News 7/22/09

From Ralph Hinckley: “Re: HIPAA. Looks like we have actual prosecution for HIPAA privacy violations by several individuals.” A doctor and two former employees of St. Vincent Health System (AR) plead guilty to federal charges of snooping into the medical records of murdered local TV anchor Ann Pressly out of curiosity. The misdemeanor charge carries a maximum penalty of a $50,000 fine and a year in prison. Here’s the part that always gripes me: the hospital canned the two employees, but let the doctor off with a two-week suspension.

From Wompa1: “Re: Ayn Rand Center for Individual Rights. I thought you might appreciate this.” The piece has a long quote from Atlas Shrugged about a surgeon who refuses to practice under a system of socialized medicine. Now I’m all hot to read Atlas Shrugged again, so I’ll have to go digging through the bookcases to find it.

From BadNoodle: “Re: [vendor name removed]. They have quietly laid off over 100 people worldwide, with software training and support hit fairly hard.” Inga is trying to confirm and I have suspicions about the anonymous source since the posting appears to have come from a competitor, so I’ll leave the company name out for now.

From Org Insider: “Re: HIMSS. HIMSS produced a Team Training seminar, ‘What is Government Relations’ on June 23, 2009. HIMSS discusses the differences between advocacy, lobbying, and government relations,’What does HIMSS do?’ It is produced by Carla Smith, Executive VP, and Dave Roberts, VP of Government Relations (who is also Mayor of Solana Beach, CA). It appears executive management is trying to sell the staff on the idea that HIMSS is not a lobbyist or vendor organization HIMSS will share IRS and congressional regulations with a ‘sister’ organization to keep under the radar. Is that AHIMA?” Please, sir, may I have some more? I couldn’t get to the link you sent and I didn’t follow the ‘sister organization’ part.

From The PACS Designer: “Re: What Would Google Do? Our fellow blogger Will Weider has read the new book about Google called ‘What Would Google Do" and recommends it for CIOs and other executives. Harper Collins Publishers has a browse version of the book on the Web for HIStalkers to view.” The preview looked good, although some of the Amazon reviews are scathing. I’d read it.

From Dr. Know: “Re: technology. Interesting article in US News about the use of advanced technology in hospitals.” Included: rounding robots with video, RFID, implanted identifiers (they must have missed the Verichip flop), EMRs, and cool rooms. Only in the last paragraph is it mentioned that hospitals have halted almost all of these projects because of economic uncertainty.

From Bob! in accounting: “Re: VA. Ha!” The VA stops (temporarily, it says) 45 IT projects that are over budget or behind schedule until the project managers submit new plans. They’re listed in the article. I see a lot of LIS stuff on the list, so I wonder if the VA is reconsidering its stated intention of replacing some of its own VistA applications with commercial ones from Cerner since it was to start with lab?

Apple’s Q3 numbers: revenue up 12%, EPS $1.35 vs. $1.19. Strong Mac sales and punishing iPhone demand led the estimate-beating numbers. Good timing for me since I had just finished my next guest editorial for Inside Healthcare Computing titled A Harvard Vision of One-Stop Shopping: Why Someday You Might Buy a Michael Jackson Ringtone, a “Pull My Finger” Game, and CPOE from the Same Vendor. It’s a very serious treatise on healthcare IT architecture and the disruptive technology of infrastructure instead of applications. Well, maybe not all that serious.

Here’s an iPhone example: Cannabis, an application that gives directions to medical marijuana suppliers and related services updated from iMedicalCannabis.com. Check the banner ad on the site for Marijuana Medicine Evaluation Centers, which apparently gives exams and certification cards to supposedly legal users (“Come get your medical marijuana card today!!”) There’s even a helpful ICD-9 list of conditions that can be treated with cannabis just in case one is looking for a disease to justify use of its treatment (hypertension? back pain? constipation? You’re in!)

Some folks added new events to the HIStalk Calendar (and why not since it’s free and the events show up on the main page of HIStalk?) You can add your event, too, or check the calendar to see what’s coming.

A reader provided a link to this ACLU video for its Surveillance Campaign, which frets about massive invasions of privacy using “invasive new technologies.” It ties ordering a pizza with having healthcare information immediately available at the call center.

Nasty Parts told you on May 29 that Allscripts would acquire Medfusion and Medem. He’s on track so far: Medfusion announced today that it has bought the health services operations (which I’m guessing is everything but the company name) from Medem. Then, Allscripts announced that it had signed a strategic agreement to make Medfusion’s patient portal available to its customers. Will Allscripts go ahead and buy Medfusion?

Also related: Allscripts posts Q4 numbers, but I’m not smart enough to understand how post-acquisition numbers are derived so I won’t comment. Glen seemed happy with the results, they seemed to beat expectations, and share price is down only a little since then. I think they did well.

The HIMSS Electronic Health Record Association re-elects Justin Barnes (Greenway) as chair and brings on Mark Segal (GE Healthcare) as vice chair and Carl Dvorak (Epic Systems) as executive committee member.

Listening: new from July for Kings, Cincinnati-based alt-rock.

I must be cranky today since I just saw something else that gripes me. A vendor executive lists a big-name business school in the Education section of his LinkedIn profile, right under his only other credential, a bachelor’s degree from a lower-tier state school. I checked out his big-name credential and it was nothing but an expensive, one-week executive seminar, maybe placed there with the hope that it would be confused for a graduate degree. It wasn’t by me, anyway.

Speare Memorial Hospital (NH) names Bob Dullea as director of IS, bringing him over from Dartmouth.

President Obama, making a healthcare speech from what was called Children’s Hospital (I assume it was Children’s National Medical Center in DC) mentions the CIO directly: “We just — I spoke to the chief information officer here at the hospital, and he talked about some wonderful ways in which we could potentially gather up electronic medical records and information for every child not just that comes to this hospital, but in the entire region, and how much money could be saved and how the health of these kids could be improved, but it requires an investment.”

A VA-funded study finds that all the paper records clinicians keep (sticky notes, index cards, and notebooks) can provide insight into how to design an improved human interface to clinical systems. It’s a shamefully small observation study (20 workers in one hospital), but still an interesting concept since everybody keeps paper for mostly good reasons. I’ve used this method: follow a clinician around and write down every piece of information they need, when they need it, where they were at the time, and what they did with it. That’s what an IT system will have to do if you really want to kick out paper.

Also from the VA: it’s testing a BlackBerry application that let cardiologists read EKGs remotely and order treatment to be immediately started in the ED or other location. “The ER pages a cardiologist and sends an electronic EKG to the doc’s mobile device. It also cc’s the electronic health record system, Vista. The cardiologist receives the EKG alert and opens the file by pressing on an icon and logging in. After reading and interpreting the image from a smartphone, the cardiologist clicks a ‘call’ button to contact the ER with a treatment orders. This all happens within 3 minutes.”

Yet another VA item: the Philadelphia VA’s brachytherapy (implanted radiation therapy) program, which was shut down in 2008, gave 92 of its 114 patients the wrong dose of radiation therapy over six years because the dose checking PC had been unplugged from the network.

ACS gets a five-year contract extension worth $10 million to run IT at Rehabilitation Hospital of the Pacific (HI).

A Fox News report says that the universal health plan in Massachusetts is an albatross around the neck of potential Republican presidential candidate Governor Mitt Romney. Costs are out of control, the state is being sued by Boston Medical Center for underpaying it, and legal immigrants who pay taxes are being dumped from the plan to save money. The parties blame each other, apparently, and the only idea anybody’s come up with to cover its costs is to tax smokers even more. They’d better hope those smoking cessation programs don’t work.

Who are some of the big spenders when it comes to healthcare lobbying? Other than the obvious drug companies: GE, AMA, AHA, Blue Cross Blue Shield, American College of Radiology, Siemens, and UnitedHealth Group.

Vanderbilt chooses Omnicell for supply systems.

Hopkins Medicine deploys Cernium video analytics software for security, which ads to the capability of security cameras by not requiring people to sit and watch them. It looks for erratic movements, lurkers, converging groups, and suspicious packages. A bit Big Brotherish, but cool, especially for hospitals.

E-mail me.

HERtalk by Inga

From Heard it thru the grapevine: “Re: rumor control. Hope you are doing well and up to your eyeballs in new shoes. Wouldn’t it be interesting if it were Eric Sellers was the one going to MED3OOO?” Eric Sellers is a former Misys exec, as “Little Birdy” suggested last week. His LinkedIn profile says he has been in real estate for the last five years.

Hayes Management Consulting and Aternity partner to help improve physician adoption of EHRs. The companies will combine the rapid prototype methodology of Hayes with Aternity’s Frontline Performance Intelligence Platform to organizations increase implementation efficiencies.

Hendrick Health System(TX) completes installation of Sentillion’s Tap & Go, which uses passive proximity cards for authentication. Hendricks uses the program in its trauma center to enable caregivers to instantly sign on to any workstation.

ENT and Allergy Associates (NY/NJ) announces it has expanded the use of their NextGen EMR system to 10 of its 30 practice sites. The practice includes about 90 physicians.

UC-San Diego Medical Center selects Dragon Medical for physician documentation.

Former Cisco exec Diane Adams joins to Allscripts as EVP of human resources.

E-mail Inga.

Being John Glaser 7/21/09

American Airlines. Amazon.com. Federal Express. Bank of America. These organizations and others are often cited as examples of exceptional effectiveness in applying information technology (IT) to improve organizational performance and, at times, achieving a significant competitive advantage.

These organizations are more than one-hit wonders. They have been exceptional over very long periods of time. They seem to have one IT success after another.

What is it that these organizations have done to achieve such IT excellence? What makes them different?

Several researchers have pursued answers to these questions. The have identified a series of factors that lead to organizational IT excellence.

Leadership was critical
The leadership in these organizations was smart, honest, seasoned, committed, and valued the healthy exchange of ideas. They were individually excellent and a great team. This leadership understood the strategy, communicated the vision, was able to recruit and motivate a team, and had the staying power to see the organization’s strategies through several years of hard work.

Strong, sustained and clear themes provided the basis for IT strategy decisions
Organizations often develop themes or strategic imperatives such as “we must continuously improve the care we deliver” or “we must relentlessly focus on efficiency.” If there is sustained commitment to pursuing these themes, organizations become increasingly competent at addressing them. This competency extends to IT. In effect, organizations, year in and year out, get better and better at improving care and get better and better at applying IT to improve care.

The evaluation of IT opportunities was thoughtful and rigorous
IT initiatives that involve major commitments of resources and significant organizational change must be analyzed and studied thoroughly. However, these organizations also understood that a large element of vision, management instinct, and “feel” often guided the decision to initiate investment and continue investment. These organizations were careful to ensure that IT initiatives were strongly linked to key organizational strategies and plans.

Extracting value from IT required innovation in business practices
If an organization “merely” computerizes existing processes without rectifying (or at times eliminating) process problems, it may have merely made process problems occur faster. In addition, those processes are now more expensive since there is a computer system to support. All IT initiatives must be accompanied by efforts to re-engineer the processes that the system is designed to improve.

These organizations often focused on continuous incremental innovations rather than “big bang” initiatives
Organizations will often introduce very expensive application systems and process change “all at once.” Big bang implementations are very tricky and highly risky. It is exceptionally difficult to understand the ramifications of such change during the analysis and design stages that precede implementation. As a result, organizations risk significant operational degradation and non-trivial project overruns.

On the other hand, IT implementations (and related process changes) that are more incremental and iterative reduce the risk of organizational damage and permit the organization to learn before they make the next change. Incremental change helps the organization’s members to understand that change and performance improvement are never-ending aspects of organizational life rather than something to be endured every couple of years.

The strategic impact of IT investments came from the cumulative effect of sustained near term initiatives to innovate business practices
The incremental steps in aggregate led to a competitive advantage. Organizations often took five to seven years for major initiatives to fully mature and the results to be seen. Persistent improvements by a talented team, over the course of years and across many initiatives, resulted in significant strategic gains. Exceptional effectiveness is a marathon. It is a long race that is run and won one mile at a time.

Innovation was encouraged
These organizations were comfortable and competent at innovation. This innovation was not confined to IT. They knew that innovation had to be practical and goal directed. Innovation had to focus on a real business problem, crisis, or opportunity and the project needed budgets, political protection, and deliverables.

Well-architected technology was the great enabler
Information systems that are difficult to change, unreliable, overly costly, functionally weak, and impossible to integrate can severely hinder an organization’s strategies. The organizations studied had taken the time to develop approaches and policies needed to ensure that desired levels of integration and reliability, for example, were achieved. Their CIO had, and shared with the leadership team, a strategic understanding of information technology architecture. 
 

Achieving organizational excellence in IT requires much more than great information systems and a great IT staff (although these are important). Excellence requires talented people, great working relationships, organizational thoughtfulness, and dogged, year-in and year-out pursuit of performance improvements. These factors are probably not materially different from the factors that determine organizational excellence in general.

It is more important for an organization to focus on addressing these factors than it is to work on any specific IT application.

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

Monday Morning Update 7/20/09

From Leo: “Re: HHS. HHS is expanding its health information privacy enforcement team.” They’ve opened two new positions for Health Information Privacy Specialist.

From Hal Ebola: “Re: execs. Isn’t it interesting that in the midst of the biggest news about HIS in decades, the senior execs at many of the largest companies in the space have gotten the boot? In the past 18 months — McKesson, Siemens, Eclipsys, QuadraMed, etc.” A couple of folks e-mailed to say that new involuntary executive departures have occurred at McKesson and Eclipsys, but I don’t have specifics. Obviously all that potential HITECH money has raised the performance bar, maybe rightfully so now that there’s more at stake (so HITECH’s unintended consequences may have been vendor brass turnover). I only hope they don’t bring in a bunch of non-healthcare people who see patients as widgets since I’ve worked for HIT execs like that and I wanted to maim then regularly. Some of the most frustrated employees I’ve seen were clinical people who went to work for vendors — they had always thought the problem was lack of company knowledge, not lack of company interest in doing anything beyond the minimum required to sell systems.

From The PACS Designer: “Re: America’s Best Hospitals. U.S. News & World Report has released its annual survey of America’s Best Hospitals. TPD likes to focus on who is new in the listings and who has moved up in the rankings as it shows institutions that have made progress to better themselves in the eyes of physicians.  Johns Hopkins remains #1, and rounding out the Top 5 are Mayo Clinic, Ronald Reagan UCLA Medical Center, The Cleveland Clinic, and Massachusetts General Hospital.” No surprises there except maybe UCLA. It would be interesting to see how the winners stack up in terms of cost (probably easy to do since the information is out there). You could do the same with the idiotic Most Wired awards, just out yet again, determining whether all of those highly wired hospitals have reduced cost or significantly improved outcomes in the last 3-5 years. Everybody involved with Most Wired stands to gain from the “buy it and they will come” illusion: HHN magazine, McKesson, CHIME, and resume-padding CIOs. Who knew that supporting your organization’s strategic goals through IT was a competitive sport?

From Nasty Parts: “Re: Sage. Exodus of talent from Sage continues. Dennis Mahoney, six-year vet, resigned last Friday. Dennis was most recently their top VP of sales.” Unverified.

From Looking for Answers: “Re: Banner Health. Isn’t it funny that if a vendor came in offering free software they wouldn’t be let in, but if they come in with expensive software and cut the price down, it all looks great?” Brilliant. In this change-resistant industry, maybe Medsphere should price OpenVista at $30 million and start the discounting at 50%, proceeding to 100% of the client insists. Like heavy software discounting by proprietary vendors, it would let providers think they are sharp negotiators.

From B.P. Fife: “Re: pretty darn good article.” Link. Washington Monthly’s Code Red: How software companies could screw up Obama’s health care reform. It’s yet another comparison between Midland Memorial’s OpenVista implementation vs. proprietary ones, this time the initially problematic Cerner one at Children’s Hospital of Pittsburgh, both of which I’ve reviewed amply here (in fact, I hate to say it, but I’m kind of tired about hearing about Midland Memorial since repeatability is a key concept and one implementation isn’t enough to judge Medsphere or, for that matter, Cerner). The article seems to imply that a sinister conspiracy exists among proprietary vendors, HIMSS, CCHIT, etc. to keep open source applications a big secret. They aren’t: CIOs, rightly or wrongly, are passing on a free system that they’re surely aware of, so you have to assume that (a) even though they may be overly risk averse, they aren’t stupid; (b) they aren’t universally easily manipulated; and (c) they would jump all over a free app if they had confidence in it and their hospital said OK. If Medsphere and companies like it can’t make their case and get traction, maybe vast collusion is just a convenient, far-fetched excuse for offering what the market doesn’t want, no different than a sign offering “free kittens”. 

Related to that, from my poll on open source EMRs: 45% of respondents said CIOs should consider them because they’re just as good as proprietary systems; 20% said they’re not as good but should be considered because they’re cheaper; 13% said they should be avoided because they’re not good enough to be worth the potential cost savings; and 23% said they should be avoided because they’re unproven and risky. Obviously it’s not CIOs responding unless their responses differ from their actions.

Weird News Andy checks in: (a) a Lortab Lothario male nurse suggests to an addicted patient that he will provide pills in return for her favors. He signs out the pills for another patient, leaves them tucked in the first patient’s belongings, and, well, read The Rest of the Story. (b) Paramedic fired after telling a woman in pain to have drink and she dies the next day. Also from WNA: “Here is a link to a purposely confusing Republican chart that describes the Democrats’ socialized medicine plan.” Link (warning: PDF).

CHIME announces its new CIO certification program for healthcare CIOs who “want to enhance their professional stature.” CHCIO is much like CPHIMS: pass a test and you are in, but in CHIME’s case, you have to already have been a CIO for three years or more (so maybe the point is to unmask those poser CIOs who really weren’t qualified after all?) Obviously CHIME gets the same benefits that HIMSS does: certification generates revenue, makes the organization look like the de facto authority, and locks certificants into further revenue-generating renewals and conference attendance. It seems pointless to me – if you’ve got three years of CIO experience, I doubt slapping a credential nobody’s heard of after your name is going to impress anyone further (especially potential employers or peers). Certification often appeals to those lacking academic credentials, but there is no excuse for someone holding a six-figure CIO job not to have a master’s degree, given the plethora of convenient, cost-effective offerings widely available (I did it myself for one of my degrees while working two jobs and writing HIStalk, so I don’t buy the “I don’t have time” excuse). Still, for the insecure folks looking for a vanity credential that demonstrates what you already know instead of studying something new to earn a recognized degree or graduate certificate, you’ve got a new option. I’m thinking of launching my own certification, Designated In Primary Study of Healthcare Information Technology. I think the acronym would look real nice on a business card.

So, new poll to your right – what do you think of CHIME’s new credential? Don’t let me influence your answer.

Buddy Fain is promoted to VP/CIO of the University of Tennessee Medical Center. He’s a UT alum.

A Kaiser Permanente hospital is hit with a $187,500 fine this week for failing to protect the privacy of Octomom’s babies, adding to the $250K fine levied against it in May for failing to protect the mom’s records. Kaiser says 27 employees inappropriately reviewed their records, of which 16 quit, two were fired, and nine were disciplined. There’s a good lesson there: the punishment is just as harsh when the “celebrity” is at the end of their pitiful 15 minutes’ of fame.

Sun, on its way to being acquired by Oracle, pairs with healthcare data management vendor BridgeHead Software to offer an enterprise archiving system that offers a half-day installation and storage of multiple copies of the same data when needed. Sun liked BridgeHead because it’s big in the Meditech world. Did you ever notice that our own industry gives Meditech short shrift compared to companies like Epic and Cerner and yet big non-healthcare technology players instantly recognize the massive Meditech customer base as fertile ground for add-on technology, complementary applications, and consulting services? They’re like Rodney Dangerfield: they get no respect.

Chip at PCC blogs from this week’s CCHIT meetings. He’s got a lot of interesting observations (changing CCHIT membership, some friction between Mark Leavitt and one of its work groups, dropping the “version lockdown” certification requirement, and disagreement over whether an increase in applicants means CCHIT is doing a good job). Kudos to Bill Zurhellen, MD who said this directly to them: “If our goal is to certify to get ARRA payments, we’re doing the wrong thing. We should be focusing on improving health care.” Leavitt actually agreed and suggested that perhaps CCHIT’s mission statement should be changed to emphasize outcomes improvement instead of HIT adoption (not exactly an original thought since AMDIS and other groups have pressed CCHIT on that previously). I take that to mean that (a) all the CCHIT criticism and potential competition from other certification agencies has made CCHIT more responsive, or (b) it’s at least awakened a belated need to pretend to be more responsive.

Related: the Health IT Policy Committee recommends that CCHIT not be named the sole certifying agency, that CCHIT gives the appearance of conflict of interest, and that HHS should set the criteria instead of the certifying agencies themselves. Full details and PowerPoints from the committee’s Thursday meeting are here. That’s pretty big news that everybody seems to have missed. A new meaningful use matrix is also on that page, which Inga had already found and referenced in Friday’s post.

Since some folks (jokingly) accused me of making up the positive comments posted against Gregg Alexander’s interview with me, here’s a real one send from Mike Nelson, CIO of 25-hospital Universal Health Services, that he invited me to post: “I would also like to extend my appreciation for the work that you put into the writing and the site. And while it may sound like a plug (but it’s not) I like having sponsors here so I have another avenue to identify healthcare firms when I have a need for something, especially specialized consulting services.” I’ll vouch for that: in the past, Mike has copied me directly on inquiries he made to HIStalk sponsors for services he was about to buy. I appreciate both his eagerness to give HIStalk’s sponsors a chance to earn his business and his nice comments.

Florida’s state senate launches an investigation into the state’s blood banks following an Orlando Sentinel story that exposed lucrative contracts given by  Florida’s Blood Centers, which takes in $100 million per year, to its board members. The chair of the Health Regulation Committee said he was “shocked” that FBC charges hospitals $310 per unit of blood. Most disturbing to me were e-mail comments from FBC’s $600K salary president, in which in one sentence she twice referred to the organization as “the company.”

Temple University Physicians signs up for Ingenix CareTracker Services for revenue cycle management and cost control in its radiology department, citing its 3% increase in collections and 16% reduction in payment times for the other seven departments using it.

As Inga mentioned, Nuance acquires Jott, a voice-to-text transcription application aimed at mobile users to create notes, use e-mail tools, and update application databases. While general cell phone users are its target audience, there certainly are healthcare possibilities there (nurses calling in vital signs to the EMR, maybe, or doing progress notes by cell phone).

Microsoft Health Users Group Exchange 2009 will be in Redmond on September 2-3. They have tracks for clinical informatics, IT professionals, and developers, with a presentation from Microsoft VP/CIO Tony Scott. Registration is here.

I’m making several changes that should help the HIStalk page load faster (for my nerd compadres, I had Apache upgaded, combined several WordPress widgets into one to reduce the number of MySQL calls, am having WordPress and all plugins upgraded, and am installing a caching application to render pages as static HTML instead of database-generated pages). Heavy server load is a nice problem to have, I admit.

Voalte needs field engineers, project managers, and clinical trainers, in case you are looking for a new gig. Other jobs: Epic ADT Consultants, Laboratory Requirements Analyst, Revenue Cycle Project Manager.

Cleveland Clinic chooses MediServe for referral tracking, authorizations, scheduling, documentation and the plan of care, integrating it with Epic.

UnitedHealth gets a $21.8 billion contract to manage DoD benefits, of which UnitedHealth will keep $1.5 billion for administrative services after paying providers. When it comes to “illions” in healthcare costs, “m” is so 1.0.

Bill Moyers lauds the choice of Regina Benjamin as surgeon general nominee, contrasting her hardscrabble upbringing and low-rent medical practice serving the less fortunate to the suits running the for-profit side of healthcare. Named: Cigna’s chair ($11 million in the last year), Aetna’s CEO ($17 million), and McKesson’s John Hammergren ($29.7 million). The list above was provided in a comment on the article. I wish I’d said this: “Here’s the difference. To Dr. Regina Benjamin, health care is a public service, helping people in need with grace and compassion. To Ed Hanway and his highly paid friends, it’s big business, a commodity to be sold to those who can afford it. And woe to anyone who gets between them and the profits they reap from sick people … As we reported last week, that behavior includes spending nearly a million and a half a day to make sure health care reform comes out their way. Over the years they’ve lavished millions on the politicians who are writing and voting on health care reform. Now it’s payback time.” From this hardcore fiscal conservative, amen, liberal brother Bill Moyers. If you want to make a million dollars a year without actually delivering patient care, then please choose another industry because healthcare can’t afford you, whether you’re a drug company czar or an overpaid hospital CEO (your results have kind of sucked anyway). Unfortunately, politicians gravitate to money like mosquitoes to a bug zapper, so people just as accomplished and dedicated as Regina Benjamin don’t carry much weight.

Stratus Technologies announces that PC Mall will sell its Avance high availability software.

iSoft gets a $17.4 million maintenance contract extension in Northern Ireland.

The Wall Street Journal says Internet companies are losers when it comes to investing, pointing out that they’re more like unexciting utilities. “Microsoft has spent billions on Internet strategy without a dime of profit. And even Google can’t seem to find any other business model other than the one they stumbled into when they bought Applied Semantics in 2001 that had a little piece of software called AdSense. And the new guys: Twitter and Facebook are still scrambling for profits despite blistering usage growth.”

GE announces Q2 numbers: revenue down 17%, EPS $0.26 vs. $0.54, much of that due to problems in its financial business (I hate to brag, but I said Jeff Immelt’s haughty dismissal of GE Capital’s problems as trivial early in the economic meltdown was BS and it was). GE Healthcare had drops of 12% in revenue and 21% in profit.

Private equity firm Warburg Pincus invests $300 million to form RegionalCare Hospital Partners, which will invest in non-urban hospitals. There’s a lot of talk in the announcement about meeting community needs and service to others, which sounds strange coming from a PE firm.

Another hospital computer breach: UCSD sends letters 30,000 patient letters after finding out about hackers hacking.

Informatics Corporation of America wins its second consecutive Future 50 award from the Nashville Area Chamber of Commerce in recognition of its growth.

Marietta Memorial Hospital (OH) “insources” its IT department to CareTech Solutions, keeping its employees but bringing in a CareTech director.

Red Hat will replace CIT Group on the S&P 500.

E-mail me.

News 7/17/08

From: Samuel C. “Re: Yesterday’s health care bill. After yesterday’s health care bill it is safe to say: ‘It could probably be shown by facts and figures that there is no distinctively native American criminal class except Congress.’ – Mark Twain.” The Senate health committee approves legislation that includes a plan to provide nearly every American with health insurance, regardless of income or medical condition. The program also calls for a government program to compete with the private insurance companies. Opponents include the private insurers, as well as small business owners who fear the financial burden of providing healthcare for all employees.

From: Little Birdy “Re: MED3000. I hear that in addition to Tom Skelton, another former Misys VP is coming out of retirement to join the company. Look for an announcement in the next couple of weeks.”

HERtalk by Inga

Yesterday we published an interview with Mr. H, which is a must-read for any HIStalk fan. I’m not sure he revealed too many secrets, but the piece does re-iterate how hard he works and how humble he is (am I gushing?)  I must admit I didn’t know the interview was coming and was a bit surprised by it. I’ve long asked Mr. H to do an interview, but he always turned me down. So, thank you Dr. Gregg Alexander for being a better arm-twister than me. Mr. H actually skipped town for a bit, leaving me at the helm. I am pondering if there is any correlation between the kind words he had for me and his delegation of all the HIStalk chores for a few days.

Wake Forest University Baptist Medical Center selects Patient Care Technology Systems to provide hospital asset tracking. The Amelior Tracker system will track and manage hospital assets throughout Wake Forest’s 4.1 million square foot campus.

Senator Jay Rockefeller orchestrates a donation of almost $2 million in medical equipment to Welch Community Hospital (WV). Rockefeller had asked staff members last year to prepare a wish list of the hospital’s greatest needs. GE Healthcare helped make wishes come true with donation of an anesthesia machine, EKG monitor, portable X-ray machine, and more.

Meanwhile, GE wins a $12.5 million from LSU Health System (LA). GE will provide LSU the technology to digitize its central database and radiology image repository. The GE contract is just the first phase of LSU’s $116 million, five-year plan to add EHR throughout its 10 public hospitals and 500 clinics.

Boston Medical Center is back in the news, this time for filing a law suit against the state of Massachusetts. BMC accuses officials of illegally cutting payments made to the hospital for treating thousands of poor patients. The state says it has done nothing wrong, and officials are quick to point out that BMC has received $1.5 billion in state funding over the past year.

Sunquest Information Systems introduces a new release to its lab and POC solution suite. The updated version incorporates new modules for molecular testing, along with increased functionality and workflow enhancements for existing applications.

The University of Ottawa Heart Institute cuts its hospital readmission rates 54% for patients participating in a home telehealth monitoring program. The program is also attributed with saving $20,000 for each patient not re-admitted.

Providence Health & Services (CA) names Peter Spitzer CMIO. Spitzer will oversee clinical IS systems in this newly created role.

Henry Ford Health System extends its IT outsourcing agreement with CSC for another 63 months. The value of the new contract is estimated to be $115 million.

Netsmart Technologies acquires Crown Software, a provider of pharmacy management software. Netsmart sells software and services for health and human service providers.

Ingenix subsidiary The Lewin Group launches The Lewin Group Center for Comparative Effective Research. The new entity will focus on providing fact-based, comparative effectiveness research to improve patient care and optimize resources.

United Health Group and Cisco Systems announce a national telehealth network to bring remote medical care to rural and underserved areas. The Connected Care network will use Cisco videoconferencing to simulate an in-person doctor visit.

The American Medical Informatics Association (AMIA) submits comments to the ONC and HIT Policy committee, stressing that EHR certification does not necessarily equate with effectively using the system’s available functions, nor does it assure changes in clinical practice or patient outcomes. AMIA does not believe the current certification process is sufficient and stresses that certification should focus on process and care improvements over time.

Meanwhile, the ONC’s HIT Policy Committee approves the latest revised definition of EHR “meaningful use.” Since the initial definition last month, the committee made a few tweaks to its draft, including:

• Establishing a 10% threshold of CPOE for hospitals in 2011 (rather than the original and less specific requirement for “CPOE for all orders”)
• Allowing the 2011 criteria apply not just for 2011, but for the provider’s first adoption year. In other words, rather than 2011, 2012, 2013 requirements, change to Year 1, Year 2, Year 3 requirements
• Starting clinical decision support sooner
• Making access to personal health records a requirement earlier than originally proposed.

More here.

The information storage vendor Iron Mountain sponsors a white paper recommending the federal government maintain a 10-year retention policy for paper records. The 10-year retention window would give providers plenty of time to migrate to electronic records. And, perhaps give Iron Mountain plenty of time to fully migrate its business model from its original off-site document storage roots.

The Nashville Area Chamber of Commerce names ICA to its list of Future 50 Award winners, based on its projected growth in revenues and employees over the next three years.

iMedica changes its name to Aprima Medical  Software to avoid confusion with several other similarly-titled healthcare companies. The company also rolled out a new website, aprimaehr.com.

Two former executives from Province Healthcare launch a company to acquire and operate rural hospitals. Marty Rash and John M. Rutledge have created RegionalCare Hospital Partners, leveraging $300 million in startup funds from Warbug Pincus.

HIMSS gives Dr. Regina Benjamin a thumbs up following her nomination for Surgeon General. After Hurricane Katrina, the HIMSS Foundation actually provided Dr. Benjamin’s clinic a $5,000 grant to acquire EHR hardware and services. Dr. Benjamin and her staff are featured in this short video about EHR and the HIMSS Katrina Phoenix Project.

Target considers following Wal-Mart’s lead and support mandatory health insurance coverage by large companies.

Nuance Communications purchases startup company Jott Networks, a provider of mobile voice-to-text technology.

A Florida mans sues a physician at the Age Defying Surgical Center in Florida after he was denied a hair transplant. Apparently the 28-year-old hair-challenge patient is HIV positive and Florida law forbids denying medical treatment based on HIV status. The lawsuit is for at  least $15,000. I’ve said it before, but I don’t get why men get so hung up on hair loss. Bald is sexy.

E-mail Inga.

CIO Unplugged – 7/15/09

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

Legacy Leaders
By Ed Marx

How can so many of us hold the title of leader, yet never be remembered? Why do some leaders make a difference while others do not? Fear.

Fear keeps us from making a difference. Too often leaders fade without notice or with merely a modicum of fanfare because of their longevity in a company, because they stuck with tradition, and perhaps they achieved small wins. Conversely, legacy leaders stick their necks out and occasionally go against the flow. They spin the roulette wheel while their peers play it safe. Anyone can play safe – status quo. But legacy leaders fight fear, calculate options, then jump in with both feet. Leaders who leave legacies take risks.

No risk, no legacy. Our founding fathers pursued a risky mission, and look at the legacy they left us. Martin Luther King Jr. took risks that prematurely ended his life, but his legacy endures. Pause for a moment and think of a legacy leader who advanced with nothing at stake? Thought so.

I overhear leaders say they want to make a difference, want to transform healthcare locally and nationally. Yet healthcare is stuck in neutral, if not reverse. Decision makers are overly conservative in their approach to innovation and opportunity. Paradoxically, some I know in management were risk takers early in their careers and enjoyed success. For whatever reason, they shifted gears into a risk-averse posture and ran out of gas short of their destination. We as healthcare leaders must intrepidly drive forward, or surrender the wheel to someone who will.

I want to encourage and reward the courageous, and the best way to do it is to lead by example. Push the envelope. Try new programs, systems, and services before they are mainstream. I don’t settle for giving lip service, I fund and staff risk ventures. Then I reward my risk takers publically, even in failure, because they gave it their all. Perseverance will eventually pay off.

Risk provides a competitive advantage. Do you want to create separation and differentiation in your marketplace? Risk. Tap into the creativity of those employees with a passion to innovate and transform. Yes, there will be failure. Use failure as a catalyst to increase your risk tolerance, not shy away from it. Learn and embrace failure. Edison did.

Stop analysis paralysis. Adopt Colin Powell’s leadership lesson #15, “P@40 to 70.” P stands for the probability of success; the numbers indicate the percentage of information acquired. Once the information is in the 40 to 70 range, go with your gut. Procrastination in the name of reducing risk actually increases the potential of failure or falling behind.

To those who favor remaining conservative. Do you fear losing your job? When you play safe, you’re rewarded with keeping your position, right? But if you don’t rock the boat or challenge the status quo, do you lose part of your soul?

A board vice chair told me, “Ed, if you do your job right, you won’t be here a year from now.” I took his comment as encouragement to take risks on behalf of our patients and providers. If I lose my job in the process, so be it. I do not operate under the fear of man but under the fear of not influencing my part of the world.

Risk is a lifestyle not just a work mode. When hiring like-minded staff, determine the risk quotient of potential candidates by finding out what they do outside of work. If they stick to the standard fare, move on. If they play it safe, move on. They won’t act any different in the workplace.

What about you? Are you a legacy leader making a difference? Will anyone remember your years of effort? Will healthcare be transformed because of your actions?

What are you doing today that is risky? What are you doing today to encourage risk?

Demand it. Live it.

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

An HIT Moment with … Mr. HIStalk

Let the record show that I didn’t want to do this since (a) it looks like a vanity piece even though I resisted and am intensely uncomfortable with the idea of featuring myself; (b) I don’t really have much to say that I don’t say every couple of days; and (c) HIStalk is about news and opinion, not about me. However, Dr. Gregg Alexander was persistent, and since he writes for HIStalk Practice, I felt bad after saying “no” the first handful of times. So, I’m disclaiming all responsibility and turning it over to Gregg. This is my first and last interview.

An HIT Moment with … is usually a quick interview with someone “we” find interesting. Today, I have been granted the unusual and tremendous honor of turning the tables upon Mr. HIStalk, HIS-self. As you know, Mr. H is founder and chief organizer of HIStalk.

You are a humble guy, but even you must admit the breadth of HIT industry folks who read HIStalk on a regular basis is pretty impressive. What’s your take on the not insignificant impact HIStalk continues to have upon this multi-billion dollar industry?

It’s hard for me to say. I just sit alone in an empty room and type onto an empty screen. I’ve never heard anyone at my job mention HIStalk. Nobody there knows I do it. I could count on one hand, probably, the number of people I’ve heard say the word HIStalk to me directly. That’s fine since it’s kind of creepy for me to hear people talking about it. It’s a private activity for me. As you know, I didn’t want to do this interview and tried to ignore your request until you asked a second time. I figured I owed you since you write some fine articles for HIStalk Practice, but otherwise, I probably wouldn’t have done it. I’ve turned down quite a few people before.

I know a fair number of people read HIStalk and I’m really happy about that, but in terms of impact I really don’t know. The only reaction I get is the occasional e-mail. I’m like the guy who throws the morning paper in your driveway. I don’t really know what you do with it, why you read it, or what affect it has had on you. I just keep doing my job and hope you find it useful enough to keep reading. If so, I’m happy to keep right on doing it.

I hope it has been fun for the people who read it. I hope it provides a virtual industry water cooler to chat around since so many of us are far-flung and maybe on the road most of the time. I hope it has educated a few industry newcomers. Most of all, I hope it has provided a dialogue, not just my monologue, on what a cross-section of industry savvy readers think about new developments and concepts that affect healthcare IT and, ultimately, patients.

Just keeping up with all you and Inga write is challenging enough, so how do you manage to work a regular day job, keep current with all the diverse news you gather, find time to write about the news you find of note (and include some insight and humor,) plus still have a family life? (I’ve heard you are actually 5 people; it would make more sense.)

It helps that I work in the industry in a non-profit hospital. Most healthcare IT writers don’t, so they don’t really know what’s important, what’s BS, and how it all fits together. They are good at crafting clever sentences, but they don’t know what they should contain. I’m pretty efficient at bringing all the information I have together and hopefully presenting it in a concise and entertaining way. There’s nothing phony or contrived about the way I write, so it’s just me, no different than what it was six years ago, so I can crank it out pretty fast. Readers help me immensely by e-mailing when they hear something new or have an opinion to share and I value that a lot. I spend hours putting together something that looks like a quick, easy read. The longer I work, the easier it looks.

I’ve gotten pretty organized at how and when I write HIStalk, but it’s still a time crunch sometimes. I’m out at least 10 hours a day at work. When I get home, we eat dinner and I head off to the computer. I’m there every evening for at least three hours, sometimes more than five. It takes a lot of time to read and reply to e-mail, to do the primitive recordkeeping I do for sponsorships and all that, and to do the actual writing. I spend a bigger chunk of time on Saturday and Sunday, sometimes more than eight hours each. Luckily, nothing invigorates me more – even after six years and many millions of words written – than sitting down fresh and starting off on another HIStalk.

Thank goodness I got Inga to help me awhile back with the writing, the research, and working with our sponsors. I was getting pretty frazzled, especially right around HIMSS time when it all comes to a head. She keeps me sane. We worked together for almost a year before we ever met in person, having decided after a five-minute phone call that we were a good match. She made it fun again.

I hope I don’t ignore my family in doing HIStalk. I worry about that. Will I look back someday and wish I’d spent more time doing something more profound? Is it really worthwhile or just a comforting distraction from reality? Or, should I be some kind of astute businessperson and make it bigger or better even though I know next to nothing about starting or running a business and I’m chronically lazy? Until I figure those things out, I’ll just keep doing what I’ve been doing.

Speaking of keeping up, there’s so much HIT hubbub these days with ARRA, HITECH, CCHIT, evidenced-based, meaningful use, etc. As you keep a pretty tight finger on the pulse of the goings on in HIT, I’d be curious to hear what your take is on the overall state of the industry.

The government wanted IT activity in healthcare and it’s getting it, albeit at a high price. Based on recent activity with the banks and auto industry, I think this administration expects to be an active partner in healthcare, not just a quiet financier of IT systems. IT will give it a way to collect information and develop policies around it. Good or bad, Uncle Sam is the biggest customer of many or most hospitals and doctors and he’s not happy about the value received, so opening the healthcare kimono via IT should be interesting.

I would be more excited about using billions of taxpayer dollars if there were at least incentives for vendors to develop new products. It’s mostly the same old systems and same old potential customers, only with federal money forcing their awkward introduction. I hope vendors use some of their new revenue to create new systems based on paradigms and technologies from this millennium instead of just patching up the old ones. I worry that all systems are starting to look and work alike since vendors keep swapping former employees with each other, ensuring cross-pollination instead of innovation. CIOs hate IT risk, though, so maybe everybody will just keep running what they always have except for some of the more exciting niche systems and technology platforms like the iPhone.

When it comes to physician practices, I’m not convinced that most of them will take the bait after comparing the potential rewards with the perceived effort required. The government hasn’t been all that reliable and supportive of a partner when it’s tried doctor programs like that before. Doctors know that everybody gets value from EMRs, but they’re the ones on the hook to actually use them. They have nothing to sell but time, so if EMRs are perceived to take more of it, I don’t think the incentives will be enough – except maybe for the small practices that have to count every penny. I would have preferred a rewards system based on sharing patient data, where you get paid extra for making your lab results, prescriptions, and notes available electronically to other providers. Then, let the providers choose whatever tools they want to support that. The final definition of "meaningful use" will most likely include that, so it will probably be fine.

All the rewards require a very short time frame for implementation and productive use, which I worry is more than either vendors or providers are ready to tackle. Resources may be an issue. We’re dealing with patient systems, so let’s hope we don’t see unintended consequences from quick and dirty implementations.

Some vendors, especially those with marketing machines that can capture the attention of prospects in the small window in which they’ll be buying products, will do very well. Those not so fortunate will have a tough time since HITECH will front-load a lot of sales that would have taken years, so those that don’t succeed in that small time window will find the pickings slim for years afterward. I think a lot of second- and third-tier vendors will scale back, close down, or sell out as a result. There’s a big wave coming, but the trough right behind it could be ugly.

We’ll get our critical mass of EMRs, at least assuming everyone gets implemented. The real job is to do something useful with them. That requires focus and change management capabilities, qualities that are hard to come by in many organizations. Without quality reporting, data interchange, and some element of practice standardization, we won’t have gained much by planting all those EMRs. They don’t provide enough efficiency benefit for that alone to be the driver. That could create a new demand for analytics, add-on tools, and formally trained informatics people who can do more than just flip the go-live switch. EMRs might eventually become a commodity as CCHIT, or whatever certifying body is named, expands their functionality checklists to become what could be a full set of specs for an EMR. Maybe you don’t need dozens or hundreds of vendors if they all meet the same basic requirements.

Overall then, I would say everybody’s going to be busy for the next five years at least. We’ll probably see mini-Gartner Hype Cycles as new customers buy systems, find them disappointing for one reason or another, but eventually gain benefits they wouldn’t have expected. Way down the road, the power will be in the connection, not the tool used to connect, so EMRs may be as unexciting as buying a PC today — just a generic tool you need do real work by connecting with everybody else on the Internet.

Your newest “offspring,” HIStalkPractice…what prompted your address of the physician practice world?

Inga came from the physician practice side of the industry, but I was a hospital guy. I knew we weren’t covering everything in HIStalk, but I wasn’t sure that audience was really interested in what was happening with practice management systems, EHRs, CCHIT, and all that kind of detailed discussion. I also knew there were a lot of potentially influential voices that weren’t being heard, such as yours, and I wanted to see if we could cultivate an audience interested in the usual HIStalk style news recap and opinion for that somewhat different market, along with more interviews and guest articles. It has been slow going, but nothing like the years it took to get a few readers of HIStalk.

Inga does pretty much all the writing for it other than what our guest authors put together, now that I’ve convinced her she has the knowledge and the ability without me looking over her shoulder. I do nitpick about how she punctuates and structures her sentences sometimes and I know she’s just neurotic enough to let that bother her, so I try to leave her alone.

On the “About HIStalk” page, you give a fairly complete background on why you started HIStalk and of your general operating standards. Pretty straightforward about your approach and principles. However, you have a sardonic wit and are often quite blunt about your opinions. Both of these traits make for a great read, but from what you do post from readers, you are often also slammed for your perspective. Do you receive more pointed or insultatory jabs for your writing that don’t make it onto the printed screen?

I run most of the e-mails I get on HIStalk if they would interest readers. I do get the occasional viciously nasty and insulting comments, usually for something silly, like years ago when I mentioned some notoriously phony schools where healthcare people were sporting MBAs and PhDs from. I got some threats over that more than once. Those were the only truly angry comments. Sometimes someone complains that I’ve been unfair to a company, have sold out to sponsors, or think I know it all. I do a little self-analysis to see if they have a point that I can learn from, then move on one way or another.

I really do try to be fair. I encourage comments that disagree with my opinions. If I rip a company one day, I try to remember to say something nice about them another day. I see my job as being a moderator who introduces a topic, maybe throws out some controversial statements to get the discussions going, and then makes sure everyone plays nice together as they debate. I like it when people get along, but I understand that some of the most valuable stuff comes from heated discussion.

I’ve heard a buzz that you and the lovely Inga might be unmasked at the HIStalk reception during HIMSS in Atlanta next year. Just wishful rumor mongering or is there any such possibility?

You never know. Inga is a lot more of a schmoozer than me. Sometimes I think she’s about to burst trying to keep the secret that she’s Inga. Unlike me, I think she would probably bask in whatever limelight there is and readers would like her even more than they do now. So, maybe we will arrange her coming out in some fashion at HIMSS. She’s probably already shopping for new shoes.

News 7/15/09

From Ex-Cerner Guy (among the many): “Re: Banner’s Cerner pricing. The pricing for the full HIS, @ $30M or so, looks pretty accurate. It likely started in the $45-50M range, then someone from KC came in and probably cut the SW pricing to get the deal. KC types will cut the pricing until the prospect says yes. From a customer perspective, there’s no value in saying yes until the SW fee is $0 and hourly rate is $125 or less. Banner probably said yes a little early.” The paper actually said each of their smallish hospitals was spending $30 million, so that’s what I questioned. Good negotiating tips, by the way.

From Bob in Accounting: “Re: sometimes you keep track of these things.” A doctor at Fletcher Allen Health Care (VT) is reprimanded by the state medical board after admitting that he improperly accessed the medical records (presumably paper ones) of eight women, one of them a previous acquaintance who found about it and turned him in. The article refers to “breeches of patient medical record confidentiality,” which either means someone makes little pants to keep records safe or the reporter trusted his spellchecker instead of his dictionary.

From Mark Moffitt: “Re: ARRA. Is anyone else viewing the ARRA as an investment opportunity v. subsidizing IT? GSMC is spending $1.3 million to net $2.7 in Year One and using the proceeds for other non-IT clinical needs.”

From The PACS Designer: “Re: SAML. The porting of applications to the web has increased the need for security enhancement solutions. To address this need, there’s a specification called Security Assertion Markup Language (SAML). SAML provides the means for multiple organizations to exchange security information to protect each other’s security requirements. Also, security software promoting federation and the use of single sign-on solution for multiple systems through the use of SAML enhances the user experience and removes the need for multiple IDs and passwords.”

From Wayne Panera: “Re: strong passwords. Pretty good paper from Microsoft called ‘Do Strong Web Passwords Accomplish Anything?’ discussing the fallacy that strong passwords produce additional security.” Link (warning: PDF). The article says that passwords are stronger than they need to be to thwart brute force attacks (as long as you don’t allow more than three incorrect login attempts) and yet do nothing to prevent phishing and keylogging. Interesting idea: it suggests making user IDs longer is easier for users to remember and equally effective in preventing brute force guessing. Their example: PayPal requires an eight-character password that isn’t in the dictionary, uses mixed case, and has at least one special character, despite the fact that even a six-digit PIN has only a 1% probability of being cracked after a 10-year brute force attack. With regard to lockouts, the article also suggests that instead of a fixed lockout, like 24 hours, that the application simply geometrically increase the lockout time between each unsuccessful login attempt and, to prevent bot attacks, consider setting the lockout by IP address.

From Lynn Devine: “Re: Healthport. They’re looking to outsource their EMR development to integrate it with their PM product. They project a year to do this – it’s only been suggested for the past five years.” Unverified. Inga is attempting contact the company.

University of Florida says it will invest $70 million in clinical and translational research over the next 5-7 years, with “a large portion of those funds” being used to roll out Epic’s EMR to the faculty practice.

Listening: Lady Ga Ga, hopelessly trendy and way outside my usual genres, but it sounds pretty good now that I’ve listened to the CD three times.

A 50-provider medical group in California drops two CCHIT-certified (“point-and-click”) EMRs, replacing them with the EMR from SRSsoft after a free pilot.

A BlackBerry executive grudgingly admits that docs love the iPhone, confirms that the Chalk Media technology BlackBerry acquired will be used for medical education, and urges healthcare customers to take advantage of their BlackBerry Enterprise Server and client licenses to push data. He also touts BlackBerry’s App World and says customers have an appetite for it “and other app stores”.  Basically, he thinks Apple is promoting innovation that BlackBerry has had in place for years. If there’s an App Store … er, App World … application to measure the sourness of grapes, it’s time to roll it out.

Thanks to the reader who sent over the BMJ article from Kaiser Permanente Hawaii on its use of HealthConnect to proactively generate risk-based nephrology referrals instead of waiting on generalists to do it. Last-minute nephrology referrals by primary care providers occurred 30-42% of the time in the pre-study population, causing missed clinical opportunities for patients. The targets and results: (a) reduce late referrals, defined as being within four months of the onset of end-stage renal disease, aka ESRD (dropped from 32% to 12%); (b) creating the “life line” arteriovenous fistula in time for it to mature (increased from 18% to 36%); and (c) start dialysis as an outpatient (increased from 35% to 56%). How they did it: HealthConnect was used to identify at-risk patients, looking at glomerular filtration rate, urinary protein, and serum creatinine lab results in a monthly download. Those patients were assigned a numerical risk rating for ESRD. HealthConnect was used to recommend the referral, capture notes about whether the PCP and patient followed through, to deliver electronic messaging between the PCPs and nephrologists, and to issue alerts for patients showing a deterioration trend from one monthly download to the next. The result was that 280 patients were referred and some of the PCPs learned how to manage the patients themselves better after electronically reviewing the work of the nephrologists. Interestingly, the original plan was to let the PCPs do all the managing themselves, but they pushed back, saying they were too busy and worried about the impending HealthConnect implementation. Good work by Kaiser, a nice example of physician collaboration, a great reminder of how medical practice can change positively once information is available electronically, and a fine service to patients who surely had better outcomes as a result.

This from Weird News Andy, who says, “They took him to get a blood test at a hospital to prove he was drunk. He proved they were right.” A DUI suspect flees Research Medical Center in a stolen ambulance before his ride is ended by “stop sticks” and a police dog’s bite. As you might expect, he was not a first-time offender, with a rap sheet that included three previous alcohol-related convictions and a revoked driver’s license.

Michael Sinno is promoted to VP/CIO of Cooper University Hospital, which is in some hitherto unknown state called South Jersey.

Thanks to IntraNexus and CEO Rick O’Pry for supporting HIStalk as a brand new Platinum Sponsor. The Virginia Beach-based company offers the Sapphire Web-based (or client-server, if you prefer that option) hospital information system (still the coolest product name ever if you ask me), a complete single-database system with patient access, document imaging, revenue cycle, scheduling, general financials, EIS, clinical care, imaging, CPOE, critical care, ED, EMR, lab, LTC (!), pharmacy, point of care, radiology, and other modules. Here’s a writeup about beta site Oswego Hospital, who said “Sapphire was the best go-live we have ever had.” They just went live at St. Luke Hospitals (KY). Thanks to IntraNexus for supporting HIStalk.

Bad news for Microsoft: a survey says that 60% of its business customers won’t buy Windows 7 because of cost and compatibility concerns (the same reasons those customers passed on Vista, in other words). Microsoft’s real problem, if you ask me (and you didn’t), is that its cash cow products aren’t strategic – everybody can live without new versions of Windows and Office. And in tough times, they apparently will.

The American Heart Association will donate $50,000 toward creation of an open source CPR learning application for the Wii.

AMDIS announces its 2009 award winners: Michael Dominguez (University San Antonio), Fallon Clinic, Cynthia Herzog (MemorialCare Orange County), Kaiser Permanente, Steve Margolis (Orlando Health), Jon Morris (Wellstar), Matt Sprunger (Dupont Hospital), and the UPMC interoperability team.

The New York Times highlights Cook Children’s Health Care System (TX), a 350-physician practice that will install a Web-based EMR from athenahealth and Microsoft’s HealthVault. It will also open an Innovation Clinic with two or three doctors that will operate under the capitation model.

Cardinal Health’s debt ratings are lowered to near junk levels because the upcoming spinoff of its clinical and technology products business means there’s not much left except low-margin drug distribution. I guess analysts weren’t distracted by the CareFusion jazz festival.

China’s health ministry puts a halt to a clinic’s rather extreme program of Internet addiction therapy in teens, saying it will no longer allow “freaky treatment” that included electroshock therapy, kneeling in front of parents, and forced confessions of wrongdoing.

While everybody’s salivating over stimulus money, here’s a sobering fact: the US budget deficit just hit $1 trillion so far this year, the first trillion-dollar deficit ever, but nothing special considering estimates are now at $2 trillion for the year (not counting the new calls for another round of stimulus money because the first one didn’t really do much, with unemployment even higher than the level threatened if the stimulus wasn’t passed).

The Terminator fires three of the six members of the California Board of Registered Nursing and its executive officer quits after a nonprofit investigative newsroom found that it took years to get dangerous RNs off the job. Newspapers run by bad businesspeople (big corporations saddled with acquisition debt) keep getting smaller, stupider, and more reliant on wire service celebrity gossip, so this example of a non-newspaper doing real investigative work in the public interest is sure to raise the debate about what journalism really is.

Odd hospital lawsuit: frightened by stories of a hospital’s hepatitis-positive surgery nurse who replaced OR needles with her own dirty ones while stealing drugs, a patient files suit against the hospital even though her own test results aren’t back yet. The patient’s attorney wants the court to oversee patient testing for hepatitis. He also says he has people who are “literally scared to death,” which even an ambulance chaser should know means they are six feet under instead of trying to jump on a class action lawsuit.

E-mail me.

HERtalk by Inga

I am back from my big vacation, a little more rested, tanned, and a new fan of rum punch. Oh, and I made time for wee bit of shoe shopping. The vacation gods made me forget the power cord to my laptop so I was forced to keep my Internet surfing to a minimum. And, low and behold, the HIT world continued without me!

Providence Associates Medical Laboratories rolls out a new billing system built on the InterSystems Cache’ database. The lab reports that month-end processing time has been slashed by 88%.

Novant Health (NC) hires CareTech Solutions to manage its web content and provide secure hosting for its 10 Web sites.

e-MDs announces the release of its 6.3.0 Solution SeriesTM, which incorporates First DataBank’s drug database solution, enhancements to its Surescripts e-rx application, support of continuity of care documents, and other features.

The National Rural Health Association’s Services Corporation selects Virtual Radiologic as its provider of choice for teleradiology services.

Image On Call, another provider of teleradiology services, promotes COO MIchael Lampron to CEO. Lampron was VP of services and GM of the Vision Series Financials Group at Amicas.

Allscripts announces it is working with the AMA to offer an AMA-branded e-prescribing tool. The tool will be available at no cost to subscribers of a new online solution being developed by the AMA, with help from Covisint.

Sales from wi-fi enabled healthcare products will total almost $5 billion by 2014, a 70% increase over today’s numbers, according to a new study.

Healthland appoints Odell Tuttle to the role of CTO. He was previously with Gearworks, focusing on  the company’s mobile healthcare product OnCare.

The financially struggling Shriners Hospitals for Children will begin accepting insurance reimbursement rather than close six of its 22 hospitals. This follows a plunge in endowments from $8 billion to $5 billion during the economic downturn. For 87 years, the Shriners have provided free care to children without billing insurance providers.

Boston Medical Center is also in financial straits, anticipating a $175 million loss in the fiscal year that starts October 1. The hospital laid off 250 people earlier this year and took other measures to cut costs by $40 million. It’s the state’s largest provider of care for the poor and also offers a food pantry for patients with special diets and legal aid. What happens when the nets collapse at safety net hospitals?

The local paper highlights EnovateIT and the niche it is building with its computer wall cabinets and moveable carts. The company, which last month announced plans to manufacture its own cart in the USA, employs 46 and has revenues of $46 million. I interviewed company president Ron Sgro last year and found him to be pretty fun (medical carts make for a pretty dry topic, but he was entertaining), plus I like their green approach to business.

Scotland becomes the first country in the UK to deliver e-prescribing services. More than 90% of all prescriptions are now submitted electronically using the national Acute Medical Service (eAMS).

Maine plans to go live on its statewide HIE later this month. HealthInfoNet will connect 15 hospitals, three health clinics, and the Maine CDC. Health information from more than 400,000 patients has already been loaded into the HealthInfoNet system, which is powered by 3M Health Information Systems.

GE announces a new partnership to integrate the Medicalis CDS-DI solution with its Centricity Imaging IT and EMR products.

The HIMSS Electronic Health Records Association (EHRA) sends a letter to the ONC recommending, among other things, that CCHIT be “the single certifying entity to avoid duplication of effort, unnecessary expense and confusion in the market.”  Uproars from the anti-CCHIT folks to follow.

E-mail Inga.

HIStalk Interviews William Bria MD, Chief Medical Information Officer, Shriners Hospitals for Children

William Bria III, MD is chief medical information officer at Shriners Hospital for Children, Tampa, FL, and  chair of the Association of Medical Directors of Information Systems (AMDIS).

What kind of response have you received from the AMDIS recommendation to not include CPOE in the first round of the HHS”meaningful use” criteria?

It’s been excellent. I’ve gotten response from our membership, but I’ve also had a number of discussions with everybody from the press to those that are in high places, shall we say, and other organizations, like the American College of Physicians. What I’ve gotten back is that both the caveat that we put in our response and the emphasis that we put the patient consideration up front was very well appreciated.

Considering the vast majority of hospitals in the country don’t yet have a fully implemented EMR, I think the concern in this economic climate of what it means to individuals personally as well as organizationally was the biggest impact, particularly when they saw how much they were going to be asked in 2011 to come up with in the draft proposal from Paul Tang and his group.

I think the patient focus of it gives us a way of balancing that concern with a very important political consideration, if I may, in that if this change in American healthcare is painted as a regulatory or a governmental imposition on the practice of medicine which some, as you well know, in the press were already doing, then it actually aligns physicians and patients against it rather than what we really believe is true, that this is one of the tools. It’s not an answer to all of the problems, but it’s a tool that can act in a very fundamental key change kind of way to empower patients and give patients the information they’ve needed forever.

My most recent experience was this afternoon at around four o’clock when my son, who has a chronic illness, a very serious one, called me and said his doctor had broken his leg in an accident. My son — he’s in his twenties — is very fastidious about seeing his doctor and careful about follow-ups, but he called the office and was told that the next appointment with his doctor was in 2010. He was trying to make an arrangement for something that was within the next two weeks before the doctor had his accident.

You know, that’s a real basic patient communication aspect that should be as difficult as saying, "Your flight was cancelled, but you can select these other flights," or "Your hotel reservation is not possible, but we can take care of you at this other hotel." The idea of some of the basic communication in the business of delivering care in America, because of the lack of automation at the level of the patient, is still far too frightening and daunting, and don’t even get into how much it’s costing to have a mostly non-automated process for delivering care in America.

Do you think ARRA encourages organizations to move too quickly in ways that may have unintended consequences when it comes to patient care? 

I think there’s no question about that. I think the first draft — and that’s all it was, it was a draft, and I think it would be wrong to make out that it’s more than that — the first draft on this saying we are going to accomplish CPOE adoption, a full EMR adoption, EHR adoption, and then successful reporting on quality and metrics out of the same system, that really speaks to me from a point of view of someone who hasn’t really done it yet. If you think it’s that mechanical that you can drop these systems in even a modest-sized healthcare setting, and moreover, settle down and actually be able to generate data, and then be able to automate a process of quality and safety reporting, it doesn’t speak to folks that actually have the experience of having to do that.

So I think that was perhaps a challenge, perhaps a way of creating controversy that levels it, because as we all know, it’s really going to be CMS that’s going to make the final decision on this, and the idea of sending the wrong message about reasonable expectations in what timeframe that should be done at some point, no question about it. Absolutely. If we didn’t put quality reporting and safety reporting as part of the expectation of the entire delivery on meaningful use, absolutely. That would be crazy. That would be a major mistake.

However, saying that it all can happen in a two-year time frame, that really puts a concern about reality testing.

Are you concerned that, since it’s an economic stimulus that requires the money to get out quickly, that they’ll just chuck out everything except the minimal criteria and say, "Look, just think of it as a slightly encumbered grant"?

Well, could that happen? Could that be a reaction formation that goes all the way or the other way? Yes. Is that what we want? Absolutely not.

From the standpoint of insisting on the introduction of tools, on the introduction of preparedness and analysis of concept redesign and genuine commitment to achieving success in introduction of the basics — departmental systems, scheduling, reporting, and data acquisition and reporting– is the key to starting the engine of information for an organization — large, medium or small — to even approach the challenge of subsequent data reporting and analysis.

So we think that dumbing it down too far is a risk, but we are anything but that. We are definitely for steadfast introduction and insistence on introduction, which I think the CMS — part of its leadership — makes it clear to most organizations, even ones that haven’t been familiar with the idea of clinical data systems as being central to their business.

Interoperability seems to have been traded off in favor of just getting systems put into offices. Do you think there will be enough emphasis on exchanging data and rewards for doing that?

I think there’s been emphasis on it, but I don’t think there’s been enough clarity about who’s responsible for doing that. If you consider the scope of the introduction of any of the existing systems, and then start to consider the scope of interconnection through interoperability of information, the systems themselves don’t need to be interoperable, the database contained must be interoperable. Who is responsible for doing that?

The idea that while you’re trying to understand and implement and accommodate the introduction of an information system into your practice — in a large, medium or small clinical setting — that you’re going to have the persons and the skill set to interconnect that data seamlessly with the rest of your community, that’s not very realistic, I don’t think, in anybody’s perception.

There has to be the identification of HIEs or other entities that are going to, in fact, have that as their main focus as communities and regions start to introduce electronic health records.

Where do you see that interoperability push coming from?

I think the notion of saying that entities — and there needs to be more clarity on what entities are going to be charged — is it going to be the small, two-doctor office that’s going to have to worry about interoperability with their region? No. That’s not reasonable or realistic, and it’s my experience that then we will have a bunch of silos, where we now have paper silos, we’ll have also electronic ones.

But the notion of making that much more explicit about in what way and in what timeframe are those considerations going to be made, will there be clear standards with regards to data exchange to the vendors? Not to the customers, but to the vendors, in order to receive approval for certification and implementation in this national scheme. That’s a whole dimension of this discussion and the response to the first draft of meaningful use. I don’t think we’ve really spent enough time with it yet as a country and in applied medical informatics as a discipline.

Since it was an economic stimulus, the bill seems to push EHR adoption as opposed to EHR benefit. Do you think those two are inseparable? Should we be trying to bring up the laggards who have no technology at all or should we be rewarding the results of the technology and let them pull themselves up accordingly?

I really believe that the idea of a critical mass of American healthcare using information technology will so tremendously change the national dialogue and the national expectation about the practice of medicine using that technology — that is the first, second and third priority.

We have to get a greater penetration. That doesn’t need to be 90% — no, it’s not going to be 90% in the next five years, but what it needs to be is greater than 17%, or 15%, or 20% even at this point. It has to be at least twice that for us to start to say that this is truly an unstoppable transformation from the standpoint of the infrastructure necessary to practice medicine and for physicians to no longer be bystanders.

I’m not talking about informatics positions, I’m talking about rank and file practitioners to no longer be bystanders in this discussion in their offices, in their hospitals, and their communities, but to be active consumers defining what is needed first, second, and third in their improvement and then moving forward.

I’ve been talking about this and speaking to physician groups on this subject since 1982 when I finished my fellowship and took my first job that included both of these paths. So the idea, I think, of really making the case that there is a critical mass and that introduction — I won’t say adoption, because that apparently is considered a bad word — of information technology in the American healthcare to a significant degree is long overdue and absolutely essential to get to the next level.

You mentioned certification. Does AMDIS support certification, and if so, do you have an opinion on whether it should be CCHIT as the certifying agency?

I think the way in which CCHIT has operated in the past has been good for that stage. I think now with the money that has been directed towards it, the idea of being anything other than an objective certification body that has at its core both the timeline and the elements of the goal of the ARRA, the HITECH portion, is essential.

What do I mean? For a number of years, since I was the chairman of the HIMSS Physician Community group, we have been asked to review the criteria that were being used at CCHIT, since HIMSS is a major partner in that. Every time, me and my colleagues, many of them from AMDIS, that were part of that re-review before CCHIT spins out its next version of criteria for certification, we said why are we delaying CDS for some future time? Why isn’t there an insistence on the existence of elements of data exchange and interoperability mandated as part of the standards of being able to have a certification of your electronic health record product?

The usual answer was that yes, they know that’s important, but they thought that that was a future development rather than an immediate necessity. That never sat well with me nor my colleagues in our review process. I would be very anxious to see that whatever new body or whatever new group was constituted that there was clearly no confusion about connection with the status quo, that it was directed towards the actual goal, the stated goals, of the ARRA itself.

You’re working on some formal informatics training programs. What do you think the industry needs in terms of the quality and quantity of people who have real informatics training, not just on-the-job training?

A lot more. (laughs) I think since the bar’s been set in this first discussion very high, I’m saying that it’s not enough to put in systems then say, "Congratulations, everybody can go home and rest," but rather data reporting and actually then make that the reason, the raison d’etre, of healthcare informatics, the quality and safety reporting and performance reporting in a national scale.

I think you’re going to need a lot more people that not only understand the information technology, which is an entry level issue, and rather get on to those who really know how to evaluate large data sources, be able to guide and manipulate information systems as necessary in order to improve performance, and a last but not least, we’ve talked for so many years about, "Are you up on CPOE yet, or did you just do results reporting? Anybody can do that results reporting stuff, but CPOE — that’s a real man’s job”.

But you know what the real man’s job? It’s to get data out of the system that is of sufficient quality, and have a dialogue with the clinicians in an organization to actually improve and change practice. There are examples of this, but boy, there’s not a lot of them. The ones that have done that as a production line, the same way we used to think about the production line of order entry and results reporting, those organizations – Cleveland Clinic, Mayo Clinic, Partners, Kaiser, etc. — those are the leadership healthcare organizations in this country. I don’t think that’s a mistake.

What are the most important projects you’re working on in Shriners and what challenges are you seeing?

We are working on clinical decision support. We are working on CIDSS, clinical information decision support services. The first one, as a practical matter, improvement in medication ordering and administration safety and quality care sets, tuning our alerts environment and refining it for the particular care line that we have — we’re a very specialized pediatric hospital system–and the CIDSS project is a data warehouse installation, evaluation, and targeting towards actual safety and quality necessities and reporting within our healthcare systems. Those are our important projects.

Do you think that outcomes analysis or process analysis in the data warehouse is going to make the underlying tool that created that data less important or more of a commodity?

Not yet, but that’s exactly what we have to get to. And again, the organizations that are leading — I don’t think people sit back and say, "Well, they did all this because of this vendor." Well, yes, it was important to have a product that had sufficient functionality and a data model and environment that could be leveraged for these reasons, but it’s really the organization and their ability to use data to make them more successful and make them appear demonstrably better than competitors. That’s the name of the game.

I truly believe that we’re going to head, in the next decade, from a time of talking about these elements of automation in the actual process of healthcare into saying, "This is the necessary tool, but that’s all it is." This is the instrument to allow leadership in organizations that are the most forward-thinking and the most attractive to the people who seek care, this has provided in the necessary grist, the fundamental data, to be able to demonstrate and succeed in innovation.

There are probably going to be a lot of organizations that are going to be pushed into buying technology only to realize that was only the little step, and the big one’s yet to come.

(laughs) Well, you know that’s how life is. Human beings need to take it a little bit at a time. If you knew how difficult it was to get married, have two kids, raise them well, help ensure that they’re going to be good people, you never would have done it. (laughs)

Anything else that we should talk about?

I just want to say that our organization, AMDIS, is for physicians and other clinicians that have now the challenge ahead of them of actually starting to deliver on all of its promise. We are so excited that the stars have come into alignment to make what we’ve been working on for many, many years now become one of the major agendas with the rejuvenation, and hopefully reinvention, of healthcare in America.

Monday Morning Update 7/13/09

From afh15: “Re: EHR data. I’d love to read your thoughts on this study and the long-term uses of EHR data in preventive care.” I don’t have access to the full text of the article, but I truly believe that once the pain of getting EMRs running as data collection appliances is over (meaning we’ve got data collection clerks known as doctors and nurses in place, which is the “pain” part), the benefit will be incredible. This article apparently deals with having nephrologists automatically consulted when the EHR finds problems. There are other benefits. You could do society-improving medical research by just slicing and dicing data from millions of patients, at least the parts of it that aren’t just clinical-sounding billing events that are useless or even misleading. You could find candidates for research trials. Patients could be followed over many years, even as they move around and use the services of a variety of providers. And for individual patients, there could be great value in putting research findings into the hands of front line doctors. Not to mention giving patients a platform whereby they can participate in their own care and add non-episodic information related to lifestyle, personal health assessment, etc. Clinical systems will not save time, as clinicians know – they exist to create data whose value mostly accrues to someone else. My advice to providers: much of your future income may be based on the data you create and the ownership in it you retain. Don’t be like the Native Americans and let greedy outsiders buy your land for trinkets.

From Anonymous: “Re: Craneware. Interesting question to ponder: How did two young Scot lads, with no US healthcare knowledge, manage to visualize and create Craneware, the country’s first automated CDM software based on complex Medicare regulations? The designer of Craneware’s core CDM products is a US healthcare consultant and not a Scot. Nora McNeil (NJ) is Keith Neilson’s American mother-in-law. She co-founded Craneware with KN and his partner Gordon Craig and taught the Scots everything they needed to know about US healthcare policy and regulations. She was  also the sole marketing and salesperson of Craneware’s CDM products for the first two years of the company’s existence. So why have the duo not publicly acknowledged Nora’s existence as a founding partner and her primary role in creating a successful company?” The company’s documents say it was founded by Keith Neilson and Gordon Craig “following on from discussions with Nora McNeil.” I would guess there’s a family squabble somewhere in the mix. And when that happens, the lawyers are usually not far behind. I don’t have a horse in the race, so I’m neutral.

From Cracker: “Re: Nuance. Nuance’s domination of health care speech recognition gets more scary when you also consider the current M*Modal customers taking a serious look at Nuance. I know second hand of two current M*Modal customers looking at Nuance and will do some research to find some more.” Cracker references a news piece describing an anti-trust investigation of Nuance’s $96 million acquisition last year of Philips Speech Recognition systems (the old SpeechMagic). My assumption, reading between the lines, is that a competitor complained and the investigation is just making sure Nuance isn’t raising prices after knocking off Philips (not likely since Philips had minimal US presence). I don’t know much about M*Modal so I don’t know how they stack up to Nuance, but they and a few other vendors are facing a large, highly successful, and aggressive competitor whose name is nearly synonymous with speech recognition.

From Captain Hook: “Re: Valco rumor. We are a current client and since the announcement have spoken with a couple of our prior contacts at Valco (and they appear to still be working for the company). It is clear that some of them have been let go. Spoke to AJ Hyland as well. No indication that Valco technology will be sunsetted, at this point but it would make sense to do so. It is clear that Hyland bought the client base and entree into Meditech clients.” Valco sold portals, electronic forms, scanning solutions, and other healthcare tools.

From Commander Cody: “Re: Medical Center Odessa. They paid $6.2 million for CPOE, but their regional neighbor Midland Memorial paid only $7 million for their entire clinical transformation project. After five years, Odessa is just now doing McKesson CPOE, two years after Midland has fully implemented OpenVista hospital-wide. Taxpayers paying for high-priced proprietary EMR systems is a bad idea.”

Should CPOE be a requirement for demonstrating meaningful use of hospital-based EMRs? Yes, according to 69% of those who answered my poll. New poll to your right, inspired by the comment above: should hospital CIOs consider open source clinical systems?

McGill University Health Centre is working with Medical.MD to develop its MedforYou PHR.

The local paper covers EMR implementations in two Arizona hospitals. Banner Health, the story says, will spend $30 million (hardware, software, and training) each at two of its hospitals: 430-bed Banner Boswell and 272-bed Del E. Webb. They’re Cerner, I believe. I hope that dollar figure is a misprint, but then again, Banner paid its CEO $2.7 million, the CFO $1.7 million,  and its CIO $600K in 2007, so maybe big numbers don’t bother them. Its 2007 profits … sorry, “surplus” …, was over $300 million. Since they’re not paying taxes, I guess the money has to go somewhere.

Say hello to TELUS Health Solutions, supporting HIStalk as a Platinum sponsor. The company, which took a big jump up the HCI Top 100 this year from #33 to #20, offers a wide range of healthcare solutions (claims management, the new TELUS Health Space personal health platform, pharmacy management systems, telehealth, patient and resource scheduling, and the renowned Oacis Unified Patient Record). The open architecture Oacis, in fact, has been supercharged into an integration platform that offers an integration gateway, EMPI, CPOE, ED tracking, clinical documentation, Web-based Enterprise EMR, and data warehouse/BI portal, making it suitable for healthcare organizations and entire regions. I remember from talking to the folks there awhile back that Oacis has two big strengths: it can handle the interoperability requirements of regional deployments and for hospitals, it can be implemented without ripping and replacing (it also excels at being customizable, as I recall). OK, I’m prattling on because I was pretty charged up with Oacis when people started telling me about it years ago, but for now, let’s leave it at this: thanks to TELUS Health Solutions for supporting HIStalk.

Cerner moves up to the Nasdaq-100 Index, replacing the Oracle-acquired Sun Microsystems.

HIMSS is thinking more and more like a vendor. How do they improve (“reposition”) the perception of its CPHIMS certification credential? Hire a marketing company to develop a “correlating creative platform and 12-month integrated communications plan.” Because of the tsunami of federal HIT dollars, “the CPHIMS new brand positioning will be more essential than ever,” at least in the eyes of the marketing people (a knowing wink to fellow grammar zealots: “more essential” makes no more sense than “more pregnant”).

The California Nurses Association union files a complaint with the state’s Department of Public Health, alleging that UC Irvine Medical Center has overdosed at least five patients with narcotics by using malfunctioning Curlin infusion pumps that let patients control the flow of pain med IVs. The hospital disagrees, saying keystroke logs indicate that in at least three of the cases, nurses entered the wrong dosage. Meanwhile, an enterprising group of ambulance-chasing lawyers has bought Google search ads trolling for victims who have “sustained damage” after a Curlin pump recall, helpfully noting that companies have to pay out even if they weren’t negligent under current strict product liability laws. Maybe the lawyer proceeds of healthcare-related lawsuits should be taxed at some reasonable rate (90%?) to help fund healthcare reform since the former lawyers in Congress keep avoiding tort reform.

Industry long-timer Bob Fetters died Tuesday at 70 in Kennett Square, PA. He worked for over 20 years at SMS and had already RSVP’ed for Vince Ciotti’s November reunion. The memorial service was Saturday morning, but messages for the family can be left here. Condolences.

I like this fresh thinking: if we’re already paying double what most countries pay for healthcare, why should healthcare reform cost anything? I also like this answer: “We owe the insurance companies, pharma, etc. a severance package, payable into the future for some undisclosed period of time. Like the Hotel California, their lobbyists are making sure we can check out anytime we like, but in fact, we can never leave.”

Former Cernerite Anne Jamieson is named CEO of Portsmouth Regional Hospital (NH).

A hospital in Canada whose computer network was infected with the CoreFlood trojan horse sends warning letters to 11,500 patients, warning that the trojan was designed to capture information and send it to hackers and therefore may have done so. The virus was not detected by the hospital’s unnamed antivirus software (considering that Symantec has been protecting against it since 2002, maybe it’s time to check the updates, change vendors, or fire employees who disabled it on their PCs). CoreFlood was written by hackers in southern Russia to capture secure information such as passwords, e-mail contents, and bank records. It’s doing its job, collecting 500G of personal financial information in just six months, including details on thousands of banking and credit card accounts.

Siemens will provide Soarian to 37 hospitals and 300 clinics in South Africa as a subcontractor. That’s a huge and much-needed deal for Soarian, which was always loaded with unrealized promise.

The VA gets $3.3 billion to spend on IT in 2010, up 30% from 2009.

West Jefferson Medical Center (LA) gets a mention from the local TV station for its implementation of GetWellNetwork, explaining that it’s not for just patient entertainment, but also patient education. The article says patients can also find a hotel, check their bill, and send an instant message to hospital departments.

I like this opinion piece on Taj Mahospitals: “If your competitors have serious woodwork, you can’t get by with woodgrain Formica. If they have armies of PR people on staff, you need them, too. If they have billboards touting the No. 1 rating conferred on their pediatric nephrology team by a local magazine, you too need billboards. If they offer their patients such amenities as wireless Internet, on-demand video, room service-style dining and concierge service, you’d better follow suit. In fact, a recent study published by the National Bureau of Economic Research found that such amenities are three times as effective in increasing demand for a hospital’s services as improved clinical results are. (What? We don’t care if we get better as long as we can have YouTube and American Idol on tap?) The irony is that it’s all necessary, even though it’s a total waste in the sense that none of it improves anybody’s health one iota.”

Scary stats out of California, not like to improve now that the state is nearly bankrupt: the state’s nursing board takes an average of three years to investigate and discipline problematic nurses, gives probation to offenders but doesn’t crack down when they mess up repeatedly, and doesn’t have records to keep fired and disciplined nurses from moving on to the next hospital. One nurse kept his license for five years after hospital complaints that he had stolen and used drugs and fell asleep while performing CPR; he admits he was high at work.

Cleveland Clinic launches its health and wellness portal.

Dossia announces an API for its PHR platform, allowing programmers of new personal health tools to exchange  information with it. Documentation for it is here.

Insurance company UnitedHealth Group announces that it will spend tens of millions of dollars to build a national telehealth network based on Cisco’s Telepresence technology. It has hired former MinuteClinic CMO Jim Woodburn to run the program. More details will be announced on July 15.

E-mail me.

News 7/10/09

From John Q. Seriously: “Re: Eclipsys. In a morning blind-side, Eclipsys has released former MediNotes CEO Don Schoen and former Bond Technologies President Travis Bond. Bond created the EHR Bond Clinician, which was acquired by MediNotes in spring of 2008. It was subsequently acquired in the the acquisition of MediNotes by Eclipsys in the fall of 2008 and renamed Eclipsys PeakPractice. Schoen was co-founder of MediNotes, known for their Charting Plus and MediNotes EMR products.” Several readers e-mailed with the same rumor, saying that business unit had been merged into an existing Eclipsys one. I’ve offered Eclipsys the chance to respond and haven’t heard back yet. It’s unusual for entrepreneurs of acquired companies to stick around after an acquisition, but they usually leave under their own power.

That rumor follows news that Chris Perkins has been named CFO of Eclipsys, rejoining his former Per-Se colleague, CEO Phil Pead. He gets an immediate 22,222 ECLP shares ($362K worth) plus options for another 133,334 shares to “align Mr. Perkins’ interests with those of Eclipsys shareholders,” who are unaligned in the sense that they had to pay for their shares with their own money. He’s also getting $400K in salary and a targeted bonus of $200K with $100K guaranteed. Also announced are severance deals with Pead and Perkins: a year’s salary, 100% of target bonus, an extra year of vesting, and 18 months of health insurance.

From Ken Kashimoto: “Re: Valco. Heard through the grapevine that as a result of Hyland Software’s acquisition of Valco Data Systems last week, all Valco employees were let go last week.” Unverified. Valco’s headcount was around 35, I’ve heard.

From The PACS Designer: “Re: Google OS. Google has announced a new web operating system called The Google Chrome Operating System. The Google Blog states, ‘Speed, simplicity and security are the key aspects of Google Chrome OS. We’re designing the OS to be fast and lightweight, to start up and get you onto the web in a few seconds. The user interface is minimal to stay out of your way, and most of the user experience takes place on the web. And as we did for the Google Chrome browser, we are going back to the basics and completely redesigning the underlying security architecture of the OS so that users don\’t have to deal with viruses, malware and security updates. It should just work.’ It appears that Microsoft and other major operating system vendors have something to worry about when it comes to competition from open source web operating systems.” Don’t underestimate the benefit of having a change-resistant customer base. Chrome is already out there and not making much of a dent in IE. Linux, on which Chrome OS will be based, is also free but has taken only a tiny percentage of PC users. People don’t like change even more than they don’t like Windows. I like all the Web emphasis, but they better not make Microsoft’s Vista mistake and tell users that dysfunctional and outdated plug-and-play drivers aren’t the fault of the operating system. Google is smart to be going after Microsoft’s cash cows of Windows and Office, though. For Netbook users and those who really don’t need anything running locally on the desktop, Chrome OS will probably be just fine, but that’s not a big bunch of users so far.

From Rhythm n’ Blues: “Re: CareFusion. I’d be interested in your response to this unique marketing tactic. Hope they’re stopping in a city near you!” Cardinal Health’s planned technology business spinoff and IPO, CareFusion, will sponsor a jazz festival series that’s going to Newport, Chicago, Montery, Sydney, Paris, and NYC. They’re using a lame excuse for it, saying that “there is a clear connection between jazz and medicine.” Dear Saint Obama, while you are looking into ways to cut massive healthcare costs by throttling the incomes of the people who deliver care, please make sure not to forget to save a little of Uncle Sam’s well-intended meddling for those companies that make a fortune from patients in the form of Pyxis and Alaris patient care devices whose high prices and market penetration have allowed them to hoard enough healthcare cash to stage an international festival series for jazz music, which nobody likes anyway except pedantic posers not quite up to classical and secretaries who aren’t allowed to play real music on the office radio. Sincerely yours, the people paying for it.

I get e-mails every few days from people aren’t getting the update blasts any more. I’m still sending them, so if you aren’t getting yours, your e-mail server is rejecting them as spam. I can’t fix that on this end, but you can contact your e-mail administrator to ask to have my e-mail address added to the “white list” of known non-spam e-mailers. If you use Gmail or one of the other free accounts, you can probably set it up yourself. I send HIStalk e-mails at least three times a week and usually 4-5, plus HIStalk Practice is good for two at minimum and sometimes 3-4. if you aren’t getting them, that’s the problem. You can also use the Subscribe to Updates box to your right to add your home e-mail address in addition to your work one since it’s usually the work one that is overly aggressive about discarding suspected spam. I don’t want you to miss anything.

Readers have added several new events to the HIStalk Calendar, which is how they got them listed and linked on the main page of HIStalk (to your right). Notice the cool way the event listings include links, direct links to a location map and weather, options to download to your e-mail calendar, etc. You can submit your HIT-related event for free. Here’s a tip for those doing so: if you click “Check If Recurring,” you can enter the event once and choose the days it covers, which is a little bit easier than making separate entries for each day.

My guest editorial for Inside Healthcare Computing this week is titled A Day in the Life of IT-Visionary Hospital VPs: Laying Out CPOE Benefits to Luddite Doctors. See if you can detect the thinly disguised sarcasm: “One was late in responding because her top-of-the- line hospital laptop had failed after her teenaged son had used it for several consecutive hours of doing Internet research for a school project in his locked room, necessitating a call to the VP-only IT support hotline so that a technician could be dispatched to her house on a Friday evening.” The publisher tells me that 88% of readers like my stuff there, with 12% chiming  in with the person who wants them to get rid of me and my “clever cynicism.” I was hoping for at least a 40% disapproval rating as validation that I’m stirring people up enough.

Origin Healthcare Solutions adds patient payment collection tools to its Origin Manager practice management system. I couldn’t follow the references to Connecticut and SSIMED, but anyone interested in that news will probably know what it means.

Jobs: Business Systems Analyst-Pharmacist, Laboratory Requirements Analyst, Regional Sales Director.

In the UK, the entire 26-member EHR team at Royal Berkshire NHS Foundation Trust has been let go as the hospital breaks away from NPfIT and implements Cerner via its vendor, UPMC (yes, a non-profit US hospital is also UK vendor, as confusing as that is). They can apply for one of 19 available one-year contracts. In the meantime, since Pittsburgh’s infrastructure is crumbling because of a billion dollars’ worth of debt, entrenched unions, a declining population (even smaller than what’s left of New Orleans, which is actually growing) and a plethora of big-income organizations that don’t pay taxes, the city is considering surcharges on its hospital admissions and college students, which would hit UPMC directly other than it will probably just pass it along in one form or another.

GetWellNetwork announces several new clients for its PatientLife System for patient engagement, including big names Florida Hospital East Orlando, Children’s National, Miami Children’s, and several Adventist facilities.

Don Miller, MD, founder of prenatal care system eNATAL, e-mailed to mention to tell me that the company has several iPhone applications for obstetrics in Apple’s App Store. The application itself is sold in an interesting ASP pricing model: OBs buy “tokens” that are good for one per pregnancy. Here’s what Don had to say about certification: “eNATAL is not CCHIT-certified, never will be, and highlights what is wrong with CCHIT certification. eNATAL is an affordable niche EMR that adds tremendous clinical value, improves patient safety, incorporates clinical decision support functionality that the ‘big boy’ EMRs only dream of, saves money for all healthcare stakeholders, and is used in a ‘meaningful’ way every day across the country. But our subscribers will not receive a nickel from Obama for its use.”

More on the government of the Philippines investigation of who spilled the beans on the rumored leaky breast implant repair of its president: the National Bureau of Investigation is interrogating employees of a hospital that it claims asked for government help to make sure its employees didn’t breach patient confidentiality.

Hospitals in New York State have readmission rates that are much worse than average. The local hospital association (trade group) blames poverty, but didn’t offer an explanation of why Harlem Hospital Center excels and IT-loaded and $3 million CEO-led Montefiore Medical Center lagged.(I noticed while snooping around Montefiore’s federal records that even its chairman of dentistry makes $1.7 million a year, which seems absurd).

Medical Center Hospital of Odessa, TX says implementing its $6.2 million McKesson CPOE system will be a “massive, difficult project,” but its seems eager to snag $5.4 million of that amount from us stimulating taxpayers. A good line from the CFO about the CIO: “I’m looking forward to the day when we have a meeting when Gary [Barnes] doesn’t speak.”

A Canadian medical malpractice jury awards more than $5 million to a man who suffered injuries from spinal tuberculosis after he ignored his radiologist’s urging to come back for more tests to investigate problems he’d spotted. The judge found the patient 30% liable as punishment for not cooperating, but made the excuse for him that he was probably to busy to follow the doctor’s advice. The hospital says it has since implemented software that will prevent misfiled records and miscommunication.

Florida-based Metropolitan Health Networks chooses eClinicalWorks for its nine internal medicine offices.

Microsoft tries to use an Obama-like pitch to get people to “join the movement” and sign up for HealthVault on its I am Enabled site. It’s loaded with the usual cliche Facebook, Twitter, and YouTube connections. Jerry Seinfeld isn’t mentioned.

Speaking of which, I think spammers are going to kill Twitter if it doesn’t die of natural causes before they can do it. It seems like most of the new followers are just the same old pests who nearly ruined e-mail.

E-mail me.

Readers Write 7/8/09

iPhone for Clinical Data – A Different Approach
By Mark Moffitt, MBA, BSEE

Many hospitals are using the iPhone as a tool for physicians to view clinical data. There are two ways to integrate the iPhone with an EMR:

• Buy a package from a vendor to display clinical data on the iPhone.
• Build a Web-based or native iPhone application.

The first option is the most common approach. Benefit: no development costs. Disadvantage: limited ability to customize the application to an organization’s specific needs.

We elected to build a Web app for the iPhone because we wanted to customize the solution to our needs and did not have funds to purchase an application from a vendor. Some of the features in our iPhone web app include:

• Sign on with four-digit PIN using large numeric virtual keypad (see image) versus entering username and password on the iPhone virtual keyboard.
• Lab data displayed as three most recent values in a simple table (see image). Lab tests grouped using common categories.
• Select and play a radiology dictation when viewing a patient’s record.
• Rounding list defined and built to physician specification. Physicians can add and delete physicians in their group using the iPhone.
• Length-of-stay information from our Case Management and Bed Tracking application, also written in-house.

It’s the subtle features that make the difference in user acceptance of software. This is especially true in healthcare for reasons too numerous to list here.

For example, physicians don’t like entering their username and password on the iPhone’s virtual keyboard, an approach many vendors use. Using the virtual keyboard takes a certain touch that is difficult for some physicians to master. We built a security feature that ties a specific iPhone to a specific physician to a specific PIN they choose. The PIN is only valid on the physician’s iPhone and is entered using a large, virtual numeric keypad that mimics an ATM. Users need only enter their four-digit PIN to log in.

The ability to ask physicians, “How would you like it to work?” versus “This is how it works” makes the difference between good software and software that physicians accept. This can best be accomplished by building the front end custom to your needs. While building software is harder and more difficult (for IT personnel) than buying vendor software, the ability to build initiative, easy-to-use software makes training, implementation, and support much easier. And the extra effort makes it much easier for the user to incorporate into their work.

It really is that simple. And why “generic” software requires much more training and process redesign than custom software. Another advantage of build versus buy is we can continue to deliver applications without being dependent on available capital dollars.

Future plans include using the iPhone with the Web app to record dictations and use of the iPhone for eMAR.

Mark Moffitt is director of information systems at Good Shepherd Medical Center of Longview, TX, proof that you don’t have to live in a big city to innovate in healthcare IT.

Meaningful Use Criteria Comments
By Arlen Dominek

I thank the members of the Health Information Technology Policy Committee and, in particular, the members of the Meaningful Use Work Group for their time and effort. I would like to provide my own comments upon the draft presentation of Meaningful Use.

I think that it will be very difficult for all ambulatory and acute care provider organizations to implement an EHR by 2011 simply because of ramp-up time and change management considerations. It takes time for an organization not only to put together an implementation team, but to ensure that the appropriate governance structure is in place. The organization must also formulate a clear focus of where it wants to go, a plan for how it’s going to get there, and how it can assess its progress in getting there.

The organization must identity the members of the implementation team. Often, the organization must recruit additional personnel or retain consultants. In addition, there is training to take into consideration. Equipment must be ordered.  Appropriate telecommunications must be in place.  Interfaces must be implemented. In addition, simultaneous implementations of ambulatory and acute applications by a delivery system can be onerous, yet a certain amount of collaboration is necessary to promote maximum utility.

Vendors will have constraints as well. Many vendors are running very lean implementation organizations today; this minimizes the number of implementations that any one vendor can support at a time. It’s no different than any other manufacturing environment;  there are capacity limitations. Moreover, any rapid implementation cycle provided by a vendor should be carefully evaluated to ensure that the needs of various provider and patient populations are being adequately met.

It’s one thing to provide content satisfying a general med/surg model, quite another to meet the needs of a pediatric BMT program. Rapid provider adoption of workflows and clinical documentation applications will be effected if provider needs are considered during the initial build of content and workflows. Workflows should be designed to meet the particular needs of the provider, e.g., a diabetes clinic or a nephrology clinic. Such consideration can minimize costly re-engineering at a later point and contribute to the success of an implementation.

Hence, Meaningful Use criteria should:

• Be sensitive to the ability of an organization to initiate its EHR implementation and in meeting Meaningful Use criteria, that is, no organization should be penalized because of implementation delays that are out of its control or the population it serves has minimal broadband connectivity;
• Be cognizant of ramp-up time;
• Reflect the maturity of any particular implementation, for instance, if evidence-based order sets comes two years after CPOE implementation, then the criterion should reflect the stage of a particular implementation and not simply a calendar year.

CDS at the point-of-care is somewhat ambiguous and restrictive. Are we referring only to those kinds of CDS that present during CPOE or are we also considering alerts which reflect changes in patient conditions and availability of new data to alert a provider and inform a decision? 

Meaningful Use calls for the capture of clinical data that can be queried and trended. I can appreciate the issue of data capture with which the Work Group has contended;  however, I feel that the objectives have minimized the value of these data and other data for data warehousing and analysis as well as for interoperability through such mechanisms as ELINCS. Hence, such data should utilize standard classification systems such as LOINC, SNOMED, and ICD-10CM to support data warehousing and analysis. Such requirements should be clearly called out so that provider organizations and vendors will incorporate this into their project plans.Such classifications are essential and often mandatory for reporting to quality, epidemiological and public health agencies and to various registries.  Meaningful Use should clearly call this out.

Moreover, there is far more information within a patient chart that could be subject to further structure and encoding. The use of standard classification systems or languages should be implemented so there is a consensual, meaningful and useful framework which governments, providers and consumers can use as a common language.Internationally endorsed classifications facilitate the storage, retrieval, analysis, and interpretation of data. They also permit the comparison of data within populations over time and between populations at the same point in time as well as the compilation of nationally consistent data. (http://www.who.int/classifications/en/) It appears to me that CCHIT and vendor organizations have avoided the issue of incorporating standard classifications or the usage of common classification languages.

Our goal should be to maximize the value we obtain by automating CPOE, clinical documentation, and result reporting.

Order sets are often viewed as provider productivity tools and are conducive to provider adoption of CPOE. Considerable effort is entailed in adopting and implementing evidenced-based order sets. The effort to implement an organization’s existing order sets only to be followed within two years by the adoption of evidenced based order sets is considerable.Perhaps such adoption should be moved up in the timetable.Reimbursements and grants should reflect the licensing cost of evidenced-based order sets. Available evidenced-based order sets tend to focus on medications;  however, standard classifications would encourage incorporation of evidenced-based data for other procedures such as radiology and laboratory.

Multi-media support capabilities are existent in many commercially available EHRs. Perhaps this objective could be moved to an earlier year.

The Meaningful Use Matrix calls for the use of bar coding in medication administration, yet it does not call for the bar coding in the administration of blood products or for positive identification of patients on whom procedures are to be performed, e.g., specimen collection. While CCHIT addresses medication administration in its category Decision Support for Medication, Immunization, and Blood Products Administration requirements, there is no mention of similar functionality for blood product administration, etc. It’s important that Meaningful Use expand beyond current CCHIT requirements and vendor offerings.

It’s admittedly difficult to elaborate workflow efficiencies, but there are some examples

• CDS for administration of immunizations and blood products and positive patient identification as mentioned previously.
• Use of commercial databases to quickly inform the provider whether a medication or procedure is covered by a patient’s payor, thereby reducing time spent in remediation or in losing revenue.  (And payments should reflect the expenses of these databases.)
• Reduction of labor costs in collecting specimens and increasing patient satisfaction by reducing needle sticks when a central line is available.
• Centralized coordination of appointments.
• Automated patient referrals.
• Improved patient satisfaction when the provider has the patient’s information at the right time and place.
• Improved transfer of information between providers.

I apologize if any of my comments have been redundant or because of my failure to notice their having been addressed elsewhere.

Arlen Dominek is practice director at Peer Consulting of Mercer Island, WA.


Subrogation
By William O’Toole, O’Toole Law Group

Regarding the SubroShare(R) press release, Mr. HIStalk was understandably a little off in his assessment; this is not about a policyholder suing the healthcare provider. It is all about personal injury claims.

Subrogation is a legal remedy that enables an insurance company to recover amounts it paid for the care of its customer (the injured patient) in situations where the patient also receives payment covering the same services from a third party (the one that caused the injury to the patient and was sued by the patient).

The key here is the third party. There must be some other party that caused the injury to the patient and from which there is the possibility of payment resulting from a lawsuit (damages) or settlement of that lawsuit.

I will go out on a limb and state that I cannot imagine any health insurance policy not having a subrogation clause. Whether or not attorneys have an obligation to inform the insurance carrier of secondary (duplicate) payments is irrelevant, because where there is a subrogation clause, there is also the obligation for the insured patient to inform the insurance company that the patient’s injuries were caused by a third party, thereby raising the flag for the insurance company.

That said, unfortunately there are those patients that do not, and processes are not always what they should be and some claims "fall through the cracks" and are not identified properly up front. Consequently insurance companies are left to hunt down reimbursement in these situations.

What I believe SubroShare(R) offers is a method to assist insurance companies in identifying situations where they may recover, through subrogation, some payments made on a patient’s behalf.  The trigger seems to be the request for the patient’s records by an attorney, which might mean third party involvement in the patient’s injury, and consequently might mean the possibility of payment to the patient directly for services already paid by the patient’s insurance company.

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

Provider Profitability
By Dichotomous Dweller

I watched with sardonic amusement as a whopping 19% of readers voted that healthcare providers are sandbagging on IT to keep the public from seeing how profitable healthcare delivery is. Really? 19% of people who read this site think that patient care plays second fiddle to profitability when it comes to EHRs?

Given the way the question was phrased, I’m supprised the number was so high, but then I think the poll question missed the point, so maybe others saw through it as well. Some better questions might have been:

• Do you believe that profitability (here defined as free market economics) enhances or threatens the quality of healthcare received by the general public?
• Do you believe that healthcare providers are have a vested interest in keeping the public from seeing how profitable healthcare delivery is?

There are lots of trick questions like these, but the answer is always both ‘yes’ and ‘no’.

The simple truth is that a dying person will usually give their last dime for a shot at one more day. Healthcare in these circumstance is every man for himself. If you are sick or dying, you’re not going to mind that the person in the bed next to you is subsidizing your stay at a rate of $100 per tablet for over the counter drugs or 33% year in income taxes. Profitability can be created by reducing costs as easily as by increasing sales, but in these circumstances, money doesn’t mean much.

Do you really think that there aren’t people profiting in healthcare from deals that they’d rather the public not know about?  (Thank god we have people like Mr H to keep us up to date on the salaries of major ‘non-profit’ executives). But why stop there? What about those doctors with lucrative research deals with pharmaceutical companies, or pharmaceutical companies who perk doctors who use their products? 

Now I have no idea if such profiteers are going to be exposed by EHRs.  Indeed, it seems EHRs can be their own unique breed of profiteering. But let’s be honest, we all know people who profit from healthcare, and no matter what happens next, single payer, socialized medicine, co-ops, EHRs, RHIOs, status quo, bankruptcy of Medicare, etc., there will always be people profiting from healthcare.

The real question is: is it fair? And it is this question, no matter how simply stated, that we can’t possibly come to agreement on. So we’ll let the market decide for us. I bid 10% of my salary. And rising.

News 7/8/09

From The PACS Designer: “Re: Palm Pre. Since the Palm Pre has employed its own Web operating system called the Palm webOS, TPD thought it would be good to give HIStalkers information on this new application. O’Reilly Media has posted the first chapter of a new book to the web on the Palm webOS covers some of the basics for this new system.”

From VSM: “Re: HITECH lawsuit. The supposed nurse (could not find evidence of license) who has filed a suit against Obama and HHS Secretary for HIPAA privacy violations due to HHS requiring EHRs has a history of legal issues. Her husband is a plaintiff’s attorney. See the court documents on their bankruptcy filing.” She’s licensed, according to the New Hampshire nursing database, and I don’t think her previous suits are relevant. It will be tough to prove her claim (warning: PDF) that HITECH is illegal because it forces disclosure of medical information from patients not on either Medicaid or Medicare. The suit’s claims wander all over the place, reading like a wacked out conspiracy theory rather than a serious challenge and making it less viable, I suspect.

From Joy: “Re: poll showing most readers don’t think providers are resisting IT to hide their profits. Isn’t this group of HIStalk readers already biased as medical and hospital informaticians?” Yes. But, we know the real reason hospitals aren’t adopting IT: they aren’t all that competent and confident about it. Still, when it comes to connecting to the outside world, I would guess that a fair number of practices and hospitals would be worried about outsiders seeing information like how much they charge and how much they make.

Listening: 10-year-old Britpop from The Charlatans.

Some calling himself or herself THR-IS Staffer left a scathing comment on Ferdinand Velasco’s interview that I deleted. It was curious for three reasons: (a) it was the only negative comment posted; (b) it was quite nasty and personal; and (c) the electronic footprints indicate that it actually came from someone inside arch-competitor Baylor Health. I like catching would-be scammers in the act, which I believe I just did.

SRSsoft bags another customer willing to drop their CCHIT-certified EMR in favor of the SRS hybrid EMR. Southeastern Orthopedic Center thought they were good to go with regard to HITECH, but says, “The CCHIT EMR we had purchased would have placed overwhelming demands on our physicians and resulted in a significant loss of productivity, even if we had overcome the initial implementation hurdles.”

A nurse poll finds that 50% would not want relatives receiving care at their workplace, 72% think staffing on their unit is inadequate, and 53% are considering leaving their jobs, most often because of staffing problems.

Emdeon, gearing up for its IPO, acquires claims processor eRX Network LLC.

Vince Ciotti is arranging a November get-together of former SMS’ers to celebrate the 40th anniversary of the company’s founding. The shindig is aimed at those who worked in King of Prussia in the 1970s, but Vince says the Malvernians who don’t mind listening to “what I did in the big war” stories are invited as well. Full details, including some cool old customer newsletter scans, phone lists, etc.

Bill O’Toole will have to explain this healthcare-related lawsuit product to me since I don’t understand it even after reading the press release and the Web site (and unless “subrogration” is in your lexicon, you won’t understand it either). It seems to be related to insurance companies being able to find out which policyholders are planning to sue providers and to get their attorney contact information. I’m sure the people who might use it would understand the description, so this is my gift to all of those folks reading.

A study of VA data finds that abnormal CT findings are often recorded in the EMR a long time afterward, if at all.

Detroit Medical Center connects to an HIE whose bizarre, contrived, and entirely forgettable name could have only come from a committee of clueless marketing people: my1HIE(R). I’m including the provided italicization to make sure you see just how weird it looks in print. Maybe it’s the same perky, brand-obsessed bunch who decided that GE-owned The Sci Fi Channel would be much more of a hot property if it “relaunched” itself as Syfy. This quote from the Syfy (gag) president should really wow its entirely geeky audience: “We really do want to own the imagination space … It made us feel much cooler, much more cutting-edge, much more hip, which was kind of bang-on what we wanted to achieve communication-wise.” They’re even mimicking GE’s “healthymagination” assault on grammar, coming up with the radical variant “Imagine Greater”, which it says is “a call to action … an aspirational, optimistic message about enhancing people’s lives.” That’s asking a lot from ancient reruns of Battlestar Galactica and Mork and Mindy.

I don’t have the records to look it up, but I wonder if Barry Chaiken is the first HIMSS board chair who works on the vendor side of the fence instead for a non-profit hospital? I’m not sure how I feel about that.

Kaiser’s Health Care Innovation Center in the San Francisco area gets a mention in the Fort Wayne paper for some reason. I think someone invited me there once, so maybe I’ll check it out one of these days.

Another use of Twitter: selling “medicinal marijuana”, including home delivery (driver tips are appreciated).

In the UK, the conservative party says they would dump NHS’s Connecting for Health and replace it with HealthVault, Google Health, or other online services. “This is an agenda we are massively keen on. We’re thinking about how in government the architecture of technology needs to change, with people ‘owning’ their own data, including their health records.”

A reporter in the Philippines says the government there is monitoring his activities after he wrote a newspaper story last week claiming that the country’s female president had breast implant repair surgery.

Merge Healthcare announces preliminary Q2 numbers: revenue up 13%, net income less than $1 million vs. $2.8 million, all complicated by its pending offer to buy etrials and the sale of its equity interest in Eklin Medical Systems.

A former Red Hat VP launches the Axial Project, which will be some kind of open source clinical information delivery system. I’m not seeing any healthcare background among the principals, so we’ll see what they come up with.

Researchers from Carnegie Mellon University (misspelled in the article) have figured out how to guess the Social Security number of people born after 1988, sending their method to the Social Security people with the suggestion that maybe they ought to start randomizing the numbers. A Social Security guy pooh-poohed the findings, saying that the code-cracking suggestion is “a dramatic exaggeration,” but simultaneously admitting that  Social Security numbers will be randomly assigned starting next year.

Sunquest names Patrice Nedelec, previously with AMICAS, as VP of Quality and Regulatory Affairs.

A Canadian woman gets a $3 million jury award for a 1999 incident in which she sat on a hospital chair that collapsed under her, causing her no physical injury except claimed fibromyalgia, an ongoing pain whose diagnosis is entirely based on what the patient says they feel.

E-mail me.

HIStalk Interviews Ferdinand Velasco MD, Chief Medical Information Officer, Texas Health Resources

What are the most important projects you are working on at Texas Health Resources?

The project is our EHR deployment. We’re an Epic customer. We’re in the middle of deploying the EHR. We’re live now with probably close to three-quarters of our beds. We’re a 14-hospital health system.

We’re very busy with the implementation, but we’ve been live at our earliest hospitals for some time. The focus there is more on optimization, really leveraging the EHR for things like patient safety, quality, and core measures reporting.

With some of our newer sites and sites where we’ve yet to go live, it’s still obviously very much in the early implementation focus — getting physicians on board, that kind of stuff. We’ve had the whole spectrum of the maturity of the implementation even within our health system.

You’ve done a lot of work with first-generation systems. Do you find it easier to work with something like Epic or are the challenges similar?

There are similar challenges. Certainly when I worked at New York Presbyterian we were rolling out Eclipsys. Back then, it was definitely very first generation. The systems have matured, so we don’t run into the same kinds of technical obstacles than we did with those first-generation systems.

Largely, what we run into now is more of the cultural adoption issues, overcoming physician skepticism with respect to health information technology and the workflow issues. I think now what’s different compared to the 90s is that there’s a higher expectation for what these things can do. It’s not enough to just be able to deploy systems and get the physicians on board using it. There are expectations for medication reconciliation and core measures that really didn’t exist in the early days of EHR systems. The bar has been raised higher.

As you know from the meaningful use discussion, the bar will continue to be raised, so there are expectations for barcode medication verification and the whole closed loop process and real-time clinical surveillance. Those are the kinds of things we’re keeping an eye on because we don’t have that yet, but we are certainly gearing up to have those things implemented in time for the expectation for meaningful use.

What are the endpoints needed to be to justify the expense and the effort?

They are always moving. [laughs]. Initially, just getting it installed and getting the docs to use it, but now there’s the expectation that it has to meet the Joint Commission requirements and help us with pay-for-performance. The endpoint now is satisfying meaningful use. The bar keeps going up. We’re just trying to stay ahead and chug away. It’s all of those things.

Where we are today is still implementing the system safely and not killing patients, but we want to go beyond that and realize benefits in terms of reduction of ADEs and improvement in operational efficiency. Our challenge is managing the expectation because that doesn’t happen Day 1. It takes time, there’s a learning curve.

Part of our problem is our own success. The more successful we are, the higher the expectation. That’s a bit of a challenge.

You mentioned the tentative definition of meaningful use. What are your thoughts on what HHS has put together?

From our perspective as an organization that has been on this journey for some time, what I like about the meaningful use is that it gives us a framework. It helps us prioritize those things that we may not have yet planned for or that we don’t have in our timeline. Things like automated surveillance, closed loop medication management including the barcode piece, and medical device integration. That helps us argue for funding those initiatives and putting the plans into place so we can get that implemented on top of our existing implementation. That’s helpful.

It’s helpful for us to use that as a yet another lever with our physicians who are not yet live with the system so that we can say, “Here’s yet another message that this is a mandate and we need to be compliant with this stuff.”

On the ambulatory side, the THR, like many health systems, is providing and making available ambulatory EHR solutions, the Epic solution, as a subsidized offering. Many of our physician practices are too small to be able to buy Epic, so we are providing Epic as a sort of ASP model. This is another sell, if you will, for that offering, this moving meaningful use intended and ultimately the stick that’s the penalty for not having an EHR system by after 2015. That’s how we’re looking at it.

Are they helping you justify what you wanted to do anyway or are they taking you in direction you didn’t want to go?

I think there’s a lot of alignment there. We were very fortunate to get on board with investing in HIT early on and defining what our vision should be. There’s a lot of alignment with what came out in that initial draft and the matrix. We’re pretty pleased — I am, anyway — with that initial draft.

Obviously it’s very aggressive and ambitious so all the organizations have come out cautioning about being so aggressive. It will be interesting to see how that shakes out over the course of the next couple of weeks before the next meeting of the HIT Policy Committee. We’re keeping an eye on that, but from our perspective, because we didn’t wait until something like this came out of the Fed, we feel pretty well positioned and, if anything, it helps clarify our future direction.

You’ve worked a lot with CPOE. AMDIS is saying it’s too much to bite off early on in the meaningful use criteria. Where do you think CPOE fits in the overall strategy?

I think it has an important role. A lot of the important benefits of deploying HIT and, more specifically, EHR is dependent on physician participation. A lot of that is based on clinical decision support. The earlier people tackle CPOE, the better positioned they’ll be to realize those benefits.

I can understand AMDIS and others pushing for it to be not quite 2011. Their point of view is that health systems that haven’t yet selected a system, haven’t yet budgeted for it — there’s no way they’re going to be able to be ready for CPOE in 2011. I think that’s where they’re coming from. I think it sends the wrong message to interpret that to mean that you can delay CPOE.

We’re in a market area where our major competitor is deploying an EHR system but not pushing CPOE. They’re deploying basically all the functionality of Eclipsys and then they’re going to go back and do CPOE, which was what David [Muntz] was going to do if he’d stayed here. That was basically the philosophy that we had here, so we had a change in leadership. I think there’s some benefit to that. You can work on the physicians and soften them up while you’re deploying the nursing components and the pharmacy and all that, but you’re not really going to get a lot of bang if you hold off on the physician engagement piece.

Ultimately you’re going to have to do it anyway. That’s how they’re approaching it at Baylor, that’s how we opted not to do it, and if CPOE stays in 2011, they’re going to have to rethink their strategy.

Just before our implementation, I asked our docs how long they thought it would take before we got to universal CPOE, The results fell into a similar distribution as from the recent CHIME survey, with about two-thirds predicting it would take three or more years. The reality is that at our first two hospitals, it took one year, At our third and fourth, 6-9 months. And at the last three, we are achieving universal CPOE within one week of our big bang implementations.

Folks are being paralyzed by a handful of failed implementations when there are scores of successful implementations at community hospitals throughout the country. Healthcare needs to get beyond this fear factor and move forward with meaningful use. Yes, this is challenging, but we can’t afford to sit still.

What are the secrets of implementing CPOE?

Physician leadership. Getting some really influential thought leaders behind the initiative, buying into it, participating in the design process, being early adopters. These are the things we did and I think we’ve been very successful.

All seven of our hospitals that are live have essentially universally adoption of CPOE, including our most recent three hospitals, which basically went mandatory CPOE on their own accord. We didn’t as an IT department or hospital administration really push it. It was the physicians themselves saying dual workflow isn’t going to work, it’s unsafe, let’s get on board early. We basically had that Day 1 with these go-lives.

I couldn’t be more pleased. I’m really quite excited about where we are with getting the physicians on board. Obviously you have to have a good system and a good build, but if you don’t have the physician leadership, all of that is really secondary.

You’ve worked with a lot of technologies such as Microsoft Surface. What of those technologies have the most promise to improve patient outcomes?

The iPhone certainly seems to be the most promising in terms of the handheld platform. It seems to be the best form factor. I’ve done some work with the tablet PC and it’s got some promise, but I really think the iPhone may be the next killer technology for healthcare.

Are you seeing pressure to have applications reconfigured to be optimally used with the iPhone?

Yes. We’re applying that pressure. We’re putting pressure on Epic to do that. Meditech has a nice iPhone client. A few others may have some as well or in development. A lot of physicians have iPhones. There are a number of medical apps for the iPhone. It’s a compelling device for use at the bedside or at the point of care. It’s a ubiquitous kind of thing — you can use it anywhere. I’m very excited about it.

Are you building anything for the iPhone or looking at other applications that physicians want for it?

We have a physician portal that’s Web-based. It’s the access point for Epic and other clinical applications and other hospital-based resources. We definitely are planning to build an iPhone-compatible portal.

We have a couple of applications that we have deployed that are iPhone-based. For instance, our fetal monitoring system. We have several physicians using the iPhone client that allows you to see that wherever you are. We obviously have Epocrates and an assortment of electronic resource that are available through the iPhone.

We have an internal development shop and we’ve done some add-on work on top of Epic, some calculators and other value-add applications that are launched from within the Hyperspace platform. We’re looking to see if we can port some of those applications to the handheld for the iPhone. That’s all future stuff. It’s not live yet.

Let’s say a well-funded startup came to you and said, “We’ve got money, backers, and technology. We’re ready to build applications that the healthcare market needs. What should we build?” What would you tell them?

Since it’s very top of line for me and we’re struggling with it, core measures and the submission of quality data. That’s the 2013 criteria right now for meaningful use. That would probably be something that would be an attractive offering. More generally, just BI tools, analytical tools, something to enhance the value of EHR systems.

Unfortunately, most of the EHR vendors fall short in terms of being able to provide BI tools. On the other end of the spectrum, you’ve got the Oracles and IBMs. There’s a little bit of a gap between the analytical capability of the software vendors on the one end and the ability of the traditional BI technology vendors that could be filled with a niche player or the EHR and BI vendors coming together in the middle.

So you don’t think Amalga is that product?

I don’t known enough about Amalga. Although we’re a strategic partner with Microsoft, we haven’t had conversations with them about Amalga. I’m somewhat familiar with them because I came from New York Presby, but they are really eclectic as far as all the different systems they have in place. They’ve got the Presby hospital, the old New York Hospital, they’ve got faculty practice plans at each of the medical colleges, so definitely you need an Amalga just to put all that together.

We’re moving more toward the integrated approach, so I don’t know that we really need Amalga. That would almost duplicate what we already have with our data warehouse. But it may be that Amalga has some front-end tools that can help us. To be honest, I haven’t evaluated it enough to be knowledgeable, but from what I’ve heard from our experts on the subject, they would say that Amalga is more hype than reality.

I assume you’re doing a lot with how to manage and use all that data you are now collecting by having physicians directly involved.

That’s a supply-demand kind of thing right now. We have a lot of physicians live with the system and using it. Their appetite and thirst for the data is growing. Our ability to keep up with that is going to be a challenge, particularly since we’re still in implementation mode.

The challenge for us now is prioritization — what do we focus on and where do we place our efforts in delivering this kind of analytical capability. It’s on the core measures and those quality measures that the organization has selected as our key initiatives, things like blood management, glycemic management, VTE prevention, and pressure ulcer prevention.

Our challenge is to keep focused on those things and not get too distracted by people that want information just because they’re curious or they have a localized initiative. We want to focus on those things that have broad value across the entire enterprise.

Now that the federal government is driving much of the IT agenda in healthcare, are physicians and patients in the field being asked for enough input?

I would like to think so. Dr. Blumenthal is a practicing physician. Several physicians on the two steering committees, the advisory committees, are physicians. Certainly there is an openness and transparency to the process so far. It has given physicians an opportunity to participate and comment on the process. I feel pretty comfortable about it.

I come from the perspective of a health organization that is very much in the midst of this. I think there may be challenges with physician practices that haven’t invested in IT and are pretty far behind. They might question whether their voice is being heard. I don’t know that answer to that question, but those physicians in our market area are interested in what we can offer to help them. We’re available to help.

Anything else?

No, we’ve covered quite a bit. I appreciate the opportunity to chat with you about what we’re doing and how we’re working to make the most out of health IT. It’s a very exciting time to be in it. Thank you for your Web site, your blog. It’s been a great resource for all of us. Thanks for the opportunity to contribute.

Monday Morning Update 7/6/09

From Cliff Kirtland: “Re: Interesting use of funds in Health Technology Center’s federal filing forms. I thought you might be interested given Molly Coye’s next role as CalRHIO CEO. Can they afford her?” Non-profit technology research organization HealthTech took in nearly $4 million in 2007, lost $700K, and paid CEO Molly Coye $630K and the COO over $400K. CalRHIO’s records show that former CalRHIO CEO Don Holmquest (now in “a senior advisory role” with CalRHIO and not listed on its site) was paid $276K. Either Molly’s taking a huge pay cut or CalRHIO is upping the ante. She’s also board chair of CalRHIO. Whatever’s left of HealthTech is going to Public Health Institute, another research non-profit (it took in $88 million in 2007 and its CEO made $380K). I need to set up HIStalk as a non-profit so I can make some real money.

From Mike Quinto: “Re: big box medicine. Dr. Halamka blogged about a local hardware store. We should support the Green’s Hardwares of the world, avoiding the big box stores that have standardized the experience and limited the menu to keep costs down. It occurred to me: aren’t we working toward standardized medicine that will give every patient the same experience at every doctor, making medicine have that big box feeling to keep the costs down through standardization?” It’s probably the same: people will moan about losing local restaurants and stores that bring back fond memories, all while spending their money at chain restaurants and Wal-Mart. Still, the masses get to vote with their dollars and their feet, and if they don’t like cookbook medicine, they will seek alternatives that others will be financially encouraged to provide. Maybe what should have been done with stimulus billions is to find a better, cheaper, faster way to educate physicians, although with loose controls on how they are paid, they would all be lighting up the sky with profitable X-rays and raising the healthcare tab even higher instead of lowering it through increased provider supply.

From CogNwheel: “Re. insurance companies. You have got to comment on this PR piece from United. An HIT vendor telling everyone that if the government and companies would only buy more of their stuff, they would all save money and the American consumer would directly benefit.” UnitedHealth says healthcare could save $332 billion over 10 years if providers updated their technology to use something like its own, although it also estimates that commercial payors like itself would reap $100 billion of that benefit. They didn’t mention specifics, but they do own Ingenix, which offers technology to providers.

Information Week profiles Chad Eckes, CIO of Cancer Treatment Centers of America. His proudest accomplishment, he says, was replacing 18 legacy applications with 25 Eclipsys modules. His most admired tech vendor CEO is (was?) departed Eclipsys CEO Andy Eckert.

The DEA is helping LAPD with its Michael Jackson investigation by analyzing the state’s controlled substance prescription database, trying to figure out who prescribed the propofol found in his house that may have killed him.

Bill O’Toole got so many responses from readers about his HIT Moment With that he decided to become an HIStalk Platinum Sponsor (sounds odd, I know, but people interviewed here are always shocked at how many old and new acquaintances they hear from). So, welcome to O’Toole Law Group PC of Duxbury, MA, an HIT-only firm involved with acquisitions, licensing, intellectual property, and contract negotiation on both the provider and vendor sides. I don’t know of many HIT-only attorneys, so if you need one (and every vendor and provider does every now and then), get in touch with Bill.

A British doctor helping out Royal Free Hospital with its Cerner implementation says he saw doctors “almost in tears” with frustration over the project. I don’t exactly know what that means since you’re either crying or you’re not, but it sounds intentionally dramatic.

Rural health center operator HealthReach (ME) will get $1.3 million in stimulus money, most of which will be used to implement an EMR. Since I’m salary-fixated all of a sudden, I’ll report that its CEO made $50K last year according to its federal records, making it clear that actually delivering care isn’t as highly valued as talking about it. A lot of administrative overhead wears suits and sits in plush offices.

A former Cigna public relations VP testifies to Congress that the company’s underwriters intentionally pushed small businesses that had filed expensive claims to drop their Cigna policies by jacking up their premiums. He quit after Cigna waffled on paying for a teen’s liver transplant, then changed its mind right before the patient died. He warned that the insurance industry will kill meaningful healthcare reform, saying, “You cannot trust these guys … What we have is rationing by corporate executives who are beholden to Wall Street.”

Cumberland Consulting Group, new to the Healthcare Informatics 100, brings on Tom Hogenkamp as a partner.

Cerner will roll out uCern later this summer, a social networking site for customers that will also offer a customer-modifiable documentation wiki and screencasts.

An article by Christiana Care CIO Steve Hess credits its GetWellNetwork rollout with increasing patient education utilization by 127% and improving patient satisfaction related to having information explained by 23%. Patient education pathway items that are triggered in the EHR alert the patient on their in-room TV, reminding them to watch the educational material until they have done so.

Mount Sinai School of Medicine is seeking “the Holy Grail” mobile device for its doctors. It sounds like they believe the iPhone would be it if Cerner and Epic would develop clients for it. They’re also expecting good things for the Kindle e-book reader.

Maybe Cerner and Epic should follow the lead of Meditech in offering an iPhone client, lauded by Doylestown Hospital (PA) CIO Rick Lang as a key reason that its physicians have flocked to the iPhone and gained “major workflow improvement” as a result.

From Weird News Andy: a Tennessee boy is arrested after sheriff’s deputies find $5,000 worth of medical supplies, an oxygen machine, and a purse in a camper on his mother’s property. Paramedics reported that the items were stolen from their ambulance while they were treating the boy’s mother.

An internationally recognized informatics professor from Canada expresses frustration that his own healthcare providers don’t share information.

David Brailer says that the government’s lack of specificity about how stimulus money will be paid out to providers is hurting EMR adoption as potential customers wait and see. He also predicts that meaningful use criteria will be loose even if that dilutes the whole point of having them. “They’ll go for the big tent as opposed to a narrow solution. That’s not good policy, but that’s the politics of the matter." The CNN article mentions EMR licensing expense and the potential use of VistA, quoting Medsphere CEO Mike Doyle in comparing the $9 million the State of West Virginia paid it for eight hospitals vs. the $90 million West Virginia University (which he incorrectly called the University of West Virginia) paid Epic. “If Obama is serious about this, he won’t be able to do it $90 million at a time.”

Former Misys CTO/CIO and current Allscripts board member Cory Eaves joins private equity firm General Atlantic as SVP.

An overwhelming 81% of you don’t believe that healthcare providers are sandbagging on IT to keep the public from seeing how profitable healthcare delivery is, according to my most recent reader poll. New to your right: should hospitals have to use CPOE to meeting meaningful use criteria?

Seattle Children’s Hospital says healthcare applications vendors are foot-dragging on certifying and supporting their applications to run in virtualized mode.

University of Florida’s Doctor of Pharmacy program will require students to own either an iPhone or iPod Touch.

I would hope that by now healthcare providers have figured out that WEP security isn’t adequate for wireless networks, but in case any need convincing, here are step-by-step instructions on how how to crack WEP passwords.

A Seattle data center fire on Friday takes down a bunch of local IT systems, including those of Swedish Hospital.

Researchers at Carnegie Mellon University develop a $2,900 mobile kiosk whose six sensors check for problems and initiate e-mail contact with the patient’s doctor if needed. The sensors measure blood pressure, balance, hand grip, hearing, and visual acuity. It also creates a personal medical history and may eventually include medication reminders.

An employee at Saint Alphonsus Regional Medical Center (ID) couldn’t resist opening the attachment in Michael Jackson e-mail spam, launching a virus that crippled several hundred hospital computers. The hospital spokesperson said, “There is a variety of things happening — slow log-ins, programs shutting down, glitches … We have a whole team working on it. It’s a major headache for us but it hasn’t hurt patient care. We have stopped the spread, and we are in clean up mode now. It’s been a bear for the IT people.”

HERtalk by Inga

OnBase developer Hyland Software purchases Valco Data Systems, a provider of software, integration, and consulting services for hospitals. Valco is best known for providing paperless hospital solutions that integrate with MEDITECH software.

UMass Memorial Health Care and Bethesda Healthcare System each sign multi-year contracts for Soarian, Siemens Healthcare’s Web-based HIS. UMass is implementing Soarian Clinicals, Financials, and Quality Measures as part of their seven-year agreement. Bethesda’s nine-year contract is an extension of its 25-year relationship with Siemens and includes migration to  Soarian Clinicals, Critical Care, ED, and several other applications.

Spectrum Health (MI) and Medicity announce they’ve successfully deployed a platform that enables the secure exchange of health information between hospitals and physicians. More than 75 physician offices are now receiving data electronically from Spectrum Health and 70 more are in the process of being connected.

Capital Regional Health Care (NH) contracts with McKesson for its Horizon Enterprise Revenue Management solution. The health care system already utilizes Horizon Clinicals.

GE Healthcare and InterComponentWare (ICW) sign a strategic agreement to integrate and co-develop their HIE solutions.

HIMSS announces four new officers and four new board members to its board of directors. Dr. Barry Chaiken of DocsNetwork Ltd. takes over as chair.

CalRHIO names Molly Joel Coye, MD, MPH as its new president and CEO. Coye was an original CalRHIO founder and has been chair of the board of directors since 2007. She was also founder and CEO of the research non-profit Health Technology Center.

AirStrip Technologies and CliniComp agree to pair both companies’ product offerings at hospitals nationwide. AirStrip provides real-time remote access to labor and delivery and intensive care data via mobile devices. You may recall AirStrip was one of a few companies given the given the opportunity to demo their iPhone application at the Apple WWDC. CliniComp is a provider of documentation and EMR systems.

Good Samaritan Hospital (NE) completes implementation of Horizon Medical Imaging PACS.

A CHIME survey of 335 CIOs finds that almost 60% of their organizations use CPOE at some level. Physician adoption continues to be low, with 45% of the CIOs indicating their physicians are using CPOE for just 20% or fewer orders. A mere 16% claim physicians are entering orders 90% or more of the time. CHIIME members tend to come from more progressive institutions, which suggests their CPOE adoptions number are likely higher than everyone else’s. Any way you look at, full CPOE adoption has a long way to go.

I’m planning to take a couple of days R&R, leaving Mr. H to fend for himself (which he does perfectly well, but my ego requires that I maintain the illusion that I am indispensible). In between fireworks, family gatherings, and adult beverages, I hope you remembered to wish the country a happy 233rd birthday!

E-mail Inga.

CIO Unplugged – 7/1/09

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

Social Networking; Why Every CIO Must Open the Gates
By Ed Marx

As the printing press fueled a transition from the Dark Ages to the Renaissance, Social Networking (SN) will be the transformation catalyst of our century. Johannes Gutenberg invented movable type to improve the production of books, which at the time were handwritten. He altered history. Seeing that SN could have the same power to enhance life as we know it—from personal and private lives to science, business, and culture at large—I have thrown open wide the gates of SN.

As with any type of reformation, new ideas will encounter opposition, even violent reactions. Traditions and the philosophy-of-the-day are challenges to overcome. Sections of the population will fail to adjust; others will dedicate their lives to discouraging and resisting change.

I don’t blame or look down on any who question today’s technological advancements, or changes. SN in particular. Resistance is natural, understandable. Sometimes it comes from personal discomfort—having to learn something new. Other times one is simply trying to make sense of SN in the confines of the corporate structure, assessing benefits, costs, risks and productivity. As with all things new, proceed with caution.

But the operative word is proceed.

I am a proponent of SN for a variety of reasons, both personal and professional. Although I will focus on the professional aspects, I do not subscribe to the theory that there is a distinct separation between the two.

Why SN?

· Training. All over the country we are implementing electronic health records and other disruptive technologies. One significant barrier common to all is a lack of basic computer skills, especially amongst older workers. I speak with many clinicians and I can tell you that those active with SN have an easier time adopting computer related technologies. The fear of the unknown has been removed. So, if it’s FaceBook that helps them to grow comfortable with how computers work then let’s be friends!

· Recruiting. My division reaches out purposefully through multiple SN media. We have already recruited a couple individuals via FaceBook and LinkedIn. Potential candidates see our organization as innovative and our leaders as active with SN. They capture a glimpse of the culture and openness. Our institutional Fan Page has also drawn many, and sharing the benefits of a career with our organization on YouTube and Twitter is also bearing fruit.

· Employee Engagement. Transparency accelerates relationships and engagement. This past week, one of our 18,000 employees reached me through the chat feature of FaceBook. In summarizing her words, this person saw my profile and determined that I was safe to approach. She shared with me some circumstances in her life, and I was able to help her. This interaction significantly exemplified the promise our organization holds dear: “Individuals caring for Individuals, Together.” Since we have moved towards a virtual office environment, SN keeps us connected with one another. We can see what is taking place in each other’s lives so when we do meet, we can skip the small talk about weather and touch on more meaningful subjects.

· Educational Community. Weekly, someone reaches out directly to me for assistance. If asked questions specific to medicine that I can’t address, I connect them to the proper authority. Other times, I’ve assisted college students with projects related to healthcare information technology. On the receiving end, I regularly access information about the latest in our field that helps me develop professionally and add direct value to my employer and customers. I have greater choice and flexibility in how I aide my development.

· Transformation. We need constant input of various sources to enable transformation. The confluence of ideas and innovations is what often lead to a Glorious Mashup. SN is the ideal tool to receive and share a wide variety of information that will lead to the next small and big change. I process and apply what I take in on a daily basis. With SN there are no limits or boundaries.

· Culture. As much as we resist, we have new generations entering the workplace and they are looking for a new kind of organization and leader. SN is an effective venue to demonstrate the transparency, flexibility, and collaboration required to successfully compete for talent.

Fear—the root motivator that causes administrators to seek tighter controls. Choruses for restrictive policies often become the norm. Critics cite loss of productivity, too much openness, and security risks as reasons to abstain. Resistance based on these judgments doesn’t outweigh the benefits. Check what’s happened recently in Iran. Leaders can no longer legislate values or write policies to seek control. People are relying more on influence and leadership than on strict rules and regulations.

The road to SN is frustrated by hedges of fear and hurdles of tradition, thus a CIO needs to lead the way confidently and smartly. Follow generally accepted SN guidelines as you advance through the opposition. Expose the lack of understanding in institutions stuck in conventional wisdom of the past.

Still hesitant? Consider a recent exchange I had with a CIO colleague who works where SN is forbidden. I sent him a birthday greeting via FaceBook; he replied shortly thereafter. How? Via his handheld of course! Even where SN is shut down, people still find ways to engage. The advanced world is moving towards SN. No one can stop it.

Don’t be left behind. Worse yet, don’t let your organization fall behind. Lead the way!

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

Readers Write 7/1/09

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

Hats Off to AMDIS
By Ann Farrell

Congratulations to AMDIS for saying what many of us believe and promote, but had feared was falling on deaf ears or been drowned out by politics and ego. It’s not surprising that the “Boston Docs” known MD-centric view of the world (healthcare and IT) produced a largely MD-centric, “CPOE first” meaningful use strategy. Hopefully this attitude was rejected when Version One of MU was sent back to the drawing board the day after the first draft was issued.

Chasing ARRA money already put some hospitals on a dangerous path to drop everything in hurry up mode to “install” CPOE without examining physician workflow, decision making, cultural and change management needs, and foundational applications. Some EMR companies and their advocates encouraged this — some unwittingly, others with an eye on increased or accelerated quarterly revenue recognition, the metric vendors are held to (incented by), particularly public companies.

For CPOE to be more than an automated requisition generator, MDs need to get tangible value, including the ability to make better informed decisions based on more timely data (not meaning the computer is making decisions for them). Since ancillary systems were ground zero for hospital clinical automation, lab and X-ray results are almost always online before or with CPOE. 

What may not be present is assessment data entered by nurses, ideally at the point of care in near real time, e.g. allergies, height/weight, vital signs, I & O, nurse-collected lab values, and an accurate medication record. That is critical data for clinical decision support (CDS) for MDs in ordering. Not having these data available wastes MD time and steps and results in suboptimal or even unsafe ordering decisions. If data is not easily retrievable (preferably “pushed” to MDs in the ordering process at the right time), physicians are forced to look for paper charts, call for information, chase nurses down, or make ordering decisions without important or current information.  

In addition to providing a clear path to CPOE, automating the eMAR/BCMA has greater  potential impact on med error reduction than CPOE. Not killing or harming patients would seem a primary goal to improve quality of care.  MDs and RNs make approximately same number of errors, but pharmacists or RNS catch 50% of MD errors downstream whereas 98% of RN errors reach the patient. And, nurses work for hospitals and are more easily corralled (in theory), thus making clinical and business sense to start with foundation pieces first.

Hopefully Drs. Glaser and Halamka (and Blumenthal) are listening. Some have recommending staging implementations as if it’s a pecking order — doctors first! To be effective, CPOE needs to be part of a bigger strategy –patient-centric, outcomes (not IT) focused, with staged functionality and a 21st century interdisciplinary care team approach that respects all caregivers’ roles and contributions.

For the good of all, we want CPOE to be embraced by MDs, but also for MDs and US healthcare reform to be more inclusive and patient-centric. I speak as clinical consultant, former EMR vendor exec, and RN who worked with first commercial EMR in a hospital with near 100% CPOE in early 1970s. CPOE is hardly a new phenomenon, yet some MDs and vendors act as if it started with them. We’ve known for decades how CPOE can be implemented successfully. Now’s the time to really get this right.

Ann Farrell is a principal at Farrell Associates of San Francisco, CA.

An Alternative Desktop Standard
By Mark Moffitt, MBA, BSEE

We have deployed a unique desktop configuration at our healthcare provider organization. The configuration is a Mac-mini running Windows 7 release candidate (RC) with a 17” wide-screen monitor.

The advantages of this configuration over a conventional PC are:

1. Smaller footprint
2. Less expensive
3. Higher quality hardware
4. Better cloning capabilities, i.e. ability to clone the windows partition using the OS X operating system
5. Run Leopard and/or Windows 7

We skipped Vista as a desktop standard. We found W7 RC to be very stable. So, rather than install XP on newly deployed machines, we opted to deploy W7 RC. Once W7 is released, we will install it over W7 RC.

The cost of the Mac-Mini, display, and keyboard and mouse was less than the conventional PC configuration we were considering. Your mileage may vary.

Power users in IS run both Leopard and W7 RC. They are both really good operating systems. Leopard is much better working with multimedia, while W7’s sweet spot is “corporate computing.” I run both on my MacBook Pro.

Mark Moffitt is director of information systems at Good Shepherd Medical Center of Longview, TX.

Physicians Using PCs
By Ben

I think you need additional inspiration!

Seriously, I think you’re confusing the work flow of an office based physician with the work flow of an inpatient physician (i.e., hospitalist or critical care specialists as examples). We (hospital-based physicians) spend much more time sitting down, sifting through and analyzing data (whether in electronic or paper formats) than we do with hands-on patient care. That’s NOT because the data analysis pulls us away from the bedside, but rather it is the bulk of the work: analysis, married with the patient visit and examination, tempered by experience and judgment, aided by decision support as available, leads to action. 

Why do computers in patient rooms fail to attract physicians? We want to work at a desk, adjacent to our colleagues, where we can sit and work without being distracted by what’s going on in the patient’s room. Doesn’t matter whether we’re working from a computer record or a paper record. 

And BTW: the “pecking away at a keyboard” has made me a vastly more efficient and informed physician than when I worked off of paper. Lawyers have the option of turning the work over to “associates”. In the absence of medical students, the patient gets the full attention of the “partner”! Score one for physicians.

News 7/1/09

From Dwarf: “Re: meaningful use. To all of the acronyms (HIMSS, etc.) who claim ‘meaningful USE’ definitions: you are defining meaningful FUNCTIONALITY, not USE. At least be honest about it. The biggest problem most EHR/EMRs have is their poor usability and this just makes it codified and worse!”

From Jack: “Re: Pittsburgh. Pervasive multi-system problems with a Cerner upgrade. The cover-up is on. Reporters will be punished to the fullest extent of medical staff by-laws and employment contracts.” This comes from a hospital I won’t name, especially since I have not verified the anonymous report.

From Carpluv: “Re: ARRA. LOL. Government , which comes up with ARRA, is going to pay doctors for EHRs. Then it does not tell them how they get reimbursed for it. This has stopped the buying cycle again. Morons.”

From The PACS Designer: “Re: CSA. The Cloud Security Alliance (CSA) has been formed by vendors to address Cloud and Internet security issues. The CSA mission statement is ‘To promote the use of best practices for providing security assurance within Cloud Computing, and provide education on the uses of Cloud Computing to help secure all other forms of computing.’ As we contemplate employing public and private clouds, it is good to consider CSA services that promote and educate everyone about security issues within cloud applications.”

Community Health Information Collaborative offers its health information exchange to providers in 18 Minnesota counties.

Virginia state officials admit that the recent hacking of the state’s doctor shopper database for drug abusers has caused doctors to prescribe fewer narcotics, sometimes to the detriment of patient care. Obama’s CTO, the former state technology secretary, put together the sexy $2 billion, 10-year cloud computing contract with Northrop Grumman that all the state’s applications are supposed to run on. At least one state delegate wants to kill the contract, saying nobody even knows whether the new contract will save money over the old one. Grumman is working hard to bag NHIN contracts, so you’d think keeping hackers out of an unexciting state patient database wouldn’t have been all that challenging. It’s still down, so doctors have to call in by telephone.

And in related (and belated) news, Lemuel Stewart, director of the Virginia agency that oversees the Grumman contract, is fired hours after he recommends not paying Grumman’s monthly invoice after a series of missed dates and what he claims were insufficiently documented invoices (not to mention that the agency is out of money). In the mean time, legislative hearings are underway as to why the state held closed door meetings to debate the massive Grumman contract. State employees give Grumman an “average at best” rating in terms of services provided. Even the interim CIO (also getting heat because he is also technology secretary and board member, all of which were supposed to be separate jobs) says Grumman’s “service levels in general are below expectations.” If anyone has an uplifting example of how a government partnership with big, publicly traded consulting firm has saved money or increased service, please send it my way since I can’t think of any.

The director of the Jefferson Regional Medical Center School of Nursing (AR) says its nursing students are benefiting from having Eclipsys Sunrise available for EMR training.

Finding it hard to get an Epic Systems job? There’s a spot for you if you are a talented cook.

Surgical information Systems (SIS) is a new HIStalk Platinum Sponsor, so welcome to them. The Alpharetta, GA company offers best-of-breed, integrated surgical solutions, exclusively focusing on the OR and perioperative systems. They’ve got a client testimonial video here and one on regulatory compliance here. I learned an important fact from the videos: I’ve been pronouncing the name wrong (I say “s-i-s” while customers say “siss”). No matter how you say it, thanks to SIS for supporting HIStalk (which, now that I think of it, has exactly the same pronunciation conundrum: is it H-I-S talk or hizz-talk?

Concerro (the former BidShift) acquires the assets of the CommandAware hospital incident command business from PortBlue Corporation. The press release tries to make a case of why an incident command system has anything to do with shift-bidding, but I wasn’t sold. Still, it looks pretty cool as long as your incident doesn’t involve downtime.

My latest driving-to-work inspiration. Doctors don’t use EMRs willingly because the entire paradigm of PC use assumes that: (a) users are sitting down; (b) they should be navigating with a keyboard and mouse since those work great when you’re sitting down; and (c) PC use requires concentration since applications are loaded with drop-downs, unforgiving edits, and user-unfriendly navigation. Have you ever seen all the available people at an airline ticket counter huddled around one screen and scowling as they try to figure out something as simple as your boarding pass? Or, hotel front desk staff who don’t look at you because they’re struggling with navigation of your room reservation? The PC is a terrible tool for on-the-go use, yet application programmers picture people seated and focused like they are when designing programs for them to use. Doctors are rarely sitting and able to interact intently with a computer (or if they are, they are not very good doctors). I know I say it all the time, but doctors the only highly educated and expensive professionals who are expected to happily peck away on a keyboard all day. Accountants, lawyers, hospital leaders, insurance company bigshots, and EMR vendor executives hardly ever do their own PC work, instead hiring assistants to free their time up for something more strategic. I don’t blame doctors for failing to see benefit since the people who are trying to convince them apparently don’t eat their own dog food.

Sixteen Mississippi hospitals receive threatening state letters for failing to collect mandatory state trauma registry information from their EDs. Some of them say Digital Innovation’s Collector Trauma Registry software, which was designed to work with national trauma databases, isn’t working too well for hospitals, taking up to an hour to abstract a single chart. They prefer the previous product, TraumaOne from Lancet Technology.

Ambulances in Franklin County, PA get connected from their laptops to the hospital for a smoother patient handoff. Why I as a federal taxpayer had to help pay for this is beyond me since I doubt I’ll ever set foot there, but that kind of common sense is hopelessly unfashionable in these feel-good days of having the government being the largest employer, insurance company, and bank.

Ireland’s health services oversight body says patient ID numbers should be rolled out immediately to reduce medical errors and simplify EMRs.

Conflicting findings among Hong Kong’s doctors: 80% say there should be a territory-wide health information exchange, but 80% of them also say their IT knowledge is insufficient to use computers themselves in practice. Nearly that percentage are worried about privacy and security.

A Kaiser article notes complaints of e-prescribing doctors, including security log-outs, inability to prescribe Schedule II drugs, and patient histories that aren’t current. One of the 50 doctors involved in a Shared Health pilot in Tennessee went back to paper. Another practice reports a 20% failure rate of prescriptions sent electronically, meaning patients show up at the drugstore and their prescription isn’t there.

An interesting thought as we move toward Internet-delivered medical applications: news of Michael Jackson’s death took down Google News, CNN, the LA Times site, and Twitter.

The CEO of a United Arab Emirates hospital credits Cerner with providing both access to patient information and management visibility that is helping them be more service-oriented. It’s a Hopkins affiliate, by the way.

RelayHealth, Medfusion, and Medem are mentioned in a Wall Street Journal article on virtual patient visits.

The pathetic soap opera that is Grady Hospital has a new episode. Two of its former CEOs are suing each other. The first CEO sued his replacement, who was head of the hospital authority that fired him, claiming she just wanted his $600K job. She just sued him for slander, claiming he told people she was sexually available and he could have had her if he wanted.

E-mail me.

HERtalk by Inga

Vitalize Consulting Services expands its existing consulting services to offerings for ambulatory care clinics. VCS is launching a new initiative that includes consulting services for Allscripts, ECW, GE Healthcare, and NextGen applications.

The privacy rights folks applaud the Supreme Court’s decision to let stand a New Hampshire law preventing prescriptions from being used to profile what each doctor prescribes. Two publishers of healthcare information argue against the NH law, claiming that data mining for commercial purposes is protected by free speech rights. Also, a federal appeals court refuses to block a Vermont law limiting the use of prescription drug data to profile the prescribing patterns of Vermont physicians. Look for more states to pass similar laws prohibiting data mining of prescription data.

New York-Presbyterian Hospital migrates a significant portion of its enterprise-wide IT server processing and storage infrastructure to Eclipsys’ Remote Hosting Services.

The Congressional Budget Office predicts that by 2082, health care will account for 99% of the nation’s gross domestic product at the rate we’re going. In 1960, healthcare spending was a mere 4.7%  of GDP. Last year we hit 16.6%. But why should we worry about that since most of us will be dead by then?

Michelle Obama announces the release of $851 million in community health center grants. The funds are part of the ARRA stimulus package and designated to address facility and equipment needs more than 1500 health centers. Over 650 facilities are expected to use funds to purchase new equipment or HIT systems and almost 400 will adopt or expand the use of EHR. Mrs. Obama made the announcement at Unity Health Care Clinic in DC, and apparently wore a light gray elbow-length jacket with a large silver high-waisted belt and dark gray pants. She accessorized with several silver bangle bracelets and diamond earrings. While I am sure the outfit was fabulous, I would have preferred this “news” article to leave out the fashion statement. That’s the kind of stuff we bloggers are suppose to discuss, right?

Tucson Medical Center markets “birth packages” to wealthy Mexican women coming to the US to give birth. Though the practice of Mexican women giving birth to children in the US is not new, the marketing efforts are. The marketing materials leave out the key draw: the newborn has US citizenship. Obviously, some folks aren’t too keen on the ploy.

Iowa Health Systems selects the Orion Health Rhapsody Integration Engine for message exchange from legacy systems and to make patient information accessible to physicians from the health systems EMR. Rhapsody replaces Sun Microsystems’ eGate integration software.

Siemens Healthcare appoints Michael Reitermann CEO of its US operations. Reitermann has served as CEO of Siemens Molecular Imaging since 2005 and was president of Siemens Nuclear Medicine before that. He will replace Dr. Heinrich Kolem, who becomes the global head of Siemens Angiography, Fluroscopy and X-ray business unit.

Physicians Medical Group of Santa Cruz County (CA), successfully demonstrates the exchange of health information within multiple communities.

CalRHIO announces its selection of RAND Corporation and USC to measure savings resulting from physicians’ electronic access to patient information via the CalRHIO HIE. The first phase will focus on emergency department savings.

Perot Systems’ Government Services Business unit wins a $119 million contract with the CDC to provide infrastructure and IT services support.

Participation in healthcare spending accounts has jumped 46% in the last year, a trend that is expected to continue at least through 2010.

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