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Readers Write 4/22/09

April 22, 2009 Readers Write Comments Off on Readers Write 4/22/09

Sense of Reality
By Greg Weinstein

I have been working on clinical systems and integration in an academic medical center for 20 years now and I am watching with growing concern the frenzy of the standards writers. Prior to going to HIMSS, I took the time to read some of the HITSP specs – specifically. the C32 document sections related to medications. Everyone has a problem with sharing medication lists and everyone wants to do it right. But while C32 has over 30 data elements for each medication record (down to the lot# and bottle cap style) the only thing required was the text of the drug name. When I asked people how they could build a data sharing system (NHIN, RHIO, HIE) with only that requirement, they answer that, within each exchange, the “details need to be agreed on”. This sounds a lot like the failure of HL7 v2, though with a lot more baggage.

I visited the IHE Connectathon at HIMSS. What I saw was not encouraging, but entirely predictable. The scenario demonstrated a patient moving through a series of care facilities with CCDs used to transfer the patient’s record. Naturally one site included only the medication names (actually they stuffed long strings with the names, routes, frequencies, dose all together into the name field) and embedded this in their CCD. The next site expected to receive the medication name, route, dose, etc. as separate fields and was unable to import the data. The demonstrator began manually re-entering the data by reading the long multi-element strings and using the data entry form of his own system. This might have allowed entry of the data into his system, but almost certainly lost the data “provenance” (that it arrived via a specific signed CCD). 

After a few minutes, the crowd became restless and he gave up, skipping the last four medications. He then generated his CCD and transferred it to the next system in the scenario, which, amazingly, only saw the medications from the last CCD, where four medications had been omitted. In fact, the contents of the multiple CCDs reflected the system limitations of the various systems more than they did the actual patient state being represented in the scenario.

Against this background of non-success, we see CCHIT certification scenarios of ever-increasing complexity and new HITSP requirements to include every data function ever conceived. And then we see published research stating that no one has proven that any of this actually improves outcomes.

Regarding CCHIT, the entire focus of application certification is wrong. We ought to be asking providers to support certain functions. The CCHIT approach of application certification implies that a single system needs to do everything. Why couldn’t a provider choose to use more than one piece of software so long as their practice did what was needed?

I sincerely hope that someone will be able to calm the waters, make rational decisions on what data is most valuable to share (medications, allergies, problems, labs, images, and “documents”), and how to go about it.  Without some focus and reasonable expectations, we may waste an entire generation of software development activity, kill innovation, and crush smaller companies, all without tangible benefit.


MUMPS to Java … Caveat Emptor
By Richie O’Flaherty

I couldn’t let this pass un-commented, having had some direct experience in language translations many years back in which the organization I was a part of translated a number of applications (mostly in-house developed) from Meditech MIIS and MaxiMUMPS. While most of the pain occurred in the MaxiMUMPS translations due to extensive non-ANSI standard extensions in the language implementation, a common theme (pronounced "fly in the ointment") became apparent in the implementation of the resulting application.

This was the shocking performance impact of the translated code. Differences between how language components are coded in the source and destination languages can have crippling effect on the translated application. A primitive operator in the source language may or may not exist in the target language. If it doesn’t exist, an equivalent piece of code must be written and invoked everywhere it occurs in the source application code. That may involve many instructions or even many lines of instructions as well as overhead to invoke and clean up every time it is used. 

The difference in the number of machine cycles to execute these "equivalent" components can (and did) bring the translated application to its knees, requiring rethinking of hardware configurations as well as targeted application redesign in the resulting language to salvage the very life of the system which was the principal IT solution for a major outpatient clinic.

I am not a Java programmer so I cannot offer perspective on speed and efficiencies that Java may bring to the table, only that this is and was the massive piece of the iceberg in our translation efforts involving MUMPS. It should be noted however, that MUMPS (and MaxiMUMPS) cut their teeth supporting an impressive number of simultaneous users on hardware that had but fractional MIPS ratings. That these outmoded dinosaurs are yet running applications anywhere is a sure sign that the possess a level of efficiency that should be at minimum respected, but more advisedly investigated when seeking to translate them to anything. Iron is certainly cheap(er) these days, but I reiterate — caveat emptor.

Do You Know What’s In Your Medical Record?
By Deborah Kohn, Principal, Dak Systems Consulting

One must go back to ePatient Dave’s main point (albeit difficult to find given all the exchanges and text): "Do you know what’s in your medical record? THAT is the question worth answering."

It doesn’t matter if the data are stored on paper, on analog photographic film, or on a digital storage medium. The only way one will be truly responsible for one’s health is to get copies (analog or digital) of one’s complete, episodic medical record, review the record with one’s provider(s) if necessary, and if errors are are found, correct them. Because one deals with people, processes, and technologies, data inaccuracies occur all the time!

However, since the 1970s, patients have been allowed to access the information contained in their medical records, and since HIPAA "I", patients have been allowed to add addenda to their records. Similar to obtaining and correcting the data contained in one’s credit report, one must ask to do this.

As a health information management professional for over thirty years and long-time member of the American Health Information Management Association (AHIMA) whose banner remains "Quality Information for Quality Healthcare", I never NOT obtain copies of my episodic medical record for review, archive, and information exchange purposes. Hopefully your readership will do same.

For example, as a health information management professional (fortunately or unfortunately) I knew only too well that when I was hospitalized five years ago my clinical records (created and stored in both analog and digital formats) would contain inaccuracies. One operative report contained my correct demographic information in the report header but described me as male (I’m a female) with inoperable colon cancer in the report body. (Either the surgeon or the transcriptionist had mistakenly switched the dictation based on another case that day). Subsequently, these data were coded as such for billing /reimbursement purposes (ICD/CPT) and clinical purposes (SNOMED), making no difference had the data populated a Google or Microsoft or other PHR.

In summary, to answer another question asked in one of the blogs, " Who’s going to validate and correct the data?", the good news is that health information management professionals working in all types of healthcare provider organizations are not only trained but tasked to validate these data. The not-so-good news is that given staffing constraints and other similar issues, it is not and never will be possible to audit 100% of the medical record content in 100% of the cases. Therefore, only YOU, the patient, can and must review and correct the data.

Comments Off on Readers Write 4/22/09

News 4/22/09

April 21, 2009 News 7 Comments

From Susie Adamo: “Re: CCHIT. Definitely adding headcount. They just hired Bobbie Byrne, who is a pediatrician who recently left Eclipsys, where she ran clinical strategy.” Unverified – not yet reflected on her LinkedIn profile or on the CCHIT site.

From Stella Artois: “Re: Being John Glaser. I love the column. I had dinner with John one night, touched his shirt sleeve, and didn’t wash my hands for days (despite all infection control precautions). He is my idol and I do so love his latest inspirational post that I am handing it out to wannabe CIOs.” John’s postings may be less frequent as he starts his ONCHIT gig in a couple of weeks, so he may be busy and/or muzzled. I replied to his e-mail asking if he’ll get to bunk over in the Lincoln Bedroom, run up a big expense account tab, and enjoy the thanks of a grateful nation. He said he’s not sure about all that, but he’ll be able to to see the Capitol from his office window. Well, that’s fairly cool.

From The PACS Designer: “Re: Oracle buys Sun. Mr. H. and HIStalk readers know that TPD has been fond of Oracle for their focus on the healthcare space. Now, an Oracle-Sun Microsystems combination will bring a powerful offering of open software solutions that prospective customers can choose to meet their upgrade needs. Additionally, Sun Microsystems storage solutions can further enhance the performance when integrating numerous databases within the enterprise to create a neutral archive.”

From Californian: “Re: the data model that nearly killed Joe. It’s from Epic. Would you have the courage to publish this factoid?” Apparently I would. Still, to single out Epic wouldn’t really be fair since the problems he describes mostly involve (a) caregivers who didn’t use the system; (b) caregivers who didn’t deliver patient care all that well; and (c) caregivers who were using a system that they claim wasn’t designed well for their work (or could it be that their work wasn’t all that well designed and standardized that no amount of programming could support it?) and (d) caregivers dealing with patient information stuck in the the never-ending and very deep chasm between outpatients and inpatients (which are actually the same patients, of course) created by different billing rules (they don’t even speak the same language, such as “episodes” vs. “visits”). Nobody puts a gun to the head of a hospital and/or practice group to buy a company’s software, so if it doesn’t work well for their situation, I’d put the blame on the user for voluntarily choosing it. I wouldn’t be able to critique the data model without seeing it and neither would a patient who experienced what they felt was substandard care, no matter how technical their background. I doubt any hospital could say with certainty that they don’t have stories just like that one in their own place.

insta

Former Wipro executive Ramesh Emani starts Insta Health Solutions, a Bangalore-based hospital information systems company selling low-cost systems for small hospitals. It has 20 customers already and plans to have 2,000 within five years.

The New England chapter of HIMSS will have its public policy event on May 8 in Norwood. Agenda here (warning: PDF).

mc50

Thailand’s medical tourism hospital Bumrungrad International Hospital will deploy a medication verification system that runs on Motorola (aka Symbol) MC50 PDAs.

A reader asks: are companies out there asking employees to resign rather than calling it a layoff (which would allow affected employees to collect unemployment, continue COBRA, etc.)?

Eclipsys announces a new release of its PeakPractice PM/EMR aimed at ambulatory surgery centers.

mayo

Mayo Clinic announces a Mayo Clinic Health Manager, a personal health Web site that uses Microsoft HealthVault to provide reminders and guidance.

Jim Stalder, former CIO of Mercy Health Services, joins call center operator The Beryl Companies as CIO.

safestick

UK hospitals roll out 100,000 SafeStick USB devices that are password-protected and encrypted.

A London hospital raises privacy concerns by trialing the use of body-worn video cameras connected to video recorders for its security guards.

A Hartford Courant article points out astronomical non-profit salaries even while big company CEOs and Wall Streeters take their public lumps: UPMC’s CEO made $3.3 million in 2006 and hospital CEO Gary Mecklenburg made $16.5 million the year he retired. One state United Way CEO made $1.2 million in a year. From the article: “Every year I sit in editorial board meetings in which CEOs of nonprofit hospitals come to press their case for more public money. They want taxpayers — bus drivers, small-business owners and public school teachers — to send them more to cover the hospital’s charity cases. And every year I can’t help but think: Before you come asking for more public money, you need to reassess your own remuneration. Until top salaries are more in line with, let’s say, the salary of a U.S. Supreme Court justice, a position that currently pays $208,100 and has no trouble attracting top talent, the poor-mouthing is a little too self-serving.”

Is this reasonable? An uninsured man had what he admits was life-saving surgery. He couldn’t pay the bill, so the hospital turned it over to a collection agency. His only asset is his house, so he’s going into bankruptcy but will still have to sell the house to pay up. He calls it a “gross injustice” and wants people to demand “affordable health care”. If the hospital writes it off for him (not unusual when the press runs stories like this), someone else gets stuck helping the hospital make its margin. Should surgeons be paid less, or drug and supply companies, or hospital CEOs ($300K in this case), or nurses? The “healthcare should be cheaper” argument requires a corollary that “someone is overpaid,” so who? If someone asked him before the surgery, “You will die unless you’re willing to sell your house,” wouldn’t he have done it? Healthcare is run like a semi-business, but we seem to want it to be a charity again like it used to be (without the multi-million dollar CEOs plotting takeovers and layoffs, anyway).


HERtalk by Inga

From Large and In Charge: "Re: consultants. I have plenty of consultant names now. Thank you! More than I expected." 

From John T: "Re: ICE. So, now that there is a new acronym in the marketplace, ICA finally has a solid place in the market. We’re an ICE Vendor – pretty cool. Actually, downright cold!" In case you missed it, ICE stands for Integrated Community EHR.

Dr. Lyle, a regular HIStalk commentator has initiated his own blog entitled, The Change Doctor. His initial post focuses on the "Three Is" for EMR adoption. One likely to create some controversy is Dr. Lyle’s take on interoperability: "While many say that we don’t have enough, I’d actually argue that we are so obsessed with this issue that we are losing the forest for the trees. In other words, let’s get doctors using systems first, and worry about interoperability later."

Ontario Systems signs a multi-year contract with Memorial Sloan-Kettering Cancer Center, which includes the purchase of Ontario Systems Revenue Savvy software.

Montefiore Medical Center’s IT subsidiary Emerging Health Information Technology signs a multi-year hosting agreement with the North Shore-LIJ Health System (NY). Emerging will provide support for a portion of North Shore’s computer network.

The folks at Vitalize Consulting Solutions collected almost $2,000 for the hungry during the HIMSS conference. Vitalize accepted food donations and cash to benefit the Greater Chicago Food Depository. Wouldn’t it be great if more vendors used such creative "marketing ploys?"

patterson 

2008 was something of an off year for Cerner’s Neal Patterson, who received 8% less compensation than the previous year. His total package — including base pay, stock options, use of the company aircraft, and other benefits — was approximately $3.5 million.

Perot Systems signs a multi-year agreement with The Christ Hospital (OH) to provide revenue cycle services.

RelayHealth introduces FastTrack5010, a online informational resource center to help health insurers prepare for and comply with new HIPAA 5010 transaction standards. The deadline for the new claim version, by the way, is January 1, 2012.

The FCC approves $35.6 million to fund the development for five telehealth networks to link rural hospitals in nine states. The Rural Health Care Pilot Program is allocating the money, plus an additional $10.4 million for the Alaska Native Tribal Health Consortium to connect rural healthcare providers.

EHNAC announces a new accreditation program for application service provider-based EHRs. The new ASPAP-EHR (catchy name) is seeking participants for both its ASP and HIE accreditation programs. Do we seriously need another certification program? And really seriously, enough with all the acronyms already.

The ever-turbulent MedQuist names Dominick Golio as CFO. Golio previously served as North American CFO for D&M Holdings.

childrens pitt

The Children’s Hospital of Pittsburgh of UPMC celebrates the grand opening of its new campus with a ribbon-cutting ceremony. The first outpatients are being seen this week and the hospital officially opens May 2nd.

The New York eHealth Collaborative partners with InterComponentWare and Surescripts on a prototype project to facilitate prescription routing and the the delivering of  prescription histories.

Tenet Healthcare announces its preliminary Q1 numbers. Net income is expected to be $178 million compared to a $31 million loss in 2008. EPS is projected to be $.37/share compared to last year’s $.06/share loss.

TeraMedica Healthcare Technology and Compressus partner to offer an enterprise-wide solution to provide comprehensive clinical workflow, data management, and a unified view to the resident EMR system. Teramedica is a provider of enterprise imaging and information management solutions, while Compressus specializes in interoperability and workflow solutions.

The New York State Department of Health selects APS Healthcare and Thomson Reuters to manage its state Medicaid clinical practice utilization review program. The program examines how Medicaid patients utilize medical services and explores patterns of potentially unnecessary care and opportunities for improving patient safety or quality of care.

The LA Times explores the huge industry of outsourced transcription to Asian countries. In the Philippines, 34,000 transcriptionists generated $476 million in revenue last year. Experts predict revenues to exceed $1.7 billion by the end of 2010. Most work costs $.10 to $.15 per line and is delivered within 24 hours. In the Philippines, a fast transcriptionist can earn about $6,000 annually, which is about three times a nurse’s salary. The median income for American transcriptionists is $31,250 a year.

Kentucky Lt. Gov. Dan Mongiardo proposes that Northern Kentucky University become a national laboratory for testing the financial viability of EHRs and is seeking up to $500 million in federal money to get it started. His proposal includes a study of how healthcare providers can set up cost-effective e-health systems. I suppose a good way to make it cost-effective is to have the government give you $500 million up front for an EHR. Mongiardo happens to be running for a US Senate seat that becomes open next year, so one has to wonder if his actions are at all politically motivated. Nothing like working to get a little extra pork for the home state!

I was flattered that Matthew Holt forwarded me an invite to the Health 2.0 conference that starts Wednesday in Boston. I won’t be able to make it, but if you are attending, make sure Matthew wears his Inga 2.0 sash.

E-mail Inga.


What Will Oracle’s Acquisition of Sun Microsystems Mean for Healthcare?
By Orlando Portale

Reading about the acquisition of Sun by Oracle yesterday brought back some fond memories for me. I recall a discussion that my team had while sitting in the lobby of Oracle’s headquarters in 2003. We were there to meet with John Wookey, the head of healthcare (now at SAP) to discuss how we would continue to align Sun and Oracle’s business development programs. 

While hanging around Oracle’s lobby, my team began discussing how a potential Sun/Oracle merger made a lot of sense. Our products fit together very well and both companies had a strong culture of innovation. We discussed how Oracle had embraced Java as its standard for software development and the many deals we had captured together. Unfortunately, the discussions didn’t go anywhere, although in hindsight, it could have been a game-changer. Better late than never, I guess.

In my view, the acquisition of Sun by Oracle is synergistic for the following reasons:

  • Oracle invested millions in standardizing all of its applications to Java. Therefore, outright ownership of Java is a plus for Oracle. IBM has also embraced Java, but Oracle will have increased leverage over them.
  • Oracle and Sun already have a large installed base in common. Many of the largest databases in the world run on these platforms.
  • Sun recently acquired MySQL, the open source alternative to the Oracle database. Oracle can now control MySQL’s destiny and any negative revenue impact it could have had against its own flagship database product.
  • Sun and Oracle have always been in the anti-Microsoft camp. Sun owns Open Office, a robust and cheap alternative to Microsoft’s cash cow. This represents another opportunity for Larry Ellison to stick it to Microsoft. In addition, there are opportunities for tighter Open Office integration with Oracle enterprise applications (e.g. Peoplesoft, Siebel), thereby obviating the need for third party Microsoft licenses.

What effect will the acquisition have on the HIS software vendors?

Cerner has a sizable installed base already on Oracle. Most of these systems are hosted on IBM hardware under the AIX operating system, and NOT on Sun Solaris. Cerner has always refused to support Sun’s Solaris OS. That may change now, if Larry Ellison drops a dime. During my time at Sun, I tried to broker a meeting between Sun CEO Scott McNealy and Cerner CEO Neal Patterson. McNealy was eager, but Patterson said he saw no reason why they should speak. "Open systems, Java, Solaris … who cares.” Hello Neal, it’s Larry calling.

With respect to Cerner and Oracle, here are three potential scenarios:

  1. Oracle Wins/IBM Loses = Cerner + Oracle + Solaris OS
  2. IBM Wins/Oracle loses = Cerner + IBM DB2 + IBM AIX OS
  3. Status Quo = Cerner + Oracle + IBM AIX

Note:  Other vendors such as Epic have a MUMPS installed base and are mostly hardware and operating system agnostic. Therefore, I believe this acquisition will have a minimal impact on Epic.

The other area of interest for healthcare customers will involve the status of Sun’s SeeBeyond SOA/Integration platform. At one time, SeeBeyond held considerable market share in healthcare, particularly for  HL7 messaging and system integration. However, in recent years, Sun has let SeeBeyond slip by the wayside. Oracle could gain considerable traction in the healthcare space by bolstering investment in SeeBeyond. This is a particularly useful platform for enabling HIE/NHIN integration. 

What will Oracle do with Sun’s assets after the acquisition?

First 180 days:

  1. Rapidly cut Sun’s sales, marketing and back office functions by integrating them into Oracle.
  2. Consolidate the Sun software and R&D organizations into Oracle.
  3. Create a separate hardware division. Consider either continuing the hardware business or divesting the assets to companies such as Fujitsu or Cisco.

Post 180 days:

  1. Oracle will begin create tightly bundled system stacks which incorporate hardware and software components. Oracle will now have all layers of the systems stack under its umbrella, including the storage, server, operating system, programming language, database, Web services, etc. If Oracle goes to market with integrated system stacks, it could put considerable pricing pressure on its hardware competitors.
  2. Integrate Sun’s open source cloud computing solution infrastructure with Oracle technology. These solutions are ideal for startup companies looking for cheap entry level systems.

What will be the potential impact on IBM, HP and Dell?

From a hardware stand point, HP and Dell may have the most to lose.  Today, both companies have captured significant revenues from their relationship with Oracle. If Oracle retains Sun’s hardware business and begins going to market with integrated hardware and software systems, it will find itself in a channel conflict with HP and Dell. Will HP and Dell be forced to work more closely with IBM to capture DB2 deals? This is problematic as well, given that IBM already sells competitive hardware platforms and can embrace a similar integrated system strategy. Should this scenario play out, clearly HP and Dell will be at a disadvantage by virtue of not owning the components of the software stack.

IBM will need to revisit its long-held Java strategy, including its heavy dependence on Java for the Websphere platform. IBM will seek assurances from Oracle that it will have equal access to Java in the future. Otherwise, the only other major development platform for IBM to embrace would be Microsoft’s .NET. A shift by IBM away from Java and toward the Microsoft .NET platform would be a monumental and costly move. In years past, when confronted with this situation, IBM would just release its own new proprietary competitive development platform, but IBM no longer has that leverage in the industry. Hello, Sam, it’s Larry calling again.


image

Orlando Portale is Chief Innovation Officer, Palomar Pomerado Health District, San Diego, CA, and former GM Global Health Industry, Sun Microsystems.

Monday Morning Update 4/20/09

April 18, 2009 News 16 Comments

From Leonard Smalls: “Re: CIOs. The selection of the HIMSS chair best highlights all that is wrong with healthcare IT. He was an X-ray technician, went to work for a healthcare IT vendor, and then to his hospital, where he is now CIO. He was groomed by vendors and HIMSS with little information technology education and experience other than vendor applications. This is what is wrong with healthcare IT. You can’t be just a good manager and join the right organizations to be an effective CIO. You must have information technology education and real-world experience in the layers below the application layer in order to make effective decisions about systems and how to integrate them. If not, you become a vendor-whore (pardon the language). I see this repeated often in healthcare organizations. Those in the industry need to stand up and shout when the emperor has no clothes.  Otherwise, sit down, be quiet, and quit complaining about crappy software in the healthcare IT space.” This is the “CIO as the technician in charge vs. generalist change leader” argument that never seems to end. One camp says hospital CIOs should be doctors and nurses, another says they should be the same kind of person you’d want for COO or even CFO, while the old-schoolers says the CIO should know the bits and bytes. I’ve yet to see a convincing correlation between CIO effectiveness and their background since so much depends on leadership style and the organization they work for. I do believe that hospital CIOs are too cozy with the idea that everything revolves around vendor software, often because that’s all they know. Look at how chummy CIOs are with vendors with HIMSS and CHIME – is that an admirable win-win position or is it an incestuous relationship? Either way, that’s why it’s an uphill battle for open source applications, internal development, or simply optimizing the use of what’s already been bought. Those less-sexy efforts rarely get you on the A-list of advisory boards, speaking engagements, and rah-rah magazines. Plus, lemming hospital executives are swayed by vendorspeak, too (“vision centers” are for non-IT execs looking through a gauzy and deceiving lens, for the most part, not CIOs) and not encouraging their CIOs to blaze any trails.

From Svetlana Stalin: “Re: two million visitors. This very intelligent and sometimes bizarre Web comic strip relates to your recent achievement. Congratulations!” Link.

From Bashkirian: “Re: the data model that nearly killed Joe. Heard the vendor was Epic. Can anyone confirm?” I believe ample clues were provided to draw a conclusion about the vendor, although the conclusions about the magnitude of the problem and who’s to blame for it could certainly vary.

From Speedo: “Re: MED3OOO. Heard Tom Skelton has inked a big deal with Tenet.”

From IT Manager: “Re: Carilion. Carilion Clinic’s EMR implementation is going as smoothly as any I have seen at several other health systems. I think we are rolling out Epic at all of our hospitals and ambulatory sites faster than anywhere else in the US. Carilion’s 140-bed hospital implemented Epic smoothly on all applications just a few months after the 800-bed Carilion Medical Center went live.”

chopra

President Obama names 36-year-old Aneesh Chopra as chief technology officer of the United States in his Saturday morning radio address. Chopra is Virginia’s secretary of technology, but more relevant to healthcare, was previously managing director of The Advisory Board Company, the publicly traded healthcare consulting and advisory firm, where he led the CFO group. His LinkedIn profile shows no technology experience or education whatsoever (that should drive Leonard Smalls, whose comment about CIOs is above, crazy), although his Democratic party participation is impeccable. Jeff Bezos, Bill Gates, Eric Schmidt, and other big-name visionaries had been touted for the job, so many are scratching their heads as to why he was chosen and what he brings to the table. HIMSS gave him a state advocacy award in 2007, so I’m sure a fawning press release applauding his selection is imminent. I wouldn’t get too stoked: he’s not a member.

Interesting: Gibson General Hospital finds a Russian hacker’s exploit on its e-mail servers that allowed them to be used to forward spam all over the world. Palisade Systems, whose packet management technology was used to detect and fix the problem, ran the press release. One case study involved using the company’s PacketSure Procotol Management Appliance to limit peer-to-peer traffic for a university.

The latest newsletter (warning: PDF) from Intellect Resources has thoughts on how to tell your kids that you’re out of work (advice you’ll hopefully never need). Check in, too, with Traveling HIT Man (their version of Flat Stanley) to see where he’s been. He may find his way to HIStalk Intergalactic Headquarters someday.

Would you please complete my reader survey? I do it every year to help me keep HIStalk on track. Thanks.

A pharmacy technician whose job was the subject of layoff rumors kills the pharmacy manager, a co-worker, and himself at Long Beach Memorial Medical Center (CA).

Anonymous whistle-blowers claim (and press-obtained documents seem to confirm) that the Australian government is rushing its Cerner systems into production without any medication functions working, presumably to get something live to avoid embarrassment in next year’s elections. The $70 million system was ripped by an unnamed health IT expert, who predicts hospitals won’t use it: “No one likes using it because it’s shit. It’s totally inflexible.”

fluno

The folks at Digital Healthcare Conference (May 6-7 in Madison, WI) are offering a special $295 registration rate (use code HISDC) for provider readers of HIStalk. It’s a pretty high-powered speaker list and a nice facility (Fluno Center for Executive Education, above). I’d go if I could get off from work.

voalte

Those pink-pantsed boys at Voalte have got their marketing on despite being a start-up. This funny video makes fun of an unnamed competitor that should be obvious to everyone, a la Apple vs. IBM (Voalte isn’t a sponsor or anyone I know, by the way, for those who may think I have a hidden agenda – I just find their product interesting and their approach fresh).

globe

BIDMC CIO John Halamka says sending clinically unreliable administrative data to Google Health for PHR use was a mistake in retrospect, as evidenced by the head-scratching conclusions e-Patient Dave found when he viewed his own records there and found a long list of medical conditions that he mostly didn’t have (but had been tested for). BIDMC is shutting down the ICD9 feed and trying to map their homegrown software’s data to SNOMED-CT instead of sending free text. e-Patient Dave, who is the public face of the problem, is advising Google and BIDMC. Not to minimize his contributions, but couldn’t Google have spent a few of its gazillion dollars to actually talk to one of the many informatics experts in the industry instead of just happily blowing in whatever data BIDMC said it could send and calling it mission accomplished? Honest to God, we’ve got real-life doctors, nurses, informatics PhDs, and nomenclature and taxonomy experts everywhere and nobody ever asks them, instead just sending off a bunch of marketing types and programmers to hack out something that looks cool even if it is somewhere between medically useless and medically wrong. Show of hands: who out there would have told Google that it was a fantastic idea to use claims data as a clinical tool? (like, “The doctor tested you for cancer once, ergo, you must have cancer.”)

If top dogs Google and Harvard’s BIDMC (and Uncle Sam, who’s putting a lot of faith in aggregating data from iffy and undocumented sources) can’t figure out this data quality issue, what does that say about an industry that’s about to spend billions on a national data exchange? Who’s going to validate and correct EMR data that’s being whisked electronically all over the country? (or, more importantly, who will use it knowing its limitations, which is the reason that PHRs are of limited value today?) Here’s what e-Patient Dave wisely said about the fiasco: “I suspect processes for data integrity in healthcare are largely absent, by ordinary business standards. I suspect there are few, if any, processes in place to prevent wrong data from entering the system, or tracking down the cause when things do go awry. And here’s the real kicker: my hospital is one of the more advanced in the US in the use of electronic medical records. So I suspect that most healthcare institutions don’t even know what it means to have processes in place to ensure that data doesn’t get screwed up in the system, or if it does, to trace how it happened.” I was talking to Robert Connely of Medicity (formerly Novo Innovations) and we agreed that interoperability is a piece of cake compared to the next mountain to climb: semantic interoperability (I’m getting this data element from you, but tell me what it really means). Vendors don’t always document that even in their own databases (see the healthcare data model critique that I wrote about earlier).

The Australian Business Journal profiles the resurrection of IBA Health, parent of British software company and NPfIT vendor iSoft. Some fun talk from IBA’s chairman about that iSoft acquisition, which initially was going the other way as the much larger iSoft was to acquire IBA, but then iSoft’s market cap dropped from $3 billion to $300 million. “It had lost 90 per cent of shareholder value and its management team and we ended up as the underdog bidder — the pissy little Australian company — wanting to take over a British institution. They did not treat us seriously. I guess there was a bit of colonialism involved. They had hoped an American company would take them over. Instead, I came back with a slingshot and we took it over.”

Speaking of IBA, it acquires Hatrix, an Australian vendor of eMAR systems.

Alaska, already the most pork-heavy state, zips through a bill pushing electronic medical records, hoping to grab some stimulus money.

A Huffington Post article by Deane Waldman (a doctor) decries poor usability in clinical systems. “I can access my Excel spreadsheets on either MAC or PC but I cannot see a chest X-ray and lab results using the same program. Inpatient files are coded (and secured) separately from outpatient records making it impossible easily to compare them … The Obama administration is encouraging the development of EMR and that is wonderful. The scary part is that I know they will do it wrong. They will do ‘business as usual’ … As a colleague on Twitter wrote recently, ‘IT tends to focus on back-end programming and loses sight of the front-end [the users]. Without usability, software is [and EMR will be] useless’ … the screen in the hospital on which I am supposed to electronically sign my letters: it has 74 icons! Talk about incomprehensible. The needs of the end-users must drive the design.”

CCHIT takes the first step toward its expansion to certify long term care systems, putting together a LTCS Advisory Task Force. The CCHIT apple didn’t fall far from the HIMSS tree: keep the paid headcount down, use volunteers to do all the real work, keep expanding, and figure out multiple revenue streams. None of that is bad, necessarily.

GE’s Q1 earnings sucked less than expected: EPS $0.26 vs. $0.43, but the GE Capital news just keeps getting worse: its earnings dropped 58% to $1.12 billion, but without a favorable, one-time tax treatment, it would have lost $153 million. GE Healthcare wasn’t exactly a bright spot, with revenue down 9% and profits off 22%.

reading

Reading Hospital (PA) will lay off 250 employees.

Turns out the cure for the nursing shortage was a recession. The RN position vacancy rate in Massachusetts is only 4%, with new grads scrambling to try to find jobs. Mass General has a 2% vacancy rate, BIDMC is laying off some nurses, and Children’s has nothing for new grads.

tmds

Top military doctors in Iraq aren’t happy with its new tracking system for wounded soldiers. The new system, Theater Medical Data Store (TMDS) replaced Joint Patient Tracking Application (JPAT). I wrote about JPAT awhile back, citing this article and others. Lt. Col. Mike Fravell was a Landstuhl Regional Army Medical Center CIO and VA fellow who built JPAT himself, where it found a wide and appreciative user audience, but his initiative annoyed top brass determined to spend big money on the TMDS replacement system. He was transferred out to his own Siberia. The main complaints about TMDS involve data loading time (it’s run from servers in Virginia) and multiple information links for each patient, making easy interpretation difficult. An army vascular surgeon sounds like his civilian counterparts: “I know JPTA is dead, but our current system is not functional. As we do more with less putting the administrative burdens on the doctors is ludicrous.”

Odd lawsuit: a woman is suing Boulder Community Hospital (CO) and nearly a dozen doctors, claiming that the hot water bottle placed underneath her while she was in labor exactly two years ago left third-degree burns on her buttocks.

E-mail me.

News 4/17/09

April 16, 2009 News 22 Comments

timelineFrom Rick Weinhaus MD: “Re: Cheezborger and usability. I agree completely. I also found Dr. Bradford’s special article in January on usability, as well as the comments, right on the mark. The promise of EHRs to improve patient care, reduce costs, and minimize errors will never be fulfilled until the software becomes more usable. As a physician, I have had first-hand experience with several EHRs. On the basis of these experiences and my sense of what mental models I actually use in taking care of patients, I have proposed two EHR design idioms to improve work flow and reduce cognitive load. If any readers would like to see detailed descriptions including graphics, they are posted as threads on the EMR Update website.” Link 1, Link 2, Link 3. Jim Bradford’s excellent article is here.

From Pete Potamus: “Re: war game EMR predictions. How about making EMRs easier to use? This includes personalization by physician or nurse, select versus enter, dictate complex orders in ‘human’ terms; use voice recognition and personalization to present the order for review and approval. Physicians and nurses are busy people. Make it easy and they will use it. Design it so they do more work and they will resist using it. But who wouldn’t respond the same way?” I like the idea, but everybody says the same thing and the products are still never really retooled. Apple creates its own market every time it adds its considerable design expertise to otherwise pedestrian and commoditized products. Why hasn’t it happened with healthcare software? I see only two possible answers: (a) customers are buying anyway, so the redesign isn’t necessary to make sales; or (b) vendors don’t expect to get ROI from doing it even though prospects say they want it. 

From Val Kelly: “Re: Epic layoffs. The last number I heard was about 400 people who were asked to resign in January and February. It’s hard to say for sure since they were told not to talk about it.”

losgatos

El Camino Hospital gets a second campus and CMIO Eric Pifer gets a hospital president’s job. Interesting financial tidbits: ECH has $400 million in cash and $1.1 billion on the books (note to self: recheck the definition of “not for profit”). Not to worry though – projections are that the new place needs a daily census of only 42 patients to throw off $11 million in annual profits … sorry, margin contribution … starting the third year.

Hedge fund Tremblant Capital discloses that it has taken a 6% stake in Eclipsys.

Listening: The Cliks, an outstanding hard-rocking Canadian band (which happens to be all-LGBT). I’m desk-drumming to Oh Yeah (seventh song down in the player). And I admit I don’t watch much TV, but I’m liking 30 Rock (smart women like Tina Fey are hot, yes?) and I’m enthralled with Brit talent show singer Susan Boyle (while the cynic in me says it could be a stunt since she surely had to audition in front of someone to get there, but watching the sniggering, superficial audience and judges reduced to slack-jawed awe and near tears is still priceless). I could get pop culture if I had more time.

The son of British TV magician Paul Daniels, an IT support manager with an NHS trust, is charged with fraud for allegedly engaging a company to perform phony IT work and skimming a fee in return for approving the invoice.

JPS Health Network (TX) mulls over a potential $150 million project to implement electronic medical records, hoping to suck up some stimulus money but still worried about the upfront cost. Nobody wins those deals except Epic, so you know they’ll be calling Judy if they get their nerve up.

South Nassau Communities Hospital (NY) goes live on the Forerun ED dashboard application commercialized from BIDMC.

It’s reader survey time! It’s a quick, non-annoying way for you to let me know how to make HIStalk better for you. Here’s the link. Thank you.

A reader asked if the HIMSS presentations can be downloaded yet. They were giving a link at the conference, but the member pages don’t show the 2009 files yet.

TeraMedica will partner with Compressus Inc. to create a workflow and data management tool that will make all of an enterprise’s imaging systems and databases available from a single worklist and will support data exchange.

natividad

Natividad Medical Center (CA) hires Kirk Larson from Cerner as CIO, intriguing the local paper because he stands to make more than previous CEO ($185K and up to a 30% bonus). Seems kind of rich for a 172-bed county hospital to pay up to $240K for a CIO to run what must be a fairly small IT shop.

Two companies selling MUMPS-to-Java conversion try to convince the DoD and VA to give them a big contract to turn VistA into a semi-new system that will run on something newer than aging DEC Alphas. The estimate to develop a new system: $15 billion (!). The estimate to convert VistA to Java: $125 million over 2-5 years, including replacement servers. The problem with that kind of porting is that all the internal expertise has to start over with a new language and database (and the fact that the resulting source code is next to unreadable and free of comments to provide documentation, at least in my limited experience). And I miss the Alphas, personally.

The local health district is trying to figure out who will help Petaluma Valley Hospital (CA) pay to replace its retired A4 hospital system with Meditech. Perot told them Meditech was a logical fit, which seems kind of self-serving since it owns the former JJWILD and needs work for those people. The hospital’s parent company has Meditech and PVH can jump on for $2.8 million, but they’re worried about parting ways when the hospital lease is up.

Bad Philips numbers have investors worried about GE’s, to be reported Friday. I’m not sure how anyone could expect good GE numbers given their big exposure to bad markets (construction, manufacturing, big-ticket healthcare equipment, aviation, and of course albatross GE Capital), but maybe they will surprise positively. The stock price is at 1995 levels, but then again the Dow itself is at 1997 levels.

Backup tapes from Penisula Orthopaedic Associates (MD) containing information on 100,000 patients are stolen from a courier’s vehicle.

This is an excellent first-person story by a technologist about how bad healthcare data models nearly killed him in facilities with supposedly state-of-the-art EMRs, leading him to conclude that any kind of nationwide health network will never work. HIT people should read every word since it dashes the notion that having an EMR means improving care. “Medical personnel at urgent care and the hospital who interacted with me all used a version of the same electronic health information system (the ‘system’). It became clear that everyone was fighting that system. Indeed, they wasted between 40% and 60% of their time making the system do something useful for them … I was in ER for 20 hours before being admitted to the intensive care unit (ICU) where I spent another 28 hours. Throughout my stay, I was hooked to network attached monitors that incessantly sounded alarms to which no one responded. I was asked 11 times to repeat my medical history, medication, and allergies to as many different medical professionals. I was seen by seven doctors each of whom asked me similar questions. Five doctors were never to be seen again. All doctors mumbled something about putting their findings into the hospital’s electronic records system – most did not according to ICU nurses. No one read my allergist’s detailed report about my condition and health history.”

Groups line up against the Australian government’s plan to use patient medical records to detect Medicare fraud. "The patient record will be completely exposed, extracts obtained, copied, retained and potentially submitted in court for all to see.”

Tech Mahindra acquires Satyam for $578 million, giving it 425 acres of land, 48,000 employees, and a big footprint (not to mention a reputation sorely in need of repair, but not unsalvageable). It’s hard to believe IBM didn’t beat that bid.

Odd lawsuit: a woman microwaving hair removal wax and apparently not following instructions overheats it, then spills it as she tries to take it out of the microwave. She was burned on the thigh and chest. She’s suing the wax manufacturer for $160 million.

E-mail me.


HERtalk by Inga

From Deborah Peel: "Re: stolen laptop at Moses Cone. The new security protections for health IT in the stimulus package require encryption of data, which will help prevent thieves from being able to use personal data in the future. But that is not enough to prevent future privacy violations like at Moses Cone. Strong state laws and medical ethics that require patient consent before medical records are disclosed were violated, but victims will have to go out and hire their own lawyers to sue hospitals and vendors to enforce these rights and protections. The stimulus package empowers state AGs to defend citizens’ privacy rights in HIPAA, but in 2002, HIPAA granted rights to hospitals like Moses Cone and over 4 million other ‘covered entities’ to disclose YOUR personal health information to outside vendors like VHA for any ‘healthcare operations’ or business use like ‘improving care’ or ‘reducing costs’ without your informed consent. Congress should have closed this giant privacy loophole in HIPAA, too."

From Large and In Charge "Re: EMR consultants. My large practice in the Midwest is looking at EHR options. Can you recommend any consultants?" If you are a consultant and/or have any names to recommend, let me know and I will forward to Large and In Charge.

imedconsnet

The County of Los Angeles signs a contract for iMedConsent, an informed consent and patient education system by Dialog Medical. The product includes thousands of consent forms and patient education documents, plus provides digital capture of signatures and other annotations.

Allina Hospitals & Clinics settles a lawsuit with the state of Minnesota over high interest rates charged on medical debt. The not-for-profit Allina will pay patients $1.1 million to settle a dispute over whether the health system broke state law by charging patients double-digit rates on certain outstanding medical bills. Allina maintains its actions were legal.

Utah implements a new task force to stop the state’s pharmaceutical drug problem. The Utah Pharmaceutical Drug Crime Project will work to eradicate the selling, buying, stealing of prescription drugs. Utah, by the way, has the country’s highest rate of non-medical painkiller abuse. (Who’d a thunk it?)

The for-profit HCA expects its Q1 profits to much better than last year’s, in part due to higher inpatient volume and better controlled expenses. Pre-tax income is projected to be $600-$650 million for the quarter compared to $344 million last year.

aurora

I am wondering if Twittering is going too far? Do we really need our doctors Twittering during surgery?

Regardless of the answer to that question, I am loving Twitter and have decided there are really two types of users: The Tweeterers (those who use Twitter to send out information) and Tweetees (those who primarily follow others to glean information.) I suppose there are also in-be-Tweeters who do a bit of both. I am primarily a Tweetee, though I do send out the occasional pearl of wisdom. IngaHIStalk if you want to follow.

IASIS Healthcare (TN) contracts with McKesson for the Horizon Medical Imaging PACS solution. IASIS is a 16-hospital system with approximately 2700 beds.

QuadraMed announces an agreement with e-MDs to provide QuadraMed’s hospital clients with the eMDs EHR/PM software for its affiliated physician groups. Sounds like e-MD is looking for a way to compete head-on with ECW for the hospital-supported physician EHR deals.

Gateway to Care, a large FQHC system in greater Houston, selects Sevocity EHR as the system’s only funded EHR solution. Five of the organization’s health centers will implement Sevocity by August for over 200 physicians and other users.

So far this month, it looks like five new ambulatory products have achieved CCHIT 2008 certification.

 power

I nominated Mr. H for this award, though its doubtful they would accept an anonymous blogger. But they should, don’t you think?

E-mail Inga.

CIO Unplugged – 4/15/09

April 15, 2009 Ed Marx Comments Off on CIO Unplugged – 4/15/09

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

Health Information Exchange Begins at Home
By Ed Marx

To date, I’ve had the privilege of holding three CIO positions. First, for a physician managed services organization. Second, in an academic-based multi-hospital system. And currently, as CIO for a large faith-based community hospital system. In my first C-suite gig, we talked about CHINs, which morphed into talks of RHIOs, while today we discuss HIEs. All of these have had the big, hairy, audacious goal to exchange information on increasing quality and decreasing costs.

Clinical, financial and now federal incentives generate a noble rush to participate. As I dug into details of certain opportunities at current and former organizations, I discovered that neither technology nor the sustainable business model posed the greatest challenges. Instead, the information exchange within the walls of my own institutions verged on nonexistence or lacked vision. We talked at high levels about exchange while knowing full-well we had not yet achieved this nirvana internally. Much work needed to be done at home, and we had to act with purpose to prepare for HIE.

In 1995, at Parkview Episcopal Medical Center, we reached advanced stages of interoperability. First, we implemented strong inpatient clinical systems and practice EMRs. We began sending electronic scripts to the local pharmacies. Participating physicians received a 10 percent discount on their malpractice insurance. We stopped printing and sent all reports to our medical staff electronically. Only after getting our own house in order could we achieve this exchange.

At University Hospitals, our team was awarded the very first NHIN grants. We freely exchanged data with other sites across the country. We exchanged clinical information with our joint-venture hospitals, with federally qualified health centers, and with others. We achieved our increased quality and reduced costs objectives. Our success came after we laid a firm internal foundation and developed our own portal.

At Texas Health, we’ve used a similar approach. Because we had disparate applications early on, we built a portal that essentially mimics an HIE but fits our health system. We exchange externally but on a limited basis. We’re just now completing our overall HIE strategy that might be as simple as plug-and-play going forward. Despite the years of futile conversations regarding data exchange taking place in the region, we would not have been ready without the current portal.

HIE is a critical component of our American health care landscape. It’s the right thing to do. Caution! First look in the mirror and ensure that you’re exchanging data internally before placing your expectations externally. We don’t want to find ourselves saying "do you remember the word HIE," just like we do today with CHIN.

Take action now.


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.”

Comments Off on CIO Unplugged – 4/15/09

News 4/15/09

April 14, 2009 News 9 Comments

mosesconeFrom HIPAA Hound: "Re: another example of poor privacy practices. Perhaps more disturbing than the loss of the patient data was that affected patients were not notified of the compromised information for a full 30 days." Link. A laptop belonging to Moses Cone Health System (NC) and containing information on 14,000 patients is stolen from a VHA office in Georgia, which was doing quality analysis of the hospital’s data. The hospital said it regrets waiting a month to let the affected patients, employees, and the public know. The laptop wasn’t encrypted, of course, and the hospital didn’t say why sending the VHA a laptop was the best way to get them data. If anyone can think of ways to screw up that the hospital missed, please let them know. And in a similar story, Southwest Mississippi Regional Medical Center finally comes clean to patients after a PC used by the billing company of its radiology group is stolen — in February.

From Skip Stephenson: "Re: diagnosis code for a tree growing in your lung?" Link. Russian surgeons looking for a suspected lung tumor instead find a fir tree growing in the patient’s lung. Also from Skip: a surgery nurse at Dean Health (WI) is called out of the OR by her manager so she could be laid off. Now those are stories you won’t read elsewhere.

From The PACS Designer: "Re: native virtualization. As we hear more about the virtualization concept in daily media presentations, it appears that still more education is warranted since there are still doubts about its versatility. Sun Microsystems has just released a new open source software version for its VirtualBox. It will give experimenters the ability to apply ‘native virtualization’ to their installed systems using a desktop workstation" Link.

From Just the Beginning: "Re: Google Health. Blasted for data inaccuracy & raises questions about data exchange." Link. I don’t blame Google, at least not entirely. Hospitals are so terrible at capturing and exchanging complete, meaningful patient information that billing data is about as good as you can get (arguably better than nothing). Google’s mistake, if it made one, was either (a) not letting patients know that its information is suspect, or (b) trying to roll out a fully functional PHR knowing that it’s way too early to expect much in the way of available information except what the patient is willing to type in, so then dropping back to claims data to sex it up a little.

From Daryle Lamonica: "Re: eHealth Initiative. Interesting way to recruit a CEO. Saving executive search fees?" eHI e-mails out a notice of its job search, providing a direct link to its site to apply via its law firm.

From TrashTalker: "Re: the incestuous relationship between CIOs and their vendors. Sad but true. When is the healthcare industry going to wake up and kick these self-promoting, mostly non-tech CIOs out?" If you’re a Maslow’s Hierarchy of Needs fan, they are just attending to their basic and safety needs, thinking that buying the big-name products is not only safe, but also a better path to a future job should one be needed. And, buying same-vendor application clusters (all clinical apps, for example) from the same vendor provides that "one number to call" peace of mind even though it drives clinicians crazy to be overridden by a CIO looking out for #1. Every provider I’ve worked for, mostly big ones, encouraged clinician input into product selection, but then ignored it in buying more stuff from the same old underperforming vendor. The predictable result: low utilization ("you asked us what we wanted, we did the research, then you just ignored our recommendation and bought what you originally wanted").

From Hello Kitty: "Re: ACS. Rumor has it that while ACS Healthcare Solutions is announcing the Marin outsourcing deal, they are losing Southwest Washington and Princeton." Unverified.

From Cheezborger: "Re: ‘the power is in the network, not the desktop’. While I agree that there is power in simply getting data online now (e.g. access, potential for analytics, personalization, etc.) we can’t put the chicken before the egg. In other words, how do we think the data is going to get there in the first place? We often seem overly focused on the end effects of the EMR without giving enough respect to the concept of GIGO. If we can’t create an EMR that makes it easy to input and read data, then don’t expect too much from the output. While INTEROPERABILITY is a big buzz word due to this network effect concept, I’d strongly argue that the real key is USABILITY – we need systems that allow for easy interaction (better input of data, better display of data) before we need to worry about how they will share data. Said a simpler way, there is no payoff without use. What was so nice about Dale’s ‘story’ was the incorporation of both these facts — creating easier systems to engender utilization, then using the network effect to make the systems even easier and better to use!"

From Da Bear: "Re: Chicago. Chicago is the greatest convention city in the U.S. My company has also exhibited there annually at RSNA. But for crying out loud, can we settle on a month that is actually nice? RSNA is locked in the Daley Machine’s death grip and can’t move off their post-Thanksgiving date. HIMSS is under no such political obligation. Late May is usually wonderful."

qualcomm

From Bill Kinsella: "Re: Qualcomm video. Like the fake article Lyle sent you, the following Qualcomm (or is it??) video is worth a peek. I don’t know whether this was produced within Qualcomm or by a competitor." Link. "We came up with this idea to implant tiny base stations into thousands of pigeons and have them fly around and form a dynamic network." Pretty funny and very well done. Bill sent the YouTube link, but I found it directly on Qualcomm’s site, so they’re going all viral on us.

Now that we’re back into the usual post-HIMSS routine, we’ll get back to the interviews, HIT Moments, etc. If you know interesting people we should talk to, let me know.

Listening: new from Metric, indie/pop/new wave from Canada. Video here. Kind of a Throwing Muses meets the Pixies sound if you ask me. I like it very much.

uf

University of Florida Physicians posts its Epic outpatient project Web page.

The authors don’t claim a high correlation, but this study suggests that states with strict privacy rules have a lower EMR adoption rate, but that the network effect means each hospital that implements electronic medical records increases the chances of others doing the same. I wouldn’t bet the farm on the privacy correlation since I can’t imagine hospitals sit around worrying about that, but certainly the lemming-like behavior of many hospitals makes the second conclusion reasonable.

New York City’s health department uses drug company marketing techniques, such as memorized pitches and free pens and condoms, to educate doctors on desirable practices.

ehrtv

Eric Fishman, MD (of EHR Scope, EMR Consultant, MCM-Medical Content Macros, and Dragon reseller) is the mastermind behind EHRtv, a wide-ranging series of professionally recorded interviews and tutorials by Dr. Eric himself. I’m enamored with the video quality, the layout, and the idea, especially since I saw him doing interviews for it at HIMSS. He captured some of the HIStalk reception and speeches, not easy since we had low light and iffy audio, and it’s a fun watch. He caught a nice speech there by Todd Cozzens of Picis.

Students from four big-name MBA schools participating in a "war game simulation" last week make interesting predictions: (1) EMR resistance will remain high, but P4P may help; (2) there won’t be enough HIT experts to implement all the EMRs being sold; (3) Allscripts and Epic will use cloud computing to drive down the cost of today’s client-server systems and make them affordable to small medical practices; (4) risky EMR implementations will push small medical practices to band together or merge; (5) Kaiser Permanente will take an active role in setting EMR-related best practices and standards; and (6) McKesson will use its logistics and value chain to increase its provider and payor IT offerings. I’ll say this: all sound reasonable, even when taking the dynamics of the organizations into account.

On HIStalk Practice, we’ve got a couple of docs sharing their thoughts about the HIMSS conference.

Excluding the university president and coaches, all of the 21 people at Ohio State University making more than $500K work for the medical center. The university claims that both the jocks and the docs are paid what the market demands even though the university’s own industry comparisons show it pays above its comparable peers in both categories. Isn’t that kind of admitting that nobody would want to work there if it wasn’t for the money? Seems like a trap hospitals everywhere have gotten into – paying more because they think they have to in order to get competent leaders (meaning: bribe them to leave somewhere else for a bigger paycheck just like when universities raid each other’s coaches). Once you’ve established yourself as a generous John, the best-looking hookers will always want more.

I’ve decided that since my day job title isn’t sufficiently lofty and I can hardly put HIStalk on my resume, I’m just going to start calling myself a thought leader and futurist. Those titles seem to be reserved for those willing to anoint themselves knowing that no approval is required, so I’m going to pad my resume. If anyone calls you to check, vouch for me.

ARRA is drawing companies into healthcare that have had zero interest previously, The Washington Post reports. Named: FreightDesk Technologies (cargo trackers turned Medicare auditors), RollStream (partner interactions), and the usual lame, just-started social networking startups (i.e., Web sites) masquerading as fervent healthcare consumer advocates.

Odd lawsuit: a woman dies a few hours after being sent home from a West Virginia hospital’s ED. Two years later, her husband gets an unsigned letter urging him to call an enclosed telephone number to find out what really happened to her. The ED doctor working that night calls back, saying nurses had killed his wife with an accidental overdose, that he had kept the original chart to prove it, and would testify on the family’s behalf. The doctor then allegedly changes his story, allegedly, telling the family there wasn’t really a medication error but he just wanted to get back at the hospital. In the mean time, the family found that the ED doctor had lost his privileges at another hospital, was not certified in emergency medicine, and had been the subject of review by both the hospital and the ED contract employer for poor care. The family is suing the hospital, the doctor, and the contract ED company.

E-mail me.

HERtalk by Inga

From Fisher of Men: "Re: changes at Sage. I hear Sharon Howard from Sage is no longer there and they have hired a new VP of Sales." Unverified, though we did ask Sage and she’ no longer listed on the Sage Healthcare site. The leadership page says Jason Dvorak, formerly of TeraMedica, joined the company this month as senior VP of sales.

From Prairie Statesman: "Re: Illinois. Sure, the weather wasn’t perfect for HIMSS, but at least our governor wasn’t asking for Illinois to be declared a disaster area." Prairie Statesman sent this link with a copy of the Florida governor’s request for federal assistance following severe storms earlier this month. I responded (I think rather cleverly) that Illinois seems to be recovering from its own disaster area, right in the governor’s office.

HIMSS releases attendance numbers from last week’s conference and the numbers are down only slightly from 2008. An estimated 27,500 attendees traveled to Chicago, compared to the 29,100 participants at last year’s Orlando meeting. HIMSS attributes the drop numbers to general economic conditions and fewer personnel staffing exhibit booths. Based on conversations I have had with various health systems, I would also say many organizations sent a smaller contingent than in past years. Apparently the figures are based on registrations, so it’s quite possible a number of organizations ended up not sending everyone originally registered. Regardless, I’d say the numbers are respectable.

This is undoubtedly one of the gutsiest PR moves I’ve seen in awhile. SRS announces that Valley Oak Orthopaedics (CA) de-installed a CCHIT-certified EMR and replaced it with SRS hybrid EMR. The legacy EMR is not named, but the administrator is quoted as saying, "We chose the SRS hybrid after the existing traditional EMR in our practice drained our productivity and became unusable." Obviously it would be fun to know who is being replaced. Will the unnamed vendor speak up or ignore SRS?

A consumer survey concludes that 55% of us want the ability to talk to our docs via e-mail, 42% want to set up a PHR, and 57% want to schedule appointments and complete other transactions online. I think the e-mail and transaction figures look about right. On the other hand, I question whether 42% of Americans really want to set up AND maintain a PHR every time they go to a doctor, get a test result, or add a new prescription. Not too many people have the time or discipline to keep that up. Great idea whose time has not yet come.

Lehigh Valley Health Network plans to leverage the training resources from Greencastle Consulting to enhance its EMR implementations process for its ambulatory care practices. I believe Lehigh Valley is rolling out GE Centricity.

The India tourism ministry is finalizing a plan that would allow medical tourists to pay for one medical treatment and receive a second, smaller procedure for free. That sounds even better than Nordstrom’s annual shoe sale!

amendola

Congrats to Jodi Amendola, CEO of Amendola Communications, for her appointment to the board of directors of The X2 Healthcare Network. Jodi’s company is a healthcare and PR firm and X2HN is a not-for-profit organization of women healthcare executives representing more than 50 companies. I don’t know Jodi, but she clearly must be cool and has the PR thing figured out because she lists the HIStalk Fan Club as one of her important professional social networking organizations.

Perot confirms the elimination of 30 to 40 jobs at its Plano, TX headquarters.

Mark Anderson mentioned the term ICE on HIStalk Practice last month, which was the first time I had heard it. It seems to be catching on since I’ve now heard others use the term. ICE is  an acronym for Integrated Community EHR (wow – an acronym that includes an acronym!) Essentially it’s a patient record produced from an IHE (integrated health network, yet another acronym.) BTW, all these acronyms make me LOL!

A federal judge sentences the former president of Roger Williams Medical Center (RI) to three years in prison for corruptly employing a former state senator to advance the medical center’s interest in the General Assembly. Supposedly Robert A. Urciuoli paid former Rhode Island state senator John Celona $260,000 in consulting fees in return for taking steps to support legislation favorable to Roger Williams and to kill bills deemed unfavorable. In October, Urciuoli was found guilty of 35 counts of mail fraud.

If you are a healthcare informatics specialist, you have one of the hottest jobs right now. According to the president and CEO of the American Medical Informatics Association, the recent passage of the ARRA legislation is creating a need for as many as 70,000 health informaticians.

E-mail Inga.

Being John Glaser 4/14/09

April 13, 2009 News 2 Comments

The foundation of any high-performing organization is talented, experienced, and motivated staff. Attracting and retaining these staff members requires that the IT organization be seen as a great place to work. Over the years, I have learned that six factors form the foundation of an organization that people want to work for.

  1. For any organization to function and for its staff to get work done, it must be organized. Departments must be formed. Processes are needed for making decisions and performing recurring activities such developing applications. People want to work for well-managed organizations.
  2. The IT organization must hire well, bringing in the talent, skills, and experience that it needs. If a person turns out to be a less than satisfactory addition to the team, the organization has to handle the situation quickly and with humanity.
  3. The IT organization has to help its staff grow and learn. Training and professional growth opportunities are needed and staff must be given time to pursue them.
  4. There should be ongoing efforts to improve the work setting. These efforts can range from events such as social functions to tele-work programs to improving space.
  5. Organizational problems need to be fixed. Process redesign efforts that streamline requests for new applications. Changes to the organization structure to reduce confusion over accountabilities. At any point in time, the organization is not firing on all cylinders across all functions. Problems need to be assessed and fixed.
  6. And finally, a tone must be set. I am not sure that I have a good definition of tone other than it is the climate of the organization. Tone results from the daily actions (or inactions) of IT management and IT staff. It seems to me that the tone of a great IT organization has several characteristics. The actions:
  • Inspire and motivate. The work is interesting. We believe that the work is important and we know that each of us is needed if the work is to happen well.
  • Exhibit integrity. The actions and words of individuals are true to their values and beliefs. There is little tolerance for dishonesty and “games.”
  • Demonstrate courage. There is a willingness to make hard decisions and stand by them. There is a realization that you may personally have to absorb the blame and anger of others.
  • Show caring. We reach out to those who need personal or professional help. Disagreements and debates avoid personal attacks. We take the time to give someone a heads-up.
  • Are demanding, but tolerant. The organization sets high standards for the work that it does. However, it recognizes that even the best people screw it up from time to time (sometimes in very big ways) and the organization does not eviscerate those who make mistakes.
  • Exhibit accessibility. Those who need us can get to us. One may or may not be able to help or help right away, but one is not sitting behind a moat.
  • Are comfortable with personal limitations. All of us have strengths and weaknesses. It is important to know yourself and be comfortable with the fact that, in some ways, you are limited. And it is a sign of personal and management strength to surround yourself with colleagues who have the strengths that you do not.
  • Being a great place to work is important. While making sure that the necessary factors are in place is a key responsibility of IT leadership, this responsibility is shared by everyone in the organization.

Of all of the factors, tone is the most important. If the tone is a good one, the climate will exist that enables all of the other factors to happen well. And tone is set by everyone.

Making sure that the IT organization is a great place to work is something that each of us does every day.

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

Monday Morning Update 4/13/09

April 11, 2009 News 14 Comments

From Ben Mehling: "Re: open source. I can state emphatically that Medsphere is ‘truly open source’. This fact is easily verifiable with a quick visit to http://medsphere.org where anyone can download copies of our software and use them within the provisions of OSI (http://opensource.org/) and FSF (http://www.fsf.org/) approved licenses under which we release software. Medsphere.org is also our community’s central hub for discussion, support and development activities — anyone interested in open source and healthcare is welcome. We’re happy to discuss this with anyone that still has concerns, either publicly or privately." Ben is director of advanced technology at Medsphere.

satyam

From MiamiRocksters: "Re: Satyam. Looks like IBM is still in the running." The company will be sold off by the end of the month, with bids due Monday. IBM said it was pulling out because of Satyam’s exposure to US class action lawsuits for accounting fraud, but I bet they’re still in the hunt (building the net present value of the lawsuit risk into the offering price, of course). Two Indian companies have been bandied about as front runners to buy Satyam, but Cognizant, HP, and CSC are also said to be interested. And why not? The accounting scandal was limited to a few hands and the business should still be sound, at least once the bad PR can be soothed. The Pricewaterhousecoopers auditors are still in jail, as should be whomever thought up that ridiculous company name.

From Kenneth Parcell: "Re: HIMSS. It was OK. The traffic seemed lighter, but the transportation was reliable and convenient. My only beef was that the shuttle service to the airport took over one hour. Chicago is a wonderful city and I would definitely enjoy it if HIMSS decided to return. Most interesting technology was Google’s PHR suppository repository. Wish I had a picture, but it looks like a little white capsule with Google written on the side. I assume it is placed in the appropriate orifice where it seeks all health information from the source. When finished, the collected data is linked to your PHR and you can Google search clinical information about yourself, such as ‘Find abnormal growths’ and ‘Am I getting enough fiber?’ Not sure why I saw others rubbing the repository on their lips … perhaps they were salesmen and were confused about where to stick it." So far, the poll to your right is running 2:1 for a Chicago return.

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From Being John Doe: "Re: Cerner’s answer to HIMSS?" Link. It’s a Cerner YouTube video about its Second Life world or whatever the fantasy-nerds call it. I have to think all those companies that hired hipsters to create Second Life sites are regretting that decision. I didn’t see or hear Second Life mentioned even once during the entire HIMSS conference.

A New York Times article profiles the use of an EMR (from e-MDs) of a rural doctor, who summarizes as follows: "I’ll never go back to the old system. I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.” This is what I’ve been saying here for years: the main value of electronic records is being able to review and create electronic data from anywhere. Just getting data into an electronic form is where the payoff lives. I’ve argued that HITECH should have rewarded providers for sharing data on a national framework such as NHIN, paying them per patient (or, even better, per record type). Using technology is one form of "meaningful use," but making data available to other providers is more so. The power is in the network, not the desktop.

And in that regard, Dale Sanders, CIO of Northwestern Medical Faculty Foundation (thanks to Dr. Lyle for the link) might change your EMR perception with his phony news article about an EMR created by Amazon.com. It’s a deceptively simple and light-hearted piece, but think about what he’s saying about software personalization, analytics, architecture, and social networking, a contrast of pre-Internet EMRs to what could be given what we know today.

deparle

C-Span has video coverage of a White House discussion on healthcare reform led by Nancy-Ann DeParle this past Wednesday. She seems fun.

The AMICAS-Emageon headcount reduction, according to one very informed source, is over 100.

intrahealth

Global nonprofit IntraHealth International launches IntraHealth Open, offering free downloads of celebrity remixes of "Wake Up (It’s Africa Calling)" and accepting donations to support open health software solutions for the developing world.

CCHIT musings: everybody wants CCHIT to "certify" EMRs on everything from usability to the financial stability of the vendor. Is that really necessary? Stimulus payments will be tied to using a product certified by CCHIT (or some other group), so it doesn’t make sense for users of already-certified systems to lose money because their vendor can’t meet new usability standards (even though that provider is actually using the product without complaint). CCHIT was formed to evaluate interoperability and reduce physician risk, back when its certification had little impact on the income of either vendors or providers. We need to be careful about wanting CCHIT to turn into KLAS, churning out a "Top X" ranking instead of certifying minimum requirements and letting the market decide which vendor is doing all the non-essential stuff better. Surely doctors are smart enough to buy wisely.

Ivo Nelson e-mailed to say his ongoing pub event HIMSS was so popular that Encore might do it next year in Atlanta. That’s the home base of the Fado’s chain, about which he mentioned that his deal with a more authentic Chicago pub fell through at the last minute because it decided to close for the weekend (hey, if they’ve got Guinness and a green flag or two, who cares?) I’m also interested in ideas for the HIStalk bash there, assuming I can get sponsors and all that. I have thoughts on just about everything except location since I don’t know Atlanta very well.

A note to all you supposedly expert media people covering Dennis Quaid’s speech: please stop capitalizing heparin. It’s a generic name, not a brand name. Thank you.

Some open source people believe they saw the beginning of mainstreaming of open source at the HIMSS conference. I don’t see that happening. Reason: hospital CIOs were raised under the influence of application vendors, often have worked for them in the past, and even more often hoping to work for them in the future, and overseeing Epic or Cerner shops is a resume builder. CIOs, like the hospitals they work for, don’t like to be the first in their area or size range to do something different. Most importantly, healthcare is driven by special interests, lobbyists, vendor people volunteering for influential committees, and job-creating potential. Open source doesn’t have any of those (not to mention a non-government track record). Even the VA seems to be itching to dump VistA in favor of commercial products (again, rightly or wrongly). When you talk about hospitals using open source, that’s mostly VistA, which would be fantastically lucky to get 1% market penetration. Not a rosy opinion, I know, but I promise to update it when any open source clinician application hits 50 hospital clients. If hospitals aren’t interested even when starved for capital as they are today, they never will be.

Since the President is promising everything to everybody and printing whatever amount of current those promises require, he goes ahead and adds "give all veterans a new electronic medical records system" to his Santa list.

New York offers $60 million in financing for HIT projects, this time targeted to medical home applications.

I see the e-mail update signups have been going like gangbusters, so that box to your upper right is calling your name, at least if you want to be among the first to know important stuff. Inga pores over the stats like a CPA, so it makes her happy.

Odd lawsuit: the patient of a plastic surgeon who claims her face-lift surgery was botched has posted an ongoing stream of nasty comments and videos all over the Web, blaming the doctor. He sued her for defamation for doing so and then, according to the patient, called the mental health department claiming she had e-mailed him saying that she planned to commit suicide live on the Internet, getting her Baker Acted. The doctor says she is psychotic and hurting business for his $5,999 Tax Time Special breast augmentation surgery. Here is her site, with a ton of documentation (seems convincing to me, but I’m not taking sides because both parties sound litigious).

utah

The Conficker worm hits University of Utah’s health sciences schools and its hospitals.

Harris Corp. gets a $14 million, one-year contract to provide an imaging system for 65 DoD hospitals, announced at HIMSS. Also announced: Harris donated $10,000 to the Wounded Warrior Project.

E-mail me.

News 4/10/09

April 9, 2009 News 8 Comments

From Big Bird: "Re: AMICAS. They are closing the former Emageon headquarters in Birmingham. Many layoffs announced today."
 mccormick
From Leo Sayers Fro: "Re: I enjoyed Chicago much more than Orlando or Atlanta. Thoughts: (1) is Fourth Hanson Brother really saying that Linux has less capacity, is older technology, creates more pollution, and appeals only to hippies who are kidding themselves? Lots of enterprises employ Linux, although they do use some middleman like Red Hat. Lots of people say that Cache is older (and complain about old technology), but InterSystems is successfully supporting a lot of enterprises across industries in this big world. Old technology is not necessarily bad technology. Maybe Medsphere is the way to go given a lack of access to capital and given that lots and lots of residents like their VistA system. I would have a better idea if the VA and DOD were on the same page (and is there still a question about Medsphere truly being an open source participant?) (2) EMRAM Stage 7. Just how many Stage 7 users really use a unified medical vocabulary underlying their clinical documentation, thereby presumably allowing for meaningful analysis (and comparison) of clinical documentation? How many use LOINC for results, not only for clinical laboratory, but waveforms and imaging? How many fully leverage SNOMED? And how can you really determine efficacy if you really can’t evaluate outcomes fully? Are their cancer registries fully linked to their EHRs and data warehouses or their pathology reporting systems? And to think: a common medical vocabulary is a Level 2 requirement!"

From Vendman: "Re: GetWellNetwork. Johnson and Johnson to invest $25 million for a substantial ownership position." I asked Michael O’Neil, founder and CEO, and he says that’s not exactly true. J&J’s development corporation invested $10 million in the company in January, reported here, and has high expectations of its impact on healthcare. That’s it so far, although the companies continue to share ideas and discuss projects. Michael did mention that GetWellNetwork recently expanded its relationship with Catholic Health Initiative and added new accounts with Norton Healthcare and an Adventist hospital.

From The PACS Designer: "Re: ETIAM CD-in. When patients are at the ER with CD’s or DVDs from previous episodes of care, it is never easy to import the image files. Now, ETIAM has a new version of their CD-in solution with enhancements that make it much easier to do the importing of other institutions’ image files into your PACS archive." Link.

From Mark: "Re: CPOE – A New Conceptual Model. Physicians use the iPhone to dictate orders and approve the transcribed order; view clinical results; and dictate reports. Say ‘Potassium Replacement Protocol’, press Send, receive a text alert with HIPAA-compliant link, click on the link to review order, select Approve. Orders flow to appropriate systems and personnel. Fast, simple, and easy." Link to presentation

From Dodele: "Re: EMRAM Stage 7 all being Epic. Sounds great, but I believe there are only two that qualify as Stage 7. Still, kudos to Epic for having a system capable of getting them there." Correct: two organizations (KP and NorthShore) with 15 hospitals (12 and three, respectively). It still makes a killer ad for Epic.

fados

From HIMSS Party Dude: "Re: HIMSS parties. Perot Systems and Dell get high marks, but the one that seemed to be most accommodating was Ivo Nelson’s Encore Pub Night at Fado’s. EVERY NIGHT he hosted folks at the pub to free adult beverages. I’m gonna guess that over 300 people were there on Monday night. Great concept – free beer, free food, come and leave when you want – EVERY NIGHT of HIMSS. Simple. And blue jeans are a welcome alternative to my stuffy suit." Sounds nice, at least if you like chain, Atlanta-based fake Irish pubs (and I’m not saying I don’t). Did you know there’s an entire company that builds fake Irish pubs in this country and others? We’ve probably got more Irish pubs than Ireland.

carnivale

My only real meal in Chicago was here and it was outstanding (and this beer was mild but amazing).

IBM says China’s healthcare reform will create the need for at least $1.5 billion in software.

Medsphere, Midland Memorial Hospital, and David Whiles get some BusinessWeek love.

Listening: Carolina Liar, pop-rock MTV darlings from Sweden (despite the name). Also: obscure Philly hard rockers Automatic Black.

New poll to your right: if you went to HIMSS, would you like to see the conference return to Chicago at some point?

I’m still getting used to being home from HIMSS. Mrs. HIStalk opened the door for me this morning and I tipped her $1.

It was funny to hear several times at HIMSS and at the reception (Todd Cozzens asked for a show of hands) that many people jump on to HIStalk first thing in the morning or sit by the PC at the time they know I usually post. I don’t know what they’re doing (scooping the competition? hoping not to find their names mentioned?) but that’s pretty funny.

Premise, now part of Eclipsys, earns the Outstanding Portfolio Company award from Connecticut Innovations.

Heard at HIMSS and elsewhere, when some pompous ass was asked where he works: "Oh, I work for this little outfit you might have heard of called Oracle." Nobody should have so little self-identity that they can’t come up with something to crow about except who pays them. I heard it again from someone from a snotty university guy.

A reader asked if I’m convinced that it will be CCHIT alone doing the government’s EHR certification going forward. I am, given its clout, connections, head start, and performance. Anyone else feel differently? I know a different group could theoretically be named, but I don’t see that happening.

The Robert Wood Johnson Foundation announces a call for proposals due June 3 for $2.4 million in grants for Project HealthDesign: Rethinking the Power and Potential of Personal Health Records. Up to five teams will be funded for 24-month demonstration projects for up to $480K each. The topic is how Observations of Daily Life (diet, exercise, sleep, pain, etc.) can be used to infer how patients feel and therefore modify their treatments. I had a great idea for offshore call center operators to call patients and ask how they’re doing, but all Americans ever say is "fine."

GE Healthcare announces its Digital Day One program, a service to get Centricity Enterprise implemented in a year or less.

MEDSEEK will integrate 3M’s CDR and vocabulary capabilities into its community portal, providing comprehensive interoperability.

A new JAMA study finds that Leapfrog Group’s safe practices (CPOE, intensivists, evidence-based surgery referrals) are not predictive for patient mortality. "The results of this study support the concerns expressed by physician groups who have discouraged public use of quality measures that have not been fully validated." Leapfrog cranks out a press release (warning: PDF) questioning the number of hospitals surveyed and citing a study with different conclusions, but admits that process improvements don’t always provide better outcomes.

Incoming national coordinator David Blumenthal says that his office needs to tighten the EHR certification process to include usability and their capabilities to support HITECH’s quality and cost goals.

Jobs: Inside Sales Executive, Sunrise Clinical Manager Consultant, Business Development Executive.

Shared Health will make its HIE technologies available to hospitals in some way, but the press release is so self-congratulatory it never really says how (that I can tell, anyway). I was looking for "free" and didn’t see that.

IBA is looking for US distributors for its iSoft Lorenzo Health Studio, hinting that the Australian company would like to get some stimulus handouts like everyone else.

IntraNexus will remarket Mediware’s Ascend pharmacy system to round out its Sapphire HIS. Ascend was the system sold by Hann’s On Software, the California company Mediware bought in November.

Yale-New Haven’s CEO breaks the $2 million compensation mark in 2008.

Odd lawsuit: A Toronto weight loss surgeon who already lost his medical license after sexual abuse claims now faces a $12 million class action lawsuit along with the hospital that employed him. He pleaded no contest to sexual abuse that included a twin sisters on which he had performed bariatric surgery, reportedly telling them that it was every man’s dream to have sex with twins, which he did in his office along with using illicit drugs he told one of them to buy.

E-mail Mr. HIStalk.


HERtalk by Inga

From Dr. G: "Re: HIMSS/Ingenix reception. Thanks for the invite. Boy, you’ve really become the ‘Fantasy Girl,’ at least with Jonathan Bush!" Even though Jonathan’s comments weren’t exactly politically correct, I must admit I enjoyed being called "luscious".

From Smaller Vendor: "Re: HIMSS impressions. The show was okay – it was really more to meet with other vendors. The most exciting booth I saw at HIMSS was … not there. I was very pleased to see the many infrastructure offerings finally bringing true connectivity (Capsule, among others). The Microsoft booth — folks raved to me about the table demos — left me ho-hum (it was really just a new table-based display). As pretty as it was, it was in reality expensive and not high enough resolution."

From Spice Guy: "Re: reception. That was an interesting night! Was talking with Matthew Holt when ‘Shhhh Inga’ (Deborah Peel) came up. Interesting to eavesdrop on their interaction!" Matt Holt, who was wearing a "Inga 2.0" sash, had the opportunity to chat with Deborah Peel (adorned in a "Shhh, I’m Inga" sash.) Suffice it to say that Matt and Dr. Peel don’t see eye to eye on all matters of privacy, though both were perfect guests.

From C-Note: "Re: Ingenix reception. I spent most of the reception going around and accusing people of being Inga, all of whom were honored at the accusation and resulted in great conversation. One person even watched me carefully as I walked by, then as he got to the ‘toe’ part of his head-to-toe scan of me, he started shaking his head. As I made eye contact with him he grinned real big and said, ‘Nope, you’re not Inga – I can tell by the shoes.’"

I’m recovering from my post-HIMSS fatigue, wondering if my feet will ever return to their original non-puffy form. All in all, I thought the meeting was great: tons of informative topics, good speakers, and a fun city. I loved catching up with old friends, chatting with new folks, and spying on our sponsors’ booths. The HIStalk/Ingenix party was in a gorgeous location atop the Trump Tower and everyone seemed to be having a great time. I got invites to a couple of vendor parties and each was very well done in its own way.

Only complaints: I hate cold. I really hated having to pay $3 each day to check my coat. Wish the shuttle buses ran more frequently. Don’t understand why it has to cost at least $14 to get lunch at a convention center. I’d have liked a few more "surf the net" stations since I chose not to lug my laptop around (the iPhone is great for checking e-mail, but not writing anything of length.)

IMG_0454

Probably not worth complaining about, but I didn’t win this cool scooter that a magazine was giving away.

IMG_0448 

Sunday morning, the Olympic International Committee toured the convention center. Everywhere you looked you saw dancing dragons, wrestlers, and tumblers. Also, these two adorable girls in Native American dress.

I spent a fair amount of time waiting for Starbucks coffee the last few days (not exactly a complaint since I did make a conscious choice to stand in the long lines.) I actually enjoyed the opportunity it gave me to talk with strangers about their HIMSS experience. One IT manager told me his large health system typically brings 30 or so people every, year but this year the employer only sent the five who had speaking engagements.

This year’s buzz words: stimulus, ARRA, meaningful use, and interoperability. The "also-ran" words were iPhone and mobility. In the mix you heard discussion about CCHIT and whether or not they provided the de-facto standard. According to CCHIT and all CCHIT-certified vendors, CCHIT is the inevitable standard. If you had a document management-only system or some sort of EMR-lite offering, you stressed the necessity of your offering to get ramped up. A reader shared that the CEO of a large CCHIT-certified vendor told an audience to expect only five major players to remain after everything shakes out.

medkey 

I tried to check out as many of the smaller vendors as possible and MedKey PHR Systems caught my eye. I’ve said before that I don’t believe the public is ready to take the time to set up a PHR. However, if you are chronically ill, for example, I liked how this technology looked. The device is a portable and wireless PHR that can be worn like a medical bracelet or be on an insurance ID card or on a key chain. It is supposedly "completely" secure and password protected. Data can be synched with the integrated USB port, or wirelessly. I suppose if a big insurance company pushed the technology, the design is convenient enough that I think people would wear/carry it. Although there is still the question of who is going to input the clinical data.

eClinicalWorks and Sam’s Club release details of their new EMR program, which is targeted for the one- to three-provider space. Check out the Sam’s Web site to see of what is included in the offering.

Greenway Medical Technologies announces a strategic deal with Detroit Medical Center to provide PrimeSuite EHR to physicians across Detroit Medical’s nine hospital network.

Streamline Health Solutions reports a net loss of $146K for the fourth quarter and $1.4 million loss for the year. The company posted a net loss of $736K in 2007.

The Texas Senate is considering raising taxes on chewing tobacco and using the funds to help doctors pay off student loans. New physicians could be reimbursed as much as $160,000 for agreeing to work at least four years in under-served areas.

The University School of Community Medicine and IBM plan to build a primary-care medical home pilot project that connects clinical data between the medical school, 325 physicians, and other area care-givers.

Sprint Nextel and GE Heatlhcare sign a multi-million contract with Methodist Healthcare (TX) for a complete wireless infrastructure across its six sites. The setup includes integration with GE’s Carescape Enterprise Access.

IMG_0463

My feet are recovering nicely, thanks to my new slippers from Chipsoft. As I was unpacking, I also found some a frosted Oreo, courtesy of HealthPort. Yummy. Next week, back to reality.

E-mail Inga.

An HIT Moment with … Judy Kirby

April 8, 2009 Interviews Comments Off on An HIT Moment with … Judy Kirby

An HIT Moment with ... is a quick interview with someone we find interesting. Judy Kirby is president of Kirby Partners of Altamonte Springs, FL (formerly Snelling Executive Search).

How would you characterize the healthcare IT job market and how do you it see changing over the next 1-2 years?

The healthcare IT job market is different than I have ever seen. I entered healthcare IT recruiting during the recession of 1992 and have witnessed its peaks and valleys. With the current economic crisis this country is experiencing, healthcare seems to be relatively stable, compared to other industries such as finance or automotive.

judykirby That being said, healthcare organizations have investments that have diminished and are struggling with shrinking reimbursement rates. According to Thompson Reuters, the median profit margin of U.S. hospitals has fallen to zero percent. There is a lot of financial pressure on hospitals and nearly half are operating in the red. Many see hope in the stimulus money that will be available for electronic health records. Right now, there is caution and uncertainty in most organizations. They have needs in their IT departments, but are being very, very cautious in hiring and we have seen the hiring time increase.

If the stimulus money for EHRs has the effect that some like Dave Garets from HIMSS Analytics predicts, there will be a shortage of implementation talent in the future. But that being said, as always, there will be positions that are “hot” and those skills that will be in abundance. Two years ago, we encountered many senior healthcare IT managers and CIOs who were approaching retirement age. They are now saying they will remain in the workforce longer and postpone retirement due to their dismal retirement portfolio performance. Healthcare IT positions, especially higher level positions, that were to open by the retirement of baby boomers will open up later rather than sooner.

There is good news, however. We recently did a survey of healthcare CIOs that showed 31% expect their organization’s IT departments will grow in the next year. 50% said their department numbers would remain the same, and only 19% predicted a decrease in their department staff levels. The survey also indicated that 39% of the respondent’s IT departments are currently actively hiring, 6% will hire in the next three months, and 4% will hire in the next 3-6 months. There are always numerous opportunities out there no matter what the current economic conditions.

The biggest effect the economy has had on our business is the number of possible candidates for positions who cannot relocate because they are upside down in their current homes or live in such a down real estate market that they can not sell their home.

You might think a firm such as ours would have experienced a downturn in the current economy. Just the opposite is true. We are as busy now as we were three years ago. 

What advice would you have for employees to both keep their current jobs and prepare for their next one just in case?

We actually are presenting at HIMSS on this same topic, “Know when to hold them and know when to fold them”, with Jon Manis, CIO of Sutter Health System. The advice for keeping your job is the same for preparing for your next move up on the rungs in your career ladder – you have to be invaluable to your organization and not just taking up space. We have heard from many CIOs they are using this recession as a way to “clean house”, so to speak. All things being equal, they will keep the employees who are doing the best job and have the best attitude. You can train skill sets, but you cannot train attitude, enthusiasm, or a desire to be successful. Those are the traits you need to exhibit.

This is also the time to update your resume. Do it before you are in need of a new position. Don’t list what you have done, but describe what you have actually accomplished in your position. It is much easier to keep track of these accomplishments on a regular basis rather than having to go back and try to remember after the fact. Quantify your results as much as possible. Plus, when having conversations with your boss, it is always nice to be able to talk about your successes.

How is the role of the CIO changing? What should CIOs be doing now?

The CIO role has really changed over the years from a “bits and bytes” individual to a true C-level leader. John Glaser, CIO of Partners HealthCare, and I did a presentation at the CHIME Fall Forum on this very topic entitled “Where are we going? Evolution of the CIO”. Put succinctly, the CIO has to be a true leader, just like any other C level position in the organization. It goes beyond just keeping the systems up and running. That is part of it and a crucial part that can get a CIO fired. But, the role is starting to go way beyond that as CIOs acquire additional departments and different responsibilities.

The CIO of today and tomorrow needs to be reaching out within their organization. They need to learn what leadership “looks like” and become more involved in working on business issues and contribute more than technology. They need to work with colleagues as peers and focus on understanding them and solving their problems. They need to fill domain knowledge gaps and skill gaps. And as we already stated, they never need to rest on their laurels, but focus on future accomplishments and how those accomplishments benefit their organization.

Management of a healthcare IT department requires the same skills as management of any other department. As more and more in the hospital domain becomes “application driven”, CIOs will shoulder more and more responsibilities. We have heard several CIOs mention recently that they have picked up oversight for other departments – even departments such as HR or marketing. You need to know your limitations, and know when and where to find true specialists to handle things you cannot. 

What will the effect of the stimulus package be on the job market?

It will be interesting to see just how the stimulus money does affect the job market. As you reported recently, Wal-Mart is entering the EHR market, and others will jump on the bandwagon to get those funds. The money will have some positive impact on those with strong implementation knowledge and for those in consulting. What the real impact of the stimulus package is will be difficult to predict until all the rules and regulations are ironed out. Any time the government is involved, your guess is as good as mine, but I do see it as a positive for those in healthcare IT.

We have talked with healthcare IT organizations that are already looking ahead to the stimulus monies and planning for the talent they need to embark on the projects that will attract these dollars. 

What kinds of roles and training are available for clinicians who want to get more involved with IT and informatics?

The roles are many and varied, depending on the clinical background. With EHR, lab, radiology, pharmacy, and informatics, depending on the background, there are lots of opportunities for the clinician who wants to be involved in technology. These include everything from a CMIO to nursing informaticist to builder and implementer. The individual needs to look at where they would like their career to take them long term, and then decide the best route to reach that career goal.

We are seeing more physicians and nurses in the CIO role. We are seeing a new position, CNIO (Chief Nursing Information Officer) develop in larger organizations. Consulting firms and vendors are utilizing these skill sets in their business models. As far as training, there are numerous masters’ programs out there and they provide a good education. If at all possible, while pursuing book learning, try to balance that out with hands-on experience. The two paired make a much better skill set than just a degree and no real technical experience. The employment world is a competitive place: degrees, experience, certifications, and a broad range of experiences do make a huge difference in how fast and how far you can move up the career ladder.

On a side note, we would like to mention we will have a name change this month from Snelling Executive Search to Kirby Partners. We feel this name will not create confusion as Snelling has. There are other Snelling personnel offices out there that focus strictly on administrative and temporary employment. Our people remain the same, and our niche remains the same. All we do is healthcare IT recruitment.

Comments Off on An HIT Moment with … Judy Kirby

From HIMSS 4/7/09

April 8, 2009 News 13 Comments

From Evil Knavel: "Re: HIMSS. Do you get special treatment from companies at HIMSS, especially sponsors like athenahealth that seem to get a lot of PR? It seems like it." Guess you missed the part about eating burgers in the hotel and at McDonalds. Only one sponsor knows who I am, so the answer is absolutely not. I am an anonymous peon at the conference, so I’m seeing it just like everyone else (intentionally – I don’t want favors, but yes, I’m sure I could milk the heck out of it if that interested me). In fact, anybody with CIO in their title is going to get treated a lot better than me since they have their own off-limits meetings, vendor giveaways, and fancy event invitations that I don’t get (disclosure: I went to the Cerner CIO event as an anonymous guest of someone, which was cool to a day-jobber like me). FYI, athenahealth is not a sponsor (and disclosure there: they don’t do much marketing, but decided to be an HIStalk sponsor about a year ago just to be nice. I turned them down because that was right after the HISsies and it would have looked suspicious, which we both agreed was the right decision).

IMG_0310 From Christi: "Re: reception. I’m ever so grateful to Ingenix for hosting the party. The Trump Towers staff was over the top on customer service – every single staff person was incredible! When I’d ask for directions to something they’d not only tell me where it was, they’d walk me all or part way to it! And the ballroom we were in was gorgeous. What a lovely site and lovely party – thanks for being so cool as to have someone who wants to throw money into doing this." Thanks to Tom for sending over the pictures.

That’s it for me – I’ll be heading home first thing Wednesday morning. I saw quite a few people with suitcases in the hotel lobby today, so I’ll guess that the exodus already started. That astronaut doing the closing keynote tomorrow afternoon may have had more people in his Mir space station than will be in the audience.

My verdict on the conference: nicely done. I actually didn’t mind the weather as much as I thought, but the Saturday start in April really threw me off. The logistics were as good as ever and Chicago and the convention center were fine. My only remaining gripe the cost of hotels. I really wish I had bypassed the Ambassador people and just used Priceline since I paid too much, but couldn’t cancel and re-book without a penalty. 

001

My favorite giveaway (other than the foam slippers): the tee shirt above from Solution Q, vendors of the Eclipse project portfolio management system. It’s not new humor, but I hadn’t heard it in a while and never from a tee shirt.

VC firm Psilos Group will raise a $450 million healthcare IT fund.

IMG_0365 It’s probably just as well that Cerner opted to stay out of town this week since an ugly PR episode might have resulted. This article says that four Chicago mental health centers closed today as a result of billing glitches in the Chicago Department of Public Health’s Cerner system caused it to lose more than $1 million in state funding when bills backed up for over six months.

Someone asked me about ARRA and innovation. They are mutually exclusive terms. ARRA was designed to dump a lot of taxpayer dollars into private hands quickly and forcefully, yet it requires CCHIT-certified products that would take years to develop from scratch. For that reason, it will just boost sales of the same old stuff. If anything, it stifles innovation because all the prospects who might have decided to sit tight and hope for better products will have to spend sooner to get their cut. The most valuable asset any company can have right now is a CCHIT certification, whose value went up multiples with ARRA.

I was chatting with someone earlier this week and he said he hated Citrix. I made my usual comment that it’s like a Denny’s restaurant – always a compromise from what you really wanted. His theory is that the availability of Citrix allowed old, primitive applications live on, providing another layer of workaround that gave vendors an easy out for bad system performance, difficult maintenance, poor security, and lack of a true thin client or Web strategy. The healthcare-only combo of Citrix-MUMPS-Cache is everywhere, of course, and there’s no customer indignation to replace it because it works.

IMG_0346 Some guys talking on the escalator this morning said that Rob Kolodner got a standing ovation in his final HIMSS appearance as ONCHIT (and deservedly so). I would be shocked if he isn’t in Atlanta next year, but in the booth of a consulting firm or vendor instead. He confirmed that he’s retiring, but looking for other opportunities. By all accounts I heard, he’s a good guy, humble and fun.

I want to get the autograph of Gay Madden, CIO of The Hospice of the Florida Suncoast, since she’s on the shuttle bus TV every morning (in a Sprint commercial, I think).

I went to a session this morning on digital pathology that was pretty cool. It’s interesting that systems exist to convert slides to massive images that can then be manipulated and studied in a cockpit of monitors rather than through a microscope. The speaker said his company had licensed satellite image processing technology since it works about the same on the cellular landscape as it does the terrestrial one.

UPMC chooses chooses the clinical research management system from mdlogix (the annoying all-lowercase name is their doing, not mine).

Ingenix announces its Care Tracker EMR, priced at $5,000 per year for a solo practitioner. Also announced: RAC software and services that help hospitals comply with the Medicare Recovery Audit Contractor (RAC) program by providing alerts of claims likely to be audited.

Someone told me of an overhead conversation this week in which national drug chain VP said his company hoped to cobble together a simple EMR (enough to claim minimal use) just to get stimulus money.

Jonathan Bush was on FoxBusiness this morning after a late night at the Trump (I don’t know how he does it). The site doesn’t support a direct link, but you can search on athenahealth and look for today’s video. The host opens with a HISsies mention, although not by name: "Jonathan was honored last night as the industry’s figure of the year in healthcare technology." He talks about HIMSS and HIT. The company also announced that its eRX module has received Surescripts certification.

Someone mentioned that it’s ironic that Sun is pitching its NHIN capabilities even as its IBM acquisition went up in smoke, implying that maybe it’s not stable enough to hang the NHIN hat on.

A HIMSS location name that sounds like 1999: "Surf the Net".

The digital pathology session talked about IT as a barrier because of locked down PCs. That reminded me of editorials I’ve written lambasting the lazy IT socialism of treating all users equally (badly) in assuming they are all too stupid and irresponsible to have any control over their PCs. Their ought to be a way to gain responsibility points based on need and ability, allowing higher level users with a defined need to perform simple software installations or OS changes.

Seen on Epic’s booth: every EMRAM Stage 7 hospital uses EpicCare. For a company that says it doesn’t market, that sure kicks the competition where it hurts.

I took a look at iMedica’s new/not new Transition product. It’s the existing product with the knowledge base turned off at a 20% discount, giving an easier and cheaper start. If you want the knowledge base later, you just pay the difference.

The last of the booth observations:

  • iMDsoft has a Visicu-like ICU monitoring. I tried to learn more, but the reps were too enamored with each other’s company to want any of mine.
  • Corepoint Health (the former Neotool) had a nice booth and seems to have grown considerably in capability and ambition.
  • iSoft was demonstrating Lorenzo, which isn’t sold in the US. One rep was, anyway. The others were sitting on the demo station stools playing around with their cell phones.
  • AT&T/Cisco Telepresence had a conference room setup in the booth with the big monitors in place, which actually looks like have a conference room since the one side of the table is for virtual participants.
  • Medicity had a good crowd.
  • I chatted briefly with the ICA person, who explained the company’s CDR and clinical portal that can also be used as an in-house clinical workstation to add capability to existing systems.
  • I checked out Bistro HIMSS: $23 (including tax and drink) gets you a paper plate on which to load up pedestrian-looking heat lamp Chinese.
  • I miss the blue nametags that distinguished vendors from providers, but that was in a simpler, black and white HIMSS world.
  • PatientKeeper had a big rack of smart phones and PDAs running their software to show its versatility.
  • I don’t know much about Orchard Software, which had some KLAS information on a booth sign that suggested it’s the highest rated lab system. I’d tell more, but nobody there was paying much attention to my eye-catching glances.
  • eClinicalWorks had a bunch of people in the booth.
  • There was a good crowd at the Sentry Data Systems booth.
  • EDIMS had a nice booth and crowd. Apparently they have a EDIS Lite kind of system with knowledge management, but nobody made an effort to talk to me.

I apologize if you e-mailed an invitation for me or Inga to visit your booth or meet you personally and it didn’t happen. We stayed very busy getting information to write each day’s HIStalk, so we ran out of time.

HISsies 2009 Winners

It’s time now to announce the winners of the 2009 HISsies, the Brutally Honest HIT Awards, as voted by the readers of HIStalk. We don’t claim the results are scientific, but they are always interesting.

  • Smartest vendor strategic move: Medicity-Novo Innovations merger.
  • Stupidest vendor strategic move: GE Healthcare losing unsatisfied clients.
  • Worst healthcare IT vendor: GE Healthcare.
  • Best healthcare IT vendor: Picis.
  • Best provider healthcare IT organization: Cleveland Clinic.
  • Hospital you’d want to go to if facing a life-threatening illness: Mayo Clinic.
  • Most promising technology development: Software as a Service.
  • Organization you’d most like to work for: Picis.
  • Company in which you’d most like to be given $100,000 in stock options: Picis.
  • Most overrated technology: speech recognition.
  • Biggest healthcare IT related news story of the year: Obama’s position on healthcare IT.
  • Most overused buzzword: interoperability.
  • “When _(blank)___ talks, people listen,” the person who influences healthcare IT the most: President Obama.
  • Best CEO of a vendor or consulting firm: Todd Cozzens, Picis.
  • Most effective CIO in a healthcare provider organization: Lynn Vogel, Ph.D., associate professor of bioinformatics and computational biology, vice president, and chief information officer, University of Texas M.D. Anderson Cancer Center.
  • HIS industry figure with whom you’d most like to have a few beers: Tom Daschle.
  • HIS industry figure in whose face you’d most like to throw a pie: Neal Patterson, Cerner.
  • Healthcare IT industry figure of the year: Jonathan Bush, CEO, president, and chairman of athenahealth.

E-mail me.

From HIMSS 4/6/09

April 7, 2009 News 9 Comments

006 Thanks to everyone who attended the reception tonight. Thanks, too, to our speakers and presenters (especially Jonathan Bush), our sash wearers, and the Ingenix folks who ran an efficient check-in process. Thanks also Ingenix and Ingenix Consulting for sponsoring the event. I hope you enjoyed it. It was an honor to have you. I’ll get the HISsies winners up soon.

It was a nice day today, actually, with very little snow and some welcome sunshine. Much better than I expected.

No expensive burger for dinner this time. I had a $5 combo from the McDonalds right by the Trump. I bet I’m the only person patronizing them back to back.

I was ruminating (always dangerous) on the shuttle bus today about all the newfound interest in HIT, but minimally focused on the patient compared to the profit. My conclusion: right or wrong, healthcare is set up under the business model, where allegedly nonprofit hospitals have to earn their keep by cranking out the bills and making shrewd business decisions (as someone told me the other day, some of the meanest executives they’ve known were in nonprofit healthcare management). So, vendors are clearly for-profit, no different than defense contractors. Looking back, one might conclude that the charity/compassion model might have made more sense, but that’s not what we have.

Here’s an interoperability idea: after hearing the cell phones of supposedly tech-savvy IT people constantly going off in the HIMSS education sessions, someone needs to invent a door sensor that automatically turns all phones to mute.

002 Best session of the day (and of the conference so far): Pat Skarulis of Memorial Sloan-Kettering, on developing an oncology order entry system for what I assume is Eclipsys Sunrise. It was quite cool and the way they handle study protocols, sequential orders, and lab alerts is sophisticated. I can see a lot of interest in how they did it since oncology OE is a tough nut to crack and MSKCC is pretty much an authority. Unlike all the other sessions I’ve been to, nobody left, even during the questions (however, the audience members asked atypically knowledgable and concise questions, so kudos to them).

Speaking of Eclipsys, they had a quite effective back-cover ad in HIMSS Daily Insider today, showing their CPOE penetration. A minor quibble is that both dimensions of the quadrant measured pretty much the same thing (number of hospitals and percent of hospitals) and didn’t show percent of orders or doctors, but it still got the message across.

I’m sure it’s just me, but people walking around with those blue-blinking Bluetooth cell phone earphones look like self-important douchebags.

Our new best friend Dennis Quaid gets some nice USA Today press, saying his new GI Joe: The Rise of the Cobra could be the next Independence Day.

Our rumor reporters had the right idea, but the wrong scope: Dell and Perot announce a partnership involving EMRs and hardware. That’s Dell’s second recent announcement: the eClinicalWorks offering through Sam’s Club was the first.

Noticed during the education sessions: nearly no one pronounces HIMSS Analytics correctly. Also, an increasingly large number of presenters use "sort of" as the modern equivalent of "um", such as "We built sort of a data warehouse, with sort of an essential item being real-time extraction."

More booth reviews:

  • RelayHealth’s was nice and cheery, also putting out their HIStalk sign.
  • Microsoft had throngs of people again for some reason (the coffee table thingie?)
  • Nextgen had what might be the largest and coolest booth (forgot to mention it yesterday). It was like the Hollywood Bowl.
  • QuadraMed had interesting stations for each product they were demonstrating.
  • Emdeon had cool arcs that spanned their booth, although the three booth mimes seemed to be causing passers-by to steer clear (people really dislike mimes and clowns who try to engage them in some kind of hijinks).
  • I made Inga push the Enovate-IT carts to show here how smooth and sexy they feel.
  • ONCHIT had a booth, believe it or not, staffed by some rather nice civil servants. They have a handout on how to start on the ARRA grants, which is their main reason for being on the show floor. They said Blumenthal won’t be starting until the end of the month. They also speculated that Rob Kolodner will retire instead of going back to the VA.
  • Eclipsys had a quite dramatic and open booth. I forgot to mention it yesterday.
  • A trend: I saw no two-level booths, so everybody went from traditional to ranch style.
  • It was nice to have the sun streaming in floor-to-ceiling windows over in the 3900 aisle.
  • BlackBerry had a cool booth (I think my AT&T Bold was drawn to it).
  • AT&T had the telemedicine setup that I always like running.
  • IBM’s booth wasn’t very big. Maybe they don’t have enough people left in this country to need a larger one.
  • Allscripts still had people packing the booth and spilling out into the aisle.
  • Greenway was demonstrating Prime Research.
  • Cumberland Consulting Group had a nice wood-floored booth and some friendly people who were starting up conversations with passers-by (an art that every vendor needs to perfect if you’re going to spend big money on a booth).
  • The folks at Legacy Data Access e-mailed pictures of their vintage, old-school Pong video game, kind of an early 80s version of the Wii or Xbox for all you youthful types I see all over the convention center.

Industry long-timer Scott MacKenzie (RelayHealth, Cerner) is named CEO of revenue cycle systems vendor Passport Health.

LMS Medical Systems of Canada sells McKesson its CALM OB suite. The company’s been in big trouble for some time, so it was a good move and McKesson gets what I think is probably a pretty good specialty system.

Medicity announces its Q1 business wins, raising its total HIE customer base to an astounding 700. Thirteen new Q1 customers are named, some of them very large. Someone asked me about them today and I was explaining how well they were doing, but I clearly didn’t know the half of it.

Sentillion-VergenceWizard

Sentillion is giving these little guys away in the booth, USB drives loaded with Advanced Authentication Solution for Direct Access to Cerner, Eclipsys, Epic, Mckesson and MEDITECH Applications. The company also announced a do-it-yourself tool for SSO and CCOW. I think I read somewhere that SSO was one of the top priorities of hospital CIOs trying to get clinical applications used, so I imagine these new announcements are timely.

Also announced: Allscripts Prenatal, a SaaS specialized EHR.

Dewey Howell of Design Clinicals gave me a demo of some new software the company is finishing up involving anticoagulant monitoring for physicians (adding to its medication reconciliation functions). I said last year that the med rec stuff was very cool – highly intuitive, functional, and taking full advantage of third-party drug databases. This is at least as cool. I’ve seen big-vendor applications sold for physician use (often meaning that some bean counters and programmers got together in 1985 to figure out how to capture charges without having to hire keypunch people) and this is how it should be done (and would be if it weren’t for the legacy baggage the big boys have to drag around).

From Blinded by the Snow Storm: "Re: Allscripts. Allscripts might need to do a bit more due diligence. dbMotion only has 2 clients in North America that have initiated a real project: 1) The Bronx RHIO, which currently has an RFP on the street to replace their core functionality, and 2) UPMC, which has an equity investment in dbMotion but has yet to announce any significant tangible benefit despite a multi-year relationship. Not exactly the type of track record that proves true interoperability." I think dbMotion’s long suit is having a ton of users, like entire countries in Europe, and a better product than the ones Misys and Allscripts brought to the table. I don’t think Allscripts will regret it.

From Glad I’m In Sunny CA: "Re: Voalte. Interesting product, but how many nurses do you know that carry iPhones?" Not many – yet. However, that’s because there has been little justification for them. Connect a nurse to a real-time alerting and communicating system using them and they suddenly look like a good deal given corporate rates and ease of use (not to mention their use as a recruiting tool).

From Ex-Broadlane: "Re: layoffs. Broadlane, the third largest GPO in the US, laid off 33 employees today, the majority being in the IT department. Ironically, the cuts come just when they are beginning to reinvent themselves as a ‘Technology enabled Service Company’ which is code for ‘we cannot scale as is and need technology’, hence the irony."

So HIMSS finally admits that both registrations and exhibitors were down. I wouldn’t say they necessarily were dishonest in bragging on the registration rate a few weeks ago, but it’s clear that they put the best spin on what they had to know was going to be the first drop in both critical categories in many years (maybe ever), most likely to stave off a last-minute bandwagon effect that would have made it worse. It would have been a complete disaster without the last-minute stimulus interest.

Speaking of positive spin, McKesson’s clinical systems are "gaining momentum," at least according to its PR people. The proof: five hospitals, some pretty obscure, bought products in 2007 (!) You would think McKesson had developed a lot of new, cutting edge clinical apps instead of continuing to sell the old, multi-heritage software bought years ago from Vanderbilt, HCS, etc. from the flowery wording. Nobody’s asking me, but here’s my advice: build something from scratch and finally get the "buyers, not builders" monkey off the corporate back and catch Cerner while they aren’t selling much either.

Susan Hagerty is named CEO and chairman of Noteworthy Medical Systems. She comes from CompuGROUP, the majority owner of Noteworthy. Larry Dolin stays on the board.

Nuance makes a series of HIMSS announcements: 25 new healthcare customers, a Dragon EHR certification program, and a preview of Enterprise Workstation Version 8.

E-mail me.


HERtalk by Inga

It’s Monday afternoon and still snowing in Chicago. So far today I have had a chance to sit in a few sessions, including one featuring the Ambulatory Care Davies winners. Three different groups were represented, including a solo physician practice, a five-doctor group, and an 85-doctor practice. If I were to come up with a common theme, it would be that ROI is not just about the tangible things, but about soft costs as well (reassigned workflow, paper elimination, faster chart access, etc.) Also, that getting up and running is the hardest part: once you have been live for awhile, it gets better.

I have had assorted conversations with folks about what the "buzz" is this year. Aside from ARRA and how everyone has a solution, a oft-mentioned word is interoperability. Of course, given that the government is making interoperability a requirement to obtain stimulus money, vendors seem to be discussing what and how they are working to make their products interoperable with the world. Seems like we have heard that word before and we still see lots of silos, so we will see if times really have changed.

Another issue mentioned is how providers will be able to fund the up front EHR costs before they are able to receive their Medicare carrots. Many hospitals are claiming they can’t afford to help physicians despite relaxed Stark laws. Not hearing any great answers to this issue yet.

boots

As I was walking I saw some great looking boots. I was pretty proud of my ability to walk and take a photo at the same time.

Overheard: "I am not sure how we will be able to be interoperable with our community when we can even interoperate within our hospital walls."

A few people mentioned that Microsoft’s booth looked quite busy, so I will go see what the buzz there is all about.

I took a guided tour of the interoperability booth (there is that word again) and saw a patient’s history flow from her PHR to the physician to the hospital and to another physician. Looks cool, but the cynical Mr. H pointed out that everything on the floor "looks" cool. One day it will happen, right? I have to say the piece that might be the hardest to implement is the PHR. How many people are really going to spend the time to keep their data current? And how many doctors are really going to trust the data?

From the look of the artwork on display in their booth, I would say Epic is making some money. I enjoyed viewing the various non-traditional paintings and statues situated around the booth. In case you were wondering, the fireplace is still there.

A reader shared details of a Perot-hosted party last night at the Hancock building observatory. "Unfortunately with the snow you could not see much from the 96th floor. Perot could have saved some money and had the same party in the basement. Party was still fun, though."

Yesterday, Mr. H and I walked by the Tech Lab (near HIMSS Central) and peeked in on the blogger round table. Mr. H was actually a bit miffed that he was not invited since he sees himself as one of the original HIT bloggers. Probably didn’t help matters that I was invited, though I declined participation in order to maintain my low profile. If the session were in a bigger room that allowed you to stand unobtrusively and listen in, we probably would have stayed, but the room was a bit too cozy for us.

Official HIMSS attendance numbers as of Sunday: 25,672, which is down 5% from last year. That number is fairly evenly split between professional attendees and exhibitors, which is consistent with previous years.The number of vendors (905) is down 15 from last year. HIMSS folks seem happy.

Someone claiming to be "in the know" says that McKesson did not lay off all their ambulatory sales staff, though a few folks were let go.

I saw the famous Matt Holt from afar today. Also Grizzled Veteran, one of HIStalk’s regular posters. Heading back to the exhibits later this afternoon, then primping for the HIStalk soiree!

E-mail Inga.

From HIMSS 4/5/09

April 6, 2009 News 4 Comments

It poured the rain all afternoon and now it’s snowing and blowing like crazy. I have to admit it seemed to draw everyone a little closer at the conference – there was nothing else to do but hang around the exhibit hall. That was OK until 6:00 when the hall closed, triggering a mass exodus to the opening reception. Inga and I took one look at the mass of humanity and left since it would have taken forever to get food or drinks. The band was probably good, but you couldn’t tell because the "room" was like a 747 hangar with a cement floor and high ceilings. The heavy rain or snow or sleet or whatever it was sent everyone to the coat check stations, the taxi stand, and the shuttle buses, so there were long lines at all of those, putting a not-so-great end to the day.

I started this morning by tripping over the giant bag of ads piled at my hotel room’s front door. There was a fake TV show on the shuttle’s TVs, complete with HIT commercials, of course. At the convention center, I thought the girls from Healthcare IT News were going to put someone’s eye out the way they were thrusting issues in everyone’s faces at every escalator and hall intersection (with most of the intended recipients using violent body English to avoid having to take one).

Since the "opening" keynote wasn’t until 12:30, I went to three morning educational sessions. Two were OK and one was horrible. Since I was bored, I noticed how many times in the conference guides that EHR came out HER. Someone needs to help those HIMSS folks customize their Word dictionary.

Lots of people showed up for the 12:30 session. HIMSS had a really good jazz band playing live (Skinny Williams Group). Last year’s official theme, "Now Is Our Time," was apparently taken off life support. Good idea. It was the usual multimedia extravaganza, with some violinists in there. They sounded good, but didn’t get to play much. The most ironic moment of the self-congratulatory HIMSS video was a shot of a wall breaking down with the label "Break down proprietary walls," with the irony being that the names of big companies were plastered everywhere and the repeated reference to the exhibit hall made it clear that proprietary has been berry, berry good to HIMSS (perhaps they meant that even more proprietary vendors should be congratulated for working on interoperability of proprietary systems).

HIMSS board chair Chuck Christian had shaved off his beard, so nobody recognized him. He read of a long list of HIMSS accomplishments, pretty much every one of them related to lobbying the government for taxpayer dollars so that organizations who didn’t want software bad enough to pay for it with their own money could buy it with someone else’s. And if you were there for management systems, forget it — there was no effort at all to even mention the MS part of HIMSS (maybe they should just call themselves HIS). They did mention something called HIMSS Plug In that was said to be a consumer technology social network or something, but I wasn’t clear on what it was or how it’s accessed. No figures were given for conference attendance, but someone said they heard 27,000 which would beat last year (if you believe the number).

Since HIMSS wants to break down proprietary walls, who better than to introduce the keynote than an executive from Siemens, the company paying for that session (and whose executives pleaded guilty of fraud for bid-rigging a PACS deal at Stroger Hospital right here in this very same Chicago not long ago). After a longish video with a deep-throat announcer proudly reading some classic Dennis Quaid cinema titles such as The Parent Trap and Innerspace, out came our keynoter.

I’m going to try to be nice here. Dennis seemed likable, happy to be at the conference, and genuinely complimentary of the HIT work done by people in the audience. He was considerably more wrinkled and hoarse than you see on the movies, but that ear-to-ear grin still lights up even a big room. Applause was polite. I didn’t find him all that charismatic like I expected. He read most of his talk from the TelePrompter (stumbling a surprising number of times – I guess he’s used to getting multiple takes). He flashed pictures of his twins and of the heparin vials he said were "deadly similar" (maybe to a layperson, but they were about as clearly labeled as they could be even in the picture, with one saying Hep-Lock and the other labeled Heparin 10,000 units/ml with slightly different colored labels and completely different colored pop tops – the only similarity was that they were both in the standard 1 ml vial). He proudly announced that his family’s incident had motivated Cedars to spend $100 million on HIT, although you’d have to wonder what other pressing projects got shelved to free up the capital. One thing I agreed with: bar codes need to be universal and interoperable (thank a weak FDA for why that’s not the case today). He said bar code technology needs to be affordable for small hospitals, but didn’t elaborate how that’s going to happen. He pitched smart card medical records and inpatient access to charts by TV or cell phone. He barely mentioned his foundation, to which HIMSS gave him a check for $10,000 at the end. I can’t imagine that anyone in the room wasn’t aware of medical errors beforehand, so I have to question why HIMSS thought this would be a compelling opening keynote (a great number of people rushed for the doors when he started taking the couple of scripted questions HIMSS had put together). But, I saw him in my hotel lobby afterward and he was just hanging out, looking good, and being a regular guy. So, I would say Dennis was just fine, but he probably shouldn’t have been put up there.

Then came exhibit time. The hall didn’t seem busy at all, but maybe it was bigger or perhaps because it was Sunday, things still weren’t in full swing. The energy level seemed low, but everybody was relaxed as a result. Some quick perceptions:

  • Booths seemed generally smaller and less elaborate. You could count the booth babes on one hand. There were a couple of magicians, a trick pool shot guy, and some mimes (seriously), but otherwise the in-booth entertainment was dialed back.
  • McKesson still had some of that wildly electric blue, but it was toned down a lot.
  • I still think Medicity’s spaceship-like booth is the coolest, but that’s just me.
  • The HMS waitresses are as sassy as ever, at least when you get the ones who are paid actors and not the HMS employees rounding out their number.
  • Kudos to OnBase with their usual sports bar theme, who served up soft drinks until 5:00, then rolled out the hard stuff. I was prowling for beer and was told EMC had some, but they had run out. Sentillion filled the bill admirably even though I clearly wasn’t a prospect.
  • If I could pick one company and booth to see that’s clearly got new ideas and strong prospects, I would choose Voalte. They were wearing Pepto-Bismol colored bell bottoms, but demoing a very cool iPhone-based communication and alerting application. CEO Rob Campbell, with a long history of developing technology (PowerPoint and Filemaker) is fun. Booth 1481 is worth a visit.
  • The busiest booth was Allscripts, which was mobbed from the time the doors opened until after the lights were dimmed. I don’t know what kind of audience they were getting or what products interested them, but it was packed. Second busiest (but in a relatively small booth) was dbMotion, whose people seemed pretty cool.
  • Epic’s booth hasn’t changed and neither has Judy. She never left the time we were there, talked to pretty much anyone who wanted to chat, and displayed nothing to indicate her net worth or place in the HIT universe.
  • The aforementioned Siemens had a nice, airy booth that I Iiked probably best of those from the big boys.
  • Inga and I liked the Risarc people in 7215, who were manning their tiki hut, wearing Hawaiian shirts and sultry tropical dresses, and pouring rum punch. They did a nice job making it fun.
  • I liked Sunquest’s booth a lot, very open and attractive in the green color (although the top looked like a big round trampoline to me). Their "Sunquest – we deliver" totes were the best ones I saw, well made in that bright green with black trim, so I’m taking one of those home.
  • Most of our sponsors displayed the "We Power HIStalk" sign we made for them prominently, but Virtelligence gets the nod for putting it front and center.
  • Somebody gave Inga and me those little chocolate bottles containing rum. Those were just about the best thing I’ve eaten lately. I wish I remember who had them since they deserve kudos – they can’t be cheap. I would like to have had about five of them since I would have simultaneously gotten both a sugar and and alcohol buzz on.

After all that, I rode the shuttle home in the snow, ate a $15 hotel hamburger alone (funny how Inga reports the same thing below), and hit the laptop for what you’re reading now.

Chipsoft

We decided we should feature a smaller, lower key booth with people we liked. Introducing Chipsoft (that’s Paulette above, looking like an unseen giant is about to scoop her up), an HIS vendor from the Netherlands in Booth 6560 (not selling to the US, but interested in European attendees). Those yellow things on the floor are the coolest slippers, shaped like wooden shoes. People everywhere were descending on those people carrying them (like Inga), demanding to know where they got them. Chipsoft will put more of them out Monday, they said.

A reader sent this: "One of the pre-Quaid speakers referred to the American Recovery and Disability Act. Does that make it the AR-DUH?" I don’t know if the TelePrompter was acting up or what, but everybody on the stage muffed their speeches several times.

RSM McGladrey has "Official HISTALK Cynic" and "INGA FAN CLUB" badge ribbons at Booth 8039. As far as I know, that’s the only giveaway or goodie (unlike last year’s Fake Ingas, shoeshines, and other badge ribbons).

We’re supposed to get 1-3" of snow tonight with winds tomorrow of 20-30 mph. Thanks, HIMSS. My hotel TV ran an ad for conventions in sunny San Diego, apparently rubbing it in.

The Sun-IBM deal is off, apparently.

vw bus pictures 023 

The Medsphere folks sent this picture over. "These photos about sum up the difference between Open Source and non interoperable, expensive proprietary models." That’s a cool PR move that must have required a lot of planning to pull off.

We already ran the rumor, but Allscripts announces its iPhone application. Allscripts also announces a joint solutions deal with dbMotion (maybe that explains the booth crowds), apparently replacing the products that both Allscripts and Misys offered previously.

iMedica announces a new PM/EHR system called Transition. We may need to swing by for a look.

That’s about all I have the energy to write today. There were some announcements today (Allscripts, for example), but I expect most of the big ones will be held for Monday when the news is full-on and the stock markets are open.

HERtalk by Inga

Let me start out by saying: My. Feet. Are. Killing. Me. And I even wore the comfy shoes. Right now I am in my lobby bar drinking an adult beverage, having had a couple of Advils to try to make the feet throbbing stop. And, I probably look like a total nerd typing away on my laptop, but who cares. I’m sitting next to a window and watching some huge snowflakes come down and waiting for my $15 hamburger to be served.

First thing this morning, I attended a CCHIT Town Hall meeting led by Mark Leavitt and Alisa Ray. I was struck by the fact that CCHIT clearly sees themselves as the entity that has established "the" standards, though they acknowledge that the standards committee will tweak the final standards required for ARRA funding. In any case, vendors are sending in their certification applications at an unprecedented rate – something like 45 new applications in the last month, with 39% being never-before-certified vendors.

I also went to the opening session to see Dennis Quaid. Cool live music and video started things off, followed by a rather lengthy intro by Chuck Christian of HIMSS. Christian shared all the great things HIMSS has done over the last year – and one might think they were personally responsible for including HIT in the recent ARRA legislation. So, I think Mr. H was a bit cynical about having Dennis Quaid as the keynote, but I personally thought it was an effective reminder that ultimately this whole HIT stuff is about the patient. Quaid admitted he is not an expert on technology or healthcare. Instead, he is a father, husband, and now an advocate. As I was walking out I overheard this comment: "There’s nothing like a human story to motivate IT. Especially when it involves babies"

Mr. H and I also spent time walking the exhibit hall (see note above about aching feet). The good news is that everyone has a way to help you take advantage of ARRA money. Random thoughts:

Allscripts was amazingly busy every time we walked by. Other booths that appeared to be getting good traffic included Google (why?), dbMotion, athenahealth, and McKesson. Not so busy: most of the other vendors in the ambulatory EMR space and all those small vendors are the outermost aisles. Far and away the best giveaway were the slippers from a Dutch company that looked like wooden shoes (I’d be wearing them if I weren’t in the lobby.) Booth babes are for the most part either eliminated due to budget constraints or simply too 20th century (in either case, I am ok with the demise of booth babes). Mr. H and I were so happy every time we saw a sponsor prominently display one of our signs (anyone see them?) Mr. H and I personally autographed each display, so thanks to all who put them out. By the end of the afternoon, Mr. H and I were getting thirsty for cocktails, so thanks to the folks at Sentillion were able to provide both Mr. H and me our beverages of choice.

I took a few photos and will get those posted soon.I have managed to snap a few nice-looking pairs of shoes and was able to educate Mr. H and what shoes were and were not practical for walking the exhibit hall. Also got caught in the Olympic committee 2016 presentation this a.m., so I took a few shots of wrestlers in their cute outfits.

In the Ribbon Race, i.e., the contest to see who can attach the most ribbons to his badge, I have so far seen two individuals tied for first place. Each had five ribbons. One is the CIO for a large health system in Texas and the other is a consultant, also from Texas. (Everything is bigger in Texas, I guess?) Surely there are some New Yorkers or Californians who can come up with six ribbons to take the lead.

Early night for me before some early morning sessions. Can’t wait for the big HIStalk/Ingenix party Monday night!

From HIMSS 4/4/09

April 4, 2009 News 5 Comments

008 It’s a pretty nice day in Chicawgah, with brilliant sunshine and tolerably cool temps. The locals are out jogging and playing shirtless volleyball like they were Canadians. HIMSS is looking pretty smart in choosing its own city for the conference, but I doubt anyone will be saying that as they slog through the snow the storm will bring Monday. If you see someone smiling, it will be a vendor chop-licking at the certain booth traffic that will result since there’s no golf or other outdoor activity as an alternative (coincidence, I’m sure). Good for them, bad for those of us who enjoy the traditionally warmer conference locales. I even heard one of the HIMSS people saying it was convenient, but not as nice as going somewhere less wintry. Look at it this way: because of the schedule-juggling needed to jam Chicago into the mix, it’s only 11 months until the Atlanta conference.

Why is healthcare so expensive? I can’t figure it out as I sit in a $250 hotel room using a $20-per-day Internet connection and ponder the $26 hamburger (including mandatory gratuity and delivery charges) that the hotel’s room service would like to sell me. (Actually, I pay my own way, so I’m not contributing to healthcare inflation). One of the sessions today was full and someone headed out to get more chairs – don’t do that, they were told, only union members can pick up convention center chairs.

That same $250 hotel just about sweated me out last night. My room must have been 85 degrees and the heat was blasting. No AC, naturally, being a historic hotel full of character (meaning: tiny closets, weird bathrooms, and a maze of halls to find each room). I figure there was some forgotten old guy down in the bowels of the basement shoveling coal into the furnace like he’d been doing since the Truman administration. Solution: I opened the window, which was surprisingly not bolted shut (the hotel must not have a legal staff). Other than the racket each time an El train lumbers by, it’s OK (as long as I don’t think how much nicer a $69 Microtel would be if I’d been smarted enough to book once, spend a little on cabs each way, and still save a bundle).

It looked like the Marines stockpiling supplies before a siege at the conference center. Vendors hauling in their exhibit stuff, food and drink people making sure not to run out of wildly overpriced inventory, and AV people setting up an endless number of rooms. The conference center is actually pretty easy to get around and, as is always the case with HIMSS, is well marked. Some sessions are across the land bridge on the west side, most seem to be on the south side, and the opening reception will be on the east side overlooking Lake Michigan (which attracted me to stroll out to the patio for a look, immediately finding myself locked out of the convention center until a maintenance guy reopened the door).

h1 It was pretty dead at the conference center today, at least in the common areas. I walked by the venture fair and it was overflowing, so I assume ARRA has attracted some people newly interested in healthcare but having no clue about the patient widgets with which we deal outside their financial realm.

The schedule still seems odd. You would think that the opening reception would be today (Saturday) since everything moved up a day, but it’s still Sunday. There’s no morning keynote tomorrow – Dennis Quaid isn’t on until 12:30. One thing is like always: the education tomorrow runs only 8:30 until noon, followed by Dennis, followed by the ceremonial herding of the attendees into the exhibit hall like cattle up an abattoir ramp. Nothing conflicts with the exhibit hall hours, of course, since that’s the entire point of the conference (a smattering of time-conflicting educational offerings notwithstanding). Sunday’s education (not counting Dennis): 3.5 hours. Exhibits: 4 hours.

Rumor heard: McKesson’s board had lost confidence in Pam Pure, believing she was in over her head. She fired all of the company’s ambulatory salespeople right before she herself was defenestrated, supposedly. A WSJ article mentions concerns about the technology division. It says John Hammergren is speaking at HIMSS, but I’m not sure where.

An anonymous reader says that Radianse chairman and CEO Manuel Lowenhaupt has left after less than a year. Steve Schiefen is now listed as CEO on the company’s Web page. The reader speculates the RFID asset/patient tracking company will be sold to Hill Rom.

A reader sent a copy of an e-mail that George Halverson of KP sent out company-wide, bragging that 12 of the 15 hospitals that will be recognized as EMRAM Stage 7 at the conference are Kaiser facilities.

HCS president Tom Fahey e-mailed news of a new Interactant sale: the five-hospital Encore Healthcare LLC (MD). They’re in Booth 7834 if you want to extend personal congrats or just say hi (Tom didn’t ask for the plug, but I figured I’d look it up in the HIMSS guide since it’s right in front of me).

I passed former HIMSS CEO John Page in the hall today. Looking good, running a CEO and entrepreneur support organization.

HIMSS is having some kind of blogger session at the conference. I was not invited. I’m insulted even though I wouldn’t have gone anyway.

TeraMedica announces Smartstore-Ultrastream, a storage optimization protocol that improves the efficiency of image storage and routing for its vendor-independent imaging and information system.

h2 GAO names 13 members of the Health Information Technology Policy Committee, the advisory group that will make policy recommendations for a national HIT infrastructure. Some are familiar names: Marc Probst of Intermountain, Paul Tang of PAMF, and Judy Faulkner, who has done more for HIT adoption than any of them because she’s selling the heck out of Epic to big hospital systems (quick: name any big-name hospital that has bought anything other than Epic in the last year or two. Need more time?)

People keep e-mailing me that Perot will be acquired by Dell shortly. Sounds farfetched, but I said the same about Misys and Allscripts right before HIMSS last year (and ran the rumor for the same reason: multiple reports). Purely speculation, but there you go.

Nine Texas patients, most of them homeless, drug abusers, or mentally ill, made 2,700 ED trips in the past six years, racking up $3 million in taxpayer cost. I bet your first reaction was: irresponsible losers screwing up the system. Maybe your second would be: perhaps the healthcare system gave them no alternative, making a business case for using the avoidable cost to fund options for them.

GE Healthcare, whose name is prominently plastered on the quite nice tote bag being handed out to HIMSS registrants, lays off more employees in Wisconsin.

Taking pictures at HIMSS? Send them my way (or maybe I should start an online album). People seem to like them.

A reader is working with a boutique RIS/PACS vendor that is looking for quality resellers. Not my sweet spot, so if you have suggestions, e-mail me and I’ll pass it along.

h3 A study in contrasts (not the same as a contrast study): a NEJM report says that only 1.5% of hospitals have comprehensive clinical systems, but HIMSS Analytics trots out its own stats saying that, hey, they’re pretty close, missing only a couple of key applications to be there. Count on it: any time anybody publishes a high-profile article (even a research one) that seems to indicate less than rosy industry use of technology (or especially that the technology itself may not be up to snuff), HIMSS will circle the wagons with a rebuttal.

Allscripts cuts revenue estimates, blaming a purchaser preference for subscription-based pricing. Overheard today: nobody’s financing companies that drop ship software like in the old days (say, before last year). True partners make money only when their customer makes money and that’s all that’s selling these days. Welcome to the recession.

My guest editorial in this week’s Inside Healthcare Computing e-mail update: Here’s President Obama’s Mandatory EMR Feature List: Firing GM’s CEO Makes it Clear That Federal Money Has Strings Attached. A key sentence: "The CEO of every company right now, right or wrong, is the former junior senator from Illinois who has never had a real job (I don’t count being a professor or lawyer) or run a business."

If you’re at the conference, welcome to Chicago. I’ll be doing some kind of daily report and I expect (and hope) that people will e-mail the good stuff they hear out and about since that’s the fun of being here.

E-mail me.

News 4/3/09

April 2, 2009 News 8 Comments

paulegermanFrom Cherry Forever: "Re: political appointments. For the HIT Policy Committee, Minority Leader John Boehner appointed Gayle Harrell. Speaker Nancy Pelosi appointed Paul Egerman. Incidentally, you can find this information if you do a search on ‘HIT Policy Committee’ in the Congressional Record." Harrell is a Republican member of the Florida House who recently railed against the stimulus bill. "One of the scariest provisions of the bill misuses the laudable goal of expanding electronic health records and spends $1.1 billion to create a new bureaucracy called the Federal Coordinating Council for Comparative Effectiveness Research. The intent is to use this new government bureaucracy and electronic health records to monitor the effectiveness of different health-care interventions and medications with the cost of treatment being considered as a factor in determining effectiveness. Such cost-based medical decision-making could eventually be used to allow the government to ration health-care goods and services. A congressional committee report stated that ‘more expensive (treatments) will no longer be prescribed’ as a result of such research." Paul’s an uber-Democrat and was co-founder of IDX and eScription (an interesting mix of social issues plus good old capitalism, the ideal combo if you ask me). If you Google him, the #1 hit is my 2005 interview with him, which was a blast to do.

From Don Frijole: "Re: Dell. Rumor, unconfirmed, that Dell will buy [big consulting firm] and announce acquisition next week at HIMSS. Hope Mr. HIStalk can get to the bottom of this one." The onset of HIMSS always starts acquisition rumors, sometimes true. If anybody has a Dell scoop, give it up.

From HCIT Girl: "Re: GE and Intel. The companies have scheduled a press conference in New York, hosted by Intel Chief Executive Paul Otellini and GE Chief Jeffrey Immelt, to discuss plans to work together to deliver health-care-related technology, including possible applications for health care IT and home health monitoring, according to people familiar with the situation. BTW, you rock Mr.HISTALK and Inga!" She sent that rumor Wednesday and this was announced Thursday: GE and Intel announce they are jointly developing products for remote health monitoring. The pair will invest $250 million over the next five years to develop new technologies in this area. Also, GE’s health care unit will take over distribution and marketing of Intel’s Health Guide home care product. Thanks for saying we rock (not in a chair, I hope).

From Irwin M. Fletcher: "Re: Sutter. Don’t know if you saw your mention in the SF Business Journal regarding Sutter Health. I looked at your site and couldn’t find any mention. The article is titled ‘Sutter Health to postpone hospitals’ and says, ‘But Fry and Chief Information Officer Jon Manis denied reports on the well-known HIStalk health-care IT blog that Sutter is giving up on its $1 billion Epic installation …’ So congrats on being well known!" Thanks – I hadn’t seen that.

From HIT Man: "Re: CMIO. The premiere issue of CMIO magazine is released. From working with many, it is evident that these folks think because they are MDs, they know healthcare IT. Wrong. So, take a look at this issue and notice the language they use. It’s like a bunch of hippies writing specialized articles for themselves. Simply another rag, at least this first issue. One of the problems with HIT adoption is physicians, and now we let CMIOs run HIT work (at least in some places). Amazing how much credential is given to those who effectively can’t even agree on standard dosages from practice to practice. I lament, but let’s empower the IT executive, not the MD that studied IT. Also, Halamka is quoted again. This guy is a relentless media hound. He really should be a PR consultant."

From The PACS Designer: "Re: JeOS. With all the virtual appliances showing up in the marketplace, there was bound to be an mini-operating system to enhance their use. Now, Ubuntu open source software has a Just enough Operating System solution (JeOS), which has been nicknamed Juice. This new solution is bound to show up in new virtual appliances to improve performance and free up valuable bandwidth for other uses." Link.

From Frankie Knuckles: "Re: Chicago food and drink. If you want to get out of the Trump hotel bar, there are a couple good spots close by. Emerald Loop is a pretty good Irish bar (owned by a Notre Dame grad, so you know it’s good). Their curry fries and a few Guinness are a fine meal. Across the street is the South Water Kitchen, with comfort food like meatloaf and fried chicken. And if you want to hang out at a real mobbed-up Chicago Italian place, head a few blocks east to Volare — some good people watching there, and good food too. Just don’t lean against the Cadillacs and Mercedes parked out front."

Other rumors heard: GE is going after a specifically named large ambulatory EMR vendor. Allscripts will announce a new iPhone offering. Cisco will be making an investment in a specifically named physician billing company. All unverified.

Allscripts reports Q3 numbers: revenue up 65%, EPS $0.09 vs. $0.12, but the numbers aren’t really apple-to-apples because of the Misys deal. Both earnings and revenue missed analysts’ expectations, but shares are up a little in after hours trading, adding to the nearly 4% rise before the market closed.

saenz

A former dialysis center nurse in Texas is charged with intentionally injecting 10 patients with bleach, killing five of them.

Listening: The Vincent Black Shadow, one of my faves, with a 2008 album I didn’t know about.

Several readers e-mailed to confirm the rumor reported here earlier that Eclipsys development SVP Joe Petro has left (he’s off the Eclipsys Web page, finally, and here’s the 8-K). Also gone, several of them said: Bobbi Byrne MD, SVP for clinical strategy. A reader reports, "The clinical solutions group now reports to Keith Figlioli, who reports to Jay Deedy. Not a clinical person in the hierarchy until you hit the fourth level in the organization."

twomillionvisitors 

HIStalk’s two millionth visitor arrived Wednesday afternoon, hailing from Johns Hopkins. March was a record traffic month as well, surprising to me since Inga and I took our respective spring breaks.

culbert 

Meet Culbert Healthcare Solutions of Woburn, MA, just joined us as an HIStalk Platinum Sponsor. They do clinical systems consulting (strategic planning, EHR readiness assessment, selection and project work), revenue cycle (PM selection and implementation, billing and A/R outsourcing, and operational assessment), practice management (management, CBO, physician recruitment and retention), and IT (interim management, implementation, help desk, interfaces). Doesn’t matter if you work for an academic medical center, a community hospital, or a physician practice group large or small – they can help. Thanks to Rob Culbert and crew for their support.

Medsphere will show OpenVista 2.0 at HIMSS.

Microsoft launches a new low-end server family that can support up to 15 users for less than $1,000 in total hardware and software cost.

JAMA’s editors are on the hot seat after repeatedly calling a neuroscientist "a nobody and a nothing" and saying, "Who do you think you are? You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry." The editors were angry after the neuroscientist brought attention to the drug company ties of a JAMA article author, which JAMA reportedly ignored until it was run in a competing journal months later.

Jobs: MS4 Patient Accounting Expert, Compatibility Test Engineer, Cerner CCL Programmer, Training Consultant.

If you’re going to HIMSS, take a look at our Must-See Vendors List (which, entirely coincidentally, are HIStalk sponsors). If they’re cool enough to sponsor some anonymous blog, they’re worth a look.

I was always curious about McKesson Paragon, a highly regarded small hospital system that escaped what looked like sure sunset death years ago. We interviewed Paragon’s GM on HIStech Report. Products like that will be essential if we’re ever going to move the needle on small hospital EMR adoption (and since there are so many of them, to move the EMR needle in general).

virtelligence 

I appreciate the support of new HIStalk Platinum Sponsor Virtelligence, a premier IT consulting firm offering solution advisory and IT consulting services to all types of healthcare organizations (which have given them a 95% repeat business rate). The company has won awards for being a great place to work (consultants average 15 years’ experience) and is listed in the 2008 Healthcare Informatics Top 100. Their "Why Virtelligence?" section of the Web site summarizes nicely: "Delivery-based contracts, low rates, fixed prices and pay on the results." Why not drop by at Booth # 2373 at HIMSS and check them out? 

I’m going to be running around in the cold Saturday and onward to tell you what’s going on at HIMSS. I’ll give you a scoop on the cool and the ugly booths, who’s getting traffic and who’s not, the certain acquisition rumors floating around, and whatever else catches my eye (and ear) as a non-profit hospital peon being ignored by the high-powered, self-absorbed suits. I’m your Everyman on the scene. Happy and safe travels to all.

HERtalk by Inga

From Dick Vitale: "Re: NCAA basketball pool. Is the basketball pool going to get a mention in HERtalk?" I’m blaming the pre-HIMSS rush for my failure to recognize one of our sponsors for inviting Mr. H and me to participate in their company basketball pool. My failure to mention these fun folks has nothing to do with the fact that for the second year in a row I am a loser. Dick, however, does point out that I am in the running for the Consistency Award because my total points/correct points are almost identical to last year (i.e., I am a consistent loser). Rather than hand over the pool winnings to the lucky winner, our gambling friends are giving 50% of the pot to a local charity for needy families. Nice.

From Dutch Treat: "Re: downing Heinekens. If you want something fun to cover while at HIMSS, there is a contingent of about 200 Dutch HIS and vendor people traveling over together for the conference. This is a fun group. I know a bunch of them. They are staying at the Hyatt and have already begun calling it ‘Holland town’ where they say they are having nightly cocktail receptions." "Fun" and "nightly cocktails". Intriguing. And with a name like Inga, I am sure that some of them might be fourth cousins or something.

Insight Health Services enters a seven-year agreement with Perot Systems to provide revenue cycle outsourcing, IT outsourcing, and other practice management tools for Insight’s free-standing imaging center facilities.

Like Mr. H, I was disappointed by the MyHIMSS09 calendar program. If only it would have had a nice, concise print option. I have now put all my picks onto one nice sheet of paper. I have a pretty nice balance between educational sessions, exhibits, and food and drink opportunities.

Hospital Rahway (NJ) is the third hospital in the Robert Wood John Health System to adopt Eclipsys Sunrise Acute Care.

AMICAS completes its tender offer of Emageon and now hold 88% of outstanding Emageon shares.

Capital Area RHIO (NJ) deploys Axolotl’s Elysium Exchange solution to facilitate secure sharing of clinical information.

Beaumont Hospitals (MI) expands its existing Agfa Healthcare IMPAX PACS to include IMPAX Cardiovascular.

McKesson’s Physician Alliance Program signs agreements with three hospital systems to provide their community physicians with EHR solutions. The announcement indicates that VARs will be responsible for selling, implementing, and supporting McKesson’s Practice Partner and RelayHealth solutions to the participating physician offices. Interesting that McKesson seems to be relying on VARS, rather than a direct sales/support team, though that model is similar to the way Allscripts is distributing its MyWay product to small offices.

The VA selects Picis to provide anesthesia record for five of its medical centers. The VA will use Picis’ Preop Manager, Anesthesia Management, and PACU Manager applications.

ne ortho

Nebraska Orthpaedic Hospital selects Surgical Information Systems (SIS) Anesthesia solution.

HIMSS attendees will have a chance to take a five-question survey about the economic stimulus and its impact on healthcare. Beacon Partners will conduct the electronic poll at their exhibit booth (4416) and real-time results will be posted on monitors. I’m stopping by because I want to be eligible to win one of the three iPod Touches they’re giving away.

MEDecision announces its intent to acquire HIE company HxTechnologies. MEDecision plans to inbed HxTI’s HIE technologies into is Alineo and Nexalign platforms.

Good news for all you Call of Duty 2 fans. A new study finds playing action video games may help adults improve their eyesight. In particular, such games can improve contrast sensitivity and benefit those with amblyopia (lazy eye syndrome).

If you originally signed up for the HIStalk/Ingenix reception and your plans have changed, please let the Ingenix folks know. I believe they may have a waiting list going and a few waitlisters are hoping to take any empty spots.

Marin Healthcare District (CA) signs a $67 million, seven-year contract with ACS to provide consulting and outsourcing services. ACS will implement an enterprise-wide EMR and provide revenue cycle services.

Heartland Regional Medical Center (MO) is considering outsourcing some technology services as it moves to Cerner’s EMR. The hospital’s CMIO says the hospital must spend millions upgrading computer equipment or outsource some in-house services. 

Kaiser opens a new hospital next to its existing flagship LA Medical Center. The $600 million, 400-bed facility is designed to withstand a major earthquake, features 85% family-friendly private rooms, and includes all the latest technology.

Surescripts names former Mastercard executive Harry Totonis as president and CEO. He replaces JP Little and Rick Ratliff, who have served as co-CEOs since RxHub and  SureScripts merged last year.

wx 

My next update will be coming direct from Chicago! I’ll be the one wearing a coat.

E-mail Inga.

CIO Unplugged – 4/1/09

April 1, 2009 Ed Marx Comments Off on CIO Unplugged – 4/1/09

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

Welcome, Welkommen, Bienvenu, Bem-vindo, Bienvenido, Vítaný
By Ed Marx

My family will host our 6th foreign exchange student this Fall. Anne will join us from Germany and stay through the academic year. Our “extended” family has expanded over the years, and these former students are now doctors, teachers, and actors. We keep in touch with several of the girls and have even visited a couple here and abroad. The experience of a single exchange—the families, students, cultures—has enriched our world.

I serve on the global healthcare CIO council for a fortune 50 company. Each year a dozen of us gather from around the world to help drive corporate strategy. We get a glimpse into the future and where the industry is headed as it relates to technologies on the horizon. We share challenges and solutions. We commiserate. We learn. We advance the corporation, our employers, and ourselves. It is rich.

Around the table this past week, I sat with CIOs from Brazil, Japan, USA, Singapore, Greece, UAE, Taiwan, Bulgaria, Mexico, Canada, Australia, and England. (How fitting that the International Olympic Committee shared the conference facility with us in Chicago.) Although we contributed and advanced the mission of the council, the biggest benefit came from the transparent sharing amongst CIOs. I’m not able to share council specific outcomes or where my organization is headed strategically, but I can offer these key takeaways:

· Innovative ideas to remove culture as obstacles to transformation

· Creative organization hierarchies that enable velocity

· Leading from the center

· Progressive management of vendors

· The world is flat and we have more in common than you think

· Negotiating the C-Suite more effectively

· Leveraging specific technologies to enhance mobility

· Expanded vision

I gained more from this intimate exchange than I could have attending a week long mega-conference or reading a year’s worth of subscriptions. I established relationships with 11 peers who I can call on as needed. We forged budding bonds through time spent together and found that we have a common burden and shared passion. Their diverse backgrounds opened my eyes to fresh thoughts and strategies. Some of us have already exchanged additional ideas and materials to further our organization’s success.

The council sponsor benefitted and they will develop enhanced products and services to meet our future needs. Our employers will benefit from this investment as we bring back executable ideas for both strategic and operational advancements. And I, like my peers, have personally benefited through this mutual exchange of ideas, cultures, and personalities. May sound trite, but I believe the world is a better place now.

Seek opportunities on different levels to share in global exchanges. I’m looking forward to what we’ll learn from Anne this forthcoming school year.


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.”

Comments Off on CIO Unplugged – 4/1/09

Readers Write 4/1/09

April 1, 2009 Readers Write 12 Comments

Comments on Ricky Roma
By Cliff Dickerson

I’ve spent most of my career on The Dark Side, but I rarely have considered it to be that.  Maybe I’m going to always be naïve, but it’s where I’ve witnessed innovation and achievement.

  • I took pride in seeing the glee on the face of the DP director when transmission of the day’s billing was transferred in less than five minutes after removing the cartridge (yes, cartridge) from the Four Phase HIS and inserting it into the Four Phase front-end of a time shared financial system. It beat a day spent key punching by multiple employees.
  • I was ecstatic when the ER nurse (pre-ED days) most vocally opposed to the new system told me that she loved it.
  • I was pleased to know that in less than six months we had registration and ADT up, something that some major medical centers spent two to three years developing in-house or that the IT staff in the early days in a turnkey operation was a fraction of that where in-house development was occurring.

Trained as a biochemist and working in a hospital clinic lab, I fled early on to an HIT vendor. I knew that my happiness was not to be found being a bench tech. (Retention of medical technologists is a tricky act. The University of Illinois Circle Campus, in fact, eliminated its medical technology program upon realization that its graduates were not going to work for healthcare providers, but rather for biotech and pharma companies.)

The vendor life, while often paying more than on the provider side, has its disadvantages. Living out of a suitcase is not fun. Missing out on activities with friends and families is a real drag. 20+ hours of commuting is not so fun either. (When I first started, I left on Sunday afternoons and got home sometime Friday nights. It’s different now. People just don’t want to do that.) 

Oh, and pay? I’ve seen some delivery organizations pay almost as much for its employees as a vendor does. $10K or $15K just doesn’t make up for long commutes and long days.

Now, I could go down a different road. Healthcare organizations traditionally have not paid IT salaries competitive with other companies. (Nor do they spend the same amount of money on IT traditionally – maybe you do get what you pay for.) And, boy, are they surprised when their clinicians turned informatics specialists say that they won’t work more than 40 hours a week unless they get overtime. But, that’s a whole other discussion about something that’s not necessarily unique to American healthcare delivery systems, but pandemic in our culture. We talk about balance, but don’t play the game.

I don’t discount anyone for wanting to make a profit – even not-for-profit health delivery organizations like to do that – and many of their employees and associates profit very well in doing so. Perhaps I should be more cynical in viewing publicly traded healthcare software vendors, but can I fault them anymore than I could fault Chase or Oracle or Phillips? No, I just can’t. (I do think that the American system has some problems. I do think that our American companies often make decisions that are poor in the long-term. I do think that we need to rethink our executive compensation system.)

Value: if someone is willing to pay $3 for $1 of value, well, I figure that they must be getting $3 of value. Or at least feel that they do. Maybe I’m a bit biased because I spent a lot of time studying pricing while working for vendors.

I’m not sure where the 66% failure rate comes from, but it does point out the need for clearly defined, achievable return on investments before the ink is signed. So many people don’t want to do their homework in advance. Technology in and by itself is no balm. It’s the implementation. How you use it. How you promote it. How you plan to ensure success.

I had a CIO teaching a class at a university ask me for a paper or case study about how poor project management lead to the failure of a project. I couldn’t find one. No one really wants to write about or talk about their failures.

Next Generation Hospital Laboratories Become a Driving Force in the Future of Diagnostic IT
By Richard Atkin, President and CEO, Sunquest Information Systems

RichardAtkin When Sunquest became a private corporation approximately 18 months ago, no one predicted the tumultuous economic conditions and events that would be taking place in the U.S. and worldwide. And we now know how important the healthcare IT industry’s role will be in helping deliver increased access to care, with improved outcomes, at lower overall cost.

Back in October 2007, we saw a great opportunity for best of suite diagnostic IT solutions and publicly stated the strategic goals that we believed would best serve the current and future needs of our customers. We committed our focus and resources towards enhancing the automation capabilities and clinical workflow of Laboratory Information Solutions, improving patient safety, helping hospitals maintain profitability through outreach services, and to becoming a driving force and leader in the exciting area of predictive and personalized medicine. Now, with the dramatic changes over the past year, these same goals are even more relevant and delivering against them remains our top priority.

We must remember at all times that healthcare delivery is largely local and must be very patient centric. The role of the hospital laboratory in the continuum of care and the effectiveness of the Laboratory Information Solutions it uses are playing an increasingly important role in the successful delivery of clinical care inside the hospital and outside in the community. With approximately 70% of clinical decisions based on results generated in the clinical laboratory, the operational efficiency of the laboratory is critical to the effective delivery of safe, timely patient care. Laboratories are becoming information hubs for patient care, business operations, revenue growth, and the successful development of new technologies for predictive and preventative medicine.

The emergence of the hospital laboratory as a strategic, revenue generating service line, central to the goal of cost effective healthcare delivery is a development we are dedicated to supporting.

Automation & Workflow Efficiency
Laboratory services are central to healthcare delivery. Hundreds of care plan and treatment workflows are dependent on decisions that use lab results – admissions, discharges, medication decisions, follow-up testing and dietary orders to name a few. The shorter and more certain the lab result turnaround time, the faster patients and care providers can make diagnostic and care plan decisions, and the more effective those decisions will be.

Laboratory information systems must not only track, route and manage samples, but also interconnect with the overall Health Information Systems and EMRs being used within hospitals and with systems being used by external physicians and laboratories. By doing so, the transition from inpatient care to outpatient and vice versa is eased, vital resources are used more efficiently and the patient experience is enhanced.

Patient Safety
Patient safety is obviously a top priority for healthcare providers. At Sunquest we developed the concept of the Five Rights of Laboratory testing to champion the contributions the lab makes to the safe delivery of care.

Additionally, we have introduced several new products that support our customer’s goals for improving patient safety, including a closed-loop transfusion management solution. Our automated Specimen-Collection Management system integrates with the LIS and blood bank system, and utilizes wireless handheld devices and bar-coding to ensure positive patient ID at the bedside.

Closing the loop on the blood administration process, the Transfusion Manager solution is specifically designed to support patient safety processes at the bedside by automating nursing workflow and reducing preventable errors from occurring during the transfusion process.

These solutions in use at dozens of our customer sites have succeeded in reducing specimen collection errors to virtually zero at every site where deployed.

Expanding the Community Footprint
In challenging economic times, hospitals must leverage their laboratory as a strategic asset to their overall business operation and revenue generation. A single admitting community physician represents an average of $1.5MM in annual revenue to a hospital. An effective outreach program builds physician and patient relationships while enhancing the reputation of the hospital in the community.

The ability to effectively manage these community relationships is an important strategy for hospitals and the reason why we made two strategic acquisitions in Q4 of 2008.

First we acquired Anglia Healthcare in the UK for their complementary product portfolio of web based communications and messaging solutions. As a result, Sunquest now has the market-leading position in the UK with over 60% market share for laboratory orders and resulting solutions and the technologies to address the broader EU market with solutions that meet the region’s protocol standards and language needs.

We also acquired the Outreach Advantage portfolio from PAML, Spokane, WA. These solutions provide a strong complement to our existing offerings, adding courier, logistics, CRM, and business intelligence applications. The Outreach Advantage portfolio, together with our LIS and revenue cycle solution, results in the single most comprehensive outreach business management suite in the industry.

Predictive & Preventative Medicine
Patient diagnosis and treatments through molecular and genomic testing represent an area of explosive growth, great promise, and significant challenges.

Molecular diagnostics is generating more than 30 million tests annually in the U.S., with dozens of new procedures introduced every year. We are strategically committed to providing the solutions that will enable laboratories to be a leading force in the upcoming revolution with predictive and personalized medicine.

Nearly 85% of our customers already perform molecular testing and interface their instruments and systems with our LIS. One leading example of this is Nationwide Children’s Hospital, who has used its expertise in molecular diagnostics testing for infectious diseases to successfully grow its outreach testing services to support an international market.

Emerging technologies in genetic testing, digital analysis and whole slide imaging are creating a new paradigm for diagnostic medicine. Certainly the workflow inside the laboratory will dramatically shift, but even more significant is the impending transformation in healthcare delivery outside of the laboratory. Pathologists and lab professionals must become more active, visible members of the care team. To do so effectively will require collaboration, communication, and results interpretations that comprise actionable information, not just data.

Conclusion
This is both a very challenging and very exciting time to be in the healthcare industry. As vendors, we must develop and implement new solutions, in partnership with care providers, which make the industry more productive while also helping in the transformation of healthcare delivery. Connecting the laboratory to the continuum of care in the community and facilitating the transition to personalized, predictive and preventative medicines have the potential to revolutionalize patient care, improve wellness, reduce the cost of healthcare over lifetimes, and enhance quality of life for all of us. Sunquest understands its role and shared responsibility towards meeting the healthcare industry’s challenges and opportunities. We are dedicated to creating diagnostic information solutions that enable hospitals to fulfill their missions.

Will $20 billion Solve This Problem?
By Frank Poggio, The Kelzon Group

There was a poignant opinion editorial in the Chicago Tribune this Sunday that got my attention, written by Candy Schulman, entitled “There is a human in that bed”. It caught my eye and got my empathy because I lived that same experience about a year ago. There were however, two major differences. First it happened in a different hospital in a different state. Second, since I have worked in the hospital world as an administrator, systems supplier, and consultant for thirty-five years, I had a better understanding of the issues and therefore was able to force a faster resolution. As I read Candy Shulman’s article I kept asking myself, as I did a year ago, what is really wrong with this ‘system’ and what can be done about it? Also, I kept thinking will $20 billion solve this problem? Let me tell you a little about both stories before I give you my assessment and prognosis.

Candy’s Story – Dumped in the Driveway
Candy tells about her frustration in caring for her elderly mother while an inpatient at a local hospital. Two of her biggest problems came in simply getting her mother discharged at a reasonable time, and the lack of coordination with hospice care. The statement I most reacted to was, “After her month long hospitalization and three weeks in rehab, I tried all day to get her discharged, but ran into a hospital quagmire when I could not get anyone to sign the discharge papers. Finally, at 6 p.m., I left, believing I’d repeat the arduous process the next day”.

“Two hours later the rehab facility sent a bedridden, demented old woman home in an ambulance—alone. I wasn’t called to accompany her home, nor was her devoted live-in aide, Nellie (I was taking her out for a bite to eat after a long, tiring day). My poor confused mother was suddenly dumped into an ambulance. In the driveway of her apartment building, the driver seemed surprised that no one was there to take care of her.”

Candy Schulman’s complete article can be found at: http://www.chicagotribune.com/news/chi-oped0329humanmar29,0,552996.story

My Story – Who’s on First?
In February of last year, I lived through a similar experience. My 88-year-old mother, after years of struggling with CHF and COPD, was admitted to a Florida hospital. After a few days of hospitalization, we were told there was nothing that could be done and death was only a month or two away. My family decided the best course was to move her home and get the local hospice involved to supplement the efforts of me and my sister. I had spoken at length with her cardiologist, internist, and case worker and agreed this was the best course.

Needing a day to work things out with a local Hospice program, the hospital agreed she would be discharged in two days. I lined up the Hospice services to come to her home to set up the medical equipment, complete their assessment and explain to her their plan and what would transpire. Although my mother was severely physically impaired, she was of sound mind and fully cognizant of her surroundings to the day she died.

On the agreed-to day of discharge, I went to the facility to get her at 9 a.m., thinking that by 10 or 10:30 a.m. we’d be on our way. The day before, I told the Hospice staff we would be at her house by 12 noon and they then could commence their process.

To make a long story short, I did not leave that hospital until 1:30 p.m. that day, and then it was only because having worked in a hospital earlier in my career I knew how disjointed things can get. I personally tracked down the admitting doctor (not her cardiologist or internist) and brought him to the room to write the discharge orders and sign it. That was at 12:30 p.m. and still a number of other nursing and related tasks had to be completed. All the while I was running around the hospital, and in and out of her room, my mother kept asking, "Don’t these people know what they are doing and when can I go home?” I kept answering, “No they don’t, and if we’re not out by 2 p.m., we will leave AMA!”

What Went Wrong?
Everything involved with communication, coordination, and follow-up. No one knew who was on first, who had main responsibility, or what needed to be done next. As best I can tell, everyone involved was waiting for the next person to do his/her task, when in fact many of the tasks could have been done concurrently. Meanwhile this hospital has been using one of the leading HIS packages in the country for more than a decade.

So let’s spend $20 billion on new HIT/EMR systems like Cerner, or Epic, McKesson, GE, Siemens, or Meditech — whatever flavor you like. It won’t matter. Although they may help a little, in my opinion, none of them can solve this problem. Here’s why.

The problem Candy and I described is not a data storage (EMR) or transactional (HIS) problem. It is a communication, coordination, trans-departmental workflow and management problem. Yes, HIT vendor systems can do communication, but they do very little, if anything, for work flow coordination and communication and almost nothing outside of ancillary medical services. These systems are great at ordering an x-ray and making sure radiology does the prep work, then delivering the results to clinicians and placing an image in the EMR. But what if that patient needs a dietary consult and the dietician comes to the room while the patient is still sitting in x-ray, one hour late for a test that was to be done at 1 p.m.? They almost totally ignore non-medical support services such as social work consults, dietary reviews, transportation needs, patient location or education, timely discharge orders, and more. Such tasks typically fall to nursing to ‘manage’. Inevitably one or more falls through the cracks, and when one fails the whole process collapses and the patient suffers.

Unfortunately, this problem is pervasive across health institutions as identified by a recent report issued by the National Academy of Sciences – Institute of Medicine (IOM) entitled Computational Technology for Effective Health Care: Immediate Steps and Strategic Direction. The report states: “Health care decisions often require reasoning under high degrees of uncertainty about the patient’s medical state and the effectiveness of past and future treatments for the particular patient. In addition, medical workflows are often complex and non-transparent and are characterized by many interruptions, inadequately defined roles and responsibilities, poorly kept and managed schedules, and little documentation of steps, expectations, and outcomes.”

If you still do not believe it is pervasive, then answer these simple questions. Does your facility have a time of discharge policy? If yes, what percentage of the cases hit that time within 15 or 30 minutes? Of course if you can’t answer either, that’s proof enough.

During my years as a hospital CIO /CFO and as a system’s developer I believed that the ever-expanding HIS tools and developing EMRs would someday address this problem. Today, after many years of hands-on experience at all levels, I am convinced they cannot and will not. In a nutshell, I have come to the conclusion this in not an information technology problem. It is a work flow process problem, a communication problem, and lastly, a management problem. It is not a department problem, but an inter-department or enterprise problem. An HIS /EMR can help solve it, but using those tools alone you are doomed to fail.

What is Needed?
The seemingly simple goal of implementing a set discharge time and meeting it has many challenges such as poor inter-department coordination and poor integrated work flow. Inter-department resource coordination founded on solid work flow documentation and monitoring tools is critical to successful patient flow and meeting discharge targets. Fortunately there are many sophisticated work flow tools developed outside of health care that can be used to help achieve better patient flow and control. Private industry has used tools such as optimization, production coordination, queuing analysis, and sophisticated enterprise scheduling for decades. Some of these are finding their way into health care now, but very slowly.

These tools go beyond electronic bed boards and digitized paper forms, both of which are needed but only address the symptoms. Hospitals need to know real time where they stand for any given patient. In effect, a Gantt chart or patient critical path for all activities is needed to meet a specific goal or target discharge time. Remember, a delayed discharge costs the hospital money and it’s the primary reason for ED diversions, which typically lead to large ED capital expenditures.

Proper coordination of all services (ancillary and non-ancillary) can help hospitals get through these tough times. It’s not easy, but by better utilizing your current resources, (staff, equipment and technology), through better work flow coordination, you can significantly improve patient throughput to drive improved productivity, reduced costs, enhanced revenues, and most importantly, increased patient satisfaction.

While in the hospital my mom, and I would believe Candy’s mom, received excellent medical care from some very dedicated and overworked people. But what we remember most clearly was the bungled discharge process that colored their entire stay. Medicare starts this year to measure patient satisfaction, so bungled discharges will soon become a costly mistake.

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