me thinking about the sanctity of life. My heart swings between brokenness and compassion, between impressed and thankful. And this all drives me to keep doing what I do.

I never want to forget that I’m here to serve those in their most vulnerable, and often dire circumstances. One benefit of no longer having an office is my increased time spent in our hospitals and on our patient floors. My weekly leadership meetings—when we do meet in person—are often held at one of our medical centers.

Why do I make my team do this, you ask?

A few years back, I realized that what separated the top performers from the average worker was neither skill nor experience but talent. Further analysis revealed compassion as the key talent. Top performers connected skills with compassion. They linked their hearts to their brains.

I had to help others understand that what they did daily affected a patient’s life. But how? A motivational speech might nick their emotions for a day or two, so that wasn’t good enough. I needed an approach that transcended their mental understanding, a connection so strong that synapses would rewire and link the brain to the heart and infect their souls forever.

Since realizing this need, I’ve employed several strategies. The single most effective method is the annual Connections program. This spring will mark my 7th year of Connections. The remarkable happens when you remove the physical barriers between clinicians and those that support them. When a programmer sees the impact of his code on a patient, his heart is changed. When a service desk agent sees the face of the physician she’d helped navigate through the electronic health record, her heart grows a size. Sympathy wakens in the data center engineer when he learns from a nurse that patient outcomes improve because of the technology delivered without interruption. And an administrative assistant understands the urgency of communication when she personally sees the life and death stress.

Their brains tap into their hearts.

Here’s how it works, and then I’ll show you the outcomes.

· Everyone must participate, especially you the leader. (Given how easy it is to revert to insular ways and become ingrown, I keep my connections fresh)

· Speak with your hospital leadership and identify points of contact

· Develop a schedule and begin registration into clinical areas

· Allow employees a choice according to their interest such as ED, OR, Lab, Nursing, Pharm, etc.

· Spend a minimum of a half day with a clinician, full day optimal

· Set up an interactive site to have employees post feedback on their experience

· Follow up immediately on any items clinicians need help with

· Send thank you notes to all clinicians involved

· Repeat yearly

Outcomes:

· Transformations-

“I must admit I hated this idea but did it because I had to. I have worked for the health system for 20 years and for the first time I realized we have patients. Of course I knew what we did as a hospital but really, this was incredibly impacting and I will never be the same.”

“I am not the same today as yesterday.”

“I volunteered to observe in the OB unit. With clinician and patient permission, I witnessed the birth of twin babies. I never realized all the behind the scenes coordination required and it opened my eyes to a whole new world.”

“I never saw myself as part of the patient care process until now.”

“My life is changed; I always wanted to be care giver but didn’t like blood so chose a different path in technology. Now I tell people I am both.”

“I run marathons. I was more exhausted shadowing a nurse today. I never knew.”

“In one day I witnessed the joy of healing and the pain of death. I now see how critical IT is and why we need to be the best that we can be to support the front lines.”

“I am a nurse and did not see why I had to take part in this program. After today, it was like I was hit by a ton of bricks! Wake up call! Thank you, thank you, thank you.”

· The clinicians shadowed learn more about technology. They learn that we care and that they have this incredible support structure surrounding them. This aspect is almost as beneficial as the Connections themselves.

· Respect from operational leaders increases because they see that you care.

· While not scientifically validated, there appears to be an overall correlation between organizational outcomes and Connections.

· As Connections form, employee engagement rises and new talents are created and nurtured.

I love a great speech, giving out raises and bonuses. But evidence suggests these have fleeting influence on performance. In fact, some studies indicate the enthusiasm over a raise lasts two weeks. I speculate this is because money only engages the brain. Conversely, transforming a person’s way of thinking and view of themselves results in long-term effects and a new person. Even the hardest of hearts and the most gifted intellectual will begin to view things differently. Once they’ve connected.

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

ONCHIT Releases Preliminary Definition of Meaningful Use

The federal government announced regulations this evening that define “meaningful use” of EHRs and the CMS incentive program associated with it, barely meeting the December 31 required date for issuing an initial set of standards.

The rules will go into effect 30 days after publication following a public comment period. The meaningful use rule is here (warning: PDF).

The incentive rule (all 556 pages of it) is here (warning: PDF). It contains specifics about percentages of orders, payment schedules, specific numerators and denominators for measures, etc. I gave it a quick skim and got most of the information about use measures, but if someone wants to summarize the payment portion early Thursday, I will post it (since I’ll be at work).

These specifications apply to Stage 1, which take effect in 2011. They fall into four categories of standards: vocabulary, content exchange, transport, and privacy and security.

Stage 2 requirements start in 2013 and Stage 3 requirements in 2015. Those will be defined later by HHS.

This is a summary of the most important information.

CPOE
Practices: Use CPOE for orders involving medications, laboratory, radiology, and referrals.
Hospitals: medications, laboratory, radiology, blood bank, PT, OT, RT, rehab, dialysis, consults, and discharge and transfer.
Orders do not have to be sent electronically to the fulfilling department (lab, pharmacy, etc.)
Practices must enter 80% of their total orders directly by the clinician into the CPOE system. Hospitals must have 10% of all orders entered by CPOE.

Clinical Checking of Orders
Real-time screening (drug-drug interactions and drug-allergy contraindications), formulary check, user ability to maintain screening rules, track user responses to alerts.

Problem List
Longitudinal current and active diagnoses coded in ICD-9-CM or SNOMED CT.
80% of unique patients must have at least one coded problem/diagnosis, with “none” being an allowed entry (hospitals and practices).

E-Prescribing
Practices only.
Must send 75% of non-controlled substance prescriptions electronically.

Active Medication List
80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).

Medication Allergy List
Longitudinal with allergy history.
80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).

Demographics
Practices: preferred language, insurance type, gender, race, ethnicity, and data of birth.
Hospitals: all of the above plus date and cause of death if applicable.
80% of patients must have demographics recorded as structured data

Vital Signs
Height, weight, BP, BMI, growth charts for patients 2-20 years old, temperature, pulse.
80% of patients aged 2 and over must have blood pressure and BMI entered.
Children 2-20 must have a growth chart.

Smoking Status
Record if current smoker, former smoker, or never smoked.
Must be recorded for 80% of patients.

Structured lab results
Display results, translate LOINC codes, allow maintenance based on new results.
Must record as structured EHR data 50% of all results that are delivered in positive/negative or numeric format.

Patient Lists
Allow user to select, sort, retrieve, and output patient lists based on demographics, medications, and conditions.

Report Quality Measures to CMS and States
Calculate, display, and submit quality measure results

Patient Reminders
Practices only: issue based on patient preferences, demographics, conditions, and medication list.

Five Clinical Decision Support Rules
Beyond drug screening, based on demographics: diagnoses, lab results, or medication list. Real-time alerts and suggestions based on evidence. Track response to alerts.

Eligibility
Allow user to record and display based on eligibility response from insurer.
Must cover 80% of unique patients.

Submit Claims
Must submit 80% of all claims filed electronically.

Electronic Copy of Health Information to Patients
Allow user to create an electronic copy of test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospitals must also provide a discharge summary but not procedures.
Must provide an electronic copy of health information to requesting patients within 48 hours.

Electronic Copy of Discharge Instructions
Hospitals only.
Must provide electronically to 80% of discharged patients who request them.

Timely Patient Access to Health Information
Practices only: diagnostic results, problem list, medication list, medication allergy list, immunizations, and procedures. Within 96 hours of availability.
Must provide to 10% of unique patients.

Clinical Summary of Each Office Visit
Practices only: diagnostic results, medication list, procedures, problem list, immunizations.
Must provide for 80% of office visits.

Information Exchange
Enable electronic sending and receiving of diagnostic test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospital requirements also include a discharge summary.
Must conduct at least one test of exchanging information.

Medication Reconciliation
Compare and merge two or more medication lists into a single list that can be displayed in real time.
Must be performed in 80% of encounters and care transitions.

Submit Data to Immunization Registries
Must conduct at least one test of submitting information.

Submit Lab Results to Public Health Agencies
Hospitals only.
Must conduct at least one test of submitting information.

Submit Syndrome Surveillance Data to Public Health Agencies
Must conduct at least one test of submitting information.

Protect Electronic Patient Information
Unique identifier, emergency access for authorized users, session timeout, encryption where preferred, encryption when exchanging information, maintain audit logs, provide integrity check for recipient of electronically transmitted information, verify user identities and access privileges, record PHI disclosures.
Must conduct a security risk analysis and implement security updates.

Transport Standards
SOAP and REST
HL7 CDA R2 Level 2 CCD or ASTM CCR
ICD-9-CM or SNOMED CT for problem lists
ICD-9-CM or CPT-4 for procedures, moving to ICD-10-PCS or CPT-4 for Stage 2
RXNorm for medication lists
UNII for Stage 2 allergy lists (no standard now)
CDA template for Stage 2 vital signs (no standard now)
UCUM for Stage 2 units of measure (no standard now)
LOINC for lab results
NCPDP Formulary & Benefits Standard 1.0 for drug formulary checks
NCPDP SCRIPT 8.1 or 10.6 for prescription information
ASC X12N and NCPDP for transactions
CMS PQRI 2008 Registry XML for quality measures
HL7 2.5.1 for submitting lab results to public health agencies, with UCUM and SNOMED CT encouraged
HL7 2.3.1 or 2.5.1 for submitted surveillance information to public health agencies and for immunization information
Encryption only if organization sets it as a standard

Median Estimated One-Time Costs for CCHIT-Certified EHRS to Be Certified as Complete EHRs
CCHIT Ambulatory 2008: $1 million
CCHIT 2007/2008 Inpatient: $1.38 million

Median Estimated One-Time Costs for Pre-2008 or Uncertified EHRS to Be Certified as Complete EHRs
Practice EHR: $2.4 million
Hospital EHR: $3.3 million

Estimated Median Industry Costs for EHR Preparation
2010: $61.35 million
2011: $54.53 million
2012: $20.45 million

News 12/30/09

From C’mon Man: “Re: would you buy an EHR from this man? Or a demonstration of how easy it is to smile at the patient, hold the computer, and enter data all at the same time. I do not get it, why is anyone fussing? This ad has sold me, outdated CCHIT and all.” Hey, have some holiday compassion: it’s tough making a living trying to get doctors to use EMRs they don’t really want. My first thought reading the “gift that keeps on giving” part of the ad: the old joke about syphilis.

Note to Mississippi Governor Haley Barbour: don’t ask a question if you don’t want to know the answer. The Gov, getting his tweet on, sends out a blurb pitching cost cutting. An administrative assistant in University Medical Center’s nursing school tweets back, suggesting that maybe he should get his medical exams during normal working hours like everybody else instead of requiring employees to come in after hours on overtime. The Governor’s Office is not appreciative, tracking her down and demanding that the hospital’s compliance officer deal with her. They did, citing HIPAA laws in telling her to quit or be fired even though she didn’t know anything about his health first-hand. The Governor’s Office claims they didn’t contact anyone.

I just noticed that the verified e-mail subscriber count has passed 5,000. Thanks to everybody who reads HIStalk. I can’t express how satisfying and humbling that is, especially when I’ve had a sucky day at work (not today, though – it’s great with everyone taking time off, although the long winter grind starts in earnest next week).

From Thanks: “Re: KLAS. Thank you for publishing the article on KLAS. I was really upset that you never said much lately about this. KLAS is a big scam.” The Readers Write article by Swearingen Software CEO Randall Swearingen drew quite a few diverse comments. Some believe KLAS is an evil money factory, while others say their approach is reasonable. Not that you care, but here are my observations about KLAS.

• I have contributed to KLAS surveys (although not recently) and never detected any suggestion of impropriety. I found their information useful and referred to it fairly often, although not to the exclusion of doing my own homework. I wouldn’t have paid for the subscription and reports.
• I would like to see more statistical transparency in their methods, preferably by external and impartial oversight. Adam Gale said he welcomed this in my 2007 interview with him, but I haven’t seen any changes.
• I don’t believe it when KLAS insists that wild result swings (the “first-to-worst” phenomenon) is a reflection of vendor changes. I think it highlights the problem of trying to extrapolate hard statistics from squishy interview data, no matter how many mumbo-jumbo graphs you include.
• KLAS doesn’t claim to be the Consumer Reports of the industry (see Adam’s comments in my interview). They are a survey company, not a software testing company. At best, they accurately summarize information that vendor customers have given them.
• KLAS has always taken specific data of limited usefulness and wildly extended it into all kinds of repurposed reports that mean very little but that provide extra sales revenue. I have always ignored those anyway, so I can’t say that bothered me.
• The KLAS business model is the same as that of HIMSS: providers pay little to nothing, but their participation motivates vendors to pay to play. Whatever they are selling, vendors keep buying of their own free will.
• Like every other survey-based award, vendors who score well plaster their results everywhere. Those who don’t complain that the process was rigged.
• For me, I paid the most attention to the user comments rather than the fancy graphs and stoplights. For we provider-siders, I bet I could provide an equally valuable service by just contacting a lot of verified system users, asking them a handful of questions, and publishing the results.
• My overall conclusion: the evils of KLAS are really a reflection of the evils of its provider and vendor members. Vendors try to game the system without getting caught, while providers unwisely overweight the value of KLAS in making their IT decisions. All of that is highly profitable to KLAS, but more power to them for creating a niche that still has minimal competition and strong business after all these years.

Back in 2005, I wrote an editorial pitching the idea of a standard healthcare database schema. I’ve seen other folks pick up that idea lately. Given the push for interoperability, I still like the idea. Here’s a snip of what I said then:

This is where my noodling got out of hand. Why can’t every vendor voluntarily or mandatorily use the same database layout for core information? How many ways can you express and repose standard elements such as date of birth, gender, address, etc.? Vendors can, when under duress, feed their data to a standard interface. Why can’t all systems just use an approved core set of tables, updated by the same core set of business rules, and then add their value through additional related tables, GUIs, business rules, etc.? Everyone’s patient database could look and work the same. Seen one, seen ’em all. Customers would be as thrilled by this idea as vendors would be appalled by it. Standard reports would work for every hospital, not just those of a particular vendor. Data translation for third-party reporting would be a no-brainer. Conversion of one system to another would be a piece of cake. Hospitals could easily merge and un-merge with each other to their heart’s content, with data conversion and extraction being assured. You might even have your choice of database software, given an Internet-like abstraction layer that supports everything from Oracle to Cache’. Talk about your interoperability!

An unconvincing article a couple of months ago concluded that remote monitoring of ICU patients by intensivists had little impact on outcomes. I can’t see the full text of this new JAMA article, but it seems much more conclusive, even though its conclusion is the same: “Remote monitoring of ICU patients was not associated with an overall improvement in mortality or LOS.” It’s the CPOE problem, however – many of the institutions had it, but weren’t really using it (although that in itself might, as for CPOE, give an organization reason to question its own capabilities before whipping out the checkbook).

LifeBot announces GA of its VoIP-based workstation for EMS telemedicine, offering full compatibility with digital radio systems.

Inga’s got a couple of great interviews running on HIStalk Practice: Scott Decker (new president of NextGen) and William Zurhellen, MD (a pediatrician and CCHIT expert panel member who has some shockingly frank things to say about the state of EMRs, CCHIT, and standardization).

Listening: Ben’s Brother, slightly whiny Britpop that still sounds good, although I eventually needed some nasty chick music to offset it and headed over to desk-drum to L7 for the zillionth time.

OHCHIT has an upcoming conference call to talk about the $6 million it will spend to get universities to develop a health IT competency exam (warning: PDF) for degree-less HIT people, a little chunk of its $120 million Health IT Workforce Development Program.

Greenway Medical rolls out its PrimeSuite EHR, PM, and interoperability product to Bethesda Healthcare System (FL).

Northwestern Medical Center (VT) gets CON approval to implement Meditech for $5 million, also expecting $577K in stimulus money as a result.

Odd lawsuit: a man sues Barnes Jewish Hospital after he claims he slipped on a Q-tip while visiting a patient, causing extensive injury, disability, and suffering.

E-mail me.

Readers Write 12/28/09

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

TPD’s Review of the RIS/PACS Relationship
By The PACS Designer

As hospitals try to get more efficient, it would be a good time to review what the Radiology Information System (RIS) and Picture Archiving and Communications System (PACS) can bring to the institution when it comes to efficiency.

First, let’s review the imaging piece, which is PACS. The main purpose of the PACS is to digitize image files for easier access and increased image sharing. While a PACS is a significant change, it does start to improve processes through more rapid access to image files. The PACS also encourages the sharing of image information with other departments.

Next, the acquisition of a PACS can be a significant draw on financial resources, as it will require workstations for each radiology department member, and other need-to-know individuals who require image file access privileges.

Weighing the cost against the benefits of a PACS, the institution can reduce film and chemical costs with a PACS, and also improve process flow for patients through quicker access to image files. These improved results have to be weighed against the financial outlay that has to be made to bring digital imaging to Radiology.

Now, adding a RIS to a PACS can further improve the scheduling of patients for Radiology procedures. The RIS allows efficient scheduling to take place through its automating of the scheduling software. The software can also highlight potential bottlenecks to alert staff to a looming problem.

The RIS lets everyone know what each radiologists workload is, and how fast equipment can be used to take advantage of each equipments efficiency features.

Another benefit of adding a RIS to a PACS is the bi-directional flow of patient information after procedures are completed and sent back to the RIS for staff review and planning.

In summary, a RIS/PACS configuration can bring great value to the Radiology imaging process, and help reduce costs overall after careful redesign of existing processes.

Awards For Sale?
By Randall Swearingen

KLAS recently named its “Top 20 Best in KLAS Awards: Software & Professional Services 2009” report. Before I list my concerns, you need to understand a few basic points about KLAS.

Their main award is the “Best in KLAS” award. It is supposed to be awarded to the vendor with the highest customer satisfaction scores in a given category (i.e. the best vendor). To be “Best in KLAS”, there has to be a minimum of three non-asterisked vendors in a given category. Vendors are asterisked when they have less than 15 customer surveys because KLAS doesn’t consider the data reliable. In addition to their “Best in KLAS” award, KLAS also has “Segment Leader” awards for those vendors whose categories don’t qualify for “Best in KLAS”.

It is important to note where KLAS gets their revenue because it seems to indicate a conflict of interest between serving the healthcare industry and serving the healthcare vendors. One source of their revenue is from selling their reports to hospitals, clinics, consultants, vendors, etc. Since hospitals and clinics can get free reports by completing just one vendor survey, very little revenue comes from them. The bulk of KLAS revenue comes from vendors. Vendors pay KLAS to survey enough of their customers to get the asterisks removed their products. That isn’t cheap.

KLAS further encourages vendors to pay to have the asterisks removed from at least two of their inferior competitors so that they can be eligible for “Best in KLAS”.

KLAS also charges vendors an annual fee to view KLAS data (including their own). The fee is calculated as a percentage of that vendor’s annual revenue. Thus, larger companies pay more than smaller companies to view KLAS data.

Of course most vendors elect not to pay KLAS, which is why most products are asterisked in their database. But, those who do pay and who are awarded “Best in KLAS” play the award up big time in ads, trade shows, etc.

See the conflict of interest yet? Isn’t the purpose of KLAS to identify and reward the best vendors on the basis of customer satisfaction? Not based on how much a vendor pays?

Back to this year’s report. As a radiology information system vendor, I went straight from the e-blast to review the radiology winners. The “Segment Leader” in the Radiology Ambulatory category this year went to a vendor who happens to be asterisked. Upon reviewing the report, I contacted one of my customers, who has a KLAS account, and asked them to compile some KLAS data for me. Turns out that the winning vendor had scores that were slightly better than those of Swearingen Software.

I then turned my focus to the Radiology Small category. Swearingen Software had the highest scores in the Radiology Small category in all three sections (PRIMARY INDICATORS, DETAIL INDICATORS, and BUSINESS INDICATORS) but the “Segment Leader” award was given to a vendor whose scores ranked seventh out of the10 vendors in all three sections! If you have a KLAS account, you can easily verify all of this information. In the KLAS e-blast, they did not disclose how the “Segment Leaders” were selected or that it doesn’t necessarily go to the vendor with the highest scores.

I felt compelled to dig deeper, so I asked my customer to review the “Segment Leader” section of the report and look for any clues that might explain this action. My customer informed me that upon close inspection of the Top 20 KLAS report on their Web site, a small note is shown below the “Segment Leader” chart which states: “Other solutions must have at least two products that meet the KLAS minimum for statistical confidence in order for a product to earn category leader status.” (That means having a minimum of two non-asterisked products somewhere in KLAS).

OK. So let me get this straight. It’s possible for a vendor to have two non-asterisked products (even if they are the absolute worst scores in their respective categories) AND they can have the absolute worst score in a different category AND they can still win the “Segment Leader” award for that category. Remember, vendors have to pay to get their asterisks removed. Hmmm. What happened to the concept of the award going to the vendor with the best scores?

Simple questions: who monitors KLAS? Who audits them? What independent source verifies their data to make sure it is accurate and fairly represented since they seem to have influence over some buying decisions? Answer: nobody.

I think the “Best in KLAS” award should be renamed to the “Deep Pockets” award. It would be more fitting.

Randall Swearingen is founder and CEO of Swearingen Software, Inc. of Houston, TX.

AMICAS To Go Private in $217 Million Buyout

Medical imaging vendor AMICAS announced this morning that it will be bought by private equity firm Thoma Bravo LLC for $5.35 per share, a 21% premium to Thursday’s closing price.

Stephen Kahane, AMICAS president, CEO, and chairman, was quoted as saying, “With the additional capital and operational expertise available to AMICAS through Thoma Bravo, we will be able to grow as the needs of our customers evolve and will be enabled to better serve our market.”

Monday Morning Update 12/28/09

From Madrigal: “Re: letter sent to Meditech customers on December 21.” Unverified, but here’s what the reader sent:

I am happy to announce that effective January 1, 2010, the products, functions, and staff of Patient Care Technologies, Inc. (PtCT) will be fully merged into MEDITECH. PtCT will no longer exist as a separate entity, and all divisions within PtCT will report through MEDITECH’s organizational structure. PtCT’s products will become part of MEDITECH’s HCIS, and will include three offerings: Home Health, Hospice, and well@home Telehealth.

From Lee Morningwood: “Re: Wellogic. Did you decide not to expose them?” I hadn’t named the Cambridge, MA HIE vendor by name, but I received several e-mails purporting to be from former employees back in August. They made a number of claims about the company. I exchanged a couple of e-mails with the CEO and sent him a list of questions, but didn’t hear back. So, all I know now is what I knew then: JobVent said in November 2006 that Wellogic asked it to remove negative postings about the company and Wellogic’s 24-hour support line rang to voice mail (and still did when I tried it today, despite the CEO’s assurance in August that it was a temporary problem due to a telephone system switchover). Meanwhile, I see that JobVent has several recent postings of unknown veracity about the company that repeat some of the same claims that I got by e-mail.

From RocketRobo: “Re: Cerner. The Vancouver Island Health Authority gets local media mention for their $67M Cerner implementation. Five years to bring up the first four hospitals, another three years to bring the rest up. A lot of remote communities will benefit from this model.”

From Ed: “Re: update. Is an update available on the rumor that a major health system will cancel its outsourcing agreement?” I mentioned previously that I had received a couple of anonymous e-mails claiming a big outsourcing contract will be cancelled in early January. The client was supposedly Ascension Health and the vendor CSC, with which Ascension signed a ten-year, $1.4 billion agreement in 2004. Ascension CIO Mark Barner did not return my e-mail of December 8. Therefore, it’s just a rumor – for now.

Construction begins on the future Kansas home of the Kansas City Wizards soccer team and 4,000 Cerner employees, encouraged by $230 million in incentives offered by an apparently desperate Kansas. This architectural rendering is apparently from Neal’s perspective as he can happily note that the parking lot is substantially full and all the Wizards are hard at work, although the pizza delivery vehicle is difficult to discern.

The DoD-VA IT integration project will be delayed for up to two years after a Pentagon review discovers an “inappropriate and potentially unethical relationship” between a DoD manager and the CEO of network performance technology vendor Adara Networks. The tiny company was reported to be under a DoD investigation in July after paying $240,000 in lobbying fees and then getting earmarked funds from Sen. Thad Cochran of Mississippi.

ONCHIT announced $80 million in grants for HIT training last month. Now comes another $38 million for universities for competency assessment and certificate programs. I’m picturing David Blumenthal wielding one of those tee shirt shooter guns like you see at sporting events, launching $5 million packets of taxpayer currency to crowds of handout-hungry universities. HIT Geek sends this assessment: “Why not a program to re-employ the many skilled workers who have been laid off from healthcare IT vendors due to the economic downturn? No need to train them, and they are available immediately.”

Speaking of David Blumenthal, he declares that ONCHIT’s advisory work group meetings will be open to the public starting January 1. Modern Healthcare reporter Joe Conn had called them on it, questioning whether “it was appropriate to close the meetings even if they had legal authority to do so” considering the President’s recent open government order. Suddenly, Blumenthal’s blog cheers the “no closed meetings” idea like he had just thought it up, declaring that “we want to do more to bring you into the conversation” without referencing the earlier resistance to open meetings (and a somewhat haughty-sounding defense of the practice). It’s a good move, but a simple “we were wrong” would have been nice, especially since I bet the closed door meetings were inconsequential anyway.

The HIStalk party at HIMSS will be Monday, March 1 at 7:00 at Max Lager’s, a short walk from the Georgia World Congress Center. Thanks to primary sponsor Encore Health Resources. Ivo Nelson and Dana Sellers know how to throw a bash, as several of you mentioned by e-mail after the last conference in Chicago. More to come, including the usual online RSVP.

Two unnamed Mayo Clinic employees, one of them a doctor, are fired for violating privacy policies.

I was in the Apple store today (Saturday, the day after Christmas). Recession or not, it was packed with buyers, not returners. A big announcement is supposedly coming in January, which I’d speculate is its rumored tablet offering. I was feeling up the Mac Mini, which is a cool little $599 computer for PC’ers like me who don’t need to re-buy a monitor and keyboard.

Recent articles aside, EMR adopters shouldn’t put too much stock in the results realized by users who preceded them, according to my last poll. New poll to your right: when I asked John Gomez from Eclipsys about Epic’s dominance, he said, “But when you get into the real serious acute care, when you get into the real treatment of very, very sick patients; to the best of my knowledge, I don’t know if they’ve proven themselves yet.” Do you think Epic has proved itself in that regard?

Creepy: a Canadian inventor creates a robotic dream girl that speaks 13,000 sentences in two languages, recognizes faces, plays games, and slaps anyone who paws her. Her “husband” says she’s the perfect woman because she “is always helpful and never complains.” He hopes his robot can serve as a home health companion, which I’m guessing could be funded by selling it for seedier purposes.

Finnish doctors have the same EMR gripes as US ones, according to this Helsinki newspaper article: work slowdowns, lack of an easily understood abstract of immense amounts of information, and decreased time with patients due to increased time entering data. “Software companies have started to become interested in listening to users only in recent years,” a board member of the Finnish Medical Association said.

E-mail me.

News 12/23/09

From BlackBerry Bramble: “Re: BlackBerry. Tonight, for hours, a widespread BlackBerry service outage has occurred and spread to Messenger. Does anyone depend on it for patient care and can I sign up for a backup system?” Sounds like a Messenger upgrade cause the problem like it did last week.

From HC Biker: “Re: Cerner’s IMC acquisition. I know IMC pretty well. They recently decided to use eClinical Works for the primary care side of their business and had some custom software written to link eCW with the occupational medicine software that they were using. Not sure what Cerner plans on doing with this business, but they had a couple of failed bids to provide employer-based primary care and perhaps this is their way to finally get some success in the business. On the surface, it does not appear to be a good fit.”

From RaleighObserver: “Re: my 2010 prediction. Dell acquires Allscripts for their footprint. Tullman pockets a ton of money before Dell realizes the house of cards that it inherited and he runs for public office.”

From The PACS Designer: “Re: Microsoft live@edu. Microsoft is trying to attract new students to its e-mail application called live@edu. So, if you are a student reading HIStalk, let your school administration know about their service. One of the key features is each user is granted 25GB of storage space for their e-mail address, plus they also have some other nice features at low cost to the institution.” It doesn’t work with Chrome, I see.

From Weird News Andy: “Re: no longer a member of the 3-H club.” Harlem Hospital gives a 54-year-old woman an advertised $15 mammogram, throwing in a blood test for free. She claims the hospital told her the blood test revealed that she had terminal HIV, hepatitis, and herpes. She suffers for weeks, then gets a call from the hospital saying it was a mistake and she’s fine after all. No apology, though. She thanked God for her new lease on life, then got herself a malpractice lawyer because “we don’t want anyone else to go through what we’ve been through.” People always say that when suing, but they always just keep the money.

From Marvin Gartner: “Re: Why nothing on the AM J Med article by Himmelstein et al entitled ‘Hospital Computing and the Costs and Quality of Care: A National Study?’ No savings – limited outcomes improvement in only one of four measures. This article needs to be discussed.” OK, allow me to rant: I get e-mails fairly often from someone who indignantly claims I missed or intentionally ignored some big story, when in fact it was prominently featured and mentioned more than once. I pretty much never miss a story, but casual readers much less rarely skim blissfully right by them. I mentioned that article twice in November, one writeup coming in uncharacteristically long at four paragraphs, 555 words, and even a picture of one of the authors (that was exactly one month ago today). So, it has been discussed amply right here, with my conclusion being that the article is not surprising, but not definitive, either. I bought a guitar once, but I’m not blaming the manufacturer for my inability to play the guitar parts of Rush’s The Trees since I’m pretty sure Alex Lifeson could pick up my old six-string and knock it out flawlessly, so mileage most definitely varies with both guitars and EMRs, mostly because of who’s playing. This article matched up a few databases and then blamed the guitar, written by folks who have a definite political agenda and who profess that “idiot hospital administrators” buy EMRs “to extract more money” and “jack up the charges.” I don’t disagree with the concept that providers haven’t historically shown impressive IT results (I preach that myself all the time), but I question the takeaway that nobody should be implementing software systems because they universally don’t work. The problem isn’t that 80% of providers are too weak in change management and reproducible processes to implement software successfully — it’s that they think they are in the 20%.

From Big Wayne: “Re: Flower. You might want to take a look at a sorta grassroots movement to get patients informed about interoperability issues and asking their providers to ‘talk’ to each other.” Flower is some kind of interoperability manifesto. I have a short attention span, so I couldn’t really figure out if it’s a movement, a technology, or a business.

I made a couple of tweaks to speed up page loads: I cut the number of front-page stories from five to three (click the Archives link at the top of the page to see the last 200) and I took pictures out of the View/Print Text Only page. In case you were wondering.

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
He cleaned out his email while I watched YouTube.

When out from Windows 7 there ‘rose an odd clatter,
I switched off The Who to check on the matter.
Then away across the ‘Net I flew – launching Flash,
I opened up HIStalk, hoping nothing would crash.

My tunes on Pandora were silenced at once
Yet 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.

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

“Now Neal! Now Glenn! Now Girish and JB!
Now Philip! Now Judy! Now Pappalardo and Sunny!
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, the wild rumors fly
The leaders read closely, hoping they will not win pie.
Daily to HIStalk – those the top dogs do 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 a Blackberry, still new from its 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 the 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 the man who turned vendors to 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 left – 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.

HIStalk Interviews John Gomez

John Gomez is executive vice president and chief technology strategy officer of Eclipsys.

 

The HIStalk reader who suggested I interview you said that you are the Steve Jobs of healthcare IT –  the industry’s leader, visionary, and celebrity. Do you see yourself in that way?

No, I don’t see myself in that way. It’s kind of funny, but no, I do not see myself in that way. I guess it should be flattering, but I don’t think I see myself as the Steve Jobs of healthcare.

His reasoning was that the areas you’ve worked in for Eclipsys have thrived, that customers follow what you do, and that employees get your message. Is it good for the company for you to have such a strong customer following and loyalty within the company?

It depends. I’d have to look at the mix of clients that we’re talking about, but I think it’s good. I think it’s great that clients love the message that I deliver, but that message is put together with all of my peers, the teams that I work with. I don’t certainly believe that it’s a one-man show.

I think it’s part and parcel for the company itself, and the company is delivering the message. If I’m the instrument or the megaphone for that, then I’m just happy that the message is resonating and that the people that are receiving the message actually are resonating with what’s being said.

But I don’t certainly think that it’s just me. It’s just the culmination of everything that’s going on around me, and the people that I’m fortunate enough to surround myself with.

Company executive turnover has made you the one constant over the past several years, the continuity between one group of executives and the next. Is there anything that you have to be cognizant of or anything you do differently knowing that you’re the continuity in the customer’s eye?

I don’t know. Although I don’t consciously sit there and go, “Ah, I think I need to make sure this is preserved or not.” I think for as much change as there’s been — and I certainly think all the changes happened for the right reasons — I kind of view it and when I talk to clients about it is that these are evolutionary changes and they’re, in my view, not disruptive.

But that said, I think the one thing that is important, at least from my standpoint — and whether this is me actively doing it or just part of the fact that it’s the way the company’s been operating — is that the message has been consistent. At least for the six years that I’ve been here and through any of the management changes, the messages have continued to be consistent. Now, more than ever, I think that message is going to continue to propel forward. The strategies and the views that we’ve been delivering to clients, that’s something that has prolonged regardless of any changes in the management.

Phil’s been with the company for six months. What changes has he made?

I think Phil is an extremely interesting person as a CEO. He has a strong technical background. He has a very strong financial sales and marketing background. I think he’s able to bring together the different perspectives. I think one of the things he’s been able to do is truly create a cohesiveness amongst the executive team, which is translating into everything we do across the company.

I think more than ever, that we’ve got a very strong synergy between our service and support, development, marketing, and sales organizations. He is also holding, very strongly, more so than ever before, people accountable through the commitments we make to our clients.

Overall, I’m actually loving working with the guy. I’m not brown-nosing if he reads this answer or not. I just think that he’s actually doing a very strong, very good job. Overall, he’s just brought a whole new set of disciplines to the company. I think it’s the right change at the right time, bringing him on board.

As a technology guy who’s worked outside of healthcare, what do you think about an industry that’s dominated by healthcare-only development tools, like MUMPS?

I think it’s time for a change, but I think not just because of the technology around MUMPS. We’ve got products at Eclipsys that are built on MUMPS, although we’re moving off those. I think that there’s a lot of opportunity in healthcare. I think the way that things are done from a technology perspective, we need the change.

I can say it’s kind of a sad situation that healthcare is so far behind the rest of the world from a technology perspective. There’s very little innovation in healthcare around pure technology. There’s a lot around the modalities, but if you think about it, the core essence of innovation doesn’t come from healthcare. That’s really sad because this is the one industry that really affects peoples’ lives every day.

One of the things I tell my engineers all the time is this is the only job you will ever have, even if you work for like a 911 system or for the government, that your code could kill someone. It seems really interesting to me that we have that responsibility in our hands, but yet overall as an industry, very, very little innovation comes from this industry. To me, it’s just upsetting, that kind of state of affairs for us.

Would you say that the limitations of today’s systems are because of their technology, or because of their design? Or, because it’s just the inertia of having to go back and start over?

I think it’s all three and more. I think that we have a lot of hospitals that are comfortable with the technologies that they’ve put in place. It’s not just hospitals. I think it goes across everything from physicians to long-term healthcare facilities. Across the spectrum of healthcare, they’ve become either comfortable or they resist it because of the fear of adopting technology and what that may mean to them in the learning curve.

Which goes back to innovation, it shouldn’t be that hard to implement and embrace these systems and put them to practical use. I think the technologies themselves create very, very challenging barriers to entry. For some cases they’re very old, twenty-, thirty-year-old technologies like the MUMPS stuff.

I think we also don’t pay attention to paradigm shifts. Right now we’re seeing paradigm shifts in other industries, like cloud computing. We’re seeing things scaled down and scaled up to either mobile platforms or large-scale, interactive platform kind of environments. We don’t embrace that. We’re not leading that, yet it can make a tremendous difference to healthcare.

Interoperability is a huge one wherethe way that this industry’s worked, has been not embracing the ability to exchange or interoperate between systems. We’ve been kind of proprietary. I think that also creates a challenge and a barrier for hospitals to move.

I also think that there’s just kind of, at least from a technology perspective — and I’m first and foremost to talk about Eclipsys, but I think we’re fortunate that we have great people — I don’t know if the industry is attracting great technologists. That also creates a challenge through this inertia of innovation.

But if it’s a perfect market, customers get what they ask for; assuming that someone would step in and give it to them if the current vendors didn’t. Are hospital customers too easy on their vendors?

That’s an interesting question. I think hospitals could push vendors much, much harder to drive the evolution of technology. I think there’s an inherent responsibility that when you work in a healthcare facility or a healthcare information technology vendor, that your responsibility is at the end of the day, to try to get the best quality care for the patients that are using that technology. If you’re not driving the vendors to innovate and evolve their product lines and embrace new technologies, then I think the hospitals are being too easy.

The studies that have come out in the last couple of weeks are suggesting that systems are not meeting expectations for improved quality and reduced cost. What should hospital software vendors do if that’s true?

If it’s true, it probably goes down to a lot of the cryptic things that you just see in a lot of the vendor systems. They’re difficult to implement, they’re difficult to configure, it’s difficult to maintain online. Quality is not what people expected it to be. The usability is, in some cases, ten-, fifteen-year-old paradigms. Those kind of things need to change, right?

The vendors need to be in a position where they’re affording people solutions that are usable, and if they’re usable, I think you can drive adoption. When you drive adoption and you can apply technology to patient care, you will translate it to better outcomes. I mean, we’ve just touched the tip of the iceberg in terms of using things like analytics or predictive informatics or diagnostic decision support instead of clinical decision support.

If you look at the Gartner Scale, there are very few vendors that are Generation 3. I think there’s only three. I could be wrong on this, but I think it’s us, and I’m thinking Cerner. Generation 4 is what vendors should be striving for. HIMSS Level 6 is just starting to become something that most vendors are able to do, and really, they should be driving for HIMSS Level 7. The hospitals should be using and applying those tests and saying, “This is where we want to be. This is our vision, and we’re just not going to buy from anybody that doesn’t allow us or enable us to get there.”

You mention data; and everybody wants to use data, but not be the one to have to create it. Eclipsys is pretty well acknowledged as the CPOE expert. Is that paradigm valid, or do you see anything changing that makes that somewhat of a dated concept itself — the idea that physicians need to type into a system to be able to reap these other benefits or provide someone else some benefits?

I think that yes, things have to get easier for physicians to want to enter the data or provide the data. I think that’s a great way to paraphrase it. Until we lower the bar or the difficulty of the user of the system to enter that data, then we’re not going to have the richness there. We’re not going to have the full picture that allows us to treat patients effectively.

What’s interesting is we’re kind of in a situation where if we can lower the bar, get people to provide the data in easier and easier ways, it actually helps all of us long term. Not just as vendors or hospitals, but even our own interest.

At some point, we don’t just want to look at episodic care, we want to look at womb-to-tomb kind of care and long-term care. The more data we have, the better outcome we’re going to have individually. Then when we go to a doctor or we go to a hospital we want that level of care, yet we’re not, in most cases, doing anything to enable it.

From an Eclipsys standpoint, we are doing a lot to try and lower that bar. There are technologies we’re looking at and changes to the way that we’re collecting data and allowing providers to be immersed with an experience that hopefully will start making things much easier to do. I appreciate you saying we’re kind of the experts in CPOE, but I don’t think we can stop. We have to keep pushing things further.

When will we see what kinds of things that you’re looking at in technology?

From an Eclipsys standpoint, not to be a teaser or things like that, there are a variety of things that we announced at our Eclipsys User Network around visual workflow and our new solutions platform and where we’re headed with that.

But in terms of the UI, we’re doing a lot to move our UI forward. Now one of the challenges for any vendor is that you don’t want to create disruptive change because that becomes very costly and becomes, in and of itself, a barrier to the healthcare institutes. What we’re trying to do is take an evolutionary approach to our UIs and incorporating usability as we go. But some of the things you’ll see in our next release are that the UI adjusts to you, it learns from you depending on where you are in the system.

One of the other things we’re doing is working on a concept of Workbenches, which create an immersive experience for a particular type of provider. So if you’re a nurse, the assistant is tailored to you as a nurse and reflects the support of your workflows. If you’re a physician, it supports your specific type of workflows.

The other thing we’ve been working on for a long time is thinking through how we can apply gaming concepts to the UI. In fact, one of the key things in terms of getting data or responding to data that involves a patient is being able to present information in the UI in a way that doesn’t overwhelm the practitioner. So we’ve been working very hard on providing the right information at the right time for whatever that practitioner may be doing in terms of their scope of the workflow.

Those kinds of changes have to be very specific. We hope you’ll start seeing some of those things come to market in the Q1 timeframe, and then we also have some things slated for the Q3 timeframe in terms of uplifts to usability and things like that.

Wall Street has typically punished publicly traded companies that rewrite. Is the technology there to allow those sorts of changes without really scrapping the database and the underlying architecture?

We started back in what, 3.5, which was about 2004, and we’re now coming to market in Q1 with our 5.5 release for our clinical solutions. We’ve been evolutionary all along, and so we’ve introduced things like ObjectsPlus, aligning third-parties that develop applets. We opened up our MLM library to allow people to develop these kinds of self-contained macros. We’re building on top of that. Our platform, going forward, we’ll continue to move those things forward.

One of the big areas that we’re investing in now is opening up the APIs so that they’ll be a service-oriented architecture. We very, very have seriously been looking at cloud computing and seeing how we can invoke that and provide kind of a healthcare information technology as a service.

None of these are disruptive. I mean, we’ve had a great legacy of our upgrades just being in-place upgrades and not requiring you to do schemas or lose the work you’ve done or redevelop the add-ins that our third-parties or our clients build. We want to just keep going forward, and the big thing we’re trying to do is open up the platform, allow for third-party innovation. Hopefully, we’ll even have competitors build on top of our platform.

We’re charting a course where none of that will occur with disruptive changes. I think there’s a time and place for disruption. I don’t think this industry is, right now, ready for disruption as they’re trying to get their arms around everything going on with the government trends and outcomes and everything else.

Some people would say that a lot of the reasons the same old systems keep selling is that IT departments want to avoid risk and perceive that that’s less risky. Do you think that that whole concept of extensibility versus just buying everything from a single vendor, even if it’s not very good, is going to be a message that will resonate with the right people who make hospital decisions?

I think you’re starting to see both. I think you’re starting to see that kind of the larger hospital systems are taking risk in saying, “Look, we’re going to change and swap out systems.” They’re starting in probably the departmentals because they’re seeing the benefits of fully integrated applications.

We’re moving down the path very strong. We have a fully integrated platform. That said, though, if you’re going to have innovation and you’re going to really drive vendors to continue evolving, I think it’s really rare where you can have one vendor that is going to continually innovate as such a pace that it will allow you to meet the needs of the hospitals in terms of patient care over the long-term.

You know Apple — you mentioned Apple at the beginning of the talk — Apple’s a very unique situation. They get innovation right and they’ve been very good and strong at what they do. I think it’s hard to replicate Apple’s success, so the answer to that is have an open platform.

Sure, you can go with integrated; you can go with single-vendor, but never tie yourself into a position where you can’t innovate on top of the platform that you’ve chosen. That openness should allow you to bring in third parties, to build your own applications as the institutions, but protect you from not being locked into a single vendor solution.

The company invested in EPSi and practice management. Are those key to the single strategy, or is that just a way to broaden the front that you put out to customers?

It’s kind of both. From one standpoint, we’re working right now to natively integrate those offerings, but the way we’re doing native integration is that everything can also stand alone.

For instance, EPSi will be integrated with our core solutions platform, so it means it’ll share security and auditing and other pieces of our platform with all of our applications. If you were to buy EPSi and you didn’t own any other Eclipsys app, when you install it, it’ll lay down the core platform. If you buy another application from us, then it will use what has already been put in place. You don’t have to redefine security. You don’t have to redefine auditing or roles, or places within the hospital or anything else — cost centers or cost codes, billing codes.

But that said, if you were to just buy EPSi and you wanted to integrate a third party, you should be able to do that without having to buy anything else from Eclipsys. So, we see that. EPSi certainly pushes forward our ability to move into new market areas and integrate in places that don’t previously own Eclipsys products. We also see it as a complete offering on top of an integrated platform. That core comes from Eclipsys so, there’s a little bit of both.

Do you see any possibility that either customers or third parties will develop open source components that work with your products?

That’s a really interesting question. For us, one of the things we announce at the Eclipsys User Network was the Eclipsys App Exhange, which will roll out in Q1. The App Exchange will be an opportunity for not only clients, but for third parties to actually build applets or MLMs or visual workflow add-ins and things of that nature on top of our platform.

If the third parties or the clients wish to put that into the public domain or license it specifically as open source, it’ll be their choice. We won’t regulate that. It’s very similar to the Apple Apps Store concept. We have not worked out yet whether or not we will invoke a commerce engine on top of our platform.

For now, we’re just seeing that clients can either exchange content or applets with each other, or get them from third-parties and then work out the revenue model between themselves. What we really wanted to do is be a facilitator and take the work we’ve done in the platform and now extend it out to third parties.

We’re talking to third parties now, who actually are competitors of ours, and they’re learning about what we’re doing and they’re saying, “Ah, this actually would reduce my cost of ownership because you guys are going to do all the plumbing work. Then, I could just snap on top of you.” What we’re saying to them is that’s great. We’d be happy to have you on the platform, but we may compete with you.

So far we’ve gotten feedback that people are saying, “Well, then let the games begin.” I think that kind of stuff is great for healthcare because it lowers costs, it opens things up, third parties can innovate, and hospitals aren’t tied into a single solution at any point in time. It kind of feels like it’s the right kind of place to be doing this.

Does Eclipsys have what it takes to compete for the long haul against some pretty formidable and well-funded competition like Epic and Cerner?

It would be hard for me to say no to that question, but my honest gut-level belief is yes. Think of it this way. Our clinical are considered the best in breed. One in four physician orders, I believe, in the US electronically placed is placed on an Eclipsys system. We’ve been improving steadily our KLAS rankings. Our customer satisfaction is up. So from that perspective, we’re doing all the right things.

We’ve just now announced the new Sunrise Financial Management product that comes out in early 2011. That’s our full-blown revenue cycle system with ambulatory billing and international support, fully integrated into our clinicals. Not interfaced, but true integration.

We’ve got fully object-level integrated pharmacy. We’ll very shortly have fully-integrated lab. Then on top of that, we’ve got one of the few fully-integrated clinical analytic packages, which will allow you to do data warehousing out of the box; do all your core measures and do visual query by example.

Then you’ve got the EPSi and the Premise workflow stuff on a single platform. On top of that you’ve got the visual workflow tools which will allow you to use Vizio-style diagramming to actually visually draw your workflows.

On top of that, that visual workflow tool can work with any web service in the world. It doesn’t matter whether it’s an Eclipsys web service or a third-party web service. So I look at that and I go, “Wow, that’s the breadth of the platform and we’ve got a very strong vision of where we want to go.”

We’re lowering the bar in terms of how usable the system is and allowing third parties to create an ecosystem through the Eclipsys App Exchange. I not only think we have the ability to compete with the Epics and the Cerners and whoever else may come along, I think in very short order they’ll be wondering like, “Holy crap. What have we been doing all along, and how are we going to deal with this?”

What does Epic have to do to stumble enough to let somebody else get back into the big-hospital game?

Good question. I’ve met Judy a few times. I think she’s a very, very brilliant person. She’s doing a great job at what Epic does. I think that right now, Epic’s situation is that they seem to be doing the right things, but I’m not really sure they’ve done anything hard.

I think they’ve gotten some preliminary implementations done. They’ve done some good large hospital implementations. But when you get into the real serious acute care, when you get into the real treatment of very, very sick patients; to the best of my knowledge, I don’t know if they’ve proven themselves yet. So it’ll be interesting to see where they go with that.

We’ve been doing long-term care, long-term disease management, critical care, oncology; you know, real in depth stuff for a very long time. Now we’re pushing very, very, very actively into the ambulatory market. So it’ll be interesting. I think it’ll be, through the next two to three years, a very interesting battle. I’m not sure if I, specifically, would feel comfortable saying that if Epic does these three things, they’ll stumble. But I think that there’s a short-term…

I would compare Epic to Netscape in that they were kind of an industry darling for a long time, but then when people wanted to get to the next level of the Internet and really start pushing things really hard, Netscape didn’t seem to be the answer. We’ll see if that turns out to be reality or not, but the reality is I think they’re a great company and Judy’s a great person. The people I’ve met from there are really talented people, so it’ll be an interesting competition.

The problem is they’ve taken away this window of time that’s driven by everybody’s first big clinical implementation and the HITECH possibility is there. They’re grabbing all the big customers who aren’t going to just dump them after they’ve spent $50 million. Are there going to be enough customers left to buy somebody else’s innovative product?

I’d let somebody else in the company talk to our financial sales, but from what I’m seeing, I think you will see that we continue to have strong, steady growth. The piece in terms of, are there other people left, right now there are selection processes going on that we’re beating up again. It’s actually good things.

We’ve introduced the “Speed To Value” methodology which reduces our implementation timelines by a dramatic amount and improves the quality. We’ve introduced a warranty that helps provide and drive our ability to assure that clients will get HITECH certified. I think if anything, we probably just aren’t talking up enough all the things that we are doing. But I don’t see that, “Wow, Epic’s doing all this stuff and Eclipsys isn’t.” So if anything, I think we just kind of walk a silent path and just keep doing what we’re doing. So far what we’ve been doing seems to feel and be on the right track.

Do you think offshoring of development has done as well as everybody expected?

I think we’ve learned a lot about offshoring. At this point, it’s just another office. The one thing that I think has helped us is we’re being able to bring a lot of young talent on board. That’s helped a lot with our ability to actually evolve the platform and evolve the other things that we’ve been doing.

I think that if I were to do it again, I might approach the problem differently, but I would certainly do it. I don’t think there’s anything in my mind that makes me go, “Wow, we shouldn’t have done this,” or “I would never do this again.” So far, it’s been an effective tool, and at this point in time, it’s another office for us.

We have development teams that have different geographic rotations. We’ve put the technology in place, like Cisco TelePresence and other things, to help coordinate those teams. We’ve got strong management layers in place to assure that those teams are held accountable. At this point, our offshore teams are no different than any of the other teams that we have.

Last question. What would you say the most important priorities are for the industry? Or what should they be over the next five to ten years?

I think interoperability’s huge. If you can’t interoperate, it does put hospitals into a position where they’re stuck with a vendor. If that vendor doesn’t get it right, it becomes really hard to whip into place. So proprietary systems that are not open and don’t interoperate with other systems, I think, are a tremendous detriment to the industry itself and so forth.

I think the second thing is we’ve got to make it really easy for people to adopt the technologies at all levels. If we don’t do that, then we’ll have great systems that can talk to each other, but no reason to talk to each other. I think usability has to be addressed. We have to see more innovative user interfaces. We have to have systems that are helping physicians and not just providing data and just kind of being like a ledger.

The third thing is I think we’re not really recognizing the value yet of home health and integrating the patient more directly into the systems and the technologies. I think the third big area that we have to concentrate on is the integration of the patient into the system, and kind of reaching out to the patient. This goes way beyond portals or mobility, I think, which is not really reaching out to our own healthcare opportunities.

Those three things, I think, will probably be the big priorities that I’d love to see. I think it would fundamentally change how healthcare information technology’s done, and thereby, help transform healthcare in the United States.

Monday Morning Update 12/21/09

From Pete Pistol: “Re: Dell/Perot. Looking at additional details on the conference call, ‘Chief Executive Michael Dell has suggested that the company may purchase another software company to beef up its offerings’. Care to speculate who that might be or what type of software they are likely to buy? I’m thinking an EMR vendor (based on another mention on that call), but not sure. They also mentioned becoming a Primary Source Vendor for the federal government and expanding services to outside of the US, which I thought was interesting.” It always makes me nervous when a company with one fading core competency, even one like Dell that was a hotbed of manufacturing and logistics innovation years ago, runs out of runway and suddenly decides to jump into something it knows nothing about without any apparent conviction, especially when patients are involved. I’m hoping it’s not an EMR vendor since the last thing we need is another big company like GE or Siemens dipping a corporate toe into healthcare just because it makes diversification sense. But, if it’s a healthcare software vendor they want, I’d suspect their partners might get a look just like Perot did (Allscripts, eClinicalWorks, AMICAS, etc.). So let’s help Michael Dell out … who should Dell buy? Tell me.

Another of those jumps into a non-core competency … Cerner’s announced acquisition of IMC HealthCare. I’m not sure I’d want a software company providing my healthcare services, any more than I’d want a healthcare provider selling software. I’d have to guess that Cerner picked it up cheap since it had only 23 health centers and was announced as having no impact on Cerner’s 2010 financials. The company says it has custom-developed software, so maybe that’s what Cerner wants. I’ve heard no rousing employee endorsements of Cerner’s health clinic, so maybe having Mr. Tick Tock managing your healthcare matters isn’t the height of employee compassion.

From Avid Reader: “Re: a summary of healthcare overhaul on a napkin.”

David Blumenthal sends an e-mail announcing availability of $60 million more of taxpayer money to “fund research focused on identifying technology solutions to address well-documented problems impeding broad adoption of health information technology,” whatever that means. He calls the program Strategic Health IT Advanced Research Projects, preferring the cute acronym of SHARP rather than the correct one of SHITARP (hey, they picked the name and decided to turn it into an acronym, not me). 

Rodney Schutt resigns as CEO of troubled vendor Aspyra. COO Ademola Lawal will replace him. I don’t have a link, but someone sent over the 8K form. Going down in flames.

I’ve said more than once that click-and-dropdown EMR forms don’t provide the richness of information as an old-fashioned narrative, despite their appeal due to supposed ease of use and the capture of discrete data. A Nuance survey proves it. When presented with an HPI note for the same patient, one dictated in Dragon Medical and the other from a completed EMR point-and-click template, 97% of doctors said the former would be more useful in their treatment of the patient. All the press people must be taking Christmas off early since I got all these announcements that aren’t on the Web yet.

National eHealth Collaborative announces Laura Adams of the Rhode Island Quality Institute as board chair; Simon Cohn, MD of Kaiser as vice chair; and Thomas Fritz of Inland Northwest Health Services as treasurer. I haven’t seen the press release posted yet. The organization is still looking for board members, with nominations due by Christmas day.

I think the above results say all that needs to be said about my last poll. A new one to your right (or to your lower left if your screen resolution is set low): should a provider implementing an EMR care about general studies that attempt to generalize success rates?

It’s a Weird News Andy twofer: he notices that Intermountain Healthcare has resumed its employee 401K contributions, but then also finds that it’s facing a class action lawsuit for claimed overcharging of patients.

Astronaut, LLC announces the beta of VistA Shuttle, a Amazon cloud-based version of either WorldVistA or OpenVista.

Southwest General Health Center (OH) finishes the first phase of its ambitious $26 million IT plan that includes clinical systems, wireless technology, tablet PCs, biometric security, mobile carts, periop documentation, speech recognition, enterprise scheduling, and an HIE. That’s a lot for a hospital of around 300 beds.

Practice EMR vendor DoctorsPartner offers the Sushoo (bless you) independent HIE, free for DoctorsPartner customers or $2,500 upfront and $80 per month otherwise.

Saskatchewan’s electronic health record could be finished for all residents within four years for an additional $365 million beyond the $235 million already spent with another $60 million a year in operating costs. The problem is they may not have the money due to “nose-diving potash prices.”

I plan to write HIStalk at least some of the time over the holidays, if for no other reason than because almost nobody else does that (pros and amateurs alike). It’s a good time to write a guest article or tell me something interesting since hard news may be in short supply (but you never know).

E-mail me.

News 12/18/09

From Lucius Q.C. Lamar: “Re: Cerner. I hear they are working with Cisco to develop a payer product.” Unverified, although the companies have worked together on Cisco’s health center and Cerner’s pilot of Cisco’s TelePresence, so maybe they are BFFs.

From Broadway Joe: “Re: Best holiday wishes to Mr. H and Inga! I really enjoy your blog and appreciate all the hard work you both do to provide us with timely and witting industry information.” Thanks and back atcha. We wouldn’t do it if it wasn’t fun for us, too.

From Hellboy: “Re: EMR articles. Why do you deny conclusions that EMRs don’t provide the expected benefits?” Because I also deny conclusions that they do. Healthcare people are already lemming-like enough without obsessing over whether a 1982 Invision implementation disappointment should mean anything to them. On the other hand, fretting doubters are probably justified in holding back since that kind of hand-wringing usually predisposes to project failure. All these articles carry the subtle message that the semi-study of a few wildly different implementations will yield a universal predictor of software-correlated outcomes. I don’t buy that for a minute. As I’ve said ad nauseam, if software was a magic bullet, every hospital spending their $50 million on Epic or Cerner would simply drive all their competitors out of business with lower costs and better outcomes. They aren’t. Your mileage will most assuredly vary no matter how many articles you read.

From Skip Tracer: “Re: GE. As the owner of a EMR reseller and a competitor to GE, it’s offensive that they received government bailout money and then have turned around and offered free financing to their prospective clients. Now, I know, we’re all feeding at the Obama trough, so I wouldn’t be as ticked if GE used the money to improve their product or services. Instead, they’re floating free money to overcome the fact their product is having problems and their successful installs are few and far between. And, in a roundabout way, I’m helping them do it. Only in America.” GE got $140 billion of taxpayer money to save the GE Capital garbage heap, but only after elbowing its way to the front of the federal bailout bread line by convincing panicking bureaucrats to broaden the definition to “affiliates” of an FDIC-insured institution.

In New Zealand, Waikato District Health Board is recovering from a Conficker computer worm attack that disrupted services to the point that non-emergent patients were asked to stay away. I read somewhere that over seven million PCs are infected with it, meaning those computers will accept remote commands from hackers.

Also in New Zealand, the former health district CIO who was accused of taking $755K worth of kickbacks from a service provider pleads guilty. He had struck a deal to approve a help desk services contract for $95 per hour, of which he received $25. When they board found out, they simply hired the same three people who were already working the help desk, saving $500K per year.

This is juicy: federal prosecutors say former McKesson chair Charlie McCall should be jailed immediately because he violated terms of his 2003 release with his 2006 arrest for soliciting a prostitute. I have a couple of boffo lines, but I like to keep it family-friendly (but I bet you are thinking the exact same ones). He’s been out on $1 million bail since 2003 with a condition that he not commit any crimes. He’s already been found guilty of the $8.6 billion HBOC stock fraud and will be sentenced in March. The US attorney says Charlie needs locked up since he might skip town before then.

RIM just announced Q3 numbers: smoking BlackBerry sales pumped up revenue by 41% and moved earnings to $1.10 vs. $0.69, with most of the good numbers coming from consumers rather than business customers.

University of Alberta professors design software that helps senior citizens identify and organize their tablets and capsules (which are not the same as “pills” no matter what the article says), hoping to port it to a smartphones.

I usually read Bruce Friedman’s Lab Soft News, which has interesting conjecture about the Abbott acquisition of Starlims:

Putting all this all together, I think that it’s possible that Abbot has the following scenario in mind as a long-term goal: sell to clinical labs, as an integrated package, analytic instruments, reagents, and test result management supported by a cloud-based LIS/LIMS. Pricing would be on a per-click or taxi-meter basis. This would be the first PaaS offering for the clinical lab industry

David Whiles, IT director at Midland Memorial Hospital (TX), is recognized by the hospital district’s board of directors for its implementation of OpenVista. He expresses surprise: “It’s a hospital project, not an IT project.” Seems like they should give him a CIO title.

Dell says its acquisition of Perot Systems will allow it to expand its healthcare services, which one might hope given that it just paid $3.9 billion for the company.

Quantros announces creation of a healthcare IT consulting division to be led by Michael Tulloch.

Cerner will offer HealthDock from Certify Data Systems, which it says will help hospitals using its Cerner Hub connectivity services exchange data with any practice EMR system.

MDI Healthcare Solutions gets a mention in the Jacksonville, FL business paper. The company uses claims data to predict the future cost of caring for a given individual. The article’s timing isn’t so great since the company’s Web site is “undergoing renovations” at the moment, consisting of just a picture of what it might look like if it actually worked.

Former Senate Majority Leader Tom Daschle, whose tax woes killed his nomination as HHS secretary, is profiting from HITECH, according to a Huffington Post article. It says he set up a law firm division to cash in on stimulus money, implying that he’s had face-to-face meetings with David Blumenthal “in trying to position our clients for meaningful use.” He’s also on the advisory board of GE Healthcare’s “healthyimagination” project, joining Bill Frist, Newt Gingrich, and “former chiefs of Medicare and the Food and Drug Administration”, although the company implies it’s not paying them much (by their standards, anyway). From the law firm’s Web site: “Our life sciences team members include former U.S. Senate majority leaders Senator Bob Dole and Senator Tom Daschle, a former CMS administrator, a former associate FDA commissioner and a former associate chief counsel for Enforcement at FDA.”

Another hospital thanks their fairy godmother Congressman for EMR money instead of the taxpayers who have to pay it: Rome Memorial Hospital (NY), which will get $250K in Congressional pork funds (aka the $410 billion “Omnibus appropriations act”).

I could write a novel from this: an Indiana otolaryngologist whose sinus clinic was raking in $3 million a year, some of it apparently via insurance company fraud, disappears from vacation in Greece owing $5.7 million. Italian authorities arrest him in the tent he’s living in on a glacier at the foot of Mont Blanc, suspecting he’s fleeing to Switzerland after stops in Monaco, China, and France (and making America’s Most Wanted in the process). He smuggles a box cutter into jail in his rectum and slashes his throat in a suicide attempt, but ends up with only minor neck injuries despite his expertise as a throat surgeon.

E-mail me.

HERtalk by Inga

From Easy Money: “Re: Lourdes whistle-blower. The whistle-blower that alerted federal officials of the potential fraud activity at Our Lady of Lourdes Medical Center earned a nice $356,000 bonus. He was supposedly a ‘consultant’. Do you think the hospital paid him a consulting fee?” Easy Money is referring to the $8 million settlement between Lourdes and the Justice Department. The hospital was charged with fraudulently inflating charges to Medicare patients. I did a quick Google search of Anthony Kite and determined he must moonlight as a whistleblower, having been awarded several hundred thousand dollars in similar lawsuits over the last few years.

Here’s some good and bad news for HIEs. The good news is most physicians believe that HIEs would improve quality of care, reduce costs, and save time. However, don’t count on the doctors to help keep the lights on. This survey of 1,000 physicians didn’t find a single doctor willing to pay a proposed $150 a month fee to connect to an HIE. In fact, half of the doctors said access should be free.

Someone might want to share the news with Thomson Reuters, who just announced plans to launch a new HIE platform.

The CIO of the 300-physician Springfield Clinic (IL) claims their Allscripts EMR plus a patient kiosk system netted a $4.5 million ROI in the first year, thanks to staff reductions and reduced transcription costs.

Stratus Technologies announces its Zero Downtime $50K Guarantee. The company says the server line has surpassed 99.999% uptime reliability since introduced in 2001.

Congrats to Cumberland Consulting Group for its #10 ranking in Consulting Magazine’s Best Small Firms to Work For, 2009.

Special alert for all you road warriors: McDonald’s, in partnership with AT&T, will provide free Wi-Fi in over 11,000 restaurants by January. Personally, I’ll remain partial to Panera when it comes to eating and surfing. But, there are definitely more McDonald’s and they have the best fries.

QuadraMed announces GA of Quantim Workflow.

WellStar Health System (GA) selects Kronos to provide workforce management solutions to manage its 11,000 employees in five hospitals.

Every time I see the name Kronos, by the way, I think about Zeus’s father, who ate his children. The Greeks also had a Kronos, the father of time. I am pretty sure that the latter Kronos is the company’s namesake.

Baylor Health Care System (TX) signs a multi-year agreement to license TeleTracking patient flow solutions across 14 hospitals.

Picis says that 67 healthcare facilities have gone live on its LYNX E/Point solution over the last six months.

Healthland wins back a hospital client that left its fold several years ago. The 15-bed Webster County Memorial Hospital (WV) re-signs with Healthland for its patient accounting system, which they claim is its first step towards moving to an EMR system.

Vangent wins a $20 million contract with the DoD to implement a an integrated SSO and context management solution throughout the Military Health System.

Cincinnati Children’s Hospital Medical Center completes a self-service check-in pilot program and now plans to deploy D2’s My Patient Passport Express kiosk throughout its facilities.

Southcoast Health System (MA) selects Wolters Kluwer’s ProVation Orders Sets for its three hospitals.

St. Joseph Health System chooses Accenx to help integrate its hospitals with affiliated physicians.

A faculty physician at UC San Francisco falls for an e-mail phishing scam and ends up exposing personal information on about 600 patients. The doctor gave out his user name and password when replying to what he thought was an internal e-mail.

And in Detroit, health department officials say that clinical and demographic information on 10,000 patients has been compromised following two separate thefts. A flash drive containing patient data was stolen from an employee’s car in October and a desktop computer was taken from a health department facility over Thanksgiving.

Cape Cod Healthcare (MA) signs a seven-year agreement with Siemens to implement Soarian, including Clinicals and Financials. The hospital expects the project to be completed by mid-2011.

Former Ottawa Hospital chair Ray Hession takes over as chairman at the troubled eHealth Ontario.

I’m betting this Congressman gets re-elected. Madison Memorial Hospital (ID), having collaborated with Congressman Mike Simpson for three years, learns it is “likely” to receive a $350,000 EMR grant from the federal government.

Collaborate here.

An HIT Moment with … Tony Cotterill

An HIT Moment with ... is a quick interview with someone we find interesting. Tony Cotterill is president and CEO of BridgeHead Software.

Should data storage be a strategic issue to the average healthcare CIO who is knee deep in planning and budgeting for electronic medical records, interoperability, and Meaningful Use?

None of these top priority issues brought about by ARRA will succeed if the underlying storage of data is not fully managed. In fact, interoperability is founded on multi access to common data generated by one application and required by another. Without a data management strategy, a hospital that’s struggling to prove meaningful use will quickly find itself overwhelmed with digital patient data. Ironically, if these new electronic patient records can’t be accessed quickly, this may result in decreasing quality of care instead of the improvements that electronic medical records are supposed to bring.

A vendor-agnostic managed data store is fundamental to a hospital’s quest for a smooth running and useful electronic health record system.

If you were advising a CIO about storage and disaster recovery as these new applications come online, what would you tell them to think about, including cost, space, and growth?

First, I’d advise the CIO to look around the storage devices already in his/her data center and figure out how to maximize their utility, paying particular attention to the primary storage tier, which is the most expensive to maintain. We’ve done studies that reveal 60% or more of the data on tier 1 storage is static and hasn’t been accessed in more than 90 days. That data is being backed up nightly or even more frequently, so time and resources are being wasted.

Typically, archiving static data can delay the purchase of more tier-1 storage for 12 to 18 months by the space it frees up for reuse. Also, using archive alongside replication and backup as part of a DR strategy streamlines disaster recovery and enables optimized use of less expensive storage assets for static data.

Disaster recovery with multiple points-in-time copies is going to be become key as people migrate to the brave new world. Failures are inevitable and the last thing that anyone wants to do is to have to start again. The sheer volume of data that is now involved means that traditional backup and replication methods will not be fast enough for the frequency that is needed. Only by moving the unchanging data to a protected data store can you relive the pressure on backup to get the number of copies that you need.

Who are the main players in healthcare backup and archive solutions and what are their competitive differentiators?

The main players in healthcare backup tend to be the same ones you see in other industries: Symantec, EMC, CommVault, to name a few. In archiving, it’s these same players as well as other systems providers in partnership with middleware vendors (think HP MAS or IBM GMAS).

When you talk about competitive differentiators, it’s important to keep in mind that these vendors are all offering a horizontal technology (backup and archiving) into one of their many vertical markets, in this case healthcare, and to varying degrees they succeed or fail in addressing the unique needs of Healthcare IT. At BridgeHead, our only vertical is healthcare, so every day we wake up thinking about how we can improve our backup and archiving solutions to serve the needs of healthcare.

How is healthcare different from other industries in terms of data retention, retrieval, and recovery?

The basic requirements are the same — that is, different data types have different retention periods, privacy rules and access requirements. However, in healthcare, data retention requirements are somewhat unique in that there are multiple federal, state, and organizational regulations that govern how long data must be retained. Therefore, it’s essential that an organization’s data management tools be easily customizable to accommodate that variation.

As for retrieval and recovery, ease and speed of access are critical in healthcare since we’re talking about a patient’s health information, and potentially a life or death situation. Privacy is a particular conundrum in healthcare with a requirement for data sharing between healthcare professionals sparring against the need for patient privacy.

Storage devices use a lot of power. Are they an obstacle for organizations that want a greener data center?

‘Obstacle’ is putting it mildly. It’s really hard to create a greener data center when you’re dealing with such power-hungry devices, especially in the face of the rapid data growth that healthcare is experiencing. One of the topical ways of decreasing the local consumption of resources is to move the storage to the cloud, but are you really decreasing aggregate consumption under that model? An alternative strategy is to use storage virtualization to optimize the use of the devices that are already in place and, as a result, delay the next storage purchase for a year or even longer.

The goal with the data center — whether through a green initiative or not — should be to maximize storage capacity using as few resources as possible, so it behooves the CIO to research the consumption profile of the storage devices they’re considering before making a purchase. In fact when you consider that any data over 18 months old is unlikely to be accessed ever again you must ask the question, why do we have it mounted and spinning at all, why not have it offline on removable disk, optical disk, or tape. Access times in a tape library or jukebox are probably still quick enough for this kind of data.

CIO Unplugged 12/15/09

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

Business Continuity is not Disaster Recovery
By Ed Marx

Colorado 1997. After six tennis matches in two days, I had played my way to the semi-finals of a USTA clay court tournament. The morning of finals, I parked in the lot then went to retrieve my gear from the trunk. I always carried three near-identical racquets to a tournament. If a string busted or the environment necessitated an adjustment, I’d simply grab another and keep playing. A great disaster recovery plan.

This time, however, the trunk wouldn’t unlock. I even tried unsuccessfully to take apart the backseat, which was not a disaster I’d planned for. The match started in 20 minutes, and I had no racket, nor had I warmed up. At least I had my wallet. I found the pro shop and borrowed a couple of demo racquets similar in weight and feel to my own, and then rushed to the court.

Texas 2009. I received a call from work delivering an automated message stating that a disaster had occurred. I immediately joined the virtual command center. Our corporate offices had been shut down and evacuated. This emergency impacted corporate and all our health system facilities within a five-mile radius, which included a hospital and our central business office. Oblivious to the fact our sixth hospital in seven months was Going Live on EHR and a revenue cycle management system, the crisis persisted.

Since corporate was located within five miles of the Dallas Cowboys Stadium, Six Flags over Texas and Rangers Ballpark in Arlington, planning for the worst-case scenario was a must. This drill evaluated how well the ITS division could respond. After significant annual trialing, we had the disaster recovery piece down pat, but we’d never tested our business continuity.

Confidence in our enterprise business continuity, however, could only come after we were prepared. We could never benefit our organization in a disaster if we were personally unable to operate in challenging circumstances.

Here are the lessons we learned:

Leadership

· Pressure reveals character. One whom I thought was a great leader had a complete meltdown. Conversely, one of our quiet leaders surprised the heck out of me. As the one most affected by the drill, she executed brilliantly

· Leaders should never leave their laptops at the workplace

· The borderless office was brilliant in hindsight

Technology

· Ensure you have enough licenses to handle increase in remote workers

· Ensure that all workers have access to systems from home (PC or laptop)

· All departments should incorporate use of remote technology and collaborative tools in daily practice

Communications

· Standardize calling trees and routinely review accuracy

· Call notification system should be branded with a familiar screen ID name so people answer the phone

· Call notifications should incorporate a minimum of 3 touch points per employee (cell; text & call, home phone, work email, home email, etc)

· Call notifications should have the ability to reach successive layers of leadership in the event primary responsible parties are non responsive

· Call plans should be backed up to flash drives and be kept with you always

· Established processes with corporate business continuity leadership to ensure coordination

· Include contractors in call notification processes

· Have multiple options for communications (traditional and 2.0) in the event your primary tools are unavailable

· Given the dependence upon technology in healthcare, set the expectation that knowledge workers are essentially on-call 24x7x365

Logistics

· Develop and routinely review coordination plan with hospitals space availability to house displaced workers

· Code worker badges to allow entrance into all hospitals

· Ensure all workers are comfortable with the remote technology both for traditional and nontraditional applications

· Purchase laptops for all IT workers. This is not the 90s!

Operations

· Ensure the Service Desk in particular is comfortable with business continuity

· Groups less prone to borderless offices tend to be the most unprepared for remote work (Service Desk, Field Services)

· Leaders should conduct more frequent leader-only drills to ensure they can run the organization remotely

· Drills should be conducted quarterly at a minimum so that everyone is mentally/physically prepared for the real thing

· Develop Business Continuity portal with step-by-step instructions on execution

· Seeing as disaster does not discriminate, do not allow exceptions for participation

Other

· Future drills should extend from 3 days to 30 days

· Make sure executives and hospital leaders are aware of the need for IT to conduct business continuity exercises, which may affect operations

· Include executives and hospital leaders in planning and coordination efforts

I was pleased with our first-ever business continuity drill performance, a significant learning experience. As healthcare IT workers, we had a massive responsibility and an obligation to our customers and patients; the show had to go on. I believe the drill better prepared us for the real thing.

Finally, no employee evaluation, leadership assessment, or 360-degree feedback analysis exists that can give as keen of insight as observing people under pressure. Some will search out the spare racquet and win the tournament while others will crumble under the pressure and double fault.

Determine who’s got talent before the next tournament.

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

News 12/16/09

From Edison Carter: “Re: another one bites the dust. Arizona Medical Information Exchange shuts down.” AMIE runs out of Medicaid Transformation Grant money and will set its sights on grabbing some ARRA cash by reinventing itself as a statewide HIE.

From Bob in Accounting: “Re: contest. If you can’t make people buy it, then give it away?” Inga mentioned this on HIStalk Practice: CDW and Cerner pair up to give one lucky (?) physician practice a Cerner EMR. The fine print is interesting: entrants must sign over the rights to use their image and biographies, agree to hold the sponsors harmless for everything in the world, and sign a liability release. Only Cerner would create a multi-page legal agreement requiring a team of lawyers to interpret just to enter a contest giving away an EMR that few want anyway. What are the odds that the winner’s implementation will never happen or will be so unimpressive that you’ll never hear anything more about them? My two-word analogy: free kittens.

From Bridget: “Re: Vigilance iPhone app. Is it FDA approved? It looks like a patient monitor to me. I looked at Acuitec’s Web site and couldn’t find any info on the FDA certification. As a clinical engineer, if it has waveforms and physiological info on it, it better be accurate, and as for alarms, you can’t call it an alarm unless it ‘alarms’ within 10 seconds of detection of physiological condition contributing to alarm status. Thanks for the excellent Web site — I work in the CE/IT interface arena.” Above is shot of Vigilance running on a different device, which I’m including because I think it’s cool. I e-mailed Acuitec and received a nice reply from Lionel Tehini, president and CEO:

Those products of ours for anesthesia charting that require FDA approval have this. In the case of Vigilance, it does not require FDA approval, provided the systems it is aggregating data from and the information being represented in the application have FDA approval. So for example displaying of the wave forms — if we render those ourselves, then it requires the FDA approval (and has it). If those use the rendering services of the vitals sign vendor (Philips, GE, etc.) then it does not, since those are already FDA approved. Yes, I know a complicated answer for such a simple question. But when it comes to the FDA, nothing is simple. My advice is always err on the side of caution and submit the for approval and let them make the judgment call.

From The PACS Designer: “Re: Windows 7 screens. InformationWeek has given use some useful information about what Windows 7 screens look like for us new users. TPD will be testing a Dell Wi-Fi netbook with Windows 7 Home Premium and will post a user perspective of the pluses and minuses for HIStalkers in the near future.”

From Lester Bangs: “Re: ARRA certification. Companies like this one (and they aren’t alone) get checked off on SOME of the ARRA criteria (which are changing) and get labeled as Pre-ARRA Certified by CCHIT. Amazing. And we wonder how folks are confused.” I found CCHIT’s disclaimer more interesting (click the above screen shot to enlarge) since it clarifies that the certification is preliminary, possibly irrelevant depending on the standards that are eventually approved, and possibly worthless since CCHIT may not even be a recognized certification body by them.

From Toadie: “Re: interviews. Some of the interviews read like a press release, while others are interesting. How do you choose who to interview?” Readers suggest some of the interviewees, PR firms sometimes e-mail to say they read HIStalk and can connect us to a CEO, and sometimes I just read about someone interesting and e-mail them. I get turned down sometimes (most recently by Atul Gawande, who was at least polite about it). Each interview is done by either Inga or me and we do our best to ask the right questions and steer the conversation away from self-promotion. It’s worked well, I think, since nearly every interview has redeeming aspects that makes it worth reading. No matter how an interview turns out, I’m always thankful that a busy person will take time to be interviewed by some idiot blogger who warns upfront that (a) the conversation will be published as transcribed; (b) I will not provide my questions beforehand for prep; and (c) I don’t allow proofing or changes afterward. What you read, good or bad, is a real conversation.

Now’s the time to add your event for free to the HIStalk Calendar (Webinars, conferences, etc.) I noticed that five items were listed for today alone, so everybody must be wrapping up before the holidays. Other housekeeping items: if you aren’t getting the e-mail blast when a new HIStalk article is posted, you really should take a few seconds to put your e-mail address in the Subscribe to Updates box to your upper right (you don’t want your competitors and co-workers to scoop you, after all). And, the best secret weapon there is for looking smart isn’t just Google, it’s the Google HIStalk search box to your right. Even industry noobs can sound like battle-weary HIT veterans when talking on the phone by quickly searching for HIStalk mentions of companies, products, and people, then uttering their newfound pearl at just the right moment to an unsuspecting colleague who doesn’t need to know that you used a lifeline.

KLAS announces the best healthcare IT software vendors, with Epic pulling even further away from the pack (I don’t have access to KLAS, so I’m going by the press release). I did learn from the announcement that Epic renamed some of its products, with its pharmacy system now called Willow and RIS renamed Radiant. Several sponsors of HIStalk and HIStalk Practice made the list: eClinical Works, Greenway, McKesson, Eclipsys, Wellsoft (coming soon), Nuance, CareTech Solutions, and Hayes Management Consulting, so congratulations to them.

Listening: The Oohlahs, reader-recommended, female-led punky pop. Reminds me a little of of Throwing Muses. I like it. Mrs. HIStalk is listening to (and watching) So You Think You Can Dance in the living room, which is obvious because I leap a foot out of my chair each time judge Mary Murphy elicits one of her incessant blood-curdling screams for no apparent reason.

My Health Direct, which sells a Web-based referral management system for EDs to send non-emergent patients to other providers, raises $4 million in Series A funding.

Regional Medical Center (SC) says they are happy with their $15 million Cerner go-live, despite significant clinical delays. “Patients have been quite patient,” a board member said without apparent irony.

Abbott Laboratories will acquire Starlims Technologies, an Israel-based lab systems company, for $123 million. It sells systems to hospitals, HMOs, reference labs, and pharma labs. All Web-based, zero client, and high tech, running the presentation code in a .NET control in the browser. Abbott mentions wanting to get into healthcare informatics, so perhaps this has more than the obvious significance.

Barnes-Jewish Hospital (MO) goes live with SIS surgical scheduling, charging, and the SIS Trax tissue management system BJH co-developed with SIS.

I’m on the EHR Scope e-mail list, so I see they’ve made some improvements to their site, fine-tuned their EMR matching system, and are now offering weekly Dragon Medical Webinars. Article submissions for the January issue are being accepted through December 30. I still think their EHRtv is brilliant and darned professional (check out the set in the interview with Evan Steele of SRS above).

The Senate’s health bill will likely not ban the use of prescription data for marketing purposes.

Pfizer’s sales reps will be required to use company-issued tablet PCs when requesting drug samples for doctors, choosing the doctor on the screen to then display a list of appropriate products for sampling. Pfizer has a mighty big meaningful use incentive: the company paid a $2.3 billion fine for illegally marketing its drugs to doctors, so Uncle Sam wants to keep an electronic eye on them.

Is it just me, or does this article about a Serbian EMR vendor have a distinctly AYBABTU quality? “Antamediamedical.com created an amazing software, which helps doctors in different ways. All the software are unique and has amazing results. Medical software is one of the most efficient and workable software, which has sorted a large number of tensions and problems of those people, who are working in medical centers and hospitals. With its installation, the doctors and other medical staff have taken a sigh of relief, for most of other issues have been resolved by it.”

Free (in some configurations) EMR vendor SynaMed announces its free HIPAA-compliant patient-doctor messaging application (the screenshot’s spelling of “Tylonal” suggests that a spell checker might prove useful). The app does look kind of cool, sort of an Instant Messenger tied into the application’s modules.

Hawaii Pacific Health launches its MyHealthAdvantage patient portal. Gee, I wonder who their unnamed vendor is?

The VA posts the raw data behind its 2008 Hospital Report Card on Data.gov, downloadable as .CSV files.

E-mail me.

HERtalk by Inga

From Professor Higgins: “Re: you must talk funny. I love that new iPhone Dragon app and have been astounded by its accuracy. The main limitation is that one needs a good, high speed connection for anything more than a sentence. But for a quick response while driving — perfect! Maybe your voice is just so charming it got distracted? Also, they explained on their app site that while they do collect names only from your contact list, it is to improve accuracy, so when I say ‘John Vinkelgardenhorse,’ they know what I mean!”

With the release of the KLAS end-of-year reports, it’s time to start the  annual discourse on whether or not the KLAS ratings are fair / objective / rigged / irrelevant, etc. I’m sure plenty of vendors lean on their happiest customers, asking them to (favorably) complete the KLAS surveys. Some likely extend honoraria for their clients’ time. That extra tweaking of the process may help move a vendor’s rankings a place or two, but, I think it’s safe to assume that if a vendor was not serving its client base, it would not have enough happy clients willing to provide a favorable report.

MED3OOO appoints Hillary Harlan, an attorney and RN, as its chief compliance and ethics officer.

PatientKeeper closes a $13 million round of funding comprised of equity and debt. The company says it will use the money to accelerate development of physician documentation and CPOE applications and extend its support operations. As part of the financing, Chip Hazard of Flybridge Capital Partners is joining PatientKeeper’s board of directors. Back in August 2008, I mentioned that PatientKeeper secured $7.5 million in Series F funding, which increased its total VC dollars to $75 million. Those funds were designated for R&D and to grow the company’s infrastructure.

3M Health Information Systems releases 3M Mobile Dictation software, a new option for its 3M Mobile Documentation System. The product is available Blackberry and Windows Mobile platforms and allows physicians to review patient detail on their smartphones.

Amcom Software also announces its new smartphone application, Amcom Mobile Connect. The app allows clinicians and staff to use a Blackberry device for messages and critical codes.

Halfpenny Technologies is also jumping on the smartphone bandwagon, introducing its ITF-Mobile application, which allows physicians to securely access test results.

Healthcare Information Xchange of New York selects InterSystems HealthShare software as its core HIE platform.

The Healthcare Authority for Baptist Health (AL) purchases McKesson Practice Complete to handle physician billing and claims management for its employed physicians. Physicians will also use the McKesson-hosted Horizon Practice Plus PM system.

Sounds like Ohio is seeing an economic turnaround, at least for healthcare workers. Cleveland Clinic says it’s planning to add 1,800 new jobs in 2010, a year after posting a $62 million loss. New positions include jobs for both staff and physicians. Meanwhile, University Hospitals (OH) plans to add 550 workers and MetroHealth (OH) has 270 full and part-time openings.

A new study concludes that EHRs often fail to achieve expected gains in healthcare efficiency. They often improve auditing and billing efficiencies, but decrease clinical efficiency.

ONC accelerates its timetable for rolling out health IT regional extension centers (HITRECs), planning to announce 30 grants on January 21 and another 40 or so in March. Sounds like a good move, given the amount of work that needs to be done in short order.

athenahealth names Dr. William Winkenwerder to its board of directors. He’s chairman of The Winkenwerder Company, a healthcare consulting company, and a former Assistant Secretary of Defense for Health Affairs.

The New York Post obtains 2008 tax records for several of the city’s biggest non-profit health systems and finds that at least a dozen CEOs received $1 million or more in compensation. Dr. Herbert Pardes of New York-Presbyterian took home a $1.67 million salary plus a $1 million bonus.

Anne Arundel Medical Center (MD) goes live on its $35 million Epic system, to which it gave the obligatory cute nickname (Alec), but at least based it on something more cerebral than a strained acronym (it means “protector of mankind” in several cultures, they claim). They even make pegged their super users as Smart Alecs, making the whole naming thing worth it.

Last year I wrote a little holiday poem for HIStalk, which I must say was very clever. I plan to update my prose this week and ask Mr. H to publish it a bit earlier, before the masses turn off their e-mail for the holidays. Stay tuned.

Holiday poems here.

HIStalk Interviews Jeffrey Robbins

Jeff Robbins is founder, president, and CEO of LiveData.

Describe LiveData’s business.

LiveData’s really got two lines of business. Relevant to your readership is our healthcare business. We also got our start, and continue to service, the electric power space with a trusted real-time middleware that’s used all around the world on the electric power grid. That’s actually how we got our start in healthcare.

We were posed a challenge by folks at Mass General, who in collaboration with CIMIT had an “Operating Room of the Future” project. The paradox of new stuff is the more new stuff they brought in, while they had increasing numbers of really great new tools in the OR, the challenge was how to actually pull it all together and use it. So they posed to us the challenge: could we pull all this different kinds of data in real time onto one screen? To which, as CEO I said, “Of course.”

Then we pulled back to figure out, well, how’s that going to work? That launched us into healthcare about five years ago.

What is CIMIT?

It’s a collaborative group that involves Partners HealthCare, the parent organization of Mass General, along with MIT, Draper Labs, and other stakeholders. Their mission is to try to find technology, sometimes outside of the traditional healthcare space, and bring it to bear on healthcare.

I’ve been hearing about “The Operating Room of the Future” for years. Has it produced technologies that are actually being used?

Well, that’s a nice softball for me. [laughs] Certainly one of the outcomes of that project at Mass General was Mass General deciding for their new operating rooms — they put this in their RFP for equipment for the new ORs –to standardize on having LiveData OR-Dashboard in every room. LiveData OR-Dashboard is the product name of what came out of that research.

I should say that the way we were enabled to actually work on this was through a generous grant from the U.S. Army’s TATRC Group. Through the SBIR grant process, we competed for and won a grant that allowed us to take our technology, which was already proven in the electric power space, and tailor it to the healthcare environment.

Everybody’s pushing doctors to use EMRs in their practices. Is anyone advocating OR technology?

The OR, in my opinion, is still in some ways the Wild West or the last frontier. It’s kind of a black box that’s definitely under the dominion of the surgeon. It’s widely recognized that they’re very obviously a delicate area of care. Changes come to it carefully in the hands of hospital administration.

You really do have a dedicated team of professionals among the doctors and nurses who take excellent care of each patient. Trying to get electronic stuff in the mix has all the pitfalls that I’m sure you’re aware of, where you can’t simply create an electronic version of the paper stuff you already have and expect to see better things happen.

You really do have to look at the workflow and find ways, creatively, that automated systems can actually help and reduce workload, not simply add more burden, because now all of a sudden someone’s supposed to not only do critical things on their feet, but then run over to a keyboard somewhere and type a description of it. I’d say that’s what keeps the OR somewhat on the outskirts of a lot of the efforts I read about in your paper.

As you said, physicians often find EMRS cumbersome and not meeting their workflow. Do you find the same challenges with surgeons in the design of your product?

Yes. We set out deliberately to address the gap between the “doing” and the “documenting”. When we started, our product was really a read-only display that derived its information automatically from other systems, be it documentation systems where a nurse was already documenting, or in some cases the physiologic monitor or anesthesia machine. Building up more information out of existing sources without requiring any new typing. That was kind of a first leveled effort to say, “For sure no one’s going to have to do more work with our system. Let’s see if we can’t help anyways.”

Then the next step was to try to see if we couldn’t reduce the amount of work involved in certain documentation steps, with our focus at first being on the Safety Time Out, which has, I think, increasingly gotten press and awareness. 

What’s the value of putting the lists in an electronic environment, as in your Active Time Out function?

There was a by-now famous study that was spearheaded by, among others, Atul Gawande out of Boston here, out of the Brigham more specifically, and also at Harvard. Brigham, being one of the teaching hospitals, it was Harvard. But the study showed that through the intervention of adding specific kinds of checklists to the surgical process, you could reduce errors and ultimately save lives and reduce complications. That’s a wonderful result and everyone gets that we need to make sure that everyone’s doing these checklists properly.

But the study itself raised the question, “How do you engineer durability into the system?” and what does that mean? If you have someone with a clipboard watching you while you work, seeing how well you actually execute a specific checklist and you’re aware of that fact, my guess is like most humans, you would start paying more attention and be kind of on-the-spot and do it.

The question is, when the person with the clipboard leaves, who’s checking to make sure you actually keep doing this checklist? Effectively doing the checklist does help. The question is, what helps people stay on task and actually do the checklist on each and every case? That’s where, again, new ways of doing the checklists using electronic technology to help and augment the process can really make a difference. That’s what we’ve been doing with our hospital customers.

For example, we give the circulating nurse a simple clicker, kind of like a PowerPoint mouse, very inexpensive, very simple. During the Time Out, the nurse literally clicks through the checklist which is up on the wall on a screen. How that differs from having a poster on the wall, let’s say, with the checklist on it is for each step in the checklist, the relevant information for executing that check — like making sure that the proper antibiotics have been given prior to incision, as an example — the system literally scours the records of the documentation to make sure that there’s indeed a record of the proper antibiotic being given and puts that up on the screen.

Simple stuff like patient name, MRN, whatnot. Rather than just having a checklist that says, “Make sure you know who the patient is,” we get the patient’s name and in some cases, even a picture of the patient up on the wall so you can confirm that you have all the salient information to do that step of the checklist.

That’s Part A of it, having all the relevant information available automatically. Part B is, this could sound a little Big Brotherish, but it’s being handled with a lot of sensitivity by our hospital customers — we provide reports for administration as to how long was spent on each step of each checklist item for each case. You actually get beyond the documentation saying, “Yup, we did the checklist; we did the Time Out.” You get some time-based statistics. Did the checklist get done before incision? How long was spent on it? You pretty quickly get a feel, as a team in the room, for what the right amount of time is to spend on a checklist, and you can then start to tell when something really wasn’t done properly.

The hospital that recently got into trouble for not doing surgical time-outs or marking their sites surely knew they should be doing that. What would you suspect caused them not to, and how would your product have made a difference?

Well ultimately “they” — the hospital — devolved into individual surgeons who often aren’t even employees of the hospital, but obviously have privileges to operate there. Our system helps people stay on compliance with the policy and provides a record for each and every case of that actuality. It’s moving, and it’s a culture change, but its part of the hospital making the decision that yes, we shall really see that this happens on every case.

Can the tool change the culture or does the culture have to be ready to accept the tool?

As much as I’d love to say yes to the former, it’s really the latter. No matter what kind of technologies they have, the culture change is ultimately people and processes. Technology is really an adjunct. But again, my point is that technology done right is a useful adjunct that doesn’t add more work. It’s still salient to that discussion about, does the electronic medical record hinder or help our health?

Take me through a typical surgery. What is your product doing and how are people using it?

The product in the OR is part of a bigger suite of products that are all about workflow in the perioperative space. In the OR, the workflow is divvied up into some very high level phases or steps, which we call Set Up — when the room is being set up. The checklist phase. Intraop — the actual surgery is underway; debriefing and some ancillary stages prior to sending the patient off to the PACU. Some of these other phases might be in their own time frame and pop in and out.

For example, there’s workflow associated, on some cases, with sending a specimen from the OR to the pathology lab. The system will, when that’s going on, switch automatically to some information about managing that flow back and forth between the OR and the pathology lab to make sure the specimens had been marked and described the way the surgeon wants; to let the surgeon see where his or her specimen is in the pathology lab’s queue; and then ultimately to get results back from pathology in a way that the surgeon can easily see and have someone in the OR sign off on.

That’s like a detailed dive on one piece, but the major steps again are: the room setup, where the goal is to make sure all the right stuff is in the room. Then once the patient’s in the room, the briefing/checklist phase, to make sure that’s all done properly. Then Intraop is largely details of the case that unfold during the case — highlights of the patient’s vital signs, estimates of any fluid loss; and depending on the kind of case, there might be more details.

Let’s say in an orthopedic case you might have an automated tourniquet pump on for a certain period of time at a certain pressure, and that kind of data can be gleaned automatically and displayed on the wall so everyone can see it, that kind of detail about the work. First of all, we talked to different people in the room and asked them, do they need that? The anesthesiologist has his or her own bank of screens from the monitors; they don’t really need that. The surgeon might think they don’t need that, and often they’ll say that to us, “Oh yeah, I don’t need that.” But once they have it and you observe them during cases, you’ll see they start using it quite frequently just to stay aware.

Most crucially, nurses, some of whom might be changing shifts in the middle of a case or relieving someone who’s going off to lunch, can get kind of a high-level Gestalt of “Where are we in the case?” in one place, versus what they could do in principle, is log into several systems — the record, so to speak — and rummage and try to find out what’s going on that way, or talk to people. But I hope no one’s under the delusion that there’s a lot of that kind ad hoc conversation going on in the OR, because there isn’t — so metaphorically, keeping everyone on the same page.

People have said that critical IT systems should work like a pilot’s heads-up display or as in real-time instrumentation that detects events and alerts. Is the industry moving in that direction?

We feel we have delivered in our product is that heads-up display. I would argue that certain kinds of IT systems already in place in the OR are, correctly, heads-down products because they’re documentation products. Certain things do require a nurse to heads-down and type.

We’re not yet at a point where voice recognition is good enough in that kind of noisy environment, and so there are places where things need to be typed in. That, to my mind, is inherently heads-down, yet there are pieces of what are being typed that are really more high level events that should be monitored and then used.

We use them, first of all, to know what phase of the case we’re in to automatically display the right subset of information. But then, like you say, to have alerts. So if we’re getting to the Time Out before incision and there’s no documentation of antibiotics being applied — sound an alert, let’s find out. You could say, “Hey, you’re actually helping to make sure they gave antibiotics.” Well maybe, but maybe more likely we’re helping make sure that someone actually documents correctly what’s already been done. So somebody’s been given antibiotics, but no one’s documented it yet. Our system serves as a reminder to get that done.

How much overlap is there with traditional surgery or periop systems, and who do you consider to be your competitors?

We’ve actually had discussions with some of the CEOs of the existing periop documentation systems who have told me that they don’t see it as overlapping, and they see it as a logical add-on. Yet if you talk to some of the other larger companies who, it’s all just software, right? At some level they have everything, at least on the drawing board, and they’ll tell you, “Oh yeah, we’re working on something like that.” But I don’t think any of the current well-known companies could claim to have something exactly like this running in a hospital.

Another technology that outsiders seem to be amazed that healthcare doesn’t have is real-time video and data capture for review or teaching or malpractice defense. I noticed your Historian product offers that. How are customers using that?

We’re not directly supplying video recording. What we’re doing is essentially adding automatic data bookmarking to what exists in video logging products. For example, our product is in the market with our distribution partner Karl Storz and they have a line of products called AIDA, which are video loggers. So that’s an example.

In specific instances that hospitals interfaced with other competing video logging systems that other companies do sell into the ORs, there are basically DVD recorders in many ORs replacing the video tape recorders that used to be there. But I think, as you were kind of leading towards, it’s the old-style kind of tape — label it by hand; the surgeon keeps it in his office, maybe shows a clip at a conference.

The next step, we believe, is to make the video part of a richer data record. At the very least, so that you can easily find the salient stretch of tape or image that you want. One of the problems with logging things is you end up with miles of images that nobody ever goes back and looks at. So by merging the data-oriented bookmarks of knowing when the Time Out’s done, knowing when they’re closing, knowing when the physiologic monitor first picked up the pulse-ox or whatever, you can actually rapidly scan ahead to where you want to be instead of wading through a lot of empty air time.

Final thoughts?

I think you already said it for me, but I’ll repeat it. The electronic medical record in many ways seems, from my vantage point, to be somewhat stalled in that documentation phase. It’s really taking that electronic data, fusing it from several sources, applying rules to it, and acting on it that I think starts harvesting the goodness of it and makes it more than just this added documentation burden. Instead, it makes it part of the care delivery system that we’re really excited to be part of. I’d say that’s the exciting trend that is enabled by the correct deployment of electronic records.

Monday Morning Update 12/14/09

Indiana Regional Medical Center thanks Congressman Bill Shuster (R-PA) for getting it $350,000 in federal money to buy an EMR. Question: shouldn’t they be thanking the people like you and me who are actually paying for the porkfest? Given the federal spending spree, It’s not shocking any more that at least a half-dozen other hospitals were named in news stories this week for getting federal grant money for EMRs.

Proloquo2Go makes Apple’s list of the top iPhone apps for 2009, surprising many who didn’t expect to see a medical app on the list. The $189 software helps people with speech problems by converting text to speech.

Quotes from this week’s e-mail from Kaiser CEO George Halvorson (forwarded by a couple of insiders):

Putting medical information in the computer and then leaving it in electronic silos is just as non-functional as putting medical information on pieces of paper and leaving the pieces of paper in file drawer silos. Medical information needs to flow to the caregiver at the point of care. It needs to be available when the patient needs care … We looked to the other biggest and most successful electronic medical record system in the United States — the Veterans Administration (VA) — and we decided to see if we could figure out ways for patients from our system to visit their system — or patients from their system to visit our system — with the medical information following the patient electronically. Our information can follow our patients now, to some degree. KP patients can remotely access their own medical record.We also often give our patient copies of their medical records. Our patients who travel sometimes carry their medical record with them on a thumb drive. That particular experiment has been a success. So we have done some data transfers for some individual Kaiser Permanente patients. But that data did not flow directly to another caregiver, or to another care team. The goal of our VA project was to see if we could design a secure way to transfer that data purely electronically. We managed to do that.

Inga found this news story, which she calls “something Weird News Andy might like.” A man is arrested after speeding down a country road and running over two people, wearing only pajamas and flip flips. He bolts from police in the five degree weather, heading for his wife’s office. But what’s really bizarre is his lawyer’s defense: “caffeine-induced psychosis”. Next think you know, Folgers will be in a class action suit.

Listening: Biffy Clyro, Scottish rock.

Jobs: Account Executive/Sales Rep, Manager Clinical Application Services, EHR Project Manager, Soarian Clinicals Consultants.

Scumbag lawyers: Google QuadraMed and you’ll get three ads with the same headline, all trying to convince QDHC shareholders to jump on a class lawsuit claiming breach of fiduciary duties by QuadraMed management. Google the names of any of the three law firms and the phrase “breach of fiduciary duties” and you’ll get thousands of hits from their previous legal efforts.
 

From my last poll, it appears that enough new folks will go to HIMSS to offset those who are dropping out. If it’s a representative sample, you might therefore expect attendance to increase a little. New poll to your right: did EMR vendors and trade associations influence the Obama administration’s decision to spend billions on EMR usage?

A WSJ editorial called Health Care’s ‘Radical Improver’ covers athenahealth. One quote from the editor:

The Athena model is superior to most electronic medical record systems, or EMRs, which are generally based on static software that are inflexible, can’t link to other systems, and are sold by large corporate vendors like General Electric. One reason the digital revolution has so far passed over the health sector is sheer bad product. The adoption of EMR in health systems across the country has been dogged by cumbersome interfaces, error propagation and other drawbacks … Mr. Bush is less sanguine about the White House cost-control approach of better living through technocracy … he singles out the idea of dispensing bonus payments to hospitals that find ways to reduce Medicare spending. If the bonus is higher than what the hospital would have been paid under the status quo, then Medicare is worse off—but if the bonus is less than what the hospital would have earned otherwise, in what sense is it an incentive to change?

And a fun quote from Jonathan Bush:

It’s probably terrible that all this new bureaucracy is being created. But there’s going to be 50 new Medicaid-type plans in these insurance exchanges, run by the same insurance commissioners, these same sort of glazed-over-looking state secretaries of health. You know, just not really the brightest bulbs in the chandeliers of the world. Medicaid, the worst payer in the country by a factor of four! Mother of pearl! So I feel a little bit like a robber baron. I am going to make oil money dealing with them.

In Canada, Campbellford Memorial Hospital joins several others in abandoning an $80 million project to use a common hospital information system (Meditech). As is happening in the UK, nobody has the money to chase a grand interoperability plan at the moment. Another hospital in Canada just started its Meditech project last week. 

Ten EDs of Orlando Health and Florida Hospital will start sharing data in January in a Central Florida RHIO project.

UPMC’s health plan will offer the $690 Insight Brain Fitness Program software to its Medicare members at no cost.

University Medical Center (NV) notifies 71 trauma patients who were seen on Halloween and the day after that their personal information appears to have been sold to personal injury lawyers. They are now requiring employees to enter PINs on copy machines and may add electronic door controls.

Red Hat will host an online forum on cloud computing on February 10.

Congratulations to the hospital IT people named as Computerworld’s Premier 100 IT Leaders:

• Avery Cloud, SVP/CIO, New Hanover Regional Medical Center
• Philip Fasano, SVP/CIO, Kaiser Permanente
• Stanley Huff, CMIO, Intermountain Health Care
• Edward Marx, CIO, Texas Health Resources
• Bill McQuaid, CIO/AVP, Parkview Adventist Medical Center
• Susan Schade, VP/CIO, Brigham and Women’s Hospital

E-mail me.