News 5/26/10

From The PACS Designer: “Re: Microsoft’s CDSA. The Clinical Documentation Solution Accelerator (CDSA) for Microsoft Office helps you create clinical document workflow by using Microsoft Office SharePoint Server 2010. CDSA is good for linking EMRs to other systems and also populating PHRs and CCRs.”

From Alan: “Re: Vermont Information Technology Leaders. It announces four more preferred partners.” They are athenahealth for revenue cycle, Concordant for consulting, MBA HealthGroup for implementation, and the University of Vermont’s Technical Services Partnership for services.

From LeBron Kydis: “Re: stats. I was charting the number of HIStalk visitors from day to day (I know, it’s a little neurotic) and realized the number of subscribers could be more interesting to watch as it climbs. Any chance you might include that number with the number of visitors?” Wow, that is compulsive. Bad news on the subscriber list, though: unlike the visitor count, there’s no widget to display it automatically. This will get you started: the confirmed count as of this minute is 5,565.

From FLgal: “Re: Epic. Tampa General (affiliated with USF) is implementing Epic. Shands (affiliated with UF) is also implementing Epic. Supposedly those two are collaborating with University of Alabama (not sure of the hospital name) to create a southeastern arc of Epic hospitals. Combine that with all the hospitals in Atlanta that are implementing (or thinking of doing so) Epic, and you’re got quite a nice chunk of the US covered by Epic.”

From A Family Affair: “Re: UPMC. A highly wired hospital with a highly connected leadership family.” UPMC paid $10 million last year to companies with ties to its directors and executive management. Relatives of the CEO, who himself made $5.16 million in 2009, received more than $3 million in payments, including his $265K daughter who was a contractor and is now executive director of UPMC’s technology development center. The CEO’s former son-in-law made $260K (until his wife divorced him and thus went his job) and his brother raked in $2.48 million for advertising. They didn’t ‘fess up until hearings convened by my hero, Senator Chuck Grassley.

Fletcher Allen Health Care lays off 23 transcriptionists who were rendered obsolete by technology such as EMRs and speech recognition. I feel bad for them, but that’s a nice plug for the cost saving potential of Nuance’s eScription, which I believe FAHC uses.

It was just over a year ago when Compuware inexplicably hired disgraced former Detroit mayor Kwame Kilpatrick to sell healthcare software, giving him a cushy six-figure job barely a week out of prison (what the hell were they thinking?) Well, today they got to fire him: he’s going back to the slammer for violating the terms of his probation. He tried the sorrowful apology route yet again, but the judge wasn’t buying it this time: he’s going away for at least 18 months and possibly up to five years. You can read up on his checkered background, but get comfy first because it will take awhile. Please hold for a job offer on Line 2, Mr. Blagojevich.

Michael from Bitwork offered an explanation of the article I mentioned that said a Hawaii clinic was saving 55 hours a month through some unspecified change. They were manually assembling quality measure information using standard reports offered by their EMR, he says. The change was to implement Bitwork’s solution, which collects the information in the background and presents it as a scorecard.

Stung by the defection of HIMSS and other conferences because of absurd costs, the governor of Illinois is considering signing a bill that would limit union shenanigans at McCormick Place. Naturally being Illinois there’s all kinds of dirty politics, union wheeling and dealing, and favoritism involved, not to mention that attendees will get stuck with newly increased bus and taxi fees to generate funds for marketing the convention center.

Weird News Andy labels this story as, “I’ve heard of dropping a transmission in a car before, but not a baby.” A Minnesota woman who is feeling labor pains drives off for the hospital, stopping to pick up the baby’s father, who can’t drive because he has epilepsy. Her water breaks while driving, she yells for him to take the wheel, and she shucks off her pants and delivers an eight-pound baby boy right in the driver’s seat. She summarizes, “I was just sitting on the seat and he just slid out.”

Some Epic youth filmed a video of the famous on-campus treehouse. I’m beginning to think I need one of those for philosophical reflection or something like that since I’ve always wanted one.

Inga and I have jumped on the Facebook bandwagon because so many of HIStalk’s readers are active there. I’ve made a site change that puts a little blue Facebook icon at the top right of every post. Click it and you can easily and quickly publish the article link with your comment to your Facebook feed.

Connecticut Attorney General and US Senate candidate Richard Blumenthal apologizes for not being “clear and precise” in claiming Marines service in Vietnam that he really spent stateside. That’s newsworthy here only because he’s the brother of national coordinator David Blumenthal, which I happened to see in one of the newspaper articles after thinking they sure look alike. You would think serving honorably in the Marines in any location would be enough without having to embellish, which hopefully he’s realizing.

Speaking of David Blumenthal, he was the commencement speaker at the University of Florida College of Medicine’s graduation this past Saturday. He told them most of what they had learned would be obsolete shortly, a sad but true fact and another reason to use technology to support pushing current best practices to the bedside.

The Raleigh, NC newspaper takes heat from UNC Health System employees after publishing the organization’s salary database online, including employee names and ages.

Tri-City Medical Center (CA) looks into alleged privacy disclosures involving employees and Facebook, denying a rumor that 26 employees have been disciplined. One conclusion is that hospitals need a social networking policy. Policies don’t usually work, of course, but at least you have grounds to fire violators.

Federal CTO Aneesh Chopra, speaking at the American Telemedicine Association conference, calls for great healthcare technology ideas and recites some examples: Voxiva’s Text4Baby (I interviewed head guy Paul Meyer in November), a Case Western Reserve telehealth project, American Well (which I just mentioned), and Project Echo (I interviewed Director Sanjeev Arora in October).

Speaking of innovation, I’ve had some conversations about scouting out more of those in HIStalk (I’m non-disclosed to say who those conversations were with, but you would probably be impressed) It could be as simple as doing interviews like those above, or it could be evaluating products with potential to benefit the healthcare system as a whole (not necessarily for their business potential, which others are doing already). If you have ideas of how to do this or want to help in some way, let me know. I was thinking of offering companies or developers the chance to pitch their wares and have them evaluated by a panel of expert HIStalk readers, but I always have high-falutin’ ideas that I don’t have time to execute properly because I’m working two full-time jobs already. In any case, if you know of cool, innovative technology that’s delivering results but not getting much attention (preferably as a user and not a company pitch person), let me know.

Monday is Memorial Day, set aside to honor men and women who have lost their lives in military service involving conflicts both popular and not. Flags are cheap, easy to find, and fun to hang (and I’m reminding you way ahead of time). And unfortunately, they stand out nicely in most neighborhoods since everybody’s too wrapped up in picnics and car races to think about dead service members and their families on the one day per year set aside to pay those respects. So if you’d like to be a rebellious contrarian like me, hoist Old Glory on Monday. End of good-natured soapboxing. 

The VA’s VistA Modernization Report

A reader sent over a copy of “VistA Modernization Report”, the work product of a committee that was convened to advise the VA about modernizing VistA. Its recommendations:

• Stabilize VistA by freezing the code to some degree, releasing only enhancements needed for patient safety or mandates.
• Contract with a research group to develop tech specs for a new open source VistA replacement.
• Contract creation of a prototype.
• Contract development of a foundation to manage the new, open source VistA.
• Get more widespread VistA deployment outside of the VA by creating an easier delivery model.
• Replace VistA’s functionality screen by screen.
• “Harvest everything of value” from VistA.
• Use commercial software where needed to complement VistA’s core functionality.

My reaction: big government contractors are wetting themselves at the prospect of getting a chunk of what is sure to be a massive cost. Remember VistA’s history: it was mostly developed by skunkworks programmers defying management orders and working directly with end users. It was not developed under an open source model and wasn’t cheap to build – it just happens to be free because taxpayers paid for it, which makes it available under the Freedom of Information act.

Software rewrites have ruined even nimble organizations who didn’t have to deal with bureaucrats and fat cat contractors. And let us not forget the $450 million taxpayer-raping by BearingPoint’s CoreFLS ERP system, overseen by an apparently napping VA IT management and mercy-killed during its beta testing when it nearly shut down Bay Pines Hospital in Florida.

All of this sounds like the usual feel-good consultantese, soothing and logical in a perfect world, dangerous when you’re dealing with the federal government and its cadre of trough-lappers. And who cares if VistA adoption is minimal outside of the VA? That wasn’t the point of writing it.

Software rewrites are usually a really, really bad idea, advocated by techies and mid-level managers who see the fun of working on something new instead of the gaping black strategic hole beneath them. The VA was lucky that VistA turned out as well as it did, but it’s a one-trick pony not likely to be repeated.

Open source or not, wanna bet this will be a billion-dollar project if it gets approved? Heck, HP got $784 million back in 2004 just to support VistA going for ten years, so imagine a stimulus-happy administration getting to announce this grand vision in front of veterans and former civil servants turned contractor lobbyists. Most vendors (including the ones that would provide commercial systems to the VA where needed) are selling systems that are just as clunky and outdated as VistA. Most of the time, they work just fine, especially if the whole package was built by the same company instead of being acquired from failing vendors anxious to sell out.

Maybe the VA should just do what everybody else seems to be doing if they really think VistA is on its last legs — buy Epic and install it using the Kaiser model. I wouldn’t want VistA replaced for the wrong reasons, but if it’s really necessary, then I’d rather see them writing Judy a huge check for a known quantity instead of a series of never-ending ones to the usual government contractors who have stars (and stripes) in their eyes.

That’s my uninformed opinion. What’s yours?

HERtalk by Inga

Baptist Health System (AL) selects Compuware’s EHR Service Delivery Solution to monitor performance and availability of its EHR.

All Children’s Hospital (FL) expands its relationship with Mediware, adding BloodSafe Tx for patient and blood verification.

The 107-bed Pioneers Memorial Healthcare District (CA) will replace its QuadraMed Affinity Clinicals with QuadraMedCPR.

Walmart cuts the price of the iPhone to $97, AT&T raises its early termination fee from $175 to $325, and rumors swirl that Verizon will soon offer service for the iPhone. Must be almost time for Apple’s Worldwide Developers Conference. June 7th is the date we’ll likely hear more about Apple’s 4G version (with video-chat, perhaps?)  plus maybe news of a Verizon deal.

Maybe one of our marketing genius readers could explain why a company would even bother to create and distribute a press release like this? Mr. H puts it on the short list for stupidest press release ever written. The company is obviously trying to raise money for programmers and designers. If they are successful, I suggest they put a few dollars aside for marketing.

If you are an HIT purist, mosey on to the next news item. A woman is denied entrance to Yankee Stadium because she is carrying an iPad. Seems the Yankees have a “no laptop” policy and a security guard placed the iPad in that category. Not be deterred, the woman put the iPad under her jacket and went in another gate. I gotta say I like this lady because she likes her technology, likes her baseball, and is willing to be a bit sneaky to get her way. Anyone who has ever scored a baseball game has to love the the idea of using an iPad to run the cool-looking iScore app.

A former University of Washington Medical Center patient complains to the local press when a hospital representative called his unlisted number to solicit donations. Turns out that HIPAA specifically allows medical centers to use patient information for fundraising activities. UWMC offers an opt-out alternative, but it requires patients write a letter to the hospital’s privacy office. I’m all for fundraising, but shame on any hospital using such tactics. At least make it easier to opt out on the front end.

Forty private equity firms form the non-profit Healthcare Private Equity Association to support the healthcare PE community. The association’s members represent about 500 healthcare portfolio companies and combined revenues of $200 billion.

Speaking of private equity investments, Phreesia announces the close of $16 million in Series D funding, led by Ascension Health Ventures. Phreesia’s technology platform automates patient check-in in physician offices and urgent care centers.

Coming soon to HIStalk Practice: a new question in our HIT Vendor Executive series (sign up for e-mail updates so you don’t miss it!) This month’s question is, “If you could give David Blumenthal one piece of advice, what would it be?”

A few quick updates:

• MEDecision names Eric Demers as SVP of life sciences.
• Three new hospitals select McKesson’s Practice Partner EHR and PM for their employed and affiliated physicians.
• Wolters Kluwer Health promotes Susan Driscoll from EVP to president and CEO of the company’s Health’s Professional & Education Business Unit. She takes over for Gordon Macomber.
• Pomona Valley Hospital Medical Center (CA) implements the Access e-Forms Repository, providing direct access to users from its Siemens Soarian portal.
• The Johns Hopkins Hospital goes live with iMDsoft’s  MetaVision AIMS in 39 operating rooms.
• St. Elizabeth Regional Health (IN) contracts with TeleHealth Services for interactive patient education systems.
• Healthcare Management Systems names F. Bradley Meyers its director of integration and Interoperability and Neal Reizer as chief architect.
• MEDSEEK awards Spectrum Health (MI) its 2010 eHealth Excellence Award for its use of eHealth technology.
• Halfpenny Technologies’ ITF-GoDoc solution now includes a new critical value alerting feature that allows hospitals or labs to send  results to physicians’ smartphones.
• Integrating the Healthcare Enterprise International names the College of American Pathologists as the primary sponsoring organization of the IHE Laboratory Domain.

E-mail Inga.

HIStalk Interviews Bob Murphy

Robert Murphy, MD is chief medical informatics officer at Memorial Hermann Healthcare System of Houston, TX.

Tell me about your priorities at Memorial Hermann.

I’m the system CMIO at Memorial Hermann. The organizational priorities really continue to be the same. We’re trying to drive quality, creating the best experience for our patients and our physicians.

The Meaningful Use thing that just came out has helped stimulate or augment the priorities, but really, they were things we were doing already. It may be helping us accelerate in some areas faster than others, but we already had CPOE planned across the enterprise. We already had CDS [clinical decision support] in a pretty deep fashion.

We’ll probably add a little bit more in the documentation and maybe getting more effort on the ability to exchange information with our physician practices. We had all of these elements in place even before the stimulus plan was announced.

What’s your reporting structure?

I report directly to Dr. Mike Shabot, who is the chief medical officer, and dual-report to David Bradshaw, the system chief information officer.

How about underneath you?

I have the area of medical informatics — CPOE and clinical decision support. I have the groups that do the order sets and support the CDS. Also, some pharmacist informaticists and some outcomes folks who work on my team.

What are your thoughts about the value of CPOE in outcomes and patient safety based on recent studies? You’ve done this in more than one place.

You know the history of the literature. You know some of the things that have come out with potential unintended consequences, and I guess I’ve been a consumer of whatever research and practices and articles that come out to learn from whatever those experiences are. I think there are certain things that, as a physician, clearly you see the benefit of simple things like handwriting. Having practiced for over 10 years, I saw quickly that handwriting is a contributor in many ways.

In addition, you start to see the benefits of what clinical decision support can do. That’s probably the area that I feel is the most valuable in all of this.

On the flip side, seeing the potential for unintended consequences has made me very thoughtful and exhaustive in preparation to make sure that we do everything we can to prepare the medical staff, prepare the clinical operation staff, and to be very dynamic in responding to issues that come up.

It’s clear to me that well-implemented physician order entry with decision support can make improvements in quality of care. Internally, certainly we are seeing some demonstrable quality outcomes from that. We’ve gone a slower approach than many, so our implementation, our first two hospitals, went service line by service line over a month. It took us almost two years to get to 75%.

That was really by design and slow and purposeful, but now as we’re bringing in additional campuses and departments online, I think we’ll be able to accelerate. I think the initial focus on careful, slow attention has been beneficial.

Are you a Cerner shop there?

We are.

Everything that you have on the clinical side is Cerner?

Everything but our OB department. That’s the only major clinical area that’s still not Cerner.

How should hospitals approach the clinical decision support requirements of the proposed Meaningful Use criteria?

You really start to see several buckets of where clinical decision support is important. The first is there’s just simple check objectives — do you have drug-drug interactions, drug formulary, drug-allergy checking? I would say that’s often the most rudimentary type of decision support.

In fact, the more and more we evaluate it, the more we are refining that from the simple tool that the vendors supply. For instance, the major pharmacy databases — First DataBank and Multum — come packaged with these drug-drug interactions. The longer we’ve gone, the more we’ve customized and turned off the alerts that are not that helpful clinically. To sites that are just going live, I think it’s some thoughtful caution and what level you set any of those settings. That’s the first big bucket of those simple ones.

Then you get into the current proposed objective that says you must have five CDS rules and those must be related to the quality measures. I think that was in advance from the original draft, and I think it’s one of which most of us embrace and are happy to see.

That gets into the more complicated type of decision support of workflow and how you’re going to capture these patients. What’s the correct trigger? What’s the correct notification to what user at what time? Folks here knew those quality measures.

If folks are just getting started, they need to keep it as simple and straightforward as they can. Simple things like on an order set for an acute MI — make sure the aspirin is checked or contraindication is documented. The one thing for some advanced hospitals is, if I look at that one — aspirin in acute MI — most of our hospitals are 100%, and have been so for the last six months.

Is that helpful for us to put a rule in place for something we’re already 100% for? For us, probably not. But for hospitals that aren’t 100% and need something simple to get in, those are thing kind of things I think you’ll see them focus on.

The third element is what clinical decision support can maybe bring as you continue to advance the tools that you have. One that we’re investigating right now is how do you correctly populate a problem list? For a large organization, on the inpatient hospital side, managing a problem has become very, very difficult with so many users — physicians, consultants, nursing, and others.

What is the most valuable part of a problem list? From a CDS perspective, we may, in fact, try to focus on identification of certain conditions — diabetes, high blood pressure, heart failure — that we can identify with good specificity and maybe add those as part of our CDS portfolio. You start to see, again, from the rudimentary to the more advanced organizations, will have to progress. I think most places will have several years to get there, but it’s still going to be a big challenge for small hospitals, I think.

Most clinical decision support isn’t guidance, but rather non-personalized canned warning messages that are either turned on or turned off for everyone. What about being able to tailor specific types of warnings to specific practitioners or types of practitioners?

We have those features in place and I would say most large vendors’ sophisticated CDS engines will have those capabilities. The problem is the work that requires for that customization. It takes an analysis of workflow and even certain elements of credentialing — which user can or cannot respond and answer to a request to initiate an order? Can it be a nurse or pharmacist or a mid-level provider, or must it be a physician? At certain places, is it the resident or the attending?

It gets into such role-based specificity it really is a challenge, even with the tools that are available. They often allow that flexibility. It’s a real burden for organizations how to effectively analyze, plan, monitor, and continue to improve those sorts of tools.

But in general, it seems there’s a gap between what outsiders who are setting these things up think physicians should need to see or want to see, versus those that the real practicing doctors actually find useful. How do you address that gap?

That, again, shows you the scale from the rudimentary — the drug-drug interactions. For instance, we’re a large organization, so we’re doing the specific work. We will turn off the Multum pharmacy formulary drug-drug interaction. We will most likely build a custom alert that will be able to analyze several parameters of that drug-drug interaction, not just this patient falls into a generic category, but your patient is this age, this weight, on these other medications all at the same time; you may want to consider X, Y, and Z. That’s the complexity that it’s going to be there for.

I do worry a little bit about the industry just trying to put in drug-drug interactions from a generic platform across large organizations or large populations. I think you’re going to see more and more refinement, and hopefully, tools for which we can all share that information.

You’re starting to hear discussion on how are we going to build these repositories of CDS knowledge through perhaps the AHRQ or other groups who could help us catalog that information that could then be more easily implementable. Right now, that’s the most basic, core format — things like drug-drug interactions that have very low utility.

The average hospital subscribes to First DataBank or Multum or whoever and then just selectively turns things on and off because that’s all the time and resources they have. How much of the value of decision support are they really getting by just looking at those warnings versus real guidance that let doctors make the right decisions instead of telling them when it looks like they didn’t?

I can share our internal experience once we began looking at specific drug-drug-based pairs. When I started five years ago, we had a large population of drug-drug interactions that were overridden 100% of the time. We had pairs that were 98-99% of the time. You start to see the incredible burden that has. That may lead to alert fatigue.

I think we need to continue to study alert fatigue. There may be a critical CDS rule or intervention that is very specific and very sensitive and very important to be addressed. If, however, that’s firing in a constant bombardment of 10 or 20 interactions and interventions, the truth is, you will begin to ignore the most important interventions.

Our attention in the last several years has been to turn off the generic, non-specific items and build more and more custom. I think it really does create some challenges for smaller organizations to address that. I just have to hope to continue to see the industry and some of the specialty societies in informatics and AHRQ who can then help us come up with more specific proposals for effectiveness in the CDS space.

The announcement just came about of the three big hospital systems that licensed their order set content to Zynx. That didn’t work so well when Eclipsys paid a fortune for Brigham’s BICS rules back in the ‘90s. Do you think that the rules that one facility creates are useful to others?

There again, you get into some of the local details that need to be built, as opposed to the medical evidence that needs to be somewhat codified. That’s where I look.

I know the AHRQ has a project underway to look at screening recommendations. Those are pretty straightforward on the evidence, but once again, that information is very helpful for us to share. Even our experience on the effectiveness of a certain rule may be useful. But as far as sharing the actual codified rule, even among Cerner clients, that’s often just a template to get started, but it often takes the customized work from the local environment.

I can give a couple of examples. What is the correct value of a potassium warning? Is it 5.0, 5.5, 6.0? You can look at it a lot of different ways, but often the sensitivity and specificity is inversely related as those levels go up. Somebody at some point must make an objective decision what it’s going to be. Is it going to be 5.5, 5, or 6? Most often, you’re going to need a local decision on governance to see what your final flag might be set at.

Isn’t that kind of a conundrum, though? All these rules that are very black-and-white specific, yet every hospital says, “I don’t like the way those come.” Is medicine really scientific enough that a rule ever fits?

You can continue to imagine, with a large amount of data points, to make them more and more specific. Like I mentioned earlier, the more specificity you can have on a patient’s age and weight and previous medications and previous problems, they give you more data elements to make the rules and interventions more specific. But once again, you’re looking at large computing power. You’re looking at ways to not negatively impact response time, for instance.

It remains, I think, one of the big challenges in the field is to have things that have a very high positive predictive value — that when an alert fires, it changes behavior. I guess the ideal state would be that’s the only kind of intervention that would fire is when it changed a behavior. Most groups think well, if you can get above 50%, you’re probably doing a pretty good job, but approaching 100% will be very difficult. If you can get above 50%, most of your users are finding things more helpful than annoying. That’s probably a reasonable goal for most interventions.

You can measure that. Are you shutting off those that don’t change behaviors?

Absolutely, and that is another component of the work required to have effective CDS is that monitoring. As I mentioned, we do analyze response to alerts. We look at the clinical outcomes, not just the response to the alert.

Another interesting fact we’re discovering is there are times in which the alert is overridden, yet later, the correct behavior is changed. At first thought you say, “Well, they overrode the alert; therefore, it was useless.” But it turns out, in certain situations, you’ve at least prompted them to think about things. You notice as you analyze more data that they actually did make a positive response.

Certain elements such as warfarin dosing with an elevated INR — that’s been a classic example where we’re seeing that those alerts are helpful even when they override the initial alert. They can maybe dose it more correctly later in the stay and during the days of administrations. It’s a component of correct design and monitoring and continuous feedback to make them better and better for the users.

I think people miss the fact that CPOE itself is clinical decision support even without all the warnings and alerts because it presents only the most common orders and the preformatted doses. Would you agree?

I absolutely agree. I think that’s what you find in the folks that do this work longer and longer. You realize that clinical decision support is really a comprehensive approach that includes how you structure your data. How you present information is even a form of decision support.

Then, the computer-based logic is only one component, but how you build the order sets, the choices you give for selections, are often — we use the phrase, “You want to make the right thing the easy thing.” You want to make the right thing in the information you present them; the right thing in the orders and the sequence of the orders, the choices that are most available; and the right thing in a clinical decision support rule that may help catch things that were missed at first. All of those elements together help you have that comprehensive approach that’s necessary, I believe.

You’ve done some work with mobile devices.

That’s been an interesting journey as well. We were a very early adopter, six or seven years ago, at Memorial Hermann. At that point, I think there were some big technology barriers — large devices, heavy batteries, needing an internal wireless network connection — that were a struggle.

Now we’ve advanced into more the iPhone-enabled group. Once again, it’s the right device with the right information at the right moment. The big one we’ve seen a huge success on is the AirStrip OB product, which allows fetal monitoring to be seen by our obstetricians. They can talk directly to the nurse about what patterns they’re seeing. It’s had a large and growing usage with our obstetricians. It’s wonderful to hear from the nurses that they feel so much more connected to the physician in being able to review strips remotely together and then making a good decision. That particular product has been very well received.

We’ve not really gone into clinical systems on our mobile platforms. We have a trial coming up this summer of one we’ve internally developed for the iPhone, and it’ll just be a snapshot of patient data. The great thing about iPhones and web development is that those things can be pretty straightforward to produce, and so we’ll be trialing our own internal version of that later this summer. We’ll continue to see.

We’ve understood vendors are out there with CPOE Lite products, but at a certain point … I’m not sure. It might be a nice bridge to help physicians though it, but for a large enterprise, I’m not sure it’s going to be the kind of solution that they’re looking for.

You mentioned that you’re pretty comfortable, or had an early start at least, on Meaningful Use. Based on the proposed criteria, how prepared is Memorial Hermann and what to-dos do you think you need to accomplish to be ready?

I guess the biggest one is going to CPOE at what percentage at our hospital. We have 11 hospitals. Our first two hospitals came live with CPOE.

We clearly had the strategy. The hospital would come up and we’d get the hospital totally up to a 75% or higher physician ordering usage. Once we had that, we quickly realized at that point, that was the inpatient ordering, and we then realized that it was critical to have our ER on the same system. So, we actually took a pause and we have installed the Cerner FirstNet product while that was going forward. With that, all of our ERs are going CPOE, so that’s really the first unit in all of the other hospitals that will go live with CPOE.

Well, Meaningful Use came out and said there’s a 10% threshold. We thought, well that’s great, because the ER would cover that 10%. Then, to find out they’ve actually excluded the ER from that calculus at present.

Once again though, we’re not going to alter our strategy. We’re going to finish our first wave of rollouts. Then this fall, we’ll have additional hospitals coming up. But we still believe that we need to have a hospital-wide approach. We don’t want to get on a partial 10% of every hospital just to get the number. Some of our hospitals will be delayed. 

That’s probably the most challenging of the measures to hit. Most of the other measures we have good plans for and projects in place. I think we should be able to meet the other objectives pretty straightforwardly.

Any concluding thoughts?

As a physician, I got into this field of medical informatics, you know, you want to make a big difference for an organization and for patient care.

The longer I’m in this, you start see that people, process, technology triangle that defines medical informatics. I think it continues to be in that order — the people, the process, and then the technology. I’m finding that with the right amount of money and the right engineering and support staff, you can get the technology right.

The people and process of healthcare are challenging in the nature of healthcare. Often they’re just challenging from being the cottage industry that we are. That individual autonomy is such a strong current. But you hope and you start to see that by providing tools that provide consistency and standardization and provide value that you can help drive hospitals and populations to improve care.

I think that’s what I continue to focus on, really — the people, process, and technology. If we can keep focused on that, hopefully we’ll continue to do good work.

Monday Morning Update 5/24/10

From Healthcare Idiot Savant: “Re: Allscripts. They are supposedly near to announcing their acquisition of the Centricity software, the old IDX suite, from GE. Timing?” I’ll guess June 1.

From Lady of Spain: “Re: editorial. Tell me what you think about this editorial. Incredibly uninformed, right?” Too many wordsmiths claim to be HIT pundits just because they’ve churned out a few articles or interviewed people from the sidelines instead of actually working in healthcare or IT. All in all, this one isn’t the worst I’ve seen, though, just not very insightful.

 
I’m running an old (legal) copy of Office XP at home since I don’t use it much, but I figured it was time to upgrade. I’ve been running the Office 2010 beta and I like it just fine, so I’ve been watching for deals on the licensed version, due out this summer. Here’s one that I just bought this morning: Amazon has Office Home and Student 2007 for $99.99, free shipping, and a free upgrade to Office 2010 when it comes out. Plus, that package includes three licenses that can be used by members of the same immediate family, so you’re down to as little as $33 per user. If you don’t need Access or Outlook, this is a great way to get the 2010 versions of Word, Excel, PowerPoint, and the underappreciated OneNote cheap. It’s a strong clue as to why Microsoft is struggling — remember when Office cost something like $400?

Speaking of Microsoft, who can resist watching an overweight, red-faced Steve Ballmer nearly stroking out on stage as he hysterically professes his undying love for everything Microsoft? I feel cheated that he didn’t freak out equally at HIMSS a couple of years ago.

According to my last poll, around 58% of HIStalk readers think a single-vendor strategy is a good idea for hospitals, primarily because integration and support are theoretically better. Those who like a best-of-breed strategy instead most often cite weaknesses in individual applications as a good reason not to give one vendor all the business. New poll to your right: if you were diagnosed with a psychiatric illness and your doctor or hospital shared your electronic information with other providers, would you be comfortable that it would remain private or would you worry about that?

Dell spent $760K lobbying the federal government in Q1, with an unnamed but apparently significant part of that amount going toward influencing decisions about HITECH money. Microsoft spent $1.72 million during the same period, also hitting HITECH.  

Flush with taxpayer cash, ONCHIT is hiring.

A retired Cincinnati cardiologist will get $23.5 million for his role as whistleblower in a DOJ lawsuit against the Health Alliance of Greater Cincinnati and Christ Hospital, accused of preferentially scheduling cardiologists based on the number of referrals they generated.

Doctors at a Minnesota hospital are beta testing technology from American Well that allows them to communicate with patients via videoconferencing, IM, and VoIP. I think I’d love that, either as a patient or a doctor. The problem has always been that few people using desktop PCs had webcams or microphones, but now that most PC sales involve laptops, those are usually standard. That’s a significant yet seldom observed development when it comes to online collaboration.

I ran a reader’s question about whether Jefferson Regional Medical Center of Pine Bluff, AR could really have upgraded Eclipsys Sunrise to 5.5 in 30 days. JRMC CIO Patrick Neece was nice to provide this summary:

JRMC and Eclipsys finalized the implementation plans at the end of March 2010. The upgrade steps began the first of April 2010 and took approximately 30 days. The implementation encompassed all of the Sunrise Clinical Manager components we have implemented in the hospital including house-wide clinical documentation and core functionality for med/surg and sub-acute areas, critical care, 12 ambulatory clinics, emergency department, labor and delivery, Sunrise Pharmacy, Knowledge-Based Medication Administration, Device Integration and other related components. It also included installation of additional hardware, Microsoft software upgrades, configuration changes, report changes, testing, and training for the technical staff and end users. As with any upgrade, there were problems that had to be worked through, but we were highly confident in the JRMC and Eclipsys team who preformed the upgrade and that we would have a successful implementation.

Former HIMSS Analytics CEO Dave Garets, now with The Advisory Board Company, joins the board of Health Care Data Works, a Ohio State spinoff led by former OSUMC CIO Herb Smaltz that sells a data warehouse solution. The company offers a pre-built Meaningful Use dashboard (above). 

A Hawaii clinic’s inconsistent and time-consuming EMR data reporting process is improved after a local technology company’s change. The article doesn’t name the EMR vendor or describe the change that was made, but it says one report that took 55 hours to run now takes less than a minute. It sounds to me like they added database indexes.

Listening: brand new (actually not even released yet) Stone Temple Pilots. Billboard has the entire album up for free streaming. Sounds pretty good. Also, The Rural Alberta Advantage, Canadian indie-electrofolk.

Some Indiana hospitals divulge what their electronic medical records projects will cost: Community Health of Munster, $40 million for three hospitals and doctors. Porter Health System, $11 million for upgrades. Methodist Hospitals, $30 million for Epic. Sisters of St. Francis Health Services, $125 million.

The University of Florida Health Science Center and Shands HealthCare announce a $580 million, five-year collaboration that includes implementing Epic across the system.

Now that I’ve got a Facebook page, I see that I should wish my new FB friend John Halamka a happy birthday this Sunday, with John Glaser’s coming up on June 2. Thanks to all who have friended me and who have clicked “like” on the HIStalk widget to your right. Social networking is exactly like high school, including the competitive aspects, so public displays of even virtual-only camaraderie are important to one’s standing.

E-mail me.

News 5/21/10

From Skinny Little B: “Re: Advance for Health Information Executives. It’s officially dead, even though the staff were told not to tell readers or advertisers that the May issue was the last one.” Former editor Bob Mitchell is a good guy; his last day there was a couple of weeks ago. Maybe not admitting defeat is like hanging a “remodeling” sign on an obviously closed restaurant — a Hail Mary that somebody will buy it before word gets around that it’s defunct (like among the advertisers). They may try to salvage the non-print parts of the business like they did for the HIM magazine. I can only imagine what a disaster it would have been if I’d been running it, considering that I use a $5 invoicing program, I refuse to do anything to encourage prospective sponsors except e-mail a crude information sheet if they ask, and I keep turning down all kinds of brilliant money-making ideas because I don’t really care about money all that much and I’m lazy. So I give them credit for hanging in there for what must be at least a dozen years. I used to read it and like it.

From Hans Solo: “Re: Colorado RHIO. A big win for Medicity, beating out incumbent Axolotl.” Colorado RHIO chooses Medicity’s platform for its statewide HIE. The organization plans to cover 85% of the state’s providers and hospitals within five years.

From Nancy: “Re: Jefferson Regional Medical Center. The press release on Eclipsys 5.5 says they did the upgrade in 30 days. Is that really possible?” The headline also claims that unnamed users declared it “blazing fast and fun to use,” but doesn’t provide details anywhere in the actual writeup. Maybe a reader from JRMC will chime in with details.

From Limber Lob: “Re: MUMPS and Cache’. MUMPS takes hits because it’s still around after 30 years and many of the ancient MUMPSters are coding the way they did 30 years ago. Old COBOL, RPG, and Pascal programmers have all passed on instead.” I like that analysis and will extend it: companies like Epic and Meditech hire trainloads of noobs and train them on a language they’ve surely never heard of even if they majored in computer science. Since it’s more of an apprenticeship, they can also train them to follow their own internal programming standards and utilities, which are arguably more important than the choice of programming language anyway. It may be true that only in healthcare would a robust market still exist for applications written in something that quirky and old (or “industry-specific” and “time-tested” if you’re a glass-half-full type). Bottom line: it works, the vendors can support it, and customers shouldn’t (and apparently don’t) care about the invisible underpinnings.

From Epic Cleans Up: “Re: Atlanta. Epic will own the Atlanta market, having won the business at CHOA, Grady, and Emory (soon to be announced). It’s not surprising given the superior software, services, and support of Judy and her team. However, it should be a wake-up call to local companies that failed, including Eclipsys, McKesson, and Philips.” Unverified, but I will say that being local isn’t really much of an advantage. And, that those companies you mentioned are surely wide awake and well aware of exactly what they’re up against. I’ve been a customer of all three of those local outfits (well, Philips is from the Netherlands, but I’ll allow it). One of them was excellent, one was very good, and one I wouldn’t wish on my worst enemy.

Jobs from the sponsor job board, where sponsors post free just because we are really nice: Implementation Consultant, Cerner Ambulatory Consultant, Regional Solutions Consultant, Healthcare Market Research Manager. On Healthcare IT Jobs: EMR Project Manager, Ambulatory Technology Trainer, Cerner Orders Consultant, Clinical Director of Field Marketing.

The health minister of Saudi Arabia is visiting Children’s Hospital of Michigan to check out its Cerner electronic medical records system. I’m not sure why since they’re already running Cerner in Saudi Arabia, but maybe they need fresh ideas.

Dell’s Q1 numbers: revenue up 21%, EPS $0.22 vs. $0.15. The former Perot was a bright spot, while PC margins weren’t.

I decided I needed a Facebook page so I won’t have to keep using Inga’s login to add to the HIStalk page (man, that’s confusing). Anyway, if you want to friend me, just search for HIStalk and I’ll pop up in all my smoking doc glory. I’m helping that obnoxious kid who started Facebook add to his several billion dollars so he doesn’t have to lifeguard this summer.

Weird News Andy and I agree: this story is sad. An admittedly inebriated woman in England falls in a bathroom, embedding a six-inch toilet brush handle in her pelvis. She tells doctors what happened, she shows them the bleeding wound, they take an x-ray, and they still can’t find the problem, so they send her home on pain meds. After two years of constant pain, she finally convinces them, but dies of massive blood loss in a 10-hour surgery to remove it, the hospital’s third attempt. Her husband summarizes, “I think it was probably down to the hospitals trying to save money and doing things as cheaply as possible … I’m sure she would have got better treatment in foreign countries.”

Miss Russia 1998, who was a physician back in the Motherland, is charged in New York with forging a Vicodin prescription using a prescription pad stolen from her psychiatrist’s office. She was already on trial for a nearly identical case. I will make a flimsy argument about illustrating the benefits of e-prescribing in order to justify running her picture.

Listening: reader-recommended Jonathan Tyler and the Northern Lights, bluesy straight-ahead rock. From the look and sound, I thought I’d traveled back in time to see Grand Funk Railroad, which isn’t necessarily a bad thing.

Inga and I appreciate our new HIStalk Platinum Sponsor, Navicure of Duluth, GA. They’re a medical claims clearinghouse, meaning they help their 20,000 physician customers get paid (eligibility, claims, remittance, recovery, productivity). The company is on several “fastest growing” lists and – get this – they GUARANTEE that every call is picked up in three rings or fewer, which as they say, is because their client services area is “purposefully overstaffed.” They also have a 90%-plus “would recommend” rating from clients (video testimonials are here). Check out their blog, The Daily Practice. You may also remember that CEO Jim Denny wrote a Readers Write piece in October the value of clearinghouses. Thanks much to the folks at Navicure for supporting HIStalk.

Nurses in Australia picket a local hospital over incorrect pay caused by a new payroll system, a problem still unresolved after five pay cycles.

The CEO of Bend Medical Clinic (OR) writes a good blog post that explains to patients what an electronic medical record is and why they use them.

A group of Florida hospitals is using a BCBS grant to track employee reports related to infections and and surgical outcomes, rather than the usual billing data. They hope to convince CMS that billing data is worthless in trying to monitor clinical results.

Greenway’s PrimeSuite EHR for the iPhone and iPad.

Baptist Health cranks up Philips VISICU eICU in its five San Antonio hospitals, where a critical care team monitors their 134 ICU beds from an office building.

Yet another sobering malpractice verdict: a six months pregnant woman is turned away by the local trauma center, whose NICU doc says his facility can’t handle a preemie that small. They call an ambulance to take her to another hospital an hour away. She delivers in the ambulance, but the baby suffers brain damage and cerebral palsy. The malpractice jury returns a $10 million verdict against the county’s non-profit ambulance service. The hospitals had already settled for $1.4 million.

North Adams Regional Hospital (MA) fights with its nursing union, with ergonomics being a key union bargaining issue. Said a union rep, “We’ve had two instances where a computer station on wheels has fallen on a nurse.”

E-mail me.

HERtalk by Inga

maxIT Healthcare and Ingenuity Solutions Group enter into an agreement to combine as maxIT Healthcare. The merger expands maxIT’s expertise with Lawson ERP solutions. Ingenuity President and CEO Phil Summer will now be maxIT’s National Practice Director.

PatientKeeper announces the availability of Mobile Clinical Results on the iPad.

Hoag Memorial Hospital Presbyterian selects Patient Care Technology Systems’ Amelior EDTracker solution for its new emergency department opening in Irving, CA later this year.

DigitalPersona, the provider of U.are.U fingerprint biometrics, will integrate its product into ScriptRX’s products. ScriptRX provides touchscreen EMR and discharge systems for ERs and urgent care centers.

For all our readers who are 7th grade boys (or 7th grade boys at heart), here’s an opportunity to come up with all sorts of tasteless jokes. HP Labs calculates that a hypothetical farm of 10,000 dairy cows could produce enough energy to power 1,000 servers.

Greenville Hospital Systems (SC) selects MedAssets for revenue cycle software and services.

RCM provider Accretive Health offers 10 million shares in an IPO that raised $120 million. The $12 per share price was well below the proposed $14 to $16/share.

E-mail Inga.

News 5/19/10

From Epic Watcher: “Re: USF. Heard that GE did not go well, Epic has been chosen, and the docs are signed. Just what I heard and I am looking to triangulate. Kinda what you do sometimes, Mr. H, if that IS your real name!” Unverified on both counts, but I’ll always answer to Mr. H since Inga started calling me that way back when and I’ve warmed up to it.

From MaxPayneUK: “Re: value probe. Is iSoft/CSC the prime target after missing ‘must meet’ delivery targets? Or BT/Cerner CCN3 because of value?” The British government will review all spending commitments made since January 1, with IT contracts a key focus of cost-saving initiatives.

From The PACS Designer: “Re: Office Live Workspace. Since Windows Office 2010 is now released for businesses, the next step is the release next month for consumers. TPD has been testing Office Live Workspace for use with Windows Office 2010 to compare it to Google Documents. Also, Microsoft just announced that Office Live Workspace is becoming Windows Live SkyDrive soon.” Sounds a lot like Google Docs except you need a licensed copy of Office on your desktop (Microsoft will imitate Google in nearly every way except when it comes to giving stuff away).

Government healthcare IT contractor Quality Software Services will hire up to 70 people for its new South Carolina office.

Physician Michael Westcott, CMIO of Alegent Health, and pharmacist Jeannell Mansur, medication safety practice leader for Joint Commission Resources, will present a Webinar on medication reconciliation next Thursday, May 27 at 2:00 p.m. Eastern. Design Clinicals is sponsoring.

Strange: up to 55 people getting free blood glucose screenings offered by physician assistant students are exposed to blood-borne diseases when the students fail to change out the glucometer’s lancets between patients.

Indiana appoints Andrew VanZee, a former Logansport Memorial Hospital VP, as the state’s healthcare IT coordinator.

Cleveland Clinic grants Carefx an exclusive license to sell its business intelligence dashboard, developed by the clinic’s startup subsidiary IntellisEPM.

Listening: I’m still enjoying old and new stuff from Hole, but a reader recommended Neon Trees, a Provo, Utah pop/rock band that sounds to me like Muse meets The Cure. I like it.

Weird News Andy notices a blog’s rant against a MEDSEEK ad campaign in which a Facebook page was created for a mythical patient named Sara Baker who updates her wall with chatty descriptions of her healthcare interactions that often involve electronic services like those offered by MEDSEEK. Perhaps the page has been changed, but from what’s there now, it’s hard to believe someone would mistake Sara for a real patient, although obviously the folks leaving heartfelt congratulations for Sara’s new twins must have been gullible (or maybe they were enlisted to help add realism). My opinion: it’s brilliant! The only thing worse than bad publicity is no publicity. Whoever wrote Sara’s postings (probably a young marketing intern somewhere) did a nice job in making it realistic. It’s giving me all kinds of ideas for various stunts a la Fake Steve Jobs (check out the Ballmer Reviews iPad video – “No Flash, no Farmville, no porn, no sports – now I know why Steve calls it Safari – ‘cause it’s a hunt to find a Web site that works on this thing.”)

The Care Collaborative (Ascension Health, Adventist Health System, and Catholic Healthcare West) licenses its collective order sets to Zynx Health. HCA has already signed up.

Doctor Dalai describes big PACS problems in all hospitals in Western Australia, where a new version of Agfa IMPAX is apparently behaving so erratically that one hospital called a Code Yellow (a disaster that prevents accepting new patients). Dalai also says that previous versions were so flaky that radiologists were bringing in their own non-Agfa image reading software on USB sticks so they could continue to provide patient care, only to have the IT department delete the software and threaten them with disciplinary action. Another article confirms the problems with a hospital source, adding a fun tidbit in which the Department of Health apparently has blocked internet Web access to Dalai’s site.

A Texas hospital runs Doc Shop, a speed dating type event that connects doctors looking for patients with patients looking for doctors.

United Arab Emirates hospitals are using government-issued ID cards to check patients in faster.

E-mail me.

HERtalk by Inga

PEPID announces the availability of its medical and drug content tools for Google Android devices.

Demand for skilled consultants is high, according to a new KLAS survey of healthcare providers. Thirteen firms enjoy significant mindshare, up from just five in 2007. CSC tops the list, followed by Vitalize, Dell, and maxIT Healthcare. Providers striving to achieve Meaningful Use guidelines are leading the demand for skilled consultants, though another key driver is the migration of Meditech clients to the 6.0 platform.

Health Management Associates (FL) will add enterprise-wide CPOE functionality to its PatientKeeper solution.

The federal government won back or negotiated approximately $1.63 billion of your money last year and sent 77 people to prison for Medicare fraud.

Lest the government hold onto your money too long, the HHS says it will conduct two surveys to learn more about patient perceptions and preferences related to HIT. ONC will collect data on patients’ opinions of EHRs, while the HHS Office’s Assistant Secretary for Planning and Evaluation will determine user satisfaction with personal health record programs.

Thirty-six hospitals conducted mass layoffs in the first three months of 2010, just one fewer than the same period last year. The number of affected employees, however, dropped from 3,003 to 2,516. The figures do not include a couple of key layoffs in April, including 1,000 from St. Vincent Catholic Medical Centers (NY) and 511 from Jackson Health System (FL).

CMS selects Northrop Grumman to develop a National Level Repository to process HITECH payments to providers meeting Meaningful Use objectives. The order is valued at $34 million over one year with five and one–half year option periods.

Providence Equity Partners pays $17.25 per share to buy Virtual Radiologic Corp. That’s about $294 million, which represents a 42% premium of the three-month average stock price.

A widow sues her husband’s doctors after he dies of uterine cancer. No, he never had a uterus, but he did receive a transplanted kidney from a woman who died of uterine cancer. His NYU doctors said that even though the transplanted kidney was covered in tumors, they felt he had a less than 1% chance of contracting uterine cancer. Sadly, the 37-year-old died just seven months after the transplant.

I finally made it to the Apple store this weekend and checked out the iPad. It was love at first touch. Must. Have. One. Don’t exactly know why, but I’m sure that I can’t live without one.

Centegra Health System (IL) is partnering with Dell to launch Centegra Physician Network, a newly created HIE. The HIE will be built on Axolotl’s Elysium Exchange platform.

The 471-bed Jefferson Regional Medical Center (AR) becomes the first hospital to activate Eclipsys Sunrise Enterprise 5.5.

Kudos to United Health Foundation for extending a three-year, $3.3 million grant to Daughters of Charity Services of New Orleans. The funds will be used to support and expand the new Daughters of Charity Health Center-St. Cecilia in the city’s 9th Ward.

Universal Health Services (PA) will purchase behavioral health provider Psychiatric Solutions in a $3.1 billion deal. Together the companies will have 196 behavioral health facilities and over 19,000 licensed beds, plus 25 acute care facilities with 5,500 beds. UHS expects to realize $35-$45 million in annual cost synergies; 35-40% of those synergies will come from the elimination of PSI’s senior management.

Mount Auburn Cambridge IPA (MA) extends its 10-year relationship with MedVentive.

The Dallas Morning News takes a look at the region’s larger health systems and how they (and their EHR vendors) may be putting patient privacy at risk. Cerner, used by Tenet Healthcare, is mentioned for its practice of sharing patient data with drug companies. athenahealth, which provides Cook Children’s Health Care System its physician EHR, is cited for its plan to offer discounts to providers willing to share patient data. The announcement by three other large health systems that they will share patient information between their separate Epic systems also raises privacy concerns. Patient privacy advocate Dr. Deborah Peel is quoted in the piece, using an analogy that Paris Hilton surely appreciates and that likely makes Mr. H chuckle:

“Once your information is released, it’s like a sex tape that lives in perpetuity in cyberspace. You can never get it back.”

E-mail Inga.

Readers Write 5/17/10

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!

Medical Image Sharing: The Future is In the Cloud
By Eric Maki

Is the world coming to an end — the healthcare IT world of proprietary silos, that is? When it comes to the sharing of radiology images and report files, the answer appears to be an emphatic YES.

My facility, the Great Falls Clinic in Great Falls, Montana is just one of dozens I know about that now share full-resolution images and reports via cloud-based technology.

The approach works seamlessly. Both uploading and downloading aren’t much more complicated than sending an e-mail with an attachment. No one needs to babysit the process, which at a leanly staffed rural clinic like ours, is a big advantage. And there are no requirements to establish and maintain the link, unlike the VPNs that were our workaround until recently.

There are advantages to proprietary healthcare IT technology. But when it comes to sharing images, proprietary IT has posed challenges throughout my entire state. Because nearly all of Montana’s medical facilities are less than full-service, we often have to transport patients with major issues to a large hospital in the nearest big city. The docs there, of course, want to see whatever imaging studies and accompanying info we generated at our facility. Proprietary IT forced us to use VPNs or other workarounds like burning and sending CDs.

There was also a major expense involved in all the time we spent to maintain our VPNs every time we installed an IT upgrade such as a beefier firewall. Some of my colleagues in Montana who relied on CDs for file sharing were having other frustrations. Sometimes the CDs couldn’t be read on the recipient hospital’s computers. Sometimes the CDs were damaged, couldn’t be read anywhere, or worse, were lost and never found.

We were fed up with this situation in our state, so 30 of our facilities formed an organization to search for a better solution. We called it Image Movement of Montana, or IMOM. We asked several PACs vendors for ideas and, fortunately, one had just developed a cloud-based service that met our needs. It required no new capital acquisition of hardware or software and bypassed all the proprietary hurdles that had plagued us to this point.

The Great Falls Clinic was one of the six facilities that tested the system on behalf of all 30 IMOM members. It worked pretty much without a hitch. A problem that vexed us for many years was suddenly solved, just like that.

The system we use is called eMix, but there are other players in this game — LifeImage and SeeMyRadiology, for example. From what I’m reading, there may soon be more cloud-based image-sharing services available. It’s clear to me that the medical image sharing’s future is in the clouds.

Eric Maki is manager of information technology at the Great Falls Clinic, Great Falls, MT.

NHIN CONNECT Code-a-thon
By iReporter

ONC sponsored what it called an NHIN CONNECT code<a>thon held in Miami a few weeks back. Like the IHE Connect-a-thon held earlier this year in Chicago, this forum’s attendees were primarily hands-on senior software architects and engineers who are refreshingly working together to tackle our industry connectivity woes. 

This meeting had three components. The main one was two days of in-depth collaborative sessions to discuss a variety of technical topics regarding the current CONNECT version as well as group planning for future version features. The second was the CCD template competition won by Georgia Tech that you highlighted here.

The third and most important component in terms of potential long-term impact on the industry was the creation of the Electronic Health Record Interoperability Special Interest Group (EHRI-SIG). To a standing room only audience (and 60 online participants), the CONNECT team presented their ideas and reached out to the private sector for help in establishing a group committed to advancing the state of practice involving medical record interoperability. 

One unique idea presented involved the use of XMPP, a protocol underneath applications like Skype and instant messaging. The idea presented was to exploit this protocol for implementing new communication and exchanges between doctors, patients, personal health records, laboratories, and pharmacies. Another interesting discussion revolved around the CONNECT teams’ desire to implement no-click solutions and to stop the phone from ringing in the doctor’s office.

The meeting video/audio and presentation and audio can be found here.

This modest event could very well signal the beginning of how health information exchange will fundamentally be changed and accelerated in this country. By combining the best of the NHIN CONNECT industrial strength “trust fabric” with the some of the same concepts being considered within NHIN Direct, this effort is positioned to provide a “sweet spot” that likely will appeal broadly to health care industry stakeholders as they tackle meaningful use under Stages 2 & 3.

EHRI-SIG will be making specific decisions on how to move forward at its second meeting in DC on June 2.  As a true working meeting, attendees are required to submit short use case descriptions and be representatives of EHR, lab, pharmacy, PHR, etc. vendors so that the outcome of the discussion can potentially translate into enhancing their own product capabilities. Information can be found here.

This initiative is an open challenge to the healthcare industry vendor community to demonstrate true leadership at a critical time in order to improve outcomes by getting the right information to the right person at the right time. It will be interesting indeed to see who steps up and who does not.

Creating Efficiencies through Enhanced Communications: Alerts and Notifications
By Jenny Kakasuleff

With the recent passage of health care reform and the 30 million newly insured individuals estimated to enter the marketplace, providers are under increasing pressure to improve productivity and efficiencies to meet increasing demand. These challenges must be met while simultaneously improving the quality of care patients receive.

Historically, providers of health care services have taken a piecemeal approach to implementing health information technologies. This has resulted in a number of disparate systems that do not communicate with one another, and contribute to a growing army of devices that health care providers must haul around with them, or have at their disposal in a largely mobile environment.

The alerting and notification systems still in use at many hospitals today are a conglomeration of proprietary systems and devices utilized to perform one particular function — a bedside monitor that sends an alert to the central nursing station to report a change in a patient’s vitals; a tracking system that allows any provider with computer access to locate a device; or a lab information system that sends an e-mail to indicate an abnormal lab result.

While this approach provides many individual solutions to overcome past inefficiencies, it has been uncoordinated, and as a result, creates its own set of problems. The responding provider is saddled with a number of different communication devices to perform a range of non-standardized tasks.

Most professionals today have the ability to perform all of their business-related (and personal) activities via a single mobile device. We make phone calls, check our e-mail, manage our calendar, pay our bills, locate people and places using GPS, listen to music, connect with friends and family through SMS text and instant messaging, or through social media networking — all through one multi-functional device. It is amazing that the same demand is not pervasive in the medical sector.

Health IT solutions now exist that not only address the problems of the past, but work to streamline the disparate systems currently in use into a single, standardized messaging system that delivers a range of alerts and notifications of varying importance to the appropriate recipient. Also, with the integration of an enterprise-class communication solution, providers now have the ability to receive alerts from each proprietary system — electronic medical record (EMR), hospital information system (HIS), nurse assignment, lab information system, etc. — via a single device powered through a unified communications system.

Different messages are delivered based upon their level of importance and escalated until its receipt is acknowledged. The HIS is then updated and auditing trails create a measure of quality tracking and control. The recipient can then respond to the relevant options generated without locating a phone, computer, or other staff member.

As the American Recovery and Reinvestment Act (ARRA) forces health care professionals to evaluate how best to implement and utilize their EMR systems to qualify for meaningful use incentives, their approach should be holistic; cognizant of current and future challenges; and focused on gaining as much mileage as possible from the investment.

Jenny Kakasuleff is government liaison with Extension, Inc. of Fort Wayne, IN.

Monday Morning Update 5/17/10

From Skyline Pollution: “Re: non-profit UPMC. They may be paperless, but can’t do without their $1.7 million skyscraper signs, according to the spokesperson for the multi-million dollar CEO. More help desk support and nurses could be had for that chump change.” CEO Jeffrey Romoff, who took a 25% pay cut this year to $3.6 million, admits that UPMC is being sued by a local sign company for an unpaid balance, but says the company’s work was substandard because high winds delayed hanging the 20-foot-tall “M” in “UPMC” atop the 64-story US Steel Tower.

From Larry’s Pizza Guy: “Re: Oracle. With the buyout of Sun completed, Oracle is reworking the contracts for EGATE/JCAPS Integration Engine clients to be based on the number of cores of a system instead of the actual number of interfaces being used. The clients’ only option is to invest time and money to replace the engine(1+ year process) or paying the outrageous increased fees (200,000+ more) to continue using the EGATE/JCAPS.” I hadn’t heard that, but I’m not a bit surprised since a lot of CEO Larry Ellison’s $30 billion in net worth came from charging licensees for theoretical usage capability rather than usage itself. Or, perish the thought, just selling the product for a fixed price. Imagine how much more money Bill Gates would have been worth if Word was licensed by CPU power or by the number of words typed. I’m still a market forces guy, so if Oracle is taking advantage of customers, those customers should bolt for a better option.

From Better Late: “Who do I call when my Monday Morning Update isn’t delivered on time?” Funny. I usually publish Saturday evening, but a pretty wonderful getaway with Mrs. HIStalk took me offline until Sunday afternoon. If it’s any consolation, you’ll get that late-breaking Sunday morning HIT news that you would have missed otherwise (irony meets irony). Thanks to those who expressed concern, best wishes, or consternation – it’s nice to be noticed.

A Wall Street Journal article called Smart Money: Is Your Favorite Charity Spying on You? highlights Sharp HealthCare, which uses data mining software to identify patients who might be financially capable of becoming hospital donors. The article points out that hospitals are even training doctors to identify prospects, and once a VIP has been tagged, hospitals may give them perks such as free visitor parking passes, direct access to staff, and priority appointments with specialists. The president of a philanthropy group admits that such targeting is kept quiet by nonprofits because it “creeps a lot of people out.”

I’ve been involved in a couple of CPOE implementations and they went well, so I’m a little surprised that 33% of respondents to my poll believe that CPOE makes outcomes worse. Maybe theirs didn’t go so well, or maybe CPOE sounds more dangerous theoretically than it really is to those without first-hand experience. Anyway, in the new poll to your right: is a best-of-breed application strategy a good or a bad idea? The poll accepts comments, so feel free to add yours along with your vote. Ed Marx stirred up a lot of commentary from his post that touched on that topic, so let’s see the consensus.

Speaking of Ed, thanks to him again for his inaugural HIStalk post, which drew a lot of thoughtful discussion. I posted his response at the end of the original article, so it’s worth a re-read.

The 150-bed Robinson Memorial Hospital (OH) recently chose Eclipsys Sunrise. The local paper discloses the overall cost of its EMR project: $39 million, or what seems to be $260K per bed.

A rare Weird News Andy weekend factoid, which he calls “Oh, the irony”. Financial organizations consider bailing out Greece’s debt-ridden economy want it to privatize its expensive government-run healthcare system, a leftover from the country’s previous Socialist Party rule.

A group of Baltimore hospitals, including Johns Hopkins, donates technology to the city’s fire department that allows EKGs to be transmitted from ambulances to hospitals, allowing faster diagnosis and treatment of heart attacks in progress.

In Ireland, a hospital requests an urgent review of its 20-year-old IT system because it poses “consequential risks to patient safety.”

Ohio State University Medical Center will operate retail clinics inside Giant Eagle grocery stores.

A local newspaper article covers the use of AirStrip OB monitoring software at Somerset Hospital (PA), paid for by us federal taxpayers.

Alpharetta-based healthcare data solutions vendor MDdatacor raises $2.6 million in funding.

Meditech says it will add 300 employees this year to its current 3,000 to keep up with customer demand.

A night shift security guard at a Texas clinic who spent his last scheduled night on the job hacking into 14 of his employer’s computer systems pleads guilty to two charges of “transmitting a malicious code” and faces 10 years in prison for each count. He hacked the clinic’s HVAC system (apparently feeling a need to mess up the air conditioning) and another that contained patient data. He’s not the brightest bulb in the circuit: the self-styled “GhostExodus” posted a dry run of his adventure on YouTube (above – some language is PG13) which led to his arrest. This isn’t an entirely original observation on my part, but the line between known criminals and security guards (especially those of the rent-a-cop variety, which GhostExodus was) is often blurry.

Vidyo introduces its telepresence system for healthcare that uses a standard broadband connection instead of a dedicated network. The system, which the company says costs around $1,000 per user or 85% less than competitive offerings, is being used by North Region Health Alliance in Minnesota and North Dakota.

A Delaware state congressman, chair of an “obscure” committee that recommends which government programs to end, subpoenas a state auditor for information on the Delaware Health Information Network. He says he wants to know where DHIN has spent $20 million in taxpayer money. The auditor calls the subpoena “a joke”, adding that “All you need to know is they sent out the subpoena and a press release at the same” and that the audit would have been completed earlier without having to deal with the surprise subpoena.

Anyone who likes to make fun of healthcare’s reliance on MUMPS and the Cache’ database: the European Space Agency chooses Cache’ to support the Gaia space mission that will map the Milky Way. Now who’s the rocket scientist?

E-mail me.

News 5/14/10

From The PACS Designer: “Re: an iPad challenger arrives. While the iPad gets all the press briefings, there’s a similar device called the Notion Ink Adam, brought to TPD’s attention courtesy of a posting by Michelle W. on HIStalk. It looks pretty cool, operates using the Tegra-Android platform, and best of all, it only weighs 1.35 pounds.” The company says they won’t release it until Flash works, which is probably a big mistake since the iPad doesn’t support Flash either and they’re letting Apple saturate the market in the meantime. It’s supposedly coming out in June for around $300, which would be an attractive price point if it works as advertised.

From Ex-Cerner Guy: “Re: Millennium and FDA’s MAUDE database. Not a huge surprise. Orders in Clinicals and FirstNet were designed and written by non-clinicians, with implementation done by non-clinicians. Try to find a Cerner Physician Executive in the field with more than two years under his or her belt. The referenced problem was evident at the Children’s Boston roll-out of FirstNet. From a sales standpoint, we used WYSIWYG-YBLI: what you see is what you get, you better like it.” Unverified.

From NorwichSammy: “Re: William Backus Hospital. Their attempt at digital cardiac access using GE’s Muse has been a big flop. It seems that paper trails are more effective for the clinicians.” Unverified.

From NoSleep: “Re: Hackensack University Medical Center (NJ). They successfully went live with Epic on May 1. It was a big bang cutover of all inpatient units, ED, radiology and several outpatient departments including nursing documentation, mandated CPOE, and medical device integration. Epic Ambulatory EMR and Practice Management will go live starting July 1, including both hospital and private practices in the rollout schedule. Rather than hire additional FTEs or engage consultants to implement Epic, HUMC recruited clinical and operational staff from within the organization, consolidated them within IT, and sent them to be trained and certified by Epic. As a result, the project was implemented on schedule and under budget. HUMC will retain its own in-house staff with expertise to support Epic.”

 

From the desk of Weird News Andy: a guy in Austria missing both arms passes his driving test by using a mind-controlled robotic arm. In England, a transsexual challenges NHS’s decision not to pay for her breast enlargement operation, claiming her female social life isn’t that great and that local street kids are calling her names because she doesn’t look like a woman. WNA editorializes a bit: “So, how many cancer patients won’t get the drugs they need to live so she can feel good about her appearance? How about, oh, I don’t know, paying for it yourself?” Lastly, WNA notices that NHS is using fear to convince patients to opt in to its Summary Care Record, warning them that its propensity to lose paperwork may expose them to NHS errors if they don’t sign up. 

SAP will buy Sybase for $5.8 billion. I hadn’t thought about Sybase for years since its healthcare dabblings have been infrequent and uninspired, but maybe I missed something.

Inga and I are a little behind, as evidenced by folks who are re-sending us e-mails when we don’t respond immediately (connected world expectations are sometimes unreasonable, I’ve noticed). We will catch up, I promise, but it may take a couple of days. Darned day jobs.

Abu Dhabi Health Services Company extends its Cerner deal to cover all applications for all of its areas, including its Lighthouse quality improvement solution.

Housekeeping: check out the Jobs Page. Drop your e-mail address in the Subscribe to Updates box to your upper right to get immediate notification when I write something new. The search box to your right now uses the new search engine I installed, so it covers all HIStalk sites (HIStalk, HIStalk Practice, and HIStalk Mobile.) The “Find us on Facebook” box to your right has adorable pictures of HIStalk readers, but also a link to our Facebook page (which Inga and I are using more often) and the thumb-up icon that gives us a Like when you click (thus temporarily soothing our raging insecurities). And as always, please support our sponsors by perusing and clicking their ads to your left, since they in turn will be motivated to continue supporting HIStalk. Thank you.

McKesson signs a big deal to implement PACS in Ireland.

How to tell you’re a hospital fanboy: when on vacation, you can’t resist following the blue signs to check out hospitals you’ve not seen. I knew a hospital executive who carried an AHA guide in his car and would choose routes that would let him check out all the hospitals along the way. He’s probably still doing it, only now with a GPS.

McKesson shares hit a 52-week high after analyst upgrades, although still below their 1998 (pre-HBOC scandal) prices. Thursday’s closing price was $68.99.

Jobs: Oacis – Clinical data Business Analyst, McKesson HED Consultant, Advanced Programmer Analyst – Interface, Meditech LSS Consultants.

Amcom’s messaging platform now supports Android smartphones.

Genesis HealthCare System (OH) will spend $40 million on an unnamed EMR (it’s Epic, of course, which should be obvious given the price and the fact that nearly every major sale is theirs these days).

Long term care operator Advocat names its IT consultant David Houghton as permanent CIO.

I see that Ed Marx’s first column here generated many comments about HIT vendor relationships. I thought both those who agreed and those who didn’t made their points quite well. Inga is sending out Ed’s PowerPoint as promised to all who commented and provided an e-mail address.

Integrated Document Solutions says it has implemented a cloud-based, RIS-less teleradiology system driven entirely by speech recognition and templates, all within 30 days.

A now-fired hospital employee of Perry Hospital (TX) is being investigated by police after allegedly using a doctor’s password to sign off on mammograms. The hospital has contacted 900 patients to have theirs redone.

A Forbes editorial by PatientKeeper CEO Paul Brient notes that all three technologies covered by Meaningful Use have been around for two decades, failed to hit double-digit adoption, and were avoided because they couldn’t pay their own way.

Odd: several dozen New Mexico residents are surprised to find themselves named as plaintiffs in a lawsuit against the local hospital. Most of them signed what they thought was a petition because a local guy asked them to.

E-mail me.

HERtalk by Inga

Henry Schein promotes Keith Slater to VP and GM of Henry Schein Medical Systems.

Northeast Georgia Health System says QuadraMed’s AcuityPlus nurse staffing management system generated $901,000 in first-year benefits. A 60% improvement in nursing productivity goals saved $659,000 in overtime and contract work and another $241,000 in incentive pay.

Diagnostic imaging provider InSight Services Holdings selects MobileMD’s HIE solution to provide electronic orders and results exchange for physicians.

A CIO involved in an HIS search shared with me his observation that the vendors that spent more time in due diligence gave better demos that met the hospital’s needs. A good reminder that cutting corners in the sales process can cut you right out of a deal.

St. Vincent Health (IN) deploys ZynxOrder to standardize evidence-based order sets. The 19-facility health system built over 350 order sets.

Grinnell Regional Medical Center (IA), Providence Kodiak Island Medical Center (AK), and Union Hospital (IN) are implementing eICU tele-health services from Philips Visicu.

Faith Regional Health Services (NE) anticipates a June 20th go-live on Siemens Soarian.

Medical transcription provider MedQuist releases its Q1 financials, which included a 6.3% decline in revenues to $74 million. Net income, however, grew from last year’s $6.8 million to $7.3 million. The company blames the revenue decline on poor February weather, which it says negatively impacted its transcription volume.

South Nassau Community Hospital (NY) selects the Capacity Management Suite from TeleTracking Technologies to manage its patient flow.

University Physicians Hospital (AZ) will use EmergisoftED for ED patient tracking and nursing and physician documentation.

Richmond Memorial Hospital (NC) is live on Wellsoft’s EDIS.

Here’s an interesting project to watch. SunCoast Health Partners is a joint venture between the SunCoast RHIO (FL) and for-profit partners. Using MedLink’s RHIO Financial Stability Model, SunCoast plans to offer products and services to over 500 practices in the RHIO, betting that providers will need clinical data to support their EHR investment. They expect to generate sales of over $4 million year in the first year and more than $7 million in the next four years.

And from a few of our much-appreciated sponsors, here are some quick updates:

• IntrinsiQ and eClinicalWork partner to integrate IntelliDose with eCW’s EMR/PM solution. eCW will offer the IntelliDose chemotherapy management solution to its oncology practice customers.
• ICA aggregates data from all core clinical systems within the HIE of Montana, which includes seven hospitals and more than a dozen clinics.
• Community & Dental Care, an FQHC in Monsey, NY, selects Allscripts Health Center Solution for its 30 multispecialty physicians.
• maxIT Healthcare announces plans to become an Eclipsys Certified Consulting Partner with Eclipsys, providing installation services for Sunrise Enterprise release 5.5.
• EDIMS and Medit Corporation form a strategic relationship to combine the EDIMS ED system with Medit’s MiRapidAccess registration tools.
• IntraNexus appoints Tom S. Visotsky VP of sales and marketing.
• Medicity announces that its iNexx platform will be generally available August, 2010. It will be free for physicians, allowing them to automate referrals to providers on the platform.
• EHRScope releases the beta version of EHRScope Reviews. End users and consultants can add information to their (free) database, so offer your opinions here.  

E-mail Inga.

CIO Unplugged 5/12/10

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

Maximizing Vendor Relationships
By Ed Marx

Vendor management can frustrate even the most elite organization. You can love ’em or hate ’em, but you can’t live without them.

Over the years, I’ve learned to take a proactive approach that allows both the organization and the vendor to achieve their goals while providing maximum benefits for the health system. Here is our simple structure.

Categorize Vendors

First, stratify vendors into four categories. You may find a better framework than what is presented below, but the point is to define how you team up with each vendor. The following categories and principles work for us:

Strategic. Out of hundreds, the vendors that qualify as strategic can be counted on one hand. Elevate these relationships to partnership status at an enterprise level. Consider them health system partners, not merely IT strategic partners. Our C-suite partakes in the selection and then personally invests time in relationship maintenance. Strategic partners identified: transformational, high-dependence, high-cost exposure vendors, and those with whom we wish to increase business. As CIO, I’m the primary relationship manager. I devote my time and energy exclusively to our strategic partnerships.

Tactical. We work with two dozen tactical suppliers. We’re similarly intentional on how we screen and invite these vendors. Tactical suppliers are typically smaller in cost and exposure and are transactional, yet they’re critical to the success of our organization. My direct reports divvy up ownership responsibilities for these important, exclusive relationships.

General. Given the existing business relationship, there’s nothing negative about this category. On average, however, these vendors supply commodities that provide little opportunity to differentiate. Therefore, we spend less time and energy with them. While we expect to maximize this relationship, we continually remind general vendors that maximization will not reach the same level as with strategic / tactical vendors. Our managers and directors own these general vendor relationships.

Emerging. This finite category of vendors has a small initial presence that we expect to build over time due to great potential. Emerging suppliers may come from our tactical or general relationships or may be a net new entrant. My direct reports manage these relationships closely.

Identify Vendors

As a Baldrige-oriented organization, we have a recognized and practiced process by which we discriminate between vendors.

• Supplier scorecards – service metrics, relationship, business model, technology, pricing
• Business technology alignment – opportunity, potential, direction, vision
• Deeper dive – presentations, discussions, research, vision
• Business technology meetings – share process, share strategies, mutuality, outcomes
• Tactical committee review – presentations, price models, benefits
• Strategic committee review – presentations, cultural fit, vision
• Decision – responses collected, responses aggregated, scorecard, decision

Manage Relationships Proactively

Each strategic, tactical, and emerging relationship is managed intentionally and includes formal controls. We also have codified rules of engagement:

• Relationship owners meet quarterly with strategic partners and conduct an annual, formal score card evaluation of both parties
• We arrange meetings between CEOs
• Strategic partners meet collectively once a year to review our organizational and IT strategic plans, working together to develop solutions. We meet offsite at locations that inspire creativity and innovation. This year we met inside Cowboys Stadium.
• We hold monthly follow-up meetings ensure we advance the collaboration.

(click to enlarge)

Next month, I will lead members of our C-suite on site visits to our strategic partners’ corporate headquarters to enhance the executive relationships. My hope is to bring about opportunities that will help fulfill our mission and vision. Although we are unable to devote equal amounts of energy to all suppliers, we do scorecard every strategic, tactical, and emerging vendor annually.

Measure Outcomes

To measure benefits differently for each level of supplier, consider the following: quality of product and service, shared value, maximization of investment, branding, influence, price points, and innovation. Assessed annually, these outcomes are part of the scorecard process as well as topics of discussion among executives on both sides. This forum for transparency and accountability leads to a win-win collaborative approach.

On a practical note

Suppliers persistently seek the CIO’s attention. I wish I had the energy to meet with each one. Having a structure and proactively managing vendor relationships allows me to treat all vendors fairly and frees me up to focus on what matters most.

By concentrating exclusively on our strategic partners, I can ensure that we exploit both investment and commitment. The described process above values vendor interests while optimizing benefits for our health system, clinicians, and patients.

To encourage comments, I will send a generic version of our strategic partnership framework to all who post. The framework contains significantly more detail.

Update: Response to Comments Posted Through 5/14/10

I appreciate the richness of the responses!

A couple of comments. As stated in the post, we work with hundreds of vendors. By definition this implies that we do not have a single vendor solution. There are so many variables to consider and it comes down to the uniqueness of each institution and culture. For us, we have found that a hybrid approach works well. A handful of broad based vendors and BoB. That said, the point of the post was not a position on either but rather the advice that you must maximize your vendor relationships. One way this can be achieved is with structure. It is not a new concept, but it is yet largely unpracticed.

With vendor partnerships, especially with those that are considered strategic, you need to build in formal controls so that the relationship does not go sideways and either party gets scarred. These controls and rules of engagement address things like kickbacks and do not allow for discounts for “talking up vendors”. I touched on this briefly and those of you who left your e-mail, you will get more detail shortly via the generic framework.

In fact if you like what you receive, let HIStalk know and I will send out our very detailed scorecard and review system. It is hard for me to believe that vendors and customers do not sit down together at least annually and score one another. It leads to some tough conversations that are crucial for shared benefit and success. You are what you measure.

I happen to agree with the sentiment that healthcare IT is so far behind and other industries are more customer-centric. You need to read my post Why Healthcare IT Lags.

One of the things we analyze when considering a vendor relationship is the leadership. I believe our strategic partners have had the same CEOs in place for many years. We look for consistency in leadership, so we have not hit the revolving door issue that someone asked about. All of our strategic, tactical, and emerging vendors have made these reciprocal relationships. If they don’t, it is not a relationship and we will end it.

I smiled when I read the comment that our vendor framework is flawed for lack of physician input. I am fortunate to have three physicians in IT and, trust me, they are not shy and I am thankful for this. In fact, they are one of the main reasons we have been so successful with leveraging IT. We have an IT governance council made up of many other clinicians and our C-suite includes an additional three docs.

I am wise enough to know that customer input is a key success factor. I shed my office 15 months ago so I would not become too comfortable. Instead, I spend more time with my customers in their environments. You don’t know me. Keep reading and you will.

You know, I am not sure on the question about inadvertently creating an internal hierarchy based on which vendor you might work with. I can see the point. None of my team has mentioned this as an issue, nor have I seen any behaviors to be concerned with. But I also know that despite my direct team engagement, I can be sheltered. I will need to watch out for this.

So for my IT colleagues, either manage your vendors or be managed. For my vendor readers, if your customer does not have a framework, recommend one. The benefits are mutual. We need one another. I am fortunate to work with many incredible vendors and feel good that we have a fair and equitable framework from which we can build on.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this 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 5/12/10

From Snoop John B: “Re: Cattails MD. Heard its implementation at Ministry Health has been suspended because of poor upgrade quality.” I asked Ministry CIO Will Weider, who says the implementation has not stopped. Three clinics are live and planning is underway for the remainder. They are reviewing their plans and figuring out how to incorporate Meaningful Use. Will was nice enough to provide a summary:

There have been the usual surprises and unanticipated occurrences. So, this won’t be my first flawless large clinical project. In March the system (it is hosted by Marshfield Clinic) had some stability problems. That may be the source of frustration from your source. It was frustrating for us too, but Marshfield Clinic, led by their CIO, has taken ownership of their problems. We at Ministry are also working through our issues. The situation has improved and Marshfield Clinic has bent over backwards to provide us reports to monitor stability. They are also quickly updating their systems to prevent recurrence of the problems. They have been very transparent in their efforts. I have lots of different clinical system vendors, so I can put Marshfield Clinic’s support in perspective. They are better than most, but admittedly, the bar is not as high as I would like. As you can see, I am not afraid to share the good and the bad (hence the blog name candidcio.com). Our contract doesn’t contain a gag clause like many vendors. So, I will email you directly if our plans change.

From 153 Anecdotes: “Re: FDA’s MAUDE database. Updated with additional anecdotes.” MAUDE is FDA’s database of voluntary reports of adverse events caused by medical devices. There are quite a few reports related to Cerner Millennium, although there’s no way to tell if they were filed by one disgruntled practitioner or several concerned facilities. Some (most?) of the reports involve design complaints rather than actual examples of patient harm, such as: “This cpoe product allows doses to be ordered that are not a multiple-s- of the pill size.”

From Nolo Contendere: “Re: does anyone do background checks? [Name omitted] was recently hired as VP of sales for [vendor name omitted]. Here are links to public records. People are sending this all around, making the vendor a laughingstock.” I’m omitting the names and the links since I don’t want to get threatened, sued, or notified that the guy killed himself or something because I mentioned his crimes (theft, drug possession, driving violations, etc. with some jail time and house arrest). Or for that matter, notified that it’s someone with his name but not the same guy. If it is, he’s bounced around quite a few EMR vendors and has also been accused of stealing leads from competitors a la Glengarry Glen Ross.

From The PACS Designer: “Re: Google search enhancements. Google has made over 500 changes to its search capabilities over the last year. TPD likes one of the new search options that now appears on the left when you first begin your search effort.” I noticed the 3D logo, the left column that allows subsetting the results by source, and some minor redesign. I like it.

Listening: She and Him, musically marginal, but I’m crazy enough about about Zooey Deschanel in movies that I’ll listen to her sing.

Weird News Andy runs across PriceDoc, which he calls “Priceline for doctors” where prospective patients can name their own cash price for specific dental, medical, and vision procedures.

I got a really nice handwritten card from Brittanie Good, marketing director of Enterprise Software Deployment, who thanked Inga and me on behalf of Team ESD for mentioning their new sponsor ad. “We are very excited about our growth and refreshed changes, and we are proud to be a sponsor of HIStalk. We love what you do – keep up the great work!” I’m always amazed and moved that I have such supportive sponsors. I’ve stood the card proudly right beside my monitor.

A New York Times article titled The Agenda Behind Electronic Health Records pits athenahealth’s Jonathan Bush against ONCHIT’s David Blumenthal over the issue of whether HITECH is a cash-for-clunkers program for old-line vendors at the expense of upstarts or the logical way to goose EMR usage among reluctant providers. According to Bush, “Established technology is being given a federally funded new lease on life … Traditional health software now is on Medicare, being kept alive like grandma.” Blumenthal’s comment was that the government had to intervene to correct a market failure, saying, “The market doesn’t reward performance.”

Speaking of athenahealth, the company responds to Dr. Deborah Peel’s HIStalk editorial on athenaCommunity and patient privacy.

Jeff Surges, sales president for Allscripts, is appointed to the board of Merge Healthcare.

Voalté releases a white paper covering the use of smartphones at the point of care.

A medical group that provides services to correctional facilities in 25 California counties chooses eClinicalWorks.

Mac McMillan, CEO of IT security consulting firm CynergisTek, is serving (warning: PDF) as a panelist at a HIPAA conference sponsored by the Office of Civil Rights and National Institute of Standards and Technology that started Tuesday. His session involves OCR’s enforcement of privacy regulations.

Evidence-based protocol platform vendor Order Optimizer forms a strategic alliance with EHR vendor Prognosis Health Information Systems. Prognosis will make Order Optimizer’s protocols and orders available to its customers, along with its SaaS-powered merging engine.

Intuit will buy (warning: PDF) Cary, NC-based patient portal vendor Medfusion for $91 million in cash. Intuit (QuickBooks, Quicken, TurboTax, and Quicken Health) says it will use the Medfusion’s technology to enable patients to communicate with providers, review their health information, and track their healthcare expenses. They also mention the Meaningful Use requirement to give patients access to their records. Medfusion founder and CEO Stephen Malik will become an Intuit SVP and general manager. Allscripts announced a deal to distribute its patient portal a year or so ago.

Vanderbilt chooses Allscripts Care Management for discharge planning.

Nuance announces Q2 results: revenue up 19.2%, EPS –$0.05 vs. $0.02 due to the cost of its acquisition of SpinVox, which converts voice mails into text and e-mail messages.

Cottage Health System (CA) expands its use of Eclipsys applications by choosing the PeakPractice PM/EMR and Eclipsys HealthXchange to link community physicians with its inpatient Sunrise Enterprise system. The HIE product is powered by Medicity.

Northwestern Lake Forest Hospital (IL) says it saved $3.4 million in nurse labor costs through its use of the Kronos workforce management system to reduce overtime and agency use.

Hunterdon Healthcare (NJ) uses InterSystems Ensemble to connect its QuadraMed Affinity HIS to the NextGen PM/EMR of its physician groups.

Twelve hospitals in Australia sign contracts for the Emendo CapPlan capacity planning software. The company plans to enter the US market next year.

Apollo Hospitals, a private hospital operator in India, signs a deal with Cisco to deploy desktop-based telemedicine applications to rural parts of the country.

All Children’s Hospital (FL) will expand its use of GetWellNetwork’s education and entertainment system, courtesy of a donation from a local entrepreneur.

E-mail me.

Readers Write 5/10/10

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!

Thoughts About athenahealth
By Deborah Peel, MD

Another misguided, uninformed EHR vendor will discount the price of EHR software for doctors willing to sell their patients’ data!

How is it possible to be so unaware of what the public wants? The public doesn’t want anything new or earth-shattering, just the restoration of the right to control who can see and use their medical records in electronic systems.

Not only is the practice of selling your patient’s data illegal and unethical, but the new protections in the stimulus bill require that patients give informed consent before their protected health information can be sold. So selling patient data without consent is now a federal crime.

Quotes from the story:

• athena’s EHR customers who opt to share their patients’ data with other providers would pay a discounted rate to use athena’s health record software.
• athena would be able to make money with the patient data by charging, say, a hospital a small fee to access a patient’s insurance and medical information from athena’s network.
• Caritas Christi [Health Care] initially launched athena’s billing software and service in October and then revealed in January that it decided to offer the company’s EHR to physicians.
• How many patients would agree to sell their health records to help their doctor’s bottom line AND at the same time put their jobs, credit, and insurability at risk?

Health information is an extremely valuable commodity, so people are always thinking of new ways to use it.

What will athena’s informed consent for the sale of health patients health data looks like? Will athena lay out all the risks of harm? Will athena lay out the fact that once the personal health data is sold, the buyer can resell it endless to even more users? Will athena caution patients that once privacy is lost or SOLD, it can never be restored?

I guess some people are so out of it they do not realize what a barrier the lack of privacy and lack of trust is to healthcare. HHS reports 600,000 people a year refuse to get early diagnosis and treatment for cancer because they know the information won’t stay private. Another 2,000,000 refuse early diagnosis and treatment for mental illness for the same reasons.

Check out slides from a recent conference at the UT McCombs Business School on the subject of patient expectations, privacy and consent.

Deborah C. Peel, MD is a practicing physician and the founder of Patient Privacy Rights.

Thoughts About athenahealth
By Truth Seeker

Um, I think we need to settle down here, folks. I may be wrong, but I believe when athena refers to athenaCommunity and the exchange of information, they are referring to the following hypothetical scenario:

A patient whose primary physician is an athena customer needs to be admitted to the hospital. athena delivers to that hospital a clean, clinically accurate, and up-to-date record of that patient’s medical history and charges the hospital a few bucks. athena is able to charge the primary care physician a lower fee for their EMR service because they are shifting some of the financial burden to the hospital. And intuitively, this make sense for a couple reasons:

The push towards electronic medical records is to enable greater exchange of information and better coordination of care, etc So when athena talks about athenaCommunity, I’m fairly certain that they’re not talking about a sinister plot to share info with hospitals so they can refuse to admit high-risk or expensive patients. (Seriously, the conclusions people draw from articles like this without doing their homework can be completely ridiculous, but I suppose that casting baseless aspersions is just the nature of informed discussion in the Internet era.)

They’re just talking about handing the patient over to another provider and making sure that the new provider has a completely accurate and up-to-date record of that patient’s medical history, and of shifting the financial burden from the handover away from the primary care physician. What a "privacy disaster" … a sheer outrage!

And second, I’m no healthcare economist, but I’m pretty sure that a) the hospital really wants and needs that patient’s medical history and that athena is probably better positioned to deliver it in a more useful format than a lot of their competitors; and b) it’s probably worth a lot more to the hospital than a few bucks. 

I’m not an athena employee or other stakeholder, but I do think that they continue to think of innovative new solutions to problems, bottlenecks, and inefficiencies in the healthcare system. Unfortunately, they seem to have a bulls eye on their backs right now. I for one am happy that we have smart people like Jonathan Bush out there coming up with creative new solutions. 

Why Emergency Physicians Prefer Best-of-Breed IT Systems
By John Fontanetta, MD, FACEP

According to a recent report from KLAS, some hospitals are replacing standalone, best-of-breed (BoB) emergency department information systems (EDIS) with enterprise solutions that are leaving ED clinicians — and often their patients — unsatisfied. Why unsatisfied? Because the clinical functionality in enterprise solutions is both less comprehensive and less efficient for the ED environment and they are just so hard to use.

This report has re-energized the debate over the benefits of the two kinds of systems. IT professionals prefer the seamless interoperability supposedly offered by single systems, but the fact is that many large vendors have simply bought and shoehorned in a separate ED system. The resulting systems have their own interface issues.

Like many of my fellow ED physicians, I have found that a first-class BoB system tailored specifically to the needs of the ED, in our case EDIMS, offers a number of advantages. For example:

• Workflow in the ED is measured in seconds and minutes rather than hours or days. The fewer clicks required, the faster the care. At Clara Maass Medical Center, we can issue complete sets of orders in as few as three clicks, enabling our physicians to be more productive.
• Trying to retrofit an inpatient IT system to the ED is difficult because the ED is just so different from the floors. Customized ED order sets with a linked charge capture system means less delay between treatment and billing, not to mention a more accurate capture of charges, which has dramatically increased our per-patient revenue.
• In the same way, customized alerts that tell the ED staff what they’re forgetting to document cuts back on the number of claims denied due to missing or inaccurate information. At Clara Maass, we have slashed such denials by 75%.

One of the most important things about a good ED system vendor is responsiveness. The vendor should be able to quickly accommodate the ongoing changes in standards and regulations. For example, at Clara Maass, when the H1N1 virus first appeared in 2009, we had templates for recommended care and discharge instructions built into our system by our BoB vendor within 24 hours. And when we decided to create an observation area, they promptly responded with observation-specific templates and order sets and created a secondary note option for the observation physicians.

The EMR system has enabled us to make a number of other improvements in our ED. For example, we have reduced the average patient turnaround time by over 30%. We have boosted the number of EKGs we perform within five minutes of a patient coming through the door from 46% to more than 90%.

Overall, my specialty has been slow to adopt EHRs, not because we don’t see their importance, but because they have a reputation for being unwieldy and unresponsive to the requirements of the ED. With more and more EDs adopting BoB systems that are designed to support ED clinicians’ intricate and demanding workflows, physicians are starting to realize that an EHR can actually be an advantage in our fast-paced environment, rather than a burden. 

CIOs are finding that these BoB systems can offer the same, if not better, integration capabilities than a single, enterprise solution. While many of the HIS vendors are inflexible when it comes to working with other systems, BoB systems have always had to offer integration solutions and many pride themselves on their ability to integrate with almost any system.

John Fontanetta MD, FACEP, is chairman of the department of emergency medicine at Clara Maass Medical Center, Belleville, NJ and chief medical officer of EDIMS.

Digging for Gold in your HIT Applications
By Ron Olsen

Over the past few years, hospitals have focused IT budgets and resources on purchasing applications to enhance their HIS. Many facilities have spent tens or hundreds of thousands — millions for the larger hospitals — on licensing, maintenance, and ongoing professional services.

In the feeding frenzy to continually acquire and implement the latest healthcare information technology, most IT/IS teams are neglecting to ask basic but important questions about their existing applications, such as:

• Are we using the software to its fullest extent?
• Have we turned on every feature we’re currently licensed for?
• Are HIT products meeting the needs we identified when planning the deployment?
• Have we asked users what they’d like to see added to the product, and if so, has that been communicated to the vendor so they can include it in a future version?

Asking questions does not cost anything and end users are usually very vocal about what they’d really like to see software do for them. Their invaluable real-world input is useless if there’s no feedback mechanism, or if your team refuses to incorporate it into product roadmap discussions with vendors.

In a time in which hospitals’ funds are tighter and IT budgets frozen or cut, it’s time to double back and review what products you have purchased and their capabilities. Maybe re-present the product to different areas of the facility explaining existing functionality again, and introducing new features that have been added since the initial implementation. Now that the users have gotten a refresher, they may identify functionality that was not implemented initially and would now prove useful.

Healthcare technology vendors are always eager to showcase new features and theoretical uses for these at sales presentations, but IT/IS admins often overlook “hidden gems” in the software that other hospitals are actually using. If the vendor has a user group, listservs, or an online forum, these are great places to start, not to mention that they cost nothing and consume very little time.

These collaborative tools may enable your team to discover other use cases that even your vendors have not thought of. There are a lot of people in the healthcare IT trenches creating workarounds every day. There may be capabilities within current products to join with other systems within your tool bag to create a new or improved process that is, again, a freebie.

One of the most over-used buzz words in healthcare IT is “interoperability,” a is really a big word that self-important people use to describe data transfer. When thinking about data transfer at a basic level, almost every HIT product can output to a printer. A printer can be easily set up to print to a file. So now you have data in a file format.

Scripting tools can manipulate those files, turning them into almost any format imaginable. With the correct format, data can be transferred to disparate systems, individually or concurrently, via a data stream. This could be a raw text file, compressed zip file, encrypted e-mail file, FTP, or an HL7 file.

This method is easily applied to an enterprise forms management system. If it has a decision engine, you could print a form set from it and then have the engine input the data to a database for audit trails (you should be able to choose the data points). Next, the engine sends the data to a file and launches an application to text the ordering physician that the patient just presented, based on the data in the text file.

If you’re a budget-conscious healthcare IT professional who wants to better meet the needs of your user community, I implore you to take another look at the systems you’re already working with. In my many years as a system admin at a community hospital, getting more out of the tools available to me (instead of just relying on new purchases) helped me deliver more effective tech solutions to my users, positively impact patient service, and keep decision makers happy by saving money.

You, too, have gold nuggets hidden in your existing software. It’s up to you to find and use them.

Ron Olsen is a product specialist with Access.

Monday Morning Update 5/10/10

From MeHere: “Re: Millennium Medical. I used to work for them. I hope there’s a full-scale investigation into their unsavory activities. The IS guy would write up employees for forgetting to encrypt inter-office e-mail.” An unencrypted portable hard drive is stolen from the Chicago offices of the medical billing company in February, exposing the information of 180,000 people. Patients are complaining that they weren’t notified promptly and that the company is not offering the usual free credit monitoring.

From Nothing More: “Re: UPMC. DOH and CMS found ‘easily resolved differences over paperwork.’ I thought that hospital was paperless.” Inspectors find that UPMC did indeed match transplant donor and recipient blood types, but didn’t document properly because the paper form has only one signature line. Doh! And in other UPMC news, it’s on pace to hit $8 billion in annual revenue this year.

From MaxPayneUK: “Re: HC2010 conference. McKesson and Eclipsys were noticed there. Both will focus on the customer base of legacy supplier iSOFT and NPfIT programme player BT/Cerner.”

The Texas Board of Pharmacy hits Parkland Hospital with one of its largest-ever fines ($20,000) for allowing five outpatient pharmacy technicians to steal 370,000 oral doses of drugs in a one-year period. Cases against three supervising pharmacists are pending. The lesson learned is that Parkland did what most hospital pharmacies do — they took drug inventory only occasionally, estimated counts, and didn’t reconcile purchasing records to dispensing records. Parkland says it’s running a perpetual inventory now, always tough to do in pharmacies and ORs.

Meditech’s Q1 results: revenue up 10%, EPS $0.60 vs. $0.48. Very good numbers. I’ve confirmed that Howard Messing will be given both the president and CEO titles, subject to routine shareholder approval in the next few weeks. The company also announces that students at Northeastern University’s health sciences school will use Meditech’s clinical systems as part of their training.

You would expect clinical systems to be a top priority for providers, but I wouldn’t have guessed that portals would score so high. New poll to your right: based on experience, what impact do you think CPOE has on patient outcomes?

Congratulations to the Georgia Tech Flatliners, a team of graduate students that finished first, second, and third at the NHIN CONNECT Code-a-Thon Challenge held last week at Florida International University. The challenge was to create an online format for a Continuity of Care Document that a primary care doctor could use to take calls after hours. Medicity sponsored the team, which as a condition of its participation was required to donate the resulting style sheets to the CONNECT Open Source Community.

An MIT medical engineering student creates print management software and lands his own university as a paying customer for his new startup. The software is Web-based, does not require installation on print servers or desktops, and encourages “community engagement” by matching user groups as rivals to reduce their printing costs.

I appreciate the several companies that have asked about sponsoring the HIStalk reception at HIMSS in Orlando next year. It’s cool to have people thinking about it this early! Anyway, I’ve chosen the sponsor and we’ve already got the venue, entertainment, and menu locked down, just in case you want to mark your calendar now for February 21, 2011 for what will be a memorable blowout. I truly appreciate the companies who support what I do, not to mention the readers who make it worth doing.

Inga and I are writing up the results of the HIStalk Practice reader survey, which I’ll probably run this weekend. My favorite reader comment: “I just absolutely adore Inga.” Who doesn’t? She is entirely adorable.

I forgot to mention that with the rumored but unannounced demise of ADVANCE for Health Information Executives, Texas Health Resources CIO Ed Marx temporarily became a blogger without a home for his CIO Unplugged writings. He’ll be moving to HIStalk this month and I’ve posted all of his previous writings. I’ve tagged them all in their own category, viewable here.

Thanks to everybody who has clicked “like”on the HIStalk Facebook widget in the right column. I’m posting to the Facebook page that Inga created each time there’s a new posting and I’m seeing inbound clicks from it, so I think readers are finding it handy. Click the HIStalk logo or link to go to the FB page.

On the job board: Eclipsys SCM Consultant, Market Research Analyst, Epic Practice Manager. HIStalk sponsors post their jobs for free and can contact me to sign up.

The VA’s VistA Modernization Working Group recommends modernizing the VistA system by moving it to open source and dumping MUMPS as its programming language. The group’s chair says VistA is “outdated and difficult to maintain” and that “we don’t think MUMPS is the answer.” That’s an interesting conclusion given that Epic, Meditech, and other systems are written in MUMPS, a programming language that is almost certainly involved in more US healthcare encounters than any other.

And as I like to do occasionally, allow me to acknowledge Meditech’s Neil Pappalardo, who with colleagues created the MUMPS language and thus the HIT industry in 1966. He’s still my #1 choice of someone to interview, although Judy Faulkner runs a close second (both are MUMPS-made centimillionaires, I should note).

The non-profit Kaiser Permanente’s net income for Q1 was $706 million on operating revenue of $11 billion.

Here’s the danger of announcing one of those sketchy correlation-causation EMR studies: an overambitious headline writer summarizes as, “Doctors: Boot Up a Computer to Save a Life.” 

E-mail me.

HIStalk Interviews Brigid O’Gorman

Brigid O’Gorman is a junior at Connecticut College in New London, CT, majoring in cellular and molecular biology as a pre-medical student. She is captain of the women’s hockey team, a registered emergency medical technician, and winner of a $10,000 Davis Projects for Peace grant for her project to implement electronic medical records in rural Uganda. Connecticut College is contributing $3,000 as well.

While traveling to the airport with a group of Connecticut College students leaving on a medical mission to an orphanage in Kaberamaido, Uganda in the spring of 2009, a drunk driver struck the van in which they were riding, injuring several of the students and killing the trip’s organizer, who would have graduated in 2010, and in whose memory the clinic in Uganda has been renamed to the Elizabeth Durante Medical Clinic.

 
Brigid O’Gorman
Photo: The College Voice

Tell me about yourself.

I’m from Eden, New York, just outside of Buffalo. I live on a farm. It’s really fun, I love it. My dad’s a physician, an internist. My mother has her own flower business.

I went to Nichols School in Buffalo for high school. It’s a private school. I was captain of the women’s hockey team there. I also played soccer and lacrosse there. Then I came to Connecticut College and I’ve been playing hockey here since freshman year. I’m now the captain of the team. I played lacrosse my freshman year, but decided not to do that any more because it was during spring break and I’d rather go to Uganda during my spring break. That was my option and that’s how I got into this whole Africa thing.

Going to Africa has been something I’ve wanted to do since I realized I wanted to be a doctor. I’d always wanted to travel. I’d been to China and Africa was the next place on my list to go. I absolutely love it.

I found out about this opportunity to go in the fall of 2008 through my school. There was a pre-health club meeting which I’m a member of. So I went to this meeting and a couple of girls were up there talking about how they wanted to take a group to Uganda on medical mission. That was like right down my alley. I went to this other meeting and signed up for it and that’s when I got to go last year.

What was it that intrigued you about Uganda?

Nothing in particular. I would have been satisfied to go anywhere in Africa, quite honestly. Uganda is where these two kids started that group to go and they had been there the year before with Asayo’s Wish Foundation. They’re out of Salt Lake City, Utah. They have an orphanage in Uganda.

I ended up going by myself, but what we did last year was go with Asayo’s Wish Foundation. I worked at a medical clinic in this town where the orphanage was. I wasn’t so much interested in children, although that was really a fun experience for me. I worked with a doctor, mainly, and I kind of played around with the kids.

 
Brigid O’Gorman, Uganda 2009
Photo: Connecticut College

What were your impressions from a medical or public health standpoint?

I got to take blood samples and got to look at the malaria parasite under a microscope. It wasn’t powered or anything, but it just had a mirror that caught the sun so it would shoot light up through so you could see it. Obviously technology is extremely lacking. They only had one of those in this medical clinic.

The doctor had one nurse that helped him out. The way it works over there in these clinics is that the doctor just kind of showed up whenever he felt like coming to work, really. He would just, like, show up and people would hear that, “Oh, the doctor’s in his office, so we can go now.” They don’t set up appointments or anything — people just show up and line up outside the office. They just kind of sit outside on the ground, first come, first served. You get there early and keep it and you get an appointment.

He and myself, we got to give them all sorts of medication. I brought over a lot of antibiotics with me that were donated by my father’s office here, so we got to hand out antibiotics. Most of the people had malaria, so we’d have to hand out malaria medication. There was a lot of STDs, so we had to hand out antibiotics for that.

From a healthcare standpoint, they really need medicine. There’s nothing. There’s practically nothing. I’d say the bulk of the supplies they had I brought over with me. That was kind of special just to donate all those things to the people.

Tell me about the grant you got to set up electronic medical records and how you got the idea.

I got the idea because while I was there last spring, whenever the doctor had a patient come in, he would write down their symptoms and ask them questions like, what are you here for? He’d write down their symptoms and what he thought they had and what he was going to prescribe them in this little blue book. It’s just like an exam book that I take my exams in here, so I was like, wow, that’s really weird that I’m seeing these thousands of miles away from my college. It was used to keep their health records in. I thought that was a little perplexing, to say the least.

After he’d fill it out, he’d give it right back to them and say, hold on to it. It would have their past visits to the doctor in it so he could go back and look and see what they last came in for and if it’s any pattern or relation or anything. A lot of the patients didn’t have these, because the doctor gives it back to them, so most of them lose them because they don’t realize how important these things are. They have no concept of staying healthy or this whole medical record system. They weren’t concerned about holding out to this blue book, so it was often that they didn’t have one, which was difficult to try and figure out if this person had a previous medical condition that you didn’t know about.

When we were there, I also worked in the orphanage with about 180 children who didn’t have any medical records either. I kind of built on that foundation of the blue book they were using. I bought blue books there and we started health records for all these children. We wrote down their name and age. A lot of them didn’t know their age because they were orphans, so we’d have estimate their age from their weight or their height. We started that last year and I’m really hoping that it’s continued and people are doing checkups on them and doctor’s visits and things like that.

This was what got me to thinking that they need a more reliable system, I would say. I mean, how are these orphans going to hold on to these little blue books when adults can’t? I thought, I’m a college student and I know about computers, which isn’t that hard to figure out. It’s not that hard to install them. I’ve done it before and it’s simple.

I was planning on using the electronic medical software, hopefully from MEDENT. I haven’t purchased it yet. I know one of the company’s branches is in based out of Buffalo, so I was hoping to talk to them and hopefully get some donations of this system for my computers. One of my dad’s doctor friends has this MEDENT software at his office and I’m going to go see it. I’ve looked at it online and it’s pretty much what I need. I actually need a simpler form of it because I don’t need X-ray scans, I don’t need all the pictures and MRIs they can set up on these systems. I just need patient assessment, patient information, history, just very general, simple things. I’m going to try to work with them and get that going.

I haven’t bought my computers yet, but I’m going to get four of them from Dell. I’ve already talked to them about it. I’m going to have them sent to my house soon and get the medical software installed at my house and set up this whole little system at my house so that when I get to Uganda, I won’t have to worry if something goes wrong with the computers. There isn’t really going to be anyone there to help me, so I’m just going to try to set it up prior to getting there.

I know they have gasoline over there and can power generators. The electricity they have isn’t a lot. They only had one light bulb that actually worked and they ran it on a gas generator, so I figured that would be easy to power the computers. I’d just get a bunch of generators and I could help them power more and have more electricity at this place. That was my original idea. Then I was talking with one of my advisors here from school and she mentioned why didn’t I think about solar panels? I decided to look into the solar panel idea. I learned a lot about them. It sounds a little complicated, but it’s really pretty interesting. It’s not that difficult.

I’ve located a business in Kampala, which is the capital city of Uganda, that sells solar panels and will install them for you. That’s where I’m going to be purchasing my solar panels and I’ll be doing that when I get there. It’s an eight-hour drive from where they are to where I’m going to be, where it’s extremely rural and there isn’t anything around. They’re going to drive them out there and install them for me, which will be great. I hired an electrician already to make sure that the electricity works. I’ve hired a computer technician. These are all native Ugandans, so we’ll see what I get. I’m pretty excited about that.

 
Brigid O’Gorman, Uganda 2009
Photo: Connecticut College

What will your system do?

I’ll have two facilities. One is at this medical center and another is at the local hospital, which is turning out to be a little difficult because this hospital is a government-run hospital and it’s actually from what I’ve heard and found out from people who are working there right now has ended up being corrupt and things are getting stolen, so I’m not sure how much I want to invest in that hospital, but I’m going to give it a try.

My primary facility for this will be this medical center that is on the orphanage property. My plan is to have two computers, one in the patient room when a patient comes in. That will be there for patient visits. The second one will be in another office in the building. That will be for collecting blue books and transferring information from these blue books into the computers. I’m going to have a system where the information is transferred from these blue books to computers, and at the same time, the doctor will be doing his normal patient care. Instead of writing things down in their blue book, he’ll be putting it into the computers, so we’ll probably be tackling two things at once.

I’m bringing printers because they don’t have any form of identification over there. That got me thinking because when I got my driver’s license, you finally have that little card that identifies you. It’s just a huge symbol of who you are to my mind. To make ID cards for these people over there, I really think would have a huge impact on them. I think they would absolutely love it.

We’re going to have webcams to take pictures of each patient, so their information will be in the computer along with their picture so that you can recognize them. The picture and their name will be printed on this card and we’ll laminate it and give it to them. It will all be on the computer, so if they lose it, we can print them out another one.

I was also thinking about making ID numbers for each name, just so that you can enter the number or name either way so the person’s medical files will pop right up. They hand you the card, you type in their number, and you have their medical file immediately sitting in front of you. You know their whole history and you know everything that’s been wrong with them up until now. That’s my goal for those cards — just to give them the thrill of having an identity and something physical to hold on to that says they’re here, they belong here. And also to expedite their gaining of their medical files that are in the computers.

They’re going to be powered by solar energy, so after the initial purchase, so it won’t cost very much, hopefully nothing at all except maybe for maintenance which shouldn’t be too bad because solar panels nowadays are pretty durable.

Part of my proposal, so that the system doesn’t degrade after I leave, is to start training some of the older children of the orphanage. There’s 18- and 20-year-olds living there, so my idea was to start training them on these computers and have a different type of vocational program where I would teach them how to input the information and teach them all about computers and what I’m doing so that they are that much further ahead.

In a country like this, especially in this rural area, having the knowledge to work on computers would be huge for children there. Maybe someday if they wanted to leave that area, they could go and work for the government in Kampala; they could work wherever they want. That’s another piece of my project that I’m really excited about, just to help boost kids up and give them something to do with their lives. 

Elizabeth Durante, 1988-2009, photo overlaid with that of the clinic renamed in her memory
Photo: Asayo’s Foundation

If someone wanted to help you with this project, what else do you need?

I actually haven’t yet bought anything for it. I’ve been trying to concentrate on my school work right now. I’m a junior and I’m taking organic chemistry and it’s not easy, so I’ve been really focusing on my studies right now. I’m not leaving until July 1, so I have a lot of time once school’s over to start getting into it.

I’m going to be needing four computers, two printers, a laminating machine, the solar panels that I’ve already purchased over in Kampala, and any kind of electronic medical record software that I can install on the computers. I’m focusing on MEDENT because my dad’s friend has used it, he’s accustomed to it, and his office likes it, so that way I can get a feel for it from him.

I kind of need everything, but I do have the money for it, so that was really cool and I’m so happy to have this grant.

Other than the fact that the patient carries the record in Uganda, we’re not all that advanced in the US, where your record is in a manila folder on some shelf someplace and people debating whether it should be in a computer instead. What are your thoughts about that?

It’s a debate and there’s a lot of sides to it. I’ve discussed this with my dad because his office runs on those manila folders. They have the hard copy paper and that’s what their patient files are. He has files full of them.

The doctors I go to personally have the electronic medical record software. I work in the ER and that’s what all their systems run on. It’s definitely faster and more efficient, but you also lose the personal aspect of sitting down with the doctor and having them actually writing things in front of you and taking those notes.

It is a difficult debate, but I would have to side with the electronic medical software because it’s permanent and it keeps things safe. The personal aspect of it can be accomplished by doctors actually learning the computer rather than just dishing off information to a nurse or something and having them try to interpret their writing and put it in. If it becomes more familiar to people, it will be really good, but you can’t lose that personal connection between the patient and the doctor. That makes people comfortable and that’s why we’re doctors.

You’ve made time for a rigorous academic curriculum, hockey, and volunteer work. Are the people you know equally involved or are you different?

I never actually thought about that before this whole story started coming out. Recently I was nominated for the Hockey Humanitarian Award, which is given to the best hockey humanitarian student, male or female, from any Division I, II, or III college. That’s what got me thinking that I guess I’m not really normal. I really thought, don’t other people do these things? I really didn’t think it was that uncommon, but apparently it is.

I just do it because I love it. I love to travel. I fell in love with those kids I got to work with last year, so that’s why I really want to go back to this part of Africa. I just really loved the kids there and I’d love to help them.

My pre-med studies are going pretty well right now. Organic chemistry is not easy for me, but it’s OK. My other classes are fine. I’ve been playing hockey since I was four years old. My dad was my coach. That was my first love and I’ve been doing that forever. That got me into school and pretty much filled up my life and who I am.

I found this other volunteering stuff. I volunteer at High Hopes Therapeutic Riding center in Old Lyme. I got there every week once a day, usually Saturdays, for two or three hours. I lead horses around and we help mentally disabled or physically disabled children learn how to ride horses. It’s a therapeutic technique and it’s actually really, really exciting. I love doing that. I started doing that my freshman year and that really got me into volunteering. I coach younger children’s hockey camps and stuff like that in the summer and girl’s lacrosse camps. I like to do all that because I love kids and helping people.

What kind of medical career do you hope for?

There’s so many options. At first, I was thinking I’d like to be a pediatrician because of my experience with these kids over in Africa. That really put me toward that path.

Right now I’m not really looking to settle into a practice anywhere because my primary goal is to get into med school and work with Doctors Without Borders for a few years before I actually grow up or anything. I would love to work with them and travel with them wherever they need help. I would have gone to Haiti in an instant if I were an actual doctor right now.

Then maybe after I’ve had my fill of traveling around and adventure, I’ll settle down and be a pediatrician or maybe a primary care provider.

Does your father approve of your going into medicine?

At first, he didn’t really have much to say about it. He didn’t think that was a choice for me because you really don’t really have a life until you’re out of school, and still you’re a doctor and don’t have a life except for what you do. He wasn’t thrilled about that, but as I’ve been doing these things, he’s really come to see that this is what I want to do. He’ll bring up a topic like, are you doing these things right now and how are your grades and are you ready to do this? He’s really come around. Our entire family thinks this would be great for me, so I’m glad to have the support from them.

What schools are you considering?

Right now what I’m thinking is that my GPA is not exactly stellar. I’m at like a 3.0 right now because of this organic chemistry. Hopefully by the time I graduate I’ll have it up to a 3.3 or something, but medical schools want 3.5 or higher from what I’ve heard.

I’m probably going to do a post-bac program. Drexel has a good program. I think you get a master’s in public health and then they ship you off right into a medical school program from there, assuming you do well on your MCATs and do well in the classes. I’ve been looking at the University of Buffalo. Their medical school is where my father went.

I would like to stay closer to home, just to have that support, but I’m seven hours from home right now in Connecticut. I like that aspect of being away, too. It’s a difficult decision, but I will go anywhere I get in. I don’t really care what part of the country it’s in. I just want to be in med school.

If anyone wants to get in touch with you or offers help, I’ll forward their information to you. And if you have an interest in writing something up or sending pictures, I’m sure people will want to know how you’re doing over there.

First of all, I’d love the help if people would like to help. I have $10,000 in grant money so far and I’m going to be fundraising a little bit more, just to gain a little money for the orphanage itself and try and buy a lot of medications for this clinic that I’m going to be at, because other than this system, they really need the drugs to make everyone healthy again. I’m going to be doing a little bit of fundraising and a little bit of extra money would be helpful.

The electronic medical records software, if anyone comes up with an idea or wants to donate something about that or a simpler version of one of these high tech ones, that would be really helpful.

I’ll definitely get back to you by the end of August or the beginning of September. They actually don’t have Internet where I’m going to be and I’d have to have a lot more money to get it shipped in if I wanted Internet. I am two hours from an Internet site, so obviously my parents aren’t happy since they can’t talk to me very often, but I will be going back and forth from this town to get supplies because there’s basically nothing where I am. It’s just like a store, your orphanage, your clinic, and a whole bunch of homeless people, but I could be able to get in touch with you.

If someone is inspired by your story and would like to make a difference like you have, what advice would you give them?

Do what you love to do. That’s all I’ve been doing. I started out loving to travel, and then that got me out to Connecticut, and then I ended up in China, and then I ended up in Africa and fell in love with a bunch of orphans and taking care of people and volunteering. My advice is just do what you love and follow that because your potential is completely unlimited. Go for it.

News 5/7/10

From Sea Pea Oui Couvert: “Re: say it’s not true. This is not supposed to happen when the entire hospital is wired. Millions spent on EMRs, yet they forget informed consent and then cover up the adverse events.” UPMC’s transplant program is cited by state health department inspectors for violating federal regulations, including failing to document organ and blood matches before transplant procedures were started. The state got suspicious when UPMC reported only one adverse even in a year.

From A Tax’ing Employee: “Re: our CEO at Sunquest. He just moved to Tennessee for what I heard were ‘tax reasons’.’ He has never lived in Tucson for the same reason. Is that fair that he is allowed to live anywhere to dodge taxes and we are not?” Unverified. If it’s my money as a customer or shareholder, I’m cynical about work-from-home CEOs unwilling to relocate to the home office. It’s their call, though, and I’m probably more old school in that regard given today’s virtual organizations.

From The PACS Designer: “Re: iPad’s booming sales. Apple has sold one million iPad’s since the recent launch, the fastest sales results ever for Apple. As we head toward the middle of this year, it will be interesting to see if there will be any waning in the monthly sales figures for the iPad Wi-Fi version now that the iPad 3G version is available for sale.”

Several dozen provider organizations, including AHA and AMA, offer HHS their comments (warning: PDF) on Meaningful Use. They and I agree on the parts we don’t like:

1. The all-or-nothing approach, where you either meet all the criteria or get nothing (actually, I’m OK with that part as a taxpayer footing the bill).
2. The aggressive timetable for complex applications such as CPOE and medication reconciliation that aren’t usually front-loaded in implementation projects.
3. The overall short timeline.
4. The underrepresentation of small practices on the HIT Policy Advisory Committee.
5. The two EDI-related non-clinical requirements for eligibility and claims.
6. The definition of a hospital using Medicare provider numbers.
7. The parts I immediately pounced on when the proposed criteria were published  — manual chart pulls are required to arrive at a denominator for electronic performance metrics, such as the percentage of orders placed via CPOE.

Weird News Andy uncovers a gem: two employees of Olive View-UCLA Medical Center are placed on leave after complaints to Joint Commission that they are running a beauty salon out of the hospital’s NICU. They were giving manicures and eyebrow waxes to co-workers, with one complaint alleging that a doctor “had a French manicure right on the high-frequency ventilator.” WNA also likes this research finding: dark chocolate can protect the brain in stroke patients, which means I’m set in an emergency because I like to keep some of the good stuff (more than 50% cacao) around.

Listening: the new CD from just-reunited Hole. Courtney Love doesn’t do it for me and I was hoping to hate the new music, but the band kicks it even though they’re all suing each other and membership changes hourly. I’ll be playing this quite a few times, I suspect.

McKesson signs an exclusive deal to eventually manufacture, implement, and support the i.v.STATION Robot and i.v.SOFT Workflow Engine from Italy-based Health Robotics. It’s pretty hot stuff.

If you are a nurse, happy National Nurses Week, which started Thursday (happy birthday, Florence Nightingale!) I love nurses (literally, since I married one), so here’s a shout-out to the one group of professionals (both male and female) that hospitals can’t run without. I wrote this in 2003 in their honor, obviously from a community hospital perspective since I was working at one of those instead of an academic medical center at the time:

The only critical people involved in patient care are nurses … My experience is that 80% of patient care is directly influenced by nurses, often via skillfully planted recommendations that allow doctors to believe they thought of it themselves. Your patient satisfaction surveys are almost purely driven by the quality and compassion of your nurses. So is your level of patient safety. Nurses clean up the vomit, hug the babies, keep doctors from killing patients, give the drugs, do the Code Blues, and comfort the families. All the rest of us are hangers-on who look like deer in the headlights on the rare occasions when we stray into an actual patient care area where human triumph or tragedy is unfolding with a nurse at its center … Not too long ago, a hospital was basically a clean building in a peaceful setting (!) where patients could rest and mend. That and nurses were about all anyone needed. Hospital work was charity. No MBAs, no arrogant doctors, no government red tape, no formulary of 5,000 drugs, and no cadre of specialists making large salaries to do small tasks. Oh, and by the way, no computers either. You know what? Life expectancy wasn’t that much different (if you exclude the benefits of vaccinations and reduced infant mortality.) Costs were a lot lower. No one got rich in healthcare. Without all the research, the computerization, the fancy architecture, and the lack of John Wayne "I will not let this patient die" heroics, things weren’t really all that much worse when it came to living and dying. If I’m sick, keep the CEO, CIO, PFS manager, and risk manager out of my room and give me the best nurses you have. When you get right down to it, a hospital is still a clean building with nurses. Everyone else is supporting cast, even if their salaries make them believe differently.

Business Week frowns at hospitals that use technology to determine whether patients can afford to pay their bills. Apparently the business publication does not like the idea that customers may actually be expected to pay for the services they consume. I clicked its Subscribe Now link and, given that philosophy, was shocked to find that their subscriptions are neither free nor payable at the reader’s discretion.

Jobs: Epic Inpatient EMR Manager, Eclipsys Physician Consultant, Senior Applications Analyst – CPOE, Epic Clarity Report Writers.

ONCHIT announces $220 million in grants to establish 15 Beacon Communities that will prove the value of HIT. I don’t exactly get that since the message is that they wouldn’t have bothered without the $15 million taxpayer gift (which doesn’t make a strong case for proving value at all), but I gave up long ago trying to dissect the particular pallets on which taxpayer money is being parachuted down over the countryside into greedily outstretched provider and vendor arms. Even the City of Tulsa gets $12 million in federal money to screw around with electronic medical records and see if anything good happens.

I see that Google now has the Google Apps Marketplace that offers third-party add-ins to Google Docs and relate apps. One I noticed contains administrator tools for rolling out Google Apps to the enterprise.

Maybe the doc-in-the-box trend died and I never noticed: Florida Hospital’s Centra Care walk-in clinics now take online appointments, saying it will significantly cut down on wait times. Meaning that if you just show up, which was the whole point, you’ll sit around like you would in the ED except instead of a seriously injured trauma patient holding you up, it’s somebody healthy enough to have made an advance appointment. That and posting ED wait times to troll for non-urgent patients makes me wonder what the heck providers are thinking out there.

Inspectors from the VA find lots of problems with the brachytherapy program at the Philadelphia VA Medical Center, among them a VariSeed radiation treatment planning PC that was unplugged for over a year despite regular clinician reports that it wasn’t working. It also wasn’t running on the hospital’s secure network and was used by employees to get on the Internet. 

Merge Healthcare’s Q1 numbers: revenue up up slightly, EPS -$0.04 vs. $0.05. Now they’ve got a couple of hundred million dollars worth of AMICAS acquisition debt to service on top of that. 

E-mail me.
 

HERtalk by Inga

From Celtic Fan: “Re: athenahealth. Don’t know if you saw this article about athena wanting to increase its profile to compete better with the HIT Big Boys. Buried in the end of the article is some information on a new product called ‘athenaCommunity.’ Bet the privacy rights folks won’t think much of it.” athenaCommunity is slated to launch later this year, with discounts for providers willing to share patient data with other providers. Hospitals will pay athena a small fee to access patient insurance and medical information. I asked privacy guru Dr. Deborah Peel what she thinks about the idea. Celtic Fan predicted correctly:

This is an ABSOLUTE nightmare—it TOTALLY violates medical ethics and the patients’ rights to privacy — not to speak of Americans’ well-known constitutional rights to privacy. Physicians who go along with that could well violate state licensing laws which often require adherence to the AMA’s principles of Medical Ethics, as well as violate many state laws that REQUIRE informed consent for disclosures of many kinds of information, from genetic tests, to mental health information, to STDs, to addiction treatment information. athena and all the many vendors who coerce doctors to disclose patient health information without consent will have NO liability. Who do you think the patients will sue for violating their privacy? Their doctor, of course, who chose to use an illegal, unethical EHR system. athena will not pay for this massive privacy disaster —their doctor/users will.

British Columbia’s Interior Health Authority begins its Meditech 6.1 migration with technical assistance from Summit Healthcare.

IBM’s Integrated Health Services division launches a multi-year research project to determine how different actions may affect health. Big Blue will combine and analyze data from a wide variety of sources, looking for cause-and-effect relationships. The project will initially focus on childhood obesity.

Kronos reports second quarter revenues of $177.9 million, a 10% increase over last year. EBITA increased 28% to $41.3 million.

Data storage company Iron Mountain urges CMS to consider expanding Meaningful Use guidelines to include subsidies for digitizing paper records. Iron Mountain’s efforts remind me of similar pleas from the transcriptionist organizations, who think digitized transcription records should be recognized in the final Meaningful Use equation.

I’ve yet to venture to the Apple store to actually touch an iPad, though a field trip does seem to be in order. This HIT writer observed a in-store demo, of sorts, where a Genius was educating a group of healthcare providers on a variety of healthcare-specific applications. Sounds like Apple wants to assure a  piece of the healthcare pie.

Clarian Health is changing its name to Indiana University Health next spring, in part to reinforce its partnership with Indiana University and the IU School of Medicine. Clarian owns or is affiliated with more than 20 hospitals and health centers in Indiana.

PatientKeeper presents Oakwood Healthcare System (MI) with its customer innovation award, recognizing the more than 1,000 users (600 of them physicians) who are using the company’s patient portal since its December introduction.

Hospital CIOs rank EMRs and CPOE as their top IT priorities for the next two years. Other high priorities include database initiatives, bar-coded eMARs, and hospital expansion. Among hospital IT managers and directors, EMR was ranked a mere 7th, far below PC refreshing, security initiatives, and CPOE. Another interest data point: the majority of hospitals were either developing telemedicine programs or already had something in place.

Albert Santalo, founder and CEO of the Web-based practice management company CareCloud, is named the Best Up and Coming Technology Innovator by the Great Miami Chamber of Commerce.

York Memorial Hospital (PA) selects Recondo Technology’s SurePayHealth solution for revenue cycle management.

The Texas Health Services Authority hires CTG to help plan the implementation of statewide HIEs.

Here’s a fun fact to share at your next cocktail hour. By 2020, the amount of digital information created within a year will reach 35 zettabytes. If you put that amount of data onto DVDs, they could be stacked halfway to Mars, making them quite inconvenient to access from your couch.

Gartner reports that Dell has gained the largest market share in HIT, making it the world’s largest provider of HIT services in the world. The ranking is based on 2009 revenues generated by both Dell and Perot Systems.

The 130-provider Jackson Clinic (TN) plans to move from its Misys EMR to Allscripts EHR, integrating it with its Allscripts Vision PM.

Siemens Healthcare appoints former Quest Diagnostics VP John Nosenzo to the newly created role of VP of Zone Customer Relations. Nosenzo will manage the company’s national accounts team and all zone general managers.

Odd: a GE Healthcare employee, having dinner with co-workers, is hit by a stray bullet. The 17-weeks-pregnant woman was sitting outdoors when she felt something hit her in the side. When she stood up, a bullet fell out. It came from a handgun fired from a shooting range that was about a quarter of a mile away. Fortunately, she was only bruised and scratched on her abdomen and both she and the baby are fine. An attorney for the shooting club says a member was at fault for shooting at an unapproved target (clearly).

Researchers at Brigham and Women’s Hospital find that using bar-code technology with an eMAR substantially reduces transcription and medication administration errors, as well as potential drug-related adverse events. The hospital documented a 41% reduction in non-timing admin errors and a 51% decrease in potential drug-related adverse events. Naysayers, feel free to send in your comments pointing out that just because A and B happened together, it in no way implies that A caused B or B caused A — as Mr. H always cautions. I’m just glad someone is taking the time and energy to try to figure out if all this technology really does save lives.

E-mail Inga.

HIStalk Interviews Amy Andres

Amy Andres is chair of the Ohio Health Information Partnership. She was interviewed for HIStalk by Dr. Gregg Alexander.

You have a diverse background. What do you bring to the table for OHIP’s (Ohio Health Information Partnership) Health Information Exchange and Regional Extension Center projects?

I know that a lot of people refer to my background working in the health IT industry, both at Allscripts and for CVS ProCare. I did some work for some software development companies.

Honestly, in this particular project, I think the area where I can be most helpful is my background and experience in the public sector. Bringing people together who may have diverse agendas or may be in a competitive situation, or an adversarial situation, and helping them come together for something that’s for the common good for everybody to cooperate in that environment.

I’ve had some experience with that, both at the Department of Education and also at the Department of Insurance. We have a lot of people with a lot of health IT experience at the table, and although I have it, I think the thing that I bring to the table is helping bring everybody together and see what the long-term good can come out of this particular effort.

OHIP is a public/private partnership. Maybe you could explain that give an elevator pitch on what OHIP does.

The thinking when this project kicked off was that there were the two main funding streams from the ARRA funding. One of those funding streams was intended for states to apply for those funds, and that was to support constructing a health information exchange. The other funding stream was designed for the regional extension centers. 

I think the way the feds thought about it originally was they would have this patchwork throughout the country. Not necessarily within state borders, but just throughout the country, there’d be a support system to help physicians adopt EHRs.

The way we thought about it is two-fold. One, it doesn’t seem like a great idea to have one group working on implementing the support mechanism for the physicians and another group building the system that they’ll be connecting to. It really made sense to bring all of those things together. The federal grant requirements allowed for the states to delegate the authority to apply for the HIE grant if they chose to do so.

What we did in Ohio is said, let’s reach out to the different stakeholder groups that truly are going to be the main participants of not only constructing this, but managing it long-term, and let’s all come together under one organization and do this together. For that reason, the Ohio Hospital Association, the Ohio State Medical Association, the Ohio Osteopathic Association, and the State of Ohio started in talks. BioOhio, who was already a non-profit entity and did some work in the space, also came to the table and offered up help to us get started and help us form such a public/private partnership.

Within a few months’ time, we really pulled that together and had those five entities get started with things. Then, in the fall after we applied for the grants and it became clear that we were going to be receiving some form of funding, we expanded to a full 15-member board that includes payers, behavioral health, federally-qualified health centers … We have consumer advocacy perspective, hospital members, and more, just really trying to bring together a diverse group that could not only give us the perspective for decision-making, but really help pull their communities together along with this process.

Are the other Regional Extension Centers (RECs) across the country working similarly? If not, how do they differ?

We’re not completely unique, but pretty close. I’d say the closest organization to us is a group in New York. Other than that, you mostly have the RECs and the HIE grants being made separately. We have had some feedback from some of the other RECs that that’s already starting to cause them some problems.

We’re one of the largest RECs. In most cases, you didn’t have a whole state form as a group. One thing I will mention about the regional extension center side is OHIP originally applied to cover the entire state of Ohio. So did an organization in the Cincinnati area called HealthBridge. HealthBridge covers the Cincinnati region, also part of Kentucky and a southeastern segment of Indiana. So they took their existing marketplace, both an HIE and they do REC-type services. They applied as well.

So what the feds ended up doing is they ended up reducing our grant slightly and awarding HeatlhBridge as well. For Ohio, it was a good thing because we ended up with substantially more funding, so it requires some level of coordination between OHIP and HealthBridge, which is not a problem. We’ve known those folks for years, have worked with them for years, and on a weekly basis have calls to make sure that we’re staying on the same page.

That’s one aspect that’s a little different, but for the most part, having all of one state covered by a REC is not common. Having it coupled with the HIE, I think there’s only one other circumstance. I guess Wisconsin, I believe is also that way. Other than that, it’s split up.

Is this the uniqueness that you mentioned one of the reasons you think OHIP received such a large chunk of the first-round funds?

I get that question a lot. Lots of people ask, “Who do you know in high places to receive this award?” I have to say this wasn’t a lobbying effort. The effort, really, just stood on its own of the model that we presented.

I do think that it helped that the administration found, and the stakeholders on the physician side came together and agreed to use, some funding that was leftover from a previous program to put up as a state match for the federal dollars in a time of a very tight budget. It was unheard of that entities would come up with that level of money for a match. I think that helps, that we were showing that we were committed to it as well.

I think the real reason that the feds gave us such a strong award is I think they see the merit in the model of having all of the stakeholders’ representation groups sitting on the board, and the level of involvement, not just rhetoric, actually, truly becoming involved. I think the feds recognize this is a model that could actually work and be propagated throughout the country. I think that they made a decision to make an investment in this model to see if it works.

EHR adoption and use timetables are exquisitely fast — very accelerated. Do you think that’s going to increase the odds of making bad decisions or failed implementations as the RECs across the country try to roll this stuff out?

There’s no doubt about it. It’s an extremely aggressive timetable. So aggressive, in fact, that some RECs … There’s definitely been some feedback and folks asking to adjust the timetables.

Here’s what personally I’ve observed in working with folks at the federal level. The interest to adjust timetables is not there. That’s going to stay, but what they have done is absolutely worked with us to try to remove the barriers that are getting in the way of getting there.

Although there was a lot of consternation, especially when everybody recognized at the same while we were in Washington that the timetable for this was really two years, not four years, I have to say that all of our board members — our initial five Board members were there — we didn’t have the same heart attack that some of the other folks had because we know our model. If any model’s going to get us there in this time period, it’s the one that we have.

Concerns over hasty decisions? Yes. When you speed up a project like this, that’s always a concern because you don’t have the time to run down every possibility and mitigate every single risk to meeting a successful project. When you’re in that situation, I think what you have to be open to is making adjustments once you recognize that perhaps a path that you were heading down may not have been the perfect path, and be willing to make adjustments as you go.

I think the other thing that’s key when you’re on this type of time period is to be really open and transparent with everybody about the risks of moving at this speed and establish trust with everybody so that when they see that maybe we made a decision that is not helpful in the process, that we’re willing to admit, yep, a change needs to be made and everybody moves on. I think that when you’re working at this pace, everybody’s got to be open and honest with each other and be willing to make adjustments when we realize they need to be made.

Some have expressed concerns that the RECs are not going to be transparent about how they’re making their decisions for choosing their partners, perhaps leaving some EHR vendors to be shut out. How do you address those concerns?

In our particular REC, our situation, we’re using a competitive process. As a matter of fact, that competitive process is going on right now. We’ve just released an RFP for preferred EHR vendors. We don’t know exactly how many we’re going to select, but we do know it will be more than three and probably less than ten. What we’re trying to get to is allowing for a manageable implementation and pricing that’s attractive for physicians right now.

Probably even most importantly, we’re looking for a commitment from vendors to Ohio. Right now, these EHR vendors, I’m sure, are expressing these concerns. They also have a market of the entire country that they’re trying to grab right now. As a group that has responsibility to make sure that this project doesn’t fall apart, we need to know that they’re not going to overextend themselves in our market, and that they’re going to be here. Once they get started here, they need to finish the job here and really be around to support it long-term.

It’s important for us that we work with vendors that are willing to make a commitment. We’re going to hold up our end of the bargain and do some things to support their efforts as well. There will be, absolutely — and there is already underway — a competitive process and several competent individuals scoring those responses to make our selection. If you’re an EHR vendor and you want to operate in Ohio and you’re not one of the preferreds, you’ll still absolutely be able to operate in this market so long as you meet the ONC certification standards. But we feel it’s important to use a competitive process to select a group of vendors that are willing to make a commitment to Ohio.

Are you saying the selection process is a transparent?

Oh, absolutely. Even though we’re not a state entity, even in the state system — which has probably a very high degree of transparency in the process — while the actual competition is going on, that information’s closed because if that information was released during the actual competitive process, it would give people an unfair competitive advantage. But after the process is completed, all of that information will be made public.

Will there be enough qualified people to help with the implementation, support, and training for all these REC projects? What kind of employees are you going to need with what skill sets and where do you think you’re going to find all these folks?

I have to tell you that that is probably, of everything that is happening within this project, that’s the thing that keeps me awake at night the most. The federal government awards grants to help with that over the long term, and in this project long term means three or four years out. That will be wonderful for long-term sustainability of workforce, but the problem that we have is that the mechanism that they contemplated to implement that through the two-year and four-year colleges does not produce a workforce when we need it, which is during this two-year push. We’re going to need it long term, but we really need some of those individuals right now.

When we were in Washington, it became very clear that the timing of that was going to be a problem. So when we got back to Columbus, the first phone call I made was to the Department of Development and the Board of Regents to see if we couldn’t put together a program for Ohio over the summer to produce, at least, the workforce that’s needed for implementation right now. We met with those folks, as well as a federal program that runs through Job and Family Services called the One-Stops. It’s a retraining program.

We’ve got a full team of people from each of the regional partners, from all of the two-year colleges in the state, the Board of Regents, the Department of Development, and the One-Stops. We’re putting together a very intense summer program to train individuals to do the office assessment and workflow support. Then, those individuals will either be employed by the regional partners — the regional entities that are part of our REC — or, they’ll be employed by the vendors. But, we know we need to create that workforce in Ohio. There’s some of that workforce, but not enough to get this job done and it’s a country-wide problem.

As we’re speaking about this, the other thing that we are contemplating is that we don’t want the EHR vendors coming in here bringing people from where they’re headquartered. We really want the workforce in Ohio to be Ohioans, and be people that stay here and support this long effort as systems are implemented. In part of our EHR process when we’re talking about vendors to partner with, one of those requirements would be that they’re hiring Ohioans to do this work. Our role in this is to make sure that there are competent Ohioans to hire for this process.

Every aspect of this project is truly going to have to be a partnership with everybody holding up their end of the bargain. I do, personally, see a lot of jobs being created out of this project. It’s not really something that’s talked about a lot compared to a lot of the other stimulus programs. What more is talked about is the tight timelines and bringing this up, bringing health information exchange structure and EHR adoption up to speed. But, out of all of this, jobs will absolutely be created. We just want to make sure that those jobs go to Ohioans.

A common theme within OHIP is the discussion of community. Why do you see that as being important, and how is the OHIP model addressing that approach?

I think that the OHIP model itself is the epitome of establishing a community around this.

Yesterday I had a speaking engagement with HIMSS. The discussion ended up turning into an hour of questions and answers, in a good way. People were very engaged. They were very excited.

I was there for another hour afterwards just answering individual questions and talking to folks. One woman said to me, “You know, this reminds me of a movement.” She’s like, “This is like you’ve got people coming out of the woodwork looking to volunteer the time and pitch in.” She said, “This truly has the makings of a movement.” When she said that I was thinking to myself, she’s absolutely right.

This is a situation where a lot of people who have wanted this to happen for quite some time see that if this is going to happen, this is it. This is our chance. People on a macro level across Ohio are coming together. What I think we need to make sure happens from this point is that same level of grassroots movement starts to propagate at the individual, local communities level. I think that that is the key to getting this done in not only an aggressive time period, but with less money than truly is needed to ultimately implement this thing. We have to contemplate a different model than the model that’s been used up to this point that, frankly, hasn’t been able to get us there.

The model that not only I believe, but several individuals who are working within OHIP believe, is getting that community level of involvement — getting physicians within their community working together on this and leaning on each other. The idea of bringing together groups of single practices, bringing those individuals together as a cohort and working through this together, it makes it more cost-effective for us to support that effort in that manner. But even more importantly, it gives them a peer group to work with as they’re working through their own problems. Certainly they can identify with each other going through this at the same time. We absolutely think that’s going to be the key to success in this project.

The next step is really bringing those communities together and helping them not only understand where we’re going with this, but understand that there’s support to help their community.

Are there any other points you’d like to bring up?

I guess just the final point, and perhaps I have spoke about it throughout this discussion, but this is one of those situations where you don’t see something like this very often. Where people who normally either are very strong competitors or have very different positions on how they see the world and how the healthcare system should work, or how health information technology should work — to see all of these individuals come together, not just rhetoric, not just the way that they’re speaking to each other, but truly their actions are showing that this is a partnership.

I’d say in my 20-plus-year career, I have never seen anything like this. It’s quite an honor to be involved and to be participating in this. I think a lot of others feel that way, and I think that’s what’s going to bring us to the dedication that’s needed to get this monumental task done on what is a very aggressive timeline. It’s just a pleasure working with folks on this project.

News 5/5/10

From Newsies: “Re: Radianse. The RTLS vendor has filed for Chapter 11 bankruptcy as of April 20.”

From Take the Time: “Re: Neal Patterson. The latest kudos.” Neal makes the Forbes list of best-performing bosses and rightly so: quibbles aside, there aren’t many executives who have transitioned successfully from scrappy startup founder to big-company CEO and kept investors financially happy most of that time. He’s a HISsies pie-in-the-face regular, but if I was investing my money in healthcare IT, he’s the guy I’d trust it with. That’s CERN (blue) vs. the Nasdaq (green) above, just in case you’re a hater.

Eclipsys announces Q1 numbers after Tuesday’s market close: revenue down slightly, EPS $0.09 vs. -$0.02. Shares are up a little in after-hours trading. In other Eclipsys news, E-Health insider reports that the company will take Sunrise Clinical Manager to the UK, offering it to trusts looking for an alternative to NPfIT’s systems.

Dr. Dalai and anonymous contributors document what they say is the end of AMICAS as Merge Healthcare does its best to screw it up after buying it. I’m linking to his main page since he’s running new pieces, so read back a couple of articles for the whole story. It’s big business as usual: layoffs of all the people that made the acquired company successful, forced relocations resulting in resignations, and apparent mothballing of previously sound products. He summarizes with a plea to Merge executives:

Bottom line is this: your actions are destroying AMICAS. If you don’t reverse what you are doing, you have just flushed $250 million down the toilet. Don’t do it to yourselves, don’t do it to the AMICAS people, and don’t do it to me and the other AMICAS customers.

I see that some new jobs have been posted on the HIStalk Job Board, so feel free to cruise over and see if any of them look interesting. Each job lists the number of times it has been viewed at the bottom of the page, so you can see which ones are hottest. I should mention, since a couple of folks have asked, that while everybody can view available jobs, only sponsors can post them.

Small-practice SaaS EMR vendor ClearPractice names pharmacist and former NotifyMD CEO Gary Ferguson as CEO. The company offers its entire suite for $425 per month, including revenue cycle management, help with stimulus funding paperwork, and CMS approval as a preferred provider for patient registry. I don’t know much about the company, so that’s just me reading the press release to you in an authoritative, yet know-nothing voice like a clueless TV news anchor.

A couple of readers e-mailed me noting quotes from both Steve Lieber of HIMSS and David Blumenthal of ONCHIT in which they discounted EHR safety issue reports. Blumenthal called such reports “fragmented” and “anecdotal”, not surprising given the lack of a central, well-publicized reporting mechanism for such problems. One reader also noted that problem reporters are often seen as troublemaking whistleblowers rather than staunch patient advocates, not to mention that some vendors prohibit such disclosure in their contractual language. My response to one e-mail was that we need this industry’s equivalent of the Institute for Safe Medication Practices to take up the banner of centralizing problem reporting and disseminating those reports out for everyone’s benefit. After all, the FDA’s medication safety track record wasn’t very impressive until ISMP got involved. Plus, you would think vendors would prefer that to FDA oversight.

Thanks to new Platinum Sponsor FormFast of St. Louis, MO. The company’s healthcare solutions include forms automation, document management, and workflow automation that help eliminate the paper chase. Specific solution examples include RAC tracking and response, admissions, bar coding, positive patient ID, cancer staging, patient self-service portals, e-signature, on-demand document printing, and importing documents into the EMR and saving the cost of preprinted forms, imprinters, embossers, and labels on the way to becoming paperless. The company is offering a free Webinar on May 25 at 11 a.m. Central, a Forrester Research update on Microsoft’s healthcare strategy called SharePoint 2010: What Value Does It Bring to Hospitals? Three attendees will win an iPad, just in case you’re interested. Thanks for FormFast for supporting HIStalk.

Revenue cycle services vendor Accretive Health sets its IPO price at between $14-16 per share for 13.33 million common shares for a market cap of $1.44 billion. The company had $510 million in revenue last year, which you’d never guess given its crude Web site and the fact that you’ve probably never heard of it except maybe when I mentioned their IPO plans back in the fall.

McKesson’s Q4 numbers: revenue up 2%, EPS $1.26 vs. $1.01, but falling short of analysts’ expectations on both revenue and earnings.

athenahealth CEO Jonathan Bush has told me that he started his internal company blog using HIStalk as a model, so now he’s got a customer-facing version as well. Unlike most CEO blogs, it’s actually interesting and sounds like someone other than a marketing department committee talking.

Smartphone application developer Voalté announces seven new hires.

I’m streaming Netflix like a madman using my new Roku box as a defensive move to Mrs. HIStalk’s usual BBC and dancing shows, so a couple of old movies inspired this week’s guest editorial in Inside Healthcare Computing, an opus I called Healthcare IT Leadership Lessons Learned from R. Lee Ermey. Spoiler: I make a convincing argument that Neal Patterson’s famous “tick, tock” e-mail was cribbed from one of R. Lee’s profanity-laden monologues in Full Metal Jacket. I don’t think a Pulitzer is in my future, but at least I snickered while I was writing it.

All the big hospitals in Madison, WI run systems from next door neighbor Epic, so now they’ve decided to share ED records in a pilot project that runs through July.

Brigid O’Gorman, a Connecticut College pre-med junior and captain of the women’s hockey team, wins a $10,000 grant from Davis Projects for Peace to implement electronic medical records in Uganda. The money will go towards four computers, solar panels to run them, two printers, software, a laminating machine, and an external hard drive. The college will contribute $3,000 to allow her to spend eight weeks there to set it up and help transfer information from the paper notebooks carried by patients into the computers. I like her spirit: “I’m not a wiz at the computer, but I figured I could get a system and teach myself how to input the data before I go.”

Mississippi Baptist Health Systems says it has saved more than $4 million by switching to Symantec for storage, backup, and archiving of its 130 terabytes of data.

This was probably embarrassing: Canadian EMR vendor Medworxx issues a corrected press release about year-end earnings when it notices that the date was given as December 31, 2010 instead of 2009.

A couple of recent journal articles try to peg CPOE and EMRs to mortality and cost, at least in the minds of the headline writers. As I always caution, just because A and B happened together in no way implies that A caused B or B caused A, even though folks looking for someone to agree with their anecdotal beliefs will always drag those articles out as evidence.

Surgeons at Children’s Hospital of Pittsburgh are using a video-over-IP system to monitor progress of cardiac transplant procedures from any VPN-connected PC using a zero-footprint software video player. The Haivision Furnace system lets surgeons know when it’s time for them to jump in to do their part.

E-mail me.

HERtalk by Inga

From Sean Fitzpatrick: “Re: Paul Levy’s lapses of judgment. I’m with you on your observation. It’s too easy to write off the little lapses, which typically reveal underlying bigger ones.” I was glad to see a number of readers agreed with me. Apparently the BIDMC board did as well, fining Levy $50,000 for his “poor judgment” and saying it will also consider his “serious lapse” when determining his next pay package (which is over $1 million now). Board member Patrick Ryan is apparently not pleased with the outcome (not harsh, enough I suppose?) and announces his resignation.

From Madrigal: “Re: Meditech. Thought you’d like to know that Howard Messing has been promoted to CEO (his new title is president and CEO). His previous title was president and COO. Neil Pappalardo’s title is now chairman (it was chairman and CEO)” Unverified, though we heard this report from a couple of readers. The company’s Web site still lists Pappalardo as chair and CEO and Messing as president. One in-the-know person suggests the change means little in the short term and is more of a symbolic shift of official responsibilities.

Lucile Packard Children’s Hospital (CA) reports a 20% drop in mortality rates since introducing CPOE, giving it the lowest rate ever observed in a children’s hospital. Until Packard published its findings, no hospital has been able to show reductions in medical errors and mortality from using CPOE. The hospital, which spent $50 million on its EHR project, attributes its success to a careful and well-planned implementation.

Peninsula Regional Medical Center (MD) selects eClinicalWorks EMR for its employed physicians at the Peninsula Regional Medical Group. The Medical Center will also promote eCW adoption with affiliated community physicians and implement eCW’s Electronic Health eXchange as its interoperability tool.

Pantain Holdings Berhad, a 1,500-bed, 10-hospital network in Malaysia, selects Eclipsys Sunrise Enterprise. John T. Mather Memorial Hospital (NY) also plans to add multiple Eclipsys Sunrise products to create a single EHR across multiple venues of care.

Washington County Hospital (MD) replaces 40 interfaces with Corepoint Integration Engine. The hospital runs Meditech and connects to referring physician offices.

Doctors from Catholic Healthcare West will serve as medical directors for 10 CVS Caremark MinuteClinics in the Phoenix area. The new CVS/Catholic Healthcare West alliance includes plans to eventually integrate EMRs.

The 54 providers at Syracuse Orthopedics Specialists (NY) and New York Spine & Wellness Center choose Allscripts to provide EHR and PM across their 11 locations.

Chatham County Safety Net Planning Council (GA) goes live on its HIE, leveraging technology from Orion Health and Initiate Catalyst Patient Registry.

Mark R. Briggs, the former COO of Carefx, takes over as CEO of HIE vendor VisionShare. He was previously with NaviNet, QuadraMed, and LinkSoft Technologies.

Fort Healthcare (WI) will partner with Cerner to create a connected health community through the use of Cerner Millennium solutions. The hospital, ambulatory surgery center, and specialty clinics will implement more than 20 Millennium products and use Cerner for IT management services.

Senior Lifestyle Corporation selects the selection and hiring solution of Kronos to manage the end-to-end hiring process.

MedLink partners with iMedicor to integrate iMedicor’s information exchange portal with the MedLink TotalOffice program. The combined solution will facilitate secure messaging and clinical data exchange. TotalOffice users will also have access to iMedicor’s ClearLobby drug and medical device information platform.

Healthcare analytics vendor Outcomes Health Information Solutions appoints Gary Velasquez CEO. Former Ingenix CIO Jim Egan is also hired to serve as the company’s CIO.

Ingenix and Health Language, Inc. launch Ingenix Global Code Manager to translate between ICD-9 and ICD-10 coding systems.

Mediware releases Q3 numbers: revenue of $12.8 million compared to $10.2 million last year, net income $891,000 vs. $483,000.

E-mail Inga.

Readers Write 5/3/10

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!

Goodbye Data Warehouse and Cubes, Hello AQL
By Mark Moffitt

For the last two years, I have been researching systems to replace the data warehouse used for report-writing in our organization. This effort has been driven by the desire to provide better service to other departments that rely heavily on data reporting for day-to-day operations.

The idea is to push data to users so they can perform in-memory analysis and display of large amounts of data, a system that would replace the current process of requesting custom reports and spreadsheets from the information services (IS) department. The current process requires considerable resources in the IS department and requests can take several days if the number of requests for reports in the queue becomes large.

The requirements for a new system are straightforward, but somewhat daunting:

1. Put data into users’ hands so they can perform business intelligence.

2. The cost of the system, including license, hardware, and consulting, must be offset by the direct costs of shutting down existing systems.

At GSMC we operate Meditech Magic and use a data warehouse for analytics and business intelligence. The data warehouse stores about nine years of financial data in about 650 GB. The data in the warehouse is updated nightly. SQL reports have been developed to provide reporting across the organization.

IS at GSMC is bombarded with requests for new reports. These requests come in the form of specialized requests for data that often require modifying an existing SQL query or writing a new query. The process is iterative that starts with gathering requirements for a report, modifying or writing new SQL queries, generating a report and sending it to the customer.

Typical turnaround times are variable and are highly dependent on the number of reports in the queue to be developed. Best case scenario is four hours, typical is two to four days. Often the customer will, upon review of the report, ask to include or exclude specific data. This back-and-forth typically occurs several times until the report meets the customer’s needs.

The IS department at GSMC has several analysts who spend a good part of their time responding to requests for data. It is a never-ending demand.

We researched the use of OLAP (online analytical processing) cubes to provide data to users. The advantages of cubes is well documented and includes the ability to drill down to details and analyze data in ways simply not possible with reports or spreadsheets. The disadvantage to cubes is that data must first be aggregated. If a user needs data not included in the cube, then the cube must be rebuilt. Also, a data warehouse is required. Finally, building and maintaining cubes require personnel with specialized skills.

About seven months ago, I read on HIStalk about a new company named QlikView. I researched the software and it sounded too good to be true. However, I was intrigued that QlikView doubled revenues in 2008, not an especially good year for selling enterprise software as the national economy was in a major recession.

On the surface, QlikView is a business intelligence solution that consists of a data source integration module, analytics engine, and user interface. QlikView is based on AQL and is completely different from other OLAP tools.

Through AQL, QlikView eliminates the need for OLAP cubes and a data warehouse, replacing the cube structure with a Data Cloud. A Data Cloud does not contain any pre-aggregated data but instead builds non-redundant tables and keeps them in memory at all times. Queries are then created on the fly and are run against the Data Cloud’s in-memory data store.

Under AQL, all data is stored only once, and all data associations are stored as pointers, so a Data Cloud database becomes more efficient at retrieving records than do OLAP databases. A Data Cloud database is also much smaller since records are not repeated through aggregation and its structure never has to change. The architecture allows for a flexible end-user experience because it doesn’t require aggregation or pre-canned queries that try to cover every possible analytical scenario a user can create, unlike data cubes that require both. (1)

Data Clouds run in memory and AQL reduces in-memory storage requirements by about 75% as compared to source data. In-memory Data Clouds can be stored as AQL files for archiving. AQL disk files are 90% smaller than source data. Think of an AQL file like an Excel file where data can be added and deleted and the file saved with different names for archiving purposes.

The price point for the software is about $150,000 (one-time fee) for our health system. Hardware costs are about $15,000 for a server with 98 GB of memory. We expect consulting fees to total $150,000 for a SME in hospital financial data with QlikView experience. We worked with RSM McGladrey on a consulting proposal as they have well-qualified personnel in this space.

If you know much about the BI/Analytics space, you may question the low cost of the software and consulting services. This has everything to do with the AQL model. RSM McGladrey quoted a revenue cycle effort at eight weeks and includes:

• Transfer data from existing systems to QlikView
• Data validation
• Census analysis
• AR analysis
• Insurance contract analysis
• Hindsight analysis
• Train IS staff on data extraction

The revenue cycle statement of work is only one component of the $150,000 quote for consulting services from RSM McGladrey for implementing QlikView at our organization.

The total cost for QlikView at GSMC is $315,000. That will be directly offset by shutting down a data warehouse, savings from using QlikView for analytics versus another system where the cost of consulting services had already been quoted and budgeted, and other savings. We expect additional direct benefits from having deep analytic capabilities with our revenue cycle data.

QlikView has a number or healthcare customers. I believe you will be hearing more about the company in healthcare in the years ahead as they achieve market awareness of QlikView software’s capabilities and price point.

We have not yet purchased the package. If we do, I’ll write a follow-up article on our experience.

1 “Qliktech, IBM Provide New View Of OLAP”, Mario Morejon, Technical writer for ChannelWeb, July 18, 2003, http://www.crn.com/software/18839582

Mark Moffitt is CIO at Good Shepherd Medical Center in Longview, TX.

Humpty Dumpty Leaves Wonderland to Visit Health Information Technology
By Jim Kretz

Suppose I told you that “voting” henceforth would mean you would only be shown a ballot, period. No more selecting your preferred candidate.

Now suppose I told you that your consent to disseminating clinical information did not mean your granting permission, but only your acknowledgement that you saw my information policy — take or leave it. This may remind you of Humpty Dumpty’s scornful assertion, “When I use a word it means just what I choose it to mean — neither more nor less.”

Surprisingly, the insanity of “…use the term ‘Consent’ to mean the acknowledgement of a privacy policy, also known as an information access policy. In this context the privacy policy may include constraints and obligations.” comes from an IHE (Integrating the Healthcare Enterprise) policy paper “IHE IT Infrastructure Supplement 2009” that was taken up  (line 157) by the IT Standards Advisory Committee Privacy Workgroup, April 23, 2010.

The authors of this paper — the American College of Cardiology, the Healthcare Information and Management Systems Society, and the Radiological Society of North America — are not mean-spirited, uninformed, or confused. What could result in their clearly having tumbled into a conceptual rabbit hole?

Jim Kretz is project officer at the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services. His comments should not be construed to reflect the official position of SAMHSA.

Massachusetts HIT Conference Thoughts
By Bill O’ Toole

I had the pleasure of attending a National Conference hosted by Massachusetts Governor Deval Patrick in Boston last week. The conference was billed as Health Information Technology: Creating Jobs, Reducing Costs and Improving Quality. 

Keynote addresses were provided by David Blumenthal, MD, National Coordinator for HIT and Vice Admiral Regina M. Benjamin, MD, MBA, Surgeon General of the United States. Health IT Policies and Standards were addressed by a panel that included John Halamka, MD (CIO, CareGroup and Harvard Medical School), Marc Overhage, MD (CEO, Indiana Health Information Exchange), Paul Tang, MD (CMIO, Palo Alto Medical Foundation), Micky Tripathi, Ph.D (CEO Massachusetts eHealth Collaborative) with Tim O’Reilly (President, O’Reilly Communications) moderating.  

Another panel discussion on Health IT, Business Opportunities and Job Creation featured leading Massachusetts vendor executives Girish Kumar Navani (eClinicalWorks), Howard Messing (Meditech), Richard Reese (Iron Mountain), Bradley J. Waugh (NaviNet) moderated by Chris Gabrieli (Bessemer Venture Partners).

I could go on and on, but the list would be too long. I mentioned those above to give readers a sense of magnitude and to perhaps share in this small article the profound comfort I felt that "we" are doing this right. Many other highly qualified participants shared their knowledge on all things HIT- and ARRA-related.

What impressed me most was the overwhelming sense of momentum. The stimulus package and its future incentives have so far done exactly what was intended, serving as the spark that has set this massive project in motion. Remaining at the forefront of it all, though, is the goal of better medical care for all. That theme was never lost and was frequently repeated.

As one who until now has found certain parts of most conferences to be extraneous (ok, boring), I felt obliged to inform the far-flung readership of HIStalk that I was extremely impressed with every minute of this two-day conference. If the energy, knowledge, and sincere interest and enthusiasm expressed by those involved in this conference are carried forward to the project at large, then we are truly in for a remarkable change in our industry.

Congratulations to the Massachusetts Technology Collaborative and its Massachusetts eHealth Institute, the Massachusetts Health Data Consortium, and Governor Patrick for organizing this special event. It should serve as the model and be repeated whenever possible throughout the country.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.