CIO Unplugged – 6/15/08

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

CIO reDefined: Chief Interview Officer
By Ed Marx

The roles of a CIO are as varied as the companies and sectors they serve. Even within these roles are multiple combinations and permutations that are expressed according to circumstance. The moniker “CIO” itself is not limited to “Chief Information Officer.” No, to be effective in our calling we must stretch the traditional definition beyond this commonly accepted interpretation. This post continues a series on how the “CIO 2.0” will push the boundaries of conventional thinking surrounding the role. We continue with the “Chief Interview Officer.”

It shouldn’t surprise you to hear me say that an organization’s greatest asset is having the right people in the right places. If we lived in a perfect world, this process would be occurring naturally. But we don’t. Instead, the selection and development of talent may be the single most challenging responsibility for a leader. Selection of talent is more often a quantity game than a quality endeavor. Many organizations bring in as many candidates as possible to fill numerous positions in a department with the focus being more statistical than productive. Although this has spawned a billion dollar industry that gives us tools to attract and select the right people, by the end of the day it still comes down to a 50/50 crapshoot.

As the leader, it is my responsibility to ensure my department is hiring only the top shelf of candidates, especially when it comes to senior leadership ranks. For starters, we must offer a compelling employment proposition to attract the right people, a topic I’ll tackle on another post downstream. Assuming you are reaching the right candidate pool, how do you elevate the 50/50 crapshoot to 75/25 or better?

Absolutely, you must leverage the tools typically available through your HR division. I am not big on “requirements” filters, but I see value in sophisticated “cultural fit” assessments that show a scientific correlation between candidates’ scores and performance outcomes. These tools are good grounds from which to build and make the following even more effective.

As suggested and supported by Gallop research, we create a talent profile for each leadership position. Some leaders have gone on to create talent profiles for all their positions, a practice I endorse and applaud. Determine what talents are common to your most productive and effective leaders and use these as the baseline during your interview process. Engineer correctly, your questions can help you unearth an interviewee’s talents. If they have what’s critical to the success of the position, consider everything else fluff.

Common to all leadership talent is the ability to lead, think, and communicate. Using the conventional interview, these talents are hard to access and evaluate. Anyone who has reached this point in his/her career will be good at answering questions regarding his thought processes or how she communicates, etc. Once the top 2-3 finalists have been identified, the greatest differentiator in singling out the best candidate is the “presentation.” We require each candidate to choose one of two real world business/technical scenarios. He/she then returns in a week and presents his recommended solution to a jury of peers. This separates the great from the good.

Through the “presentation” technique, you’ll observe an actual real-time demonstration of these talents. In the standard interview, any candidate can tell you that she can handle conflict and even throw in an anecdotal example. During a presentation, however, a peer will deliberately disagree with a point so you can watch how the candidate responds. Is he nervous, timid, aggressive, thoughtful, etc? During the interview, a candidate can share the academic, five-step process on how she tackles a complex situation; during the presentation, she’ll have to apply that five-step process (or not!). How much research did she do? Was her process rational? Did she communicate clearly? Did she reach out to others? Oh, the things you’ll pick up on that are impossible to discern in the conventional interview.

And the bonus? You get free consulting! Sometimes the solutions are ones you’ve missed and can now apply.

Let’s face it, interviewing to ensure you hire only the best is not easy. Ensuring that the right people are in the right places, especially at the leadership ranks, is one of the most critical functions of the Chief Interview Officer. Whatever interview process you use, those around you will follow your example and carry the tradition down through the ranks. So do it right.

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.”

Monday Morning Update 6/16/08

From Bignurse: "Re: primary care. Someone I know who is a less-than-compliant diabetic was recently dismissed by his primary care physician because his HgA1c was too high. The letter said they could no longer manage his diabetes and he would have to see a specialist. So much for primary care. This is the scary part about P4P and other incentives-based medicine." 

From Don Artest: "Re: lawsuits. A better idea than the plaintiff paying if they lose is for the plaintiff’s legal representation to pay the defendant’s costs. Sometimes the loser is right and shouldn’t be penalized for seeking redress. But it sure would cut down on lawyers gone fishin’."

From The PACS Designer: "Re: STM PMI standard. In my HIStalk interview last September, I mentioned that ASTM was working on a Privilege Management Infrastructure format to enhance HIPAA requirements. This month, ASTM has released the ASTM E2595 – 07 Standard Guide for Privilege Management Infrastructure document for healthcare. The PMI standard contains a guide that defines interoperable mechanisms to manage privileges in a distributed environment. This guide is oriented towards support of a distributed or service-oriented architecture (SOA) in which security services are themselves distributed and applications are consumers of distributed services. The mechanisms defined in this guide may be used to support a privilege management infrastructure (PMI) using existing public key infrastructure (PKI) technology. Also, the guide addresses an environment in which privileges and capabilities (authorizations) shall be managed between computer systems across the enterprise and with business partners." Link.

Chuck Podesta went to Fletcher Allen Health Care (VT) as CIO, so his CIO job at Caritas Christi is posted. Odd requirement: "Meditech is a definite must-have and current." I thought CIOs were supposed to be strategic thought leaders and visionaries, not application experts. That’s like searching for a CEO with experience retrieving Nortel voice mail.

Listening: The Muffs, LA garage pop with big guitar hooks. They’re defunct, but still sound great. Digital recordings means bands live forever.

I have no idea what this Merge Healthcare stock announcement means, but I’m sure it’s earth-shattering given that share price has rocketed up to 96 cents.

And speaking of imaging companies on the ropes, the "corporate pirates" trying to get enough shareholder proxies to overthrow Emageon’s board turn down the company’s offer of some seats in return for going away.

Thank you for reading. Click a few of those ads to your left and take a look if you get a minute. If you’re not getting e-mail updates or the Brev+IT newsletter, you can sign up to your right. I’m always up for rumors and news and you can submit longer pieces of your own (anonymous or otherwise) for the Readers Write weekly edition. Bye.

E-mail me.

News 6/13/08

Two readers confirmed that University General in Dubai will be selecting Epic based on cost of ownership, although they haven’t started contract negotiations yet. That shouldn’t take long unless Epic gives them more options than the usual "here’s our boilerplate and non-negotiable price list." Epic’s taking over the world, it seems, so maybe that "Intergalactic Headquarters" silliness actually has some merit. Imagine if they had a Vision Center (or is that an oxymoron?)

A reader confirms that Novlet Bradshaw is joining Rex Healthcare (NC) as CIO, coming over from Seton Family of Hospitals in Austin, TX.

John Halamka posts a list (warning: XLS) of the components of the medical record and showing BIDMC’s progress in moving them from paper to electronic. I really like this scorekeeping idea and have advocated it previously. Hospitals need to know what parts make up the legal medical record, where they are storing each part of it today (especially if it’s not consistent among nursing stations or facilities), and a running progress report on how close they are to becoming fully electronic. I’ve seen Joint Commission blast hospitals who were wishy-washy about this, to the point where nobody could even tell them where specific documents were stored (and in some cases, duplicated).

Hospitals are actually expecting patients to pay and checking their credit-worthiness online, apparently shocking the whole country with their brazen gall. "But critics say access to patient financial information can lead to abuse. Hospitals might deny non-emergency care to patients with a poor credit history. Overzealous billing personnel might nudge patients to tap into available lines-of-credit to pay for care." Unfortunately, health care is not free to deliver, which also makes it not free to consume. It’s too bad that insurance has dumbed consumers down to this fact. Substitute "car owners" for "patients" and "engine repairs" for "care" where I’ve bolded and you’ll see how silly this argument is.

Welcome to new HIStalk Platinum Sponsor PatientKeeper of Newton, MA. Need to increase physician use of those expensive and hard-to-implement physician systems? You’ll want to talk to them – it could save your job if you’re a CIO or CMIO. I’ve mentioned the interview we did with CEO Paul Brient and it’s a good introduction to what the company does. I was looking over their site just now and darned if they don’t have a video (the one called Saving Time) from Berkshire Medical Center that includes CMIO Michael Blackman, who I just interviewed (I didn’t realize they were PatientKeeper customers until I saw his picture on their site). Thanks to PatientKeeper for supporting HIStalk and its readers.

It looks like we’ve settled on a Wednesday run for Readers Write, so feel free to jot down your best or most amusing thoughts and send them over.

Here’s a great editorial on the VA’s misguided and DoD-led push to rid itself of the VistA system that was supposed to be a guiding light for all of healthcare trying to drag itself out of the dark ages. I’ve talked before about the billions AHLTA cost DoD (most of it going to fat cat contractors) and now those folks are trying to make their system the favorite over open source and paid for VistA while the VA starts heavy petting of its own with Cerner.

Stanford Hospital & Clinics hits a big cost-savings target through a variety of creative and employee-driven changes, the EMR doesn’t get a tip of the hat: "The installation of EPIC, the new electronic medical records system, produced a temporary glitch that set back some savings." Doh!

Nuance announces a voice search function for the iPhone, allowing users to use search engines hands-free.

Yahoo ends talks with Microsoft for the final time, watches its shares tank 10%, and resorts to putting Google’s ads on its search page. Shareholders, time for the torches and pitchforks.

Odd lawsuit, this time in Canada. A couple find a dead fly in their bottled water. They sue the water company, claiming the shock caused depressive disorders and all kinds of aftermath that required medical care. The guy even threw up on the witness stand for effect, resulting in a $450,000 award. The water company appealed and won. The couple somehow got their case in front of the Supreme Court (don’t they have anything better to do?), who ruled that the man’s psychiatric illness was debilitating, but also ruling that he’s a wuss and the water company couldn’t have done much about that. The best thing is that, since they don’t have the archaic US civil litigation system, the couple have to pay all the legal bills for the people they sued, close to $500K. Imagine how rational lawsuits would become if the plaintiff couldn’t just try Lawsuit Lotto with no risk.

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Inga’s Update

Quality Infusion is implementing Misys EMR and Vision across its 25+ clinics in Southeast Texas.

Non-profit Allina Hospitals & Clinics is creating a $100 million Center for Health Care Innovation to support clinical and population health research innovation. The goal is to improve health and health care within the community. I personally think it’s a better use of extra funds than employing private jet service.

The University of Utah Hospitals and Clinics is busy notifying 2.2 million people that their billing records were stolen. The records, which included social security numbers, were stolen from a courier’s van. The hospital has agreed to provide free credit monitoring for all affected, which could be a windfall for whoever wins that contract.

SCI Solutions announces 24 new contracts for its Order Facilitator and Schedule Maximizer products.

After discussions with 150 healthcare professionals, KLAS announces a list of its top ten considered vendors for healthcare business intelligence.

Island Hospital (WA) is successfully using Motion C5 tablets for point of care nurse documentation with their MEDITECH Magic system.

CCHIT announces a new advisory task force to contribute strategic and policy guidance for PHR development. I wonder if they will consider how to convince providers they are worth using?

The healthcare guys at Stratus Technologies are excited about the company’s new software-based high availability product running on standard x86 servers. Stratus will market Avance to hospitals and medical clinics, as well as a number of other verticals.

MedcomSoft’s founder and CEO is stepping down following a special executive committee’s study evaluation of the company’s market potential for its PM/EMR product. Chairman Dr. Steven Small, who led the evaluation, is also retiring. Stepping in are Robert Wilson as CEO and John Gillberry as chairman. Toronto-based MedComSoft is hoping to expand its US presence.

Lynx Medical Systems and the Health Management Academy announce a joint research project to explore the impact of ED services on hospitals and health systems. Researchers hope the results will provide benchmarks for improving quality of care and ED financial health.

eRx is on the rise according to an eHealth Initiative. Last year more than 35 million prescriptions from 35,000 prescribers were sent electronically, a 170% increase over the previous year. While that’s great progress, the numbers represent only six percent of physicians and two percent of the eligible prescriptions.

The CDC releases new estimates on life expectancy rates and I’m happy to report that odds are pretty good that I can keep writing HIStalk for many more years. Currently life expectancy is 80.7 years for women and 75.4 years for men. I may outlive Mr. H by a few years, so that should be enough time for me to get really good at this.

E-mail Inga.

Readers Write 6/11/08

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

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

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

A Pharmacy Perspective About CPOE+CDS
By augurPharmacist

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

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

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

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

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

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

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

Never Underestimate the Determination of Your Customers
By Nick Khruschev

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

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

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

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

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

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

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

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

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

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

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

News 6/11/08

From David Kissinger: "Re: Vision Center. You don’t have to wait until you are San Francisco to see the NEW McKesson Vision center. Click the video on the right of the screen." Link. I nearly choked when Hammergren said "integrated" in the two-minute informercial since the folks in the trenches know that’s a stretch, but I’ll assume that’s another Vision yet to be realized. And, even though he talks about the Vision Center, the video is just generic stock footage – there’s nothing from the Vision Center (or Centers, since the page says there are three of them). Nothing to see there, don’t bother clicking, although the Hammer is one smooth-talking guy in the narration (in a professional way, I mean).

From The PACS Designer: "Re: PDF/H. We are all familiar with the Portable Document Format or PDF.  Healthcare now has two PDFs. The original PDF becomes PDF/A and the new PDF/H is born thanks to the joint efforts of ASTM International and AIIM (formerly called "Association for Information and Image Management"). The new PDF/H now incorporates the use of the eXtensible Markup Language or XML, so you now will be able to provide transfer technology along with security options such as digital signature and audit capabilities to make the PDF/H desirable for collaboration amongst patients, providers, and others in the healthcare industry." Link.

From Dr. Who?: "Re: NHS inflexibility. That sounds like a version of ‘blame the victim.’ Perhaps Cerner and the other big vendors need to examine their own internal assumptions, inflexibility, and leadership." Great plan, except NHS has gone through just about all the vendors and isn’t happy with any of them. Playing solo hardball isn’t much fun. Maybe they should have gone through with Richard Granger’s threat to write their own apps.

From Keith Moon: "Re: reading it first. I see obscure stories in HIStalk and magazines and e-mail newsletters have them right after. I bet they get their ideas from you." Some have openly admitted as much and thanked me. Others just seem to coincidentally find the exact same stories from the gazillions I go through to choose the most important ones for HIStalk. I don’t mind either way.

From Mack: "Re: Dubai. I heard that the university hospital in Dubai chose Epic over Cerner and Eclipsys." I hadn’t heard that. It would be somewhat of a shocker since Cerner has put forth strong efforts there. Confirmation welcome if you can provide it.

From Doug Dinsdale: "Re: Misys Open Source. According to his LinkedIn profile, the tenure of Ryan Bloom, Director of Open Source Development at Misys, appears to have lasted a whopping seven months." Look like the company’s Open Source revolution is over, or at least being led by an understudy. Bloom left Misys month and is working for RadarFind, a healthcare RTLS systems vendor in nearby Morrisville, NC. VP Tim Elwell is still at Misys, according to his profile.

From Independently Irritated: "Re: QuickBooks. I hate it as well. I was told Peachtree is an easier alternative. Wondering what other independent consultants use?" I’m not sure any of the packages are both strong and simple. I’ve used MYOB and it was OK, but maddeningly clunky.

From Interested: "Re: ONCHIT. I read the section in BrevIT about the ONCHIT strategic plan and I’m curious about your opinion on what that means for EMR/RHIO connectivity companies like Medicity." Medicity is sittin’ pretty, to make a rhyme. The plan was broad and maybe short on details, but nothing suggests a reduced interest in interoperability. Medicity has big clients, has picked up valuable domain expertise like a snowball rolling down a mountain, and is associated with RHIOs that are actually successful (and was itself involved in developing the business model of CalRHIO, I’m sure). The failing RHIOs had one typical attribute in addition to being naive about financing: they chose weak technical partners learning alongside them, which will give Medicity a strong Round 2 pipeline.

From kidzdoc: "Re: HealthLogic. Has everyone at HLSC vanished since Bank of America acquired them? I knew the owner and the CEO both departed shortly after the buyout, not seeing eye to eye with the six billion dollar Treasury divisions leader. More key executives have vanished. Is anyone left that is old school HealthLogic?" It’s been almost two years since the revenue cycle vendor was acquired. I’ve not heard a peep and all that’s left is what could well be the ugliest and most dysfunctional web site I’ve seen.

From IT RN: "Re: FAAN. Rosemary Kennedy, Chief Nursing Information Officer at Siemens, will be inducted as a Fellow into the American Academy of Nursing this fall. This is one of the highest honors that can be bestowed on a nurse. This is particularly impressive as very few Fellows are from the vendor arena."

From xtremegeek: "Re: Jon Burns, stuck cleaning up the mess at the University of Maryland Medical System, is making his move. Major restructuring on the way. Stephanie Reel might finally have some legitimate competition in Baltimore, MD. Also, a new CIO at Rex Healthcare in Raleigh, a senior PM from Dell, to start June 16, 2008." Thanks. I didn’t run the Rex name because I’d hate to be wrong and get her in trouble, but I don’t doubt your information.

From Tom Yumgoong: "Re: hated software. Top of my list is Office 2007. Outlook is fine, but I hate the ribbons on Word, Excel, and PowerPoint. My productivity has gone down so much because of trying to find things and extra keystrokes. It just sux." Indeed it does. I got tired of bizarre Access behavior and had that POS yanked off and Access 2003 put back on my work PC. The ribbon is just absurd, items gray out for no apparent reason, the help function is horrible, and the damn thing would lock up at odd times, like just clicking into a field definition or when trying to save a tiny SQL. You’re right – it was taking me half a day to do something that I could have cranked out in 20 minutes in the old version (to be fair, I didn’t take any training, so maybe there are dark secrets).

Someone posted a comment about some former CIOs who joined HIMSS and since left. I don’t know names, but it shouldn’t be hard to figure out. I did note that Liddy West has left there.

Microsoft names its Healthvault "Be Well Fund" recipients, organizations who will build applications for HealthVault. They look kind of interesting.

The folks at Sentillion have some hot jobs (engineers, analysts, implementations, and others). And speaking of Sentillion, Duke University Health System will deploy Tap & Go proximity card single sign-on solution for identity and access management, adding to its Vergence implementation.

We  interviewed Sentillion CEO Rob Seliger a few weeks ago, by the way. We also interviewed Paul Brient, PatientKeeper CEO, and former HTP CEO Ray Shealy on the RelayHealth acquisition. Good thoughts from the top.

NHS says 15 hospitals will be up on Millennium by the end of the year (five more, in other words).

Odd lawsuit: a woman receiving injections in a pain clinic develops an infection that paralyzes her. She claims the doctor didn’t swab her neck with alcohol first and neither the doctor or nurse can remember (since it’s such a routine practice, one might guess). She filed suit and jurors went with her version of the story, awarding her $6 million.

Listening: Go Betty Go, LA chick punk.

You’d think a hospital in chichi Boca Raton, FL would be doing well, but Boca Raton Community Hospital lost $42 million last year. Snip: "The hospital improved its billing system, hired nurses instead of using temporary ones and took control of spending on medical products." What kind of execs would wait until a whopping loss to do the obvious? And this sounds ominous: "New software and other improvements should bring $11 million that was missed last fiscal year." Like many hospitals that are on the ropes, they’re trying to build their way out the problem with new construction.

Interesting: Adventist Midwest Health is using EndoTool by MD Scientific of Charlotte, NC for glucose management (IV insulin dose calcs) which exchanges information with the EMR. I hadn’t heard of it, but here‘s the site (not very slick and disclosing no management information).

Donna Beed of Walter Reed Army Medical Center was promoted to lieutenant colonel in April and will become CIO for the Pacific Regional Command and Tripler Army Medical Center (HI) in August.

Big iPhone news, as scheduled: the iPhone 3G will go on sale for as little as $199 next month with an AT&T service contract. It’s faster, thinner, has GPS built in, supports VPNs, and has a software store. Docs will be carrying them within weeks, I’m guessing. Think of it as a computer that makes calls, not a telephone. Medical software introduced during Steve’s speech: MIMvista and Modality.

Drug companies are developing a system with CRIX International (which in turn seems to be working with Northrop Grumman) that will allow them to file clinical trial forms electronically, to enroll study participants, and to report adverse drug events directly from practice EMR systems (that part will launch in September at Brigham and Women’s).

The city council of Colorado Springs is upset with Memorial Health System to the point of considering selling it. This councilman summarized what I’ve seen of typical hospital board relations: "You whip 15 slides past me and I’m put in a position to draw the conclusion I’m led to draw." Council members didn’t know until they read it in the paper that the hospital’s new CEO had been hired and was given a $550,000 salary.

HIMSS announces two new organizations: the Institute for eHealth Policy (which sounds like a lobbying group, but may not be) and the National Health IT Collaborative for the Underserved.

E-mail me.

Inga’s Update

New recently announced installations: Virginia Commonwealth University Health system has successfully implemented McKesson’s Horizon Medical Image system; Pinecrest Hospital (WV) is now live on Medsphere’s OpenVista; and Robert Wood Johnson University Hospital has activated Eclipsys Sunrise Clinical Manager for its 4,000 users and claims its doctors are entering 75% of their 12,000 medication orders a day online.

The local Fall River (MA) newspaper features local employer Meditech and the high job satisfaction of its employees. It’s a nice, feel-good story that includes mention of the beautiful facility and very low turnover rates (two employees out of 60 in the last 2 1/2 years).

The Pittsburgh newspaper details the usage and costs associated with (non-profit) UPMC’s private jet. The paper estimates that over a nine-month period, UPMC staff flew the jet 58 times, averaging $18,752 per flight.

SleepEx announces the release of a new EMR that interfaces with sleep diagnostic equipment. Apparently the software is on display in Baltimore at SLEEP 2008, a national convention for sleep specialists (who knew there was such an organization?)

I came across a funny video from those zany Stratus Technologies folks describing virtualization and high availability servers. As the YouTube post says, even your mother-in-law could understand these concepts.

Greenway Medical Technologies, NextGen, Initiate Systems, and IBM are some of the technology companies demonstrating real-time standards-based clinical healthcare data exchange at this week’s National Health IT conference in D.C.

Secretary Leavitt names the 12 communities selected to participate in its national Medicare demonstration project. The five-year project provides financial incentives to providers using EMRs, with the goal of improving quality of care.

E-mail Inga.

Monday Morning Update 6/9/08

From McK Nugget: "Re: Vision Center. The new McKesson Vision Center is opening in San Francisco at the world headquarters (the second floor, to be exact). It has been under renovation for the past six months. It’s pretty cool to check out if you are ever in town." 

From Horton Hears a Who: "Re: hospital delay. St. John Health System has been implementing Cerner for quite some time." Link. Providence Park Hospital (MI) has pushed back its opening 28 days for EMR system work. Snip: "We changed some of our thinking around technical issues. We delayed the opening to allow for changes in our IT systems to occur. We are implementing the first fully electronic medical record system, in our health system. It is a very complex installation."

From Victoria Winters: "Re: conferences. Your HIMSS coverage made it more interesting and fun. You should report from others." It’s no coincidence that well known and well traveled bloggers are usually self-employed since they can snag add-on business to make it worth the trip. I’m an anonymous wage slave, so I’d be using my own money and days off. But, we’ll see.

From Steve Alaimo: "Re: Thomson Health. Heard on the street they reorganized their sales team. They hired a former VP of Sales from SoftMed to run the West Coast region."

A journalistic stretch: the local paper tries to goad Lawrence & Memorial Hospital (CT) into saying they regret signing with McKesson for clinical systems now that the state’s own attorney general is now suing the company for AWP inflation. It must have been a mighty slow news day or the paper works too hard to find local connections to somebody else’s story. First, being sued doesn’t mean you’re guilty. Second, guilty or not, the hospital is in final negotiations, so walking away doesn’t make sense. Third, the suit doesn’t change the reasons McKesson was picked in the first place. And fourth, it’s a massive company, so one part has little impact on the other.

I missed this: the guy behind WhereTheMoneyGoes.com, which rails against profits and salaries at non-profit hospitals, has been outed in The New York Times as not only running that site, but also an anti-Obama site. "The operative behind it is Joe Novak, 54, a consultant whose colorful history in Illinois politics earned him the nickname Low Blow Joe. A Chicago Sun-Times columnist once wrote that if dirty tricks were an art form, ‘Novak would be Renoir.’ … Mr. Novak said in an interview that lately he had been working almost exclusively for Mr. Rooney. His projects, he said, involve exposing inequities in health care that result in poor people’s being denied medical treatment or gouged by insurers and hospitals, topics of interest to Mr. Rooney, who champions medical savings accounts as an alternative to conventional health insurance." I interviewed him in 2005 and, to a large extent, agree with his cynicism about "nonprofit" hospitals raking in the money and paying big salaries, although now I see that our motivations differ.

Kudos to four IBM employees in Ireland, who used open source software to create a free service that lets senior citizens sign up for a daily "how are you doing" call. IBM also paid for the hardware.

Pittsburgh insurer Highmark will spend $29 million (0.42% of its $6.8 billion revenue) to encourage physicians to buy technology, paying 75% or up to $7,000 per doctor. Its similar 2005 program ran afoul of IRS restrictions on money transfer, so Highmark will pay doctors directly this time.

eCast, which sells provider and drug trials software, will  bring on up to 100 new employees in Raleigh, NC to double its size. Moving to Raleigh: Medis, which sells software for imaging modalities.

The nursing union at HCA hospital Centerpoint Medical Center (MO) petitions the hospital to complain about nurse understaffing, citing poor patient ratings. The hospital says the suit is a union tactic (they’re in contract negotiations) and that it’s trying to hire 300 nurses in a tight market. In a related lawsuit against another HCA hospital, plaintiffs representing a deceased patient claim (from the court filing): "… that HCA injured them and other class members by maintaining inadequate numbers of nurses at its hospitals as a cost-savings strategy. According to their complaint, HCA developed a computer software program,  implemented by its subsidiary hospitals, that caused the hospitals to provide inadequate levels of medical staff."

UK hospitals have had 522 laptops stolen in the past three years.

Former McKesson CEO Mark Pulido, who was de-pantsed by Charlie McCall into paying $14 billion for the book-cooking HBOC and fired six months later when the accounting scandal story broke, now works for an investment company … advising them about acquisition opportunities. Maybe Charlie should emerge from seclusion to sell him something else, like his new company, Hazmat Systems.

The White Stone Group’s newsletter (warning: PDF) not only has an interesting case study from West Jefferson Medical Center (LA), but also a recipe for hot fudge cake. They’ll be at HFMA, but probably without the cake.

I was Googling some old acquaintances and noticed that Wayne Miller is now with Vitalize Consulting Solutions in their McKesson practice. That led me to snoop around the website of some other HIStalk sponsors to see what’s happening, so I noticed that Intellect Resources has a weekly newsletter for job seekers (news and position listings). Hayes Management Consulting has an online newsletter.

Providence Portland Medical Center (OR) implements real-time locating of periop personnel and equipment from Sonitor Technologies and PCTS’s Amelior OR Tracker.

I was reading an article about software that users truly hate. My list: (5) SmartFTP. (4) QuickBooks. (3) Internet Explorer. (2) Windows Vista. (1) Lotus Notes. For me hate to software, it has to be a resource hog, counterproductive to what I want to do, and illogically designed by an arrogant company. I know a few healthcare apps that could have made the list from what I’ve seen firsthand, but I don’t use them enough to hate them.

E-mail me.

News 6/6/08

From Sherman McCoy: "Re: HCI 100. I highly doubt that VersaSuite is a $300 million company and that E*HealthLine has $290 million in revenues. Healthcare Informatics did a much better job this year in scouting out private company and divisional revenues for the rankings, but there are a good percentage that seem to be off by a number of decimal points." Link. I’m always suspicious of voluntarily submitted numbers that are hard to audit and incented toward exaggeration, but this is the best measure for those looking for some correlation of size to anything else. Too bad they can’t use tax records since those numbers are surely far more conservative. A good read in any case. Congrats to those HIStalk sponsors who made the list: Sage Software (#20), NextGen/QSI (#32), QuadraMed (#34), Picis (#37), Vitalize Consulting Solutions (#71), and Hayes Management Consulting (#86). Another handful of companies from the list are in the process of joining us, so that’s pretty cool. In case I haven’t said it lately, I thank all of our sponsors (on the list or not) for supporting HIStalk and its readers.

From Happy Days at McKesson: "Re: execs. Michael Simpson has been removed as the GM over Horizon Clinicals and sent over to the UK on a ‘special project’. While he did drive delivery of 10.1, which finally drives some semblance of integration and fills some of the major holes from a functional standpoint, his style did not work well with the development organization. Mike Myers has been asked to step in as the interim GM in addition to maintaining his responsibility for Life Sciences. The big question now: who is Mike grooming as the heir apparent? Billie Waldo is always a safe option. Merrie Wallace and Gerry McCarthy were recently moved into Horizon Clinicals as Pam Pure pointed at one of the recent All Hands meetings. Time will tell, but our team is going to step back and enjoy the fact that McKesson management seems to finally be listening to the development team vs. sales." Inga confirmed with McKesson: Simpson has been named CTO of the International Operations Group and Mike Myers is interim GM for Horizon Clinicals. Your information was dead on the money – thanks.

From Dr. Lisa Cutty: "Re: Cerner. I am wondering why Cerner is so relaxed about their NHS failures? According to this article, it was the poor Cerner performance which caused Fujitsu’s leaving. In their last shareholder meeting, there was no word about the troubles and the audience missed a chance to ask the CEO." Link. I don’t know if it’s Cerner’s problem entirely since NHS wrote the specs (I assume) and they’ve run off other big vendors with their inflexibility. If NHS didn’t budget money for scope creep localization and Cerner is already on a tight margin, I can see why there would be a stalemate on who pays. My opinion is that no vendor can make them happy for the price they want to pay. Cerner would take a black eye for losing business there, but I bet it’s so minimally profitable that they wouldn’t be too upset (once shareholders got over it, anyway). There’s always the Middle East.

Inga and I like doing interviews because (a) we have the same questions as readers and enjoy having them answered, and (b) we learn a lot by doing them. We just talked to PatientKeeper CEO Paul Brient and I have to admit that I didn’t realize how broad the company’s offerings are (who knew they have RHIO and HIE customers?) and that 10% of US hospitals are PatientKeeper users. They’ve got a good handle on the "last mile" problem of getting physicians to use hospital-related clinical systems. The interview is on HIStech Report. Worth a read, but I could be biased about that just a little.

I also interviewed former HTP CEO Ray Shealy, now a VP at RelayHealth after that company announced its acquisition of HTP just four weeks ago. I think this may be the first interview (and surely the most in-depth) with anyone at either company since then. It’s a meaty read that explains how the former HTP’s offerings fit with those of RelayHealth and gives a look at the broad industry trends of consumerism, the shift to patient financial responsibility, and the increased patient satisfaction that results from providing clear financial information upfront. Readers like me (non-experts in patient financial services) will get a good overview of what’s changing in that area of hospitals (hint: a lot).

Time has a nice piece on Cleveland Clinic’s use of information technology (if you can forgive the title’s absurd pun, Medical Mouse Practice). A snip: "Hospital policy mandates that every time a Cleveland Clinic patient sees a doctor in any of 37 buildings on the main campus or dozens of satellite locations in Florida, Abu Dhabi and southeastern Ohio, that doctor will be holding his or her medical chart. With paper records, physicians didn’t have those records 20% of the time. As soon as charts were digitized, EHRs were at their fingertips."

Listening: The Unlovables, NY female-led punk. Also: Sahara Hotnights, Swedish all-girl pop/punk. Punk chicks rule.

A study says that hospitals in which IT reports to the CFO have better financial performance. Actually, I’m reading between the lines since reading the actual lines themselves would set me back $7.95 and I don’t really buy the premise (and therefore the article). I recognize some Florida State University names among the authors, I think. I would think it’s hard to prove that IT reporting influences the hospital bottom line vs. happens to correlate to it in some way. There’s also the question of value and quality, of course.

St. Luke’s Episcopal (TX) will use McKesson’s Horizon Clinicals Care Team Release.

Speaking of McKesson, it will reopen its Vision Center that features futuristic technology (sharing the name and function of rival Cerner, apparently and oddly). The article doesn’t say where it is, but since Robot RX is pictured and I know the old one was in the Automation division in PA, I assume it’s there.

An analyst says online pharma advertising doesn’t have demonstrable ROI, so WebMD’s future may not be rosy. A good point: most sites simply repackage the same consumer information from a handful of sources, meaning the sites are pretty much alike. An insightful snip: "Consumers, frustrated by a lack of content depth and few new products or services, desperately pound Google to try and find ‘long tail websites’ to quench their information thirst (leaving Google the big winner in the online health space; not Pharma, not advertisers, not agencies)." Thanks to the reader who sent this over.

CHUM and McGill hospitals in Montreal will work together on clinical systems. Both use Oacis.

Hearst subsidiary First DataBank, drug data vendor for many (most?) hospital information systems, will pay $1 million in a class action settlement over allegations that FDB and McKesson conspired to inflate the average wholesale prices of drugs. McKesson continues to fight the suit.

The graduation ceremony for Verona Area High School (WI) will be held this Sunday in the auditorium of Epic Systems, whose 5,300 seat capacity eliminates the need for a ticket allotment for the friends and families of the 340 members of the Class of 2008.

California will launch a prescription drug database, the AG (former "Governor Moonbeam" Jerry Brown) announced Wednesday. Some of its expense is being funded by the charitable foundation of a web entrepreneur whose two children, ages 8 and 10, were killed in a traffic accident by a doctor-shopping drug abuser.

ACLU jumps into the electronic medical records privacy fray.

Erlanger Health System (TN) finally chooses PHNS in an eight-year outsourcing deal for the entire IT department.

E-mail me.

Inga’s Update

The Merge Healthcare saga continues as the company announces a reorganization of business operations and some executive management replacements. The company will rename itself to Merge Fusion, eliminate 60 of its 360 employees, and replace the CEO, president, CFO, and Cedara division president. Ken Rardin is out. Two of the four new officers come from Merrick Ventures, from which Merge borrowed $20 million last month, giving them five of 11 Merge board seats.

An Ann Arbor newspaper reports that the University of Michigan Health System has cut medication mistakes 29% following its online order entry implementation. UM also claims the $95 million UM-CareLink system (Eclipsys Sunrise) has cut 40% off the time between ordering and administration medications.

Mr. H mentioned in his last post he will be away for a few days next month, leaving me in charge. I look forward to ranting, “I’m in control here.” We’ve already had some entertaining (and famous) guest authors step up to offer their services, but we have room for a couple more. We have secured a couple of “Johns,” though I believe we only have one writer from the fairer sex (not Judy). E-mail us if you would like to participate.

I can’t decide what is worse: having to sell almost $8 million in stock options to satisfy a divorce settlement or having to send out a press release announcing it. If I were the ex-Mrs. Jonathan Bush, I would be planning some exotic vacations, replacing my SUV, and buying lots of new shoes.

KLAS releases the results of its ambulatory EDI clearinghouse survey. Navicure received top honors over the eight other rated vendors. Zirmed and Gateway also ranked high; Availity and Emdeon were at the bottom of the pack. The other evaluated vendors included The Consult, Misys, RelayHealth, and Ingenix.

The 45-physician Rush-Copley Medical Group (IL) selects Allscripts for its EMR/PM solution.

In an article about Oracle’s possible push into the healthcare space, an industry analyst predicts Oracle’s most likely targets to be Cerner, Eclipsys, and Epic. Epic claims they have absolutely no interest in being acquiring because they enjoy their private status.

Starbucks announces a new program that allows participants to sip a coffee and enjoy free Wi-Fi. There are a few requirements and limitations, but in my mind, few things go better together than HIStalk and a latte.

Beth Israel Deaconess selects iMDsoft’s MetaVision critical care system for its seven intensive care units.

Nuance Communications recognizes 17 healthcare organizations that achieved 125 percent or greater productivity gains or at least a million dollars savings using eScription’s CAMT solution. The Million Dollar Savings and Productivity Award winners included Brigham and Women’s Hospital, which was recognized for the highest savings total ($9MM since 2001.)

MultiCare Health Systems (WA) selects Sunquest’s LIS for the health system’s new hospital. MultiCare is also adding Sunquest’s CoPathPlus, Microbiology, and Blood Bank products.

Sunquest also announces that St. Cloud Hospital has achieved 100% patient identification accuracy and reduced non-identification specimen collection errors to virtually zero since implementing Sunquest Collection Manager in November.

Appalachian Regional Healthcare System is installing HealthPort’s revenue cycle management solution in three hospitals.

GE Healthcare and UPMC announce their forming a new company specializing in making digital pathology equipment. Omnyx is GE’s first standalone company formed with an academic medical center. Gene Cartwright, a former GE molecular diagnostics president, will serve as CEO.

E-mail Inga.

Readers Write 6/4/08

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

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

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

HIStalk vs. Trade Magazines
By MrDan

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

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

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

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

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

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

M.U.S.E Conference
By Green Tea

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

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

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

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

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

One prominent vendor was missing again– MEDITECH. 

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

Personal Health Records
By Tommy Callahan

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

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

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

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

Open Source Software Review – caGRID 1.2
By The PACS Designer

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

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

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

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

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

TPD Usefulness Rating:  9.

News 6/4/08

From Dr. D: "Re: Stanford. Seems like Stanford Medical isn’t the only lost account problem facing a certain big consulting company these days. Two more are about to fall due to missed milestones."

From DRPend: "Re: CEMHR. I have come to conclude that what’s really required is what could best be categorized as an Central Electronic Medical Health Record (CEMHR). The patient would have audit control and a place for personal information, but the vast majority would be a centralized repository that would take standardized medical data from a variety of sources. I favor the astronomy community standard of using geographically separate, redundant ‘central’ storage centers. I’d use a VMS login security OS with tunneling into other OS and Data environments. This would access a meta language-based interfacing engine to help build record variance recognition rules and provide an audit trail for anyone gaining access to the data. The big issue, of course, is security control, and that would most likely need a neural circuit algorithm based on multiple ID recognition criteria. No one method would work alone, so the whole process would require the kind of cross sectional parallel studies that only the Open source community could provide. Maybe it’s time to have a Healthcare Public Utility created which could bridge the gap between proprietary Software and OpenSource Software."

From Carol Wayne: "Re: Cerner/Google Health. Call me cynical, but I think there are other motives involved here. Of course the patient will not enter accurate medical information – they can’t. They don’t have it all in the first place and no one would trust something typed in by the patient for medical-legal reasons. BUT, if Cerner found a way to enter standardized information into a Google health record, in a fully locked-down, non-repudiated (is that a word?) manner, then the local hospital CIO will want to use that same message stream to populate their own data warehouse. So, Cerner and everyone else will be a step farther away from locking in the customers with proprietary messaging. Also, it will cost Cerner (and the other vendors) a LOT of money to convert to those kinds of standardized messages and no one is offering to pay the bill. So, while they can say that the PHR is useless to the patient/physician interface, there are other reasons to downplay the movement. Any patient with a complex medical problem can see the advantage of having an integrated data feed from multiple providers. Any vendor can see that, too, but wants to get paid. Stalemate." Agreed. Neal’s "electronic shoebox" comment is accurate for what PHRs are today, but of course he has the capability to turn them into something more, yet also has the proprietary interest to avoid doing so. PHR vendors need EMR vendors much more than vice versa. From a patient’s point of view, that sucks, but from a company/shareholder angle, why would I spend resources to help a potential competitor (and my existing competitors) for no benefit? Answer: if customers demand it. So in that regard, only Cerner’s customers can change his mind.

From Bobby Orr: "Re: electronic shoebox. Neal should be careful about throwing stones in glass houses. He already tried to put out a PHR that he charged for (HealthVault is free) with little or no success a few years ago. It was donated (free) to Type I juvenile diabetics and even that had little traction because everything had to be done by the patient (or their parents). Regardless, it is a solid concept, especially for chronic disease management, regardless of who provides the tool." Excellent point — Cerner does indeed offer its own PHR, so Google and MSFT are its direct competitors (and free).

From Dagny Taggart: "Re: Epic and NHS. About nine months ago, a high-level delegation of NHS personnel paid a visit to Evanston Northwestern Healthcare in Chicago to take a look at their Epic installation as a backup vendor. They were very impressed with what they saw, so much of the groundwork for Epic and the NHS has already been done."

From The PACS Designer: "Re: virtual storage networks. In the months to come, you’ll be hearing more about a new concept called the Virtual Storage Network or VSN. It is different from virtualization in that a VSN is an enterprise virtual network addressing storage. It makes efficient use of all storage locations within the enterprise through disc and tape partitioning. For example, if you have 100 PCs, the hard drive of each PC will be partitioned to grant 10 to 12 percent of that hard drive to VSN usage. An advantage that you can gain through this method is, if a PC is stolen, you will not lose the entire record file if parts of the stored file are archived elsewhere."

Listening: The Hellacopters, Swedish punk/pop, on their farewell tour right now.

Clarification: Healthcare IT News is not selling its e-mail list (I wasn’t implying they are, but an unrelated general comment I made might have misled one or two people) and the mailing list it is selling doesn’t include HIMSS members (which their list broker didn’t say in the announcement I cited). The publisher laid on some heavy-handed sarcasm in a forum posting that I didn’t care much for, but I’m still willing to clarify.

The Rockefeller Foundation will host Making the eHealth Connection: Global Partnerships, Local Solutions in June and July in Italy. It’s invitation-only, though.

Sign up to your top right in the Subscribe to Updates box and join 3,459 of your friends to get updates when I write something new at HIStalk.

Allscripts sent over a transcript of a couple of its customers touting its proposed merger with Misys. A snip: "It supports our best-of-breed strategy. We really went out there and said, Misys is the best on the practice management side, and Allscripts is the best on the EHR side, and we took a risk. We’ve been rewarded and we truly believe that both products are the best in the industry, so this potential merger really supports our best-of-breed strategy." That’s one thought, but here’s another: do enough prospects simultaneously feel that the respective company’s products are good enough to want them both and, even then, which products do you run with to avoid confusing the market? I’m not sure Misys has strong enough PM offerings to match up with the Allscripts EMR, especially with strong competitors tearing up the market on price. Of course, it doesn’t matter at all what Allscripts or I think … prospects will vote with their dollars and nobody can predict that outcome.

Dell Children’s Hospital (TX), less than a year old, gets a rented diesel generator courtesy of Austin Energy after that company’s failover to a backup generator didn’t work, leaving the hospital with power outages on three occasions.

Here’s an opportunity: I’ll be taking a few days off in July and I’m looking for guest authors who can amuse and inform HIStalk’s readers (but not too well since I don’t want to obsolete myself). Inga likes the idea of people whose first name is John/Jon (Halamka, Glaser, Bush), which is a fun. I like CEO-types (Judy, now’s your chance), clinicians, pundits, or celebrities (if you’re connected by one of those six degrees of separation thing to some big star who isn’t illiterate, they’re in). E-mail me if you’ve got the right stuff. I’ll feel better about being away if I know it’s in good hands, along with Inga’s of course.

Walter Reed Army Medical Center says an "outside company" breached one of its PCs, possibly exposing the information of 1,000 patients.

Not surprising: despite what I’m pretty sure were quite a few nominating votes, somehow I didn’t make the ballot for the 100 Most Powerful People in Healthcare even though I’ve never heard of many of the folks who did. I cry dangling chad!

A reader is looking for an HIT colleague from the 70s, Dr. Ed Heller. E-mail me if you can help. Thanks.

Just announced: HLTH Corp. will sell its ViPS data analytics business to General Dynamics.

Jobs: Product Consultant – Sales Support (virtual), Systems Analysts (FL), Sales Executive – McKesson Practice (PA), Executive Project Manager – Nationwide (virtual).

St. Mary’s Hospital (WI) goes live on Epic, one of 20 SSM hospitals that will be implemented by 2011 at a cost of $330 million.

Interesting: a new study gave tablet PC-powered health surveys to adolescents waiting to see a doctor. 59% of respondents screened positive for injury risk, depression, or drug abuse, allowing doctors to address them immediately. I’ve read other studies showing that patient histories are more accurate when completed on the impersonal computer rather than face-to-face or on paper because issues perceived as embarrassing.

An article about a medical tourism conference predicts the future: you take your own blood sample and mail it off, check your result on a web site, then call a 24-hour help line of Indian doctors to get advice on what to do next (or in which country to have surgery). Unrealistic? Not if it saves money.

Speaking of medical tourism, patients are sneaking across the Mexican border for better medical care. From the US side, that is, since hospital care in Mexico is apparently a lot more responsive and less expensive. Says a patient: "U.S. hospitals are too slow, too expensive and treat you like a herd of cattle. It’s a vicious cycle of people and doctors who abuse the system."

The Wall Street Journal reports that hospitals or their collection agencies are selling patient debt in online auctions, raising concerns that buyers (often collection agencies themselves) will strong-arm patients to pay up (a novel concept in healthcare). Auction sites mentioned: ARxChange and Medipent.

The opening of a new Providence Park Hospital (MI) is delayed a month to install EMR hardware.

CMS says that hospitals can pay for custom interfaces to physician practice EMRs without violating Stark.

Just in case you want to read the 2003 employment agreement of the president of Allscripts’ TouchWorks division, it’s on the web for some reason.

Thanks to readers for reading and sponsors for sponsoring. Criticisms aside, I spend a ton of time trying to get you the right information quickly (with the occasional entertainment thrown in). I’m proud that, in my reader survey, 75% of you said HIStalk helps you do your job better.

Idiotic lawsuit: a guy claimed he broke his wrist in a single-car accident in 1999, but the hospital ED didn’t X-ray it. He got surgery later that year after a walk-in clinic visit and sued the hospital and three doctors. He agreed to delay the original 2005 trial date, skipped a 2007 date claiming he had new injuries, and didn’t show up at all for trial this year. His lawyer quit, he disappeared, and the defendants had to hire a skip tracer to try to track him down (with no success). Case dismissed.

Odd lawsuit: a hospital employee sues her employer for not training her to walk across a rug, leading her to fall over it. The employee tripped on a scrub room rug and fell. She’s suing, claiming permanent injuries, past and future pain, mental anguish, impairment, disfigurement, lost earnings, medical expenses, and attorneys’ fees.

E-mail me.

Inga’s Update

I hear that Medventive, a developer of evidence-based medicine software solutions, has raised $3.55 million in Series B funding. Former Sentillion president Nancy Ham is president.

I could use a little funding myself, despite receiving my economic stimulus check in the mail this weekend. I suppose I should count myself lucky that I got one at all, but it’s hard to feel stimulated by $10.78, especially after just spending $100 (!) to fill up my SUV.

Ophthalmic PM/EMR software vendor First Insight partners with DrFirst for e-Rx and medication reconciliation. Meanwhile, Kryptiq is GE’s exclusive Centricity e-RX partner.

A delegation from the Hashemite Kingdom of Jordan trekked over to Midland Memorial Hospital to check out their Medsphere OpenVista installation. I have actually been to George Bush’s home town and found the people very nice, but I wonder if Midland felt a little “simple” compared to life in a Kingdom.

The birth of the new Allscripts-Misys Healthcare Systems, Inc. is still on track, following the expiration an anti-trust regulatory waiting period (13-syllable name and all).

If you are a road warrior, you might want to check out Computerworld’s list of “8 incredibly useful tools for road warriors.” Lots of nifty gadgets mentioned including an oldie but goody, cellophane tape.

Eclipsys and Emerging Health announce a partnership to provide joint services in the NY/NJ/CT area. Eclipsys will leverage Emerging Health’s implementation expertise while Emerging will market Eclipsys and provide remote hosting services.

The Insight Research Corporation, which does market research for the telecom industry, releases a report estimating the US healthcare system will spend $55 billion on telecommunications services over the next five years. That is a compounded rate of 8.4% over the forecast period.

The Federation of American Hospitals, which includes for-profit members LifePoint Hospitals, Universal Health Services, and Tenet spent $630,000 on lobbying in the first quarter. That is about half of what Oracle spent over the same period.

Our little HIT world seems fascinated by the drama going on in the UK and their NHS. It’s somewhat like our culture’s intrigue with Britney’s struggles or the latest celebrity divorce. We’re addicted to other people’s problems because it makes our own struggles seem smaller. If you need to feel better about your little world, read about the recent woes of several trusts that were forced to shut down their Personal Demographics Service after a software upgrade.

The Kroger Company invests in The Little Clinic LLC and plans to expand the grocery chain’s walk-in medical clinics. Kroger operates 26 PA and/or NP-staffed Little Clinics.

E-mail Inga.

ONCHIT Releases New Strategic Plan

ONCHIT today released its strategic plan for 2008-2012. The full PDF file is here.

A few highlights: develop a privacy and security framework that reconciles inconsistent standards, “foster the business case” for the exchange of health information and encourage competition, encourage standard formats for freestanding PHR information, increase the number of EHRs that have clinical decision support, and develop standards for aggregating population health information.

Specific 2012 targets for physician practice EHR adoption: 40% overall, 12% for practices of five doctors and fewer.

More emphasis on CCHIT certification: “Specify that, to the extent permitted by law, certified EHRs and products are necessary components for any federally funded programs, pilots, and demonstrations that include the use of health IT.” A 2010 milestone is to have the majority of physician EHRs in use to be CCHIT certified.

ONCHIT will encourage health profession licensing bodies to include informatics criteria in their standards.

CIO Unplugged – 6/1/08

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

Got Clinicians?
By Ed Marx

If you don’t, you should. How many credentialed clinicians should a healthy IT department have? We presently have twenty percent—MDs, RNs, Radiology, Medical and Pharmacy techs, Pharmacists, therapists and a smattering of other less common specialties. I’m pushing to raise that figure.

I was recently requested to be the keynote speaker at a Nurses Week celebration at one of our system’s hospitals. Being a keynote is an honor in itself. But for me, speaking to the caregivers of our patients put this opportunity over the top. Although my presentation did not rank at what I’d have labeled top notch, preparing for it proved invaluable. It reinforced my admiration for caregivers, especially nurses. It also reminded me to permeate my IT staff with clinicians to ensure that our labor is accomplished with the caregiver in mind.

I long for the day clinicians are present throughout IT, including technical domains such as networking, data center, and other atypical areas. True, they are more dominant in application areas, but why limit the potential? The blending of clinicians with technologists could lead to higher levels of transformation and innovation. Here is our most recent revolutionary venture: we just added a physician employed by our organization that possess clinical and technical skills and leadership talents, and who will work closely with our CTO. I’m watching eagerly for the effects to unfold over the next few months.

Okay, so you’ve read the existing articles on how clinicians benefit an IT staff. But once you have them, how do you best position them and your traditional IT staff for success? What are the inherent challenges for clinicians and IT?

Note: Are you aware? When a clinician comes aboard as an IT staff member it is equivalent to starting a brand new job?

Think back to your own job changes. Could a swim coach apply her swim skills to her new waitress position? What about a massage therapist employing his talent in a paralegal job? Keep in mind this concept as you read the following practical tips on clinicians joining IT as shared by one of our clinicians, Diana Gibson, RN…

Challenges for Clinicians:

· Adapting to the office environment

Cubes vs. nursing station reduces the sense of teamwork

Use of meeting rooms is equated with loss of casual social interaction

Taking work home

Going out to lunch vs. grazing between patient care tasks

· Difficulty recognizing accomplishments/results

Need to understand the bigger picture (see beyond the patient)

IS systems are configurable with lots of gray areas; reduced workflow focus

No more rapid results (average patient los is 3 days)

Used to implementing changes quickly

Giving up precision and timing on tasks

· Loss of familiarity generates stress. The clinician must:

Learn new tasks, find new resources, and create a new employee network

Learn basic IT software (No more IVs)

Fight pressure to already understand IT on the first day of work

Assimilate IT language/acronyms

· Facilitation skills are not in the typical nursing repertoire

Scheduling appointments

Creating agendas

Taking minutes

Using a meeting room to solve problems as opposed to on-the-spot interactions

· Common conflict areas and issues of concern for clinicians

IT staff is generally unaware of clinician’s former environment and the required adjustments

Lack of training for clinicians in IT subjects

Clinicians are expected to already know what to do

Downtime scheduling affects issues regarding patient care

Clinicians have an inherent desire for more testing on software/applications (like testing a drug before giving it to a patient)

Bridging the gap and investing in clinicians:

Preceptor program

Increase depth of typical IT orientation

Pair new clinical staff with experienced IT person; identify future clinician leaders

Document and publish referable guidelines

Create web based training on IT tools

Project Management Training

Create PM processes that nurses/doctors can relate to

Help user/clinician visualize the big picture and break it down into tasks

Professional Development

Develop a Facilitation/Leadership class

Provide Continuing Education Credits (CEU)

Create internal training opportunities specific to clinical IT

Develop clear development pathways, like a clinical ladder

Clarify the position’s responsibilities

Embrace the significance of melding clinicians with IT. Be more intentional with it, maximize the value, and encourage further adoption. A healthy mix is a key to a high performing healthcare IT organization.

Got Clinicians?

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.”

Monday Morning Update 6/2/08

From Dr. Know: "Re: Stanford. Spoke with a physician at Stanford today. They recently went live with Epic. The physicians are in revolt: ‘takes too much time and is very difficult to use.’  Also, if you admit a pediatric patient through the ER and they need to be admitted into the children’s hospital, all of the information needs to be re-entered manually from paper, as Lucille Packard runs Cerner and it is not interfaced with Epic, which is running at Stanford Hospital."

From kcstar: "Re: Jay Parkinson. For all of your fawning, it seems he was more of a self-promoter than a physician. The outcome was predictable, and as he even stated, ‘unsustainable’." Link. I interviewed him, but I wouldn’t say I fawned. He has some good ideas and I like the idea of going off the grid (as Scott Shreeve says), but he’s not fault-free. He thinks he’s got the entire system figured out despite being a new med school grad, he seems to be a bit smug, his kind of medical practice has zero relevance to the 99.99% of the country that’s not in New York City treating young and healthy hipsters for the occasional sniffle, and he seems to hate just about everything and everybody involved in medicine outside his little world. For a brand new doctor, he’s shrewdly wangled his 15 minutes of fame, but can his "tear it down and start over" ideas scale and is he really the best spokesperson for changing medicine just because he does magazine interviews and blogs and sometimes finds time to see a patient for cash? Time will tell. Give him credit for some pretty fresh ideas, at least, even though his experience with the non-fresh ones is minimal. I’m happy he took the time to be interviewed here since few in the industry had heard of him back in November and the ensuing debate was interesting.

Speaking of 15 minutes of fame, Dann, who started the HIStalk Fan Club on LinkedIn, let me know that it’s up to 58 members, which I find astounding and immensely gratifying (especially when I see the roster of highly accomplished folks who signed up – thanks!) I keep thinking I should offer something in return, like dibs on signing up for the HIMSS shindig or something (which, FYI, looks to be on track). Having a fan club is pretty darned cool, especially since being anonymous eliminates the possibility of egomania.

I do my share of Neal Patterson ribbing, but I’m also on record as being a fan in many ways (started Cerner and stuck around, didn’t sell out to some conglomerate, says whatever he damn well pleases). Case in point: Google is sweet-talking Cerner about jumping on the shaky Google Health bandwagon, but Neal is keeping them at arm’s length since he doesn’t buy the PHR concept, which he calls "electronic shoeboxes" that put the onus on consumers for record-keeping. I’m with Neal on that one. Consumers might use healthcare search engines and social networks, but they aren’t going to keep reliable medical records.

If you get Healthcare IT News, your information is available to anyone willing to pay $150 per thousand addresses for list rental. HIMSS calls the publication a "member benefit," i.e. you get a subscription by default to boost its ad rates, but apparently the benefit isn’t entirely yours. I must be the only person who has thousands of industry e-mail addresses that I won’t share with anyone.

Ah, to have minimally inquisitive publications willing to print whatever companies send over. Health Imaging News crows about McKesson’s "unveiling" of MyPacs.net. A 10-second Google fact-check would have shown that to be false: the original journal article describing its development was accepted in 2001 and the site was announced at RSNA 2002. Unless "unveil" means "bought the original company and put out a press release," it most certainly was not just unveiled.

Fundraising software vendor Blackbaud, whose products are used by many hospital foundations, will buy struggling competitor Kintera for $46 million in cash.

The 12-hospital group in Canada whose MEDITECH systems were down is back online. The company blames a corrupted file, but the media report says two US hospitals had the same problem at the same time. Seems suspicious that three customers all had corrupted files simultaneously.

Wyoming is considering allowing CNAs to administer medications, but only for specific drugs, most of them non-prescription. A waste of time, it would appear, since patients seldom need only those meds, so the nurse would have to go behind them to finish the med pass anyway.

Ontario will invest $109 million to improve ED efficiency, with part of the money set aside for IT.

Thanks for reading. If you aren’t getting the e-mail update or Brev+IT, you can sign up to your right (and I won’t sell your information). I’m always interested in rumors or thoughts, easily submitted by clicking that big green Rumor Report box to your right.

E-mail me.

Art Vandelay’s 10 Tips for Finding IT Budget Cuts

1. Create a list of all contracts. Detail the benefits of the components to the business. Document the key terms. Be sure to include the impact of canceling and restarting maintenance. Look for consolidation opportunities. Also look for areas of low impact if a cut occurred. Possibly negotiate longer-term maintenance deals (ex: go from one-year maintenance to three-year). Review contracts for network carrier services, cellular and wireless data, pagers, real estate leases, and power.

2. Review your application inventory and document functions. Look for overlaps and apps with few benefits. Consider the cost of consolidation and migration.

3. Review the project inventory budget impact. Consider initial and recurring costs. Look for overlaps, low tangible benefits, and those with long paybacks. Consider leasing hardware or software. Also consider risk-based contracts for services.

4. Create chargeback reports if you aren’t doing so. This requires developing a list of all costs and an allocation method. Look for business units with an inordinate amount of costs with little tangible return. In more progressive organizations, the reports allow leaders to monitor and adjust their variable costs with some explanation of the impact.

5. Create a database of staff ratings including true performance reviews. Next, align the output with the project inventory and application importance or benefits. Identify staff that can be cross-trained to pick-up other projects in the pipeline if a staff reduction occurs.

6. Run a zero-based budget with a fair-minded financial analyst involved. Note the areas where cuts occur so you are ready if asked.

7. Analyze the use of your reporting applications. Provide real examples of where the tools can benefit this type of analysis, such as staffing, lost revenue, cost reporting, and supplies.

8. Consider virtualization and consolidation. Potentially related benefits include reduced power consumption, heat generation, and maintenance costs Align hardware with key benefits. Focus investments in hardware on those platforms benefiting the business the most as well as where you have the most skills.

9. Bid all hardware purchases even if it moves them away from your standard suppliers. Minimally, this gives you leverage to keep your suppliers honest.

10. Consider use of open source software where you have or can buy or build skills.

News 5/30/08

From Moses: "Re: CCHIT. Big changes for 2008 CCHIT ambulatory certification criteria that goes into effect with the first application window 07/01/08. Two new extensions to the base certification, Child Health and Cardiovascular. Certified status good for two years as opposed to current three. Lots of new interoperable functional requirements." Link. The two new extensions are optional, but enhanced interoperability is not (sending and receiving patient summaries per HITSP standards). And, did you notice that those exciting new NAHIT acronym definitions differentiate the term EHR from EMR by basically saying that CCHIT-certified EMRs are by definition EHRs, but everything else is an EMR? Seems a bit self-referential. I personally think EHR is a standard no vendor has yet reached (longitudinal, containing health and not just medical records, accessible for reading and updating by all providers from pharmacies to acupuncturists, and contributing to aggregate data sources). But, who am I to argue with BearingPoint, especially when I’m not the one getting $500K?

From Craig Garrison: "Re: Misys. The end of their fiscal year is May 31 and apparently only about 10% of the sales force is expected to achieve quota. Bet that a number of salespeople become available for hire over the next few weeks (some by their own choosing and some to Misys choosing)."

From The PACS Designer: "Re: miniPACS. A new miniPACS has been developed by researchers in South Korea. The team at Seoul National University Bundang Hospital reports that the miniPACS they developed is wireless and saves time when compared to manual archiving of digital records. The researchers utilized a laptop computer with 802.11b wireless LAN functionality and incorporated internally developed DICOM modality and storage server modules. The mean time interval from image acquisition to main PACS server storage was five minutes and 42.4 seconds when the wireless miniPACS was used, compared with 38 minutes and 25.5 seconds without." Link.

From Curious: "Re: downtime. Last week, while visiting a patient at Hillcrest Medical Center in Tulsa Oklahoma (an Ardent facility), I heard the nursing staff complaining of their system being down. Being the curious HIS professional, I could not resist inquiring as to the nature of the problem. They were told the downtime was the result of a fire at the Nashville data center.  Also, they were told it could last several days. Not sure what happened, my friend was discharged the next day. Sounded like big news! Does anyone know if Ardent or McKesson made an announcement or possibly declared a sentinel event?" Perhaps Inga can make an inquiry.

Hartford Hospital will repay $800,000 to Medicare for chemotherapy overcharging. I don’t know why hospitals don’t complain more about the ridiculously complex software and process requirements just to get bills out to the feds, which I’m guessing gave Hartford heartburn. Example: now they want NDC numbers and complex package size calculations every time outpatients get drugs. Nobody barcode scans outpatients (surgery, cath, etc.) Nobody except the caregiver knows exactly what they used to prepare an individual patient’s dose. It’s nearly impossible to follow the guidelines about package size choice and wastage. Imagine the clinical good that could be built into systems if they weren’t constantly being overhauled just to keep Uncle Sam happy. Anybody complaining about how far behind healthcare IT is compared to other industries should have to sit through an overview of how grouper and case mix programs work. No industry I know of has to spend so much automation energy just to create an invoice.

This article on practice EMR adoption is more interesting when it talks about the inpatient EMR cost of a couple of hospitals: Texas Health Resources ($200 million) and Baylor ($240 million.)

Scott Shreeve noticed that Ingenix apparently plans to go open source with its analytics tools. Check this quote: "I think it is because we don’t define ourselves by our products alone, but the problems we solve and the imagination of our people and clients. Believe it or not, our employees would rather be known to our clients for solving bigger problems and being known as industry leaders than for competing based on proprietary data and methodologies. This represents a whole new way of thinking for us if we are willing to improve." That’s pretty cool. I’ve asked for an interview, so we’ll see.

Inga mentions below that Fujitsu is pulling out of its NHS contract (following Accenture, of course, which already retreated tail between legs). BT is the heir apparent, but here’s the rub: like Fujitsu, BT uses Cerner as its subcontractor for the London region. Some NHS folks have been bitterly and vocally opposed to Cerner Millennium, possibly the point that NHS could decide not to choose another contractor at all, letting the trusts go their own way. I’ve said all along that localization issues would be a struggle for Cerner and that iSoft had plenty of problems before it ever hooked up with NHS. Are there any vendors left ready to step up to the plate immediately with a greater chance of success? Just one: Epic. Here’s why that makes sense: they’ve proven through Kaiser that they can handle massive deployments, they’ve been rumored to have an interest in going international, it’s by far the highest KLAS-rated system, and just about every large US health system making a clinical systems decision seems to pick Epic these days and they’re all doing just fine (other than the monstrous cost). If they want to expand outside the US, the UK is the obvious choice, especially since it’s big business in one swoop. I don’t have any information (insider or otherwise), but if Millennium comes under serious UK fire, I bet Judy will be on a plane (if she hasn’t already been). CERN shares were down 2.7% today.

Proof that spell check still requires human oversight: this press release. Sunshine Medical Clinic became SunShine Medial Clinic, which implemented Electronic Medial Records software. And course, you just know that mistakes of that magnitude will conclude with a HIPPA gaffe and you won’t be disappointed. I could point out a few more errors, but that’s plenty.

A new problem: researchers are getting caught Photoshopping the images they submit to journals.

Jobs: Clinical Applications Specialist (MA), Database Administrator/Architect (MA), HL7 Interface Analyst (TX), Medical Billing Professionals (CO), Service Specialist (TX). Gwen writes a fun, chatty weekly newsletter with all the jobs that even I read, for which you can sign up here.

Orion Health is offering a white paper about the use of its integration products with MEDITECH.

Cardinal Health may have one of its drug warehouses shut down by the Ohio board of pharmacy for selling large quantities of controlled substances to a company that was peddling them on the Internet.

E-mail me.

Inga’s Update

The EEOC files a federal class action lawsuit against John Muir Health (CA), claiming that it didn’t hire at least seven nurses based on a doctor’s incorrect diagnosis of latex allergies. The lawsuit contends the organization acted "with malice and/or reckless indifference to (the nurses’) federally protected rights."

NHS terminates its $1.8 billion contract with Fujitsu for EHR implementation at a southern England hospital following a dispute over the government’s demands for more flexibility over the system being installed. NHS and Fujitsu could not agree on payment terms for the changes.

Meanwhile, the CEO of Worthing and Southlands Hospital says its Cerner Millennium system is still suffering from “inferior functionality,” leading to “significant level of discontent among clinicians.” He also goes on to say the hospital is unable to satisfactorily capture, record, and bill all activity. Sounds like they’ve got themselves one big ole mess over there.

Moses Taylor Hospital replaces Microsoft Exchange with Linux-based Exchange clone PostPath. The IT staff claims PostPath was half the price and is working well for its 700 users.

A few days ago, we mentioned the city of San Francisco is suing McKesson for allegedly conspiring to artificially inflate wholesale drug prices. Now Connecticut has followed its lead with a similar suit.

Microsoft announces it has bumped its funding an additional $1.5 million for its HealthVault Be Well awards, designed to “encourage innovative online solutions to address significant health issues.” If I were Mr. H, I would probably say something cynical, like Microsoft is simply trying to pay more companies to interface with HealthVault. Since I am Inga, I will instead say kudos for any effort to improve health and outcomes for patients.

Berger Health Systems announces its successful deployment of the PatientKeeper Platform and Physician Portal.

Aetna is named the top payer for its business dealings with physicians in athenahealth’s latest PayerView rankings, which are based on actual claims performance for athenahealth providers. The State of New York’s Medicaid program ranked last in the nation due to its complex patient referral authorization requirements, slow or non-existent reimbursement policies, insistence on the use of proprietary medical claims forms, and confusing and paper-based billing requirements.

A computer crash Monday affects 12 northwest Ontario hospitals. The hospital issued this statement Tuesday: “We currently know that this is not a hardware issue, but is rather an issue related to software code. Our vendor, Meditech, is working diligently to remedy the situation. The delivery of patient care will be slowed as a result of this interruption of service. Expect longer waits, especially in the Emergency Department.” Officials also say the outage poses no risk to patients or their data (assuming you are not bleeding to death in the ER, I suppose). They also claim it’s difficult to project when the problem will be fixed.

E-mail Inga.

News 5/28/08

From drNurse: "Re: new site. Thanks for the best blog in the world! Fabulous news! HIStalk makes my day. Have you seen this? (It showed up on the AMIA OpenSource working group list…)  Pretty funny, and, sadly true. One of our faculty just wrote to ask if they have an academic advisory board. They need one, don’t you think?!" Link, and also its sister site. Somebody mocked up a pretty fun parody of CCHIT and EMR vendors. Given the carefully hidden registration information, the elaborate site design, and the flurry of blog mentions that surely aren’t coincidental, I’m betting it’s a viral marketing project of a vendor. I got quite a few e-mails about both sites. I think they do need an advisory board and you and I should be on it (for an appropriate stipend and travel to exotic meeting locales, of course). Thanks for your ultra-nice comments, by the way.

From Charles Bronson: "Re: RHG. They laid off their entire Employer Group business unit on Thursday, 21 people representing most of the seasoned health care people." Unverified, but I’ll ask Inga to check it out.

From HIS_Grue: "Re: Philips selling MedQuist. MedQuist is the world’s largest medical transcription company and would be larger if the Cbay/MedQuist merger goes through. The new MedQuist transcription platform has speech recognition technology from Philips firmly embedded in it and MedQuist resells products from Philips. The plan mostly worked, other than the litigation issues that caused selling for a loss and taking away near-term revenue gains."

From Rogue: "Re: retail clinics. In the 80s and 90s, it was all about walk-in clinics or, as they were so horribly monikered, ‘Doc in the Boxes’. Having consulted to 20 or so of them, they were very different from today’s retail clinics. They were staffed by physicians and the well-done ones partnered with the local medical staff for PCP and specialist referrals. However, the best revenue models relied on 1/3 of patients being repeat customers, so there was inherent conflict in trying to hook everyone up with local medical staff for an ongoing relationship. Hospital-sponsored clinics had to wrestle with economic viability vs. peace with the medical staff. Today’s clinics can learn from the walk-ins. Those I saw never had an electronic record and it was a cash/credit card business – here’s your superbill, you go hassle the insurance company."

I got a response from Dossia’s PR firm about the reader’s speculation that they would part ways with Indivo, which the CHIP people denied last week. "Dossia has no plans to change from using Indivo as its core technology and is working closely with the Children’s Hospital team to deliver the next release of Dossia; to that end we are even moving into the same office space in Cambridge." Sounds like that rumor has been put to rest.

That RAND study that Cerner paid for and quotes widely (claiming HIT will save $77 billion a year) is hogwash (warning: PDF), according to the Congressional Budget Office. Criticisms: (a) it estimated potential impact, not likely impact; (b) it excluded studies that didn’t show positive HIT effects; and (c) it used 2004 adoption trends. The benefits, it says, will mostly accrue to integrated delivery systems, which are, not coincidentally, the only constituency installing them in significant numbers. CBO was equally critical of a similar study by the Center for Information Technology Leadership, declaring its assumptions to be "overly optimistic." The conclusion is exactly what you’d expect: it’s not the systems, it’s what providers do with them that might provide benefits, and they are more likely to improve quality than save money. And you know what? Improved quality is reason enough.

Listening: new from The BellRays, fierce soul from California, like Tina Turner backed by the best indie band you’ve ever heard. Check the second video if you’re sick of lip-synching posers. My highest rating.

Consumer Health World gives (warning: PDF) the Order Facilitator product of SCI Solutions an award for "Best Web Tool for Promoting Community."

Inga and I are getting more user-submitted material (which we like), so we’ve decided to give those writings their own issue of HIStalk once a week or so (on a day we don’t usually write). Send in your editorial or other commentary (under 500 words and subject to editing) and maybe we’ll feature them on Reader Day. Informative, amusing, sarcastic … it’s up to you.

Final results of the CIO education poll: 57% say no Master’s degree is needed, 43% think it is (if you don’t have one, hope your future boss is in the slight majority). New poll to your right: will NAHIT’s freshly minted abbreviations increase HIT adoption? Not to show my cards, but my guest editorial in the newsletter tomorrow is entitled Hello, NAHIT? Wanna Buy My Dictionary for $29 Billion? Here’s a snip: "Note: it is law that every healthcare IT article written by dull reporters or unimaginative academics must start with one of two opening lines, either, (a) ‘In 2004, President George Bush called for every American to have electronic health records by 2014’ or, (b) ‘In its landmark 1999 report To Err is Human, the Institute of Medicine said that medical errors kill 98,000 Americans each year.’ Spoiler: this one goes with (a)."

A CIO told me a curious story about a new computer virus he’s seen that isn’t in McAfee’s definition files. Microsoft says they’ve seen it only in healthcare. If you’ve had a similar experience, let me know and maybe we can figure out if there’s a common software exploit or geographic area.

Robertson Research Institute (MI) releases a new version of its medical diagnosis software NxOpinion, which is marketed primarily outside the US.

Best wishes and thanks to James Liska, 42, a biomedical equipment manager at Lawrence & Memorial Hospital of New London, CT and sergeant in the Connecticut National Guard, shipping out for the Middle East next month with his unit. Hospital CIO Kim Kalajainen took time to attend an employer appreciation event Friday at Fort Dix, leading to the article I ran across.

Cerner announces a Millennium go-live at a 468-bed Johns Hopkins-affiliated hospital in United Arab Emirates.

Medsphere is offering a June 4 webinar on Midland Memorial Hospital’s reaching Stage 6 of the HIMSS Analytics EMR Adoption Model.

McKesson’s CERME makes this hospital software coordinator’s Bad, Bad Software list. "During this debacle, the tech guy informed me that the database name ‘Care_Enhance_Review_Manager’ was unacceptable. (It’s a frickin database name. It’s frickin acceptable) How do I know it’s frickin acceptable? Because it was THEIR previous tech person who frickin named it that and it worked for years that way. So anyway, this guy insists on creating a new database with the proper name ‘cerme’. Hmm… why not just rename the old one? BECAUSE HE DIDN’T KNOW HOW TO FIX IT." It’s amusing and honest, which means someone will probably demand it be taken down.

And speaking of McKesson, this is odd: the company reimburses CEO John Hammergren for his lawyer’s time in convincing them to boost Hammergren’s pay.

MedAvant will sell its lab results reporting business to focus on EDI.

Thailand-based medical tourism hospital Bumrungrad International will rent laptops to patients, hinting that it may eventually use conferencing applications to connect patients to caregivers.

Two employees of Maimonides Medical Center (NY) are arrested for patient identity theft and using a doctor’s PC to set up an account at Neiman Marcus.

Former GEMS IT CFO Brian Gladden is named CFO of Dell.

Odd: a British hospital RN loses her license for offering sexual services via a web site, then meeting with an undercover reporter posing as a john while wearing her hospital uniform (complete with badge) and using her real name.

New appointees to the HHS’s National Committee on Vital Health Statistics: Harry Reynolds, BCBS of NC; Mark Hornbrook, Kaiser Permanente; Blackford Middleton, Center for Information Technology Leadership; Walter Suarez, Institute for HIPAA/HIT Education and Research; and Sallie Hunt Milam, chief privacy officer for WV and executive director of the WV Health Information Network. NCVHS advises HHS on health data, statistics, and national health information policy.

I hope you had a nice holiday (and flew your flag). I did nothing work-related for two whole days, a personal best that left me bored but rested.

E-mail me.

Inga’s Update

We can land an aircraft on Mars, but we can’t get rid of the ants in NASA’s computers. Ants are infiltrating computer systems in NASA’s Texas area and knocking systems offline. Sounds like a movie waiting to be made.

Neal Patterson is bullish about Cerner and healthcare IT companies in generally, predicting continued growth in the industry. The comments were made at Cerner’s annual shareholder’s meeting last week.

A British newspaper publishes a few of the top medical errors at Norfolk and Norwich University Hospital. Most were the result of human error and were medication incidents (sound familiar?) However, the accidental gluing of a patient’s eyelid sounds pretty unusual.

Meanwhile in the UK, the NHS has announced full deployment of their new EHR system has been delayed an additional four years, until 2014-15.

CCHIT announces the 2008 Ambulatory EHR certification requirements. The new criteria include additional interoperability requirements. Also new are optional certifications in pediatrics and cardiovascular medicine. Look for announcements on the inpatient requirements sometime in June.

The Advisory Board Company purchases Crimson, a provider of data, analytics and business intelligence software to hospitals, health systems, and physician clinics.

Imprivata releases results from its Identity Management Trends in Healthcare 2008 survey of 171 healthcare IT decision makers. On the rise: tools for accessing applications and networks regardless of location in and out of an organization’s facility. Password management and application security are productivity obstacles.

NextGen announces (warning: PDF) that Health Management Associates will utilize its revenue cycle management services. Healthcare Management already uses NetGen’s PM and EPM solutions.

Dutch scientists claim they have completed the first sequencing of an individual woman’s DNA. Since 2001, the DNA of four men has been sequenced, lending proof to the theory that women are harder to figure out.

E-mail Inga.

News 5/23/08

From Garrnut: "Re: TEPR. TEPR was a bust. Not very well managed. Badges were hard to read (titles were bigger than company  names – who cares about them when you can’t tell where someone is from?) Exhibits were few and small and staffed by 10-year-olds. Sessions were repetitive and some were downright boring. I read somewhere that they’re trying to shake the boring stuff and broaden it like a poor man’s HIMSS for 2009. The one and only time I went years ago, it was horrible, fraught with logistical problems and bad speakers who would have emptied a HIMSS local chapter meeting room in about 60 seconds (no lie: one poorly credentialed speaker was so badly prepared that within 10 minutes, an irritated audience member had hijacked his session and turned it into a freeform discussion group while the presenter watched helplessly from the podium). I’m not entirely convinced that the vendor awards (you must be present to win) and gimmicky product shootouts really require a whole separate conference. They had a few good speakers this year, but the vast majority of presenters were vendor people. I’ve never known anyone who has attended, but someone must go (HIM people trying to get into IT, maybe?)

From Intel_Inside: "Re: Dossia. Dossia has fired Indivo/Children’s Hospital and is now working with a third partner." Not true, according to the two CHIP sources we contacted. I tried Dossia and haven’t heard back, but unless the scoop is so hot that the CHIP folks haven’t been told, this looks to be wrong. Confirmation welcome, however.

From DRPend: "Re: soup story. I could be mistaken, but I think that pretty much any meat-based soup contains body fluids, albeit not human. Seems strange though, I have done coliform counts on restaurant food, but never a fluid analysis." Reminds me of an old story about Adolf Hitler. Right as people started sipping bouillon at dinner, he’d squick them out by referring to it as "corpse tea." What a funster.

From The PACS Designer: "Re: PACS/RIS integration. TPD has done numerous posts on the various aspects of integrating PACS and RIS. As we are seeing more installations of PACS, it would be a good time to mention how important an integrated system PACS/RIS is for improving radiology efficiency and workflow processes. Since more modalities are now tied to the PACS/RIS, it would be best for a fully integrated system from the same manufacturer, which in turn will eliminate the need for custom application interfaces to the older systems."

From Alex Handris: "Re: retail clinics. Back in the 90s, consultants suggested that hospitals sponsor retail clinics to serve the community and bring in new patients. There was a HUGE pushback from their attendings, who saw it as a threat to their office practices. No one seems to be mentioning this, but I bet it’s still an issue."

If you’re thinking about presenting as HIMSS09, your proposal is due May 30. They could use better presentations, so jump right in. Maybe I’ll submit a scientific topic and then get up there and instead pitch HIStalk shamelessly for the entire session, flanked by Fake Ingas.

WebMD plans to outdo real science with ad-support crapware, as evidenced by the 10 most popular articles being sought by its dimwitted audience (note the preponderance of headlines that promise pictures or lists for those who need to rest their lips before forging ahead): 10 Surprising Health Benefits of Sex, The Flat Belly Diet, Pictures of Adult Skin Problems, 6 Serious Medical Symptoms, Sex Myths vs. the Facts, Learn How to Spot Bedbugs, 12 Embarrassing Body Problems, 7 Causes of Fatigue, Personal Questions from Women, View Common Childhood Skin Problems. And these are the people who are supposed to maintain their own medical records online?

Have fun this weekend and don’t forget those who lost a lifetime of weekends on your behalf. You may not agree with the jobs they’re ordered to perform, but respect the soldiers and sailors who do it for their country, allowing the rest of us to remain blissfully unaware of the horrors of war and of being maimed or killed on hostile, distant soil. Fly the flag, thank a veteran and their family, and remember the fallen this Memorial Day, even if for only a minute, OK?

 
Photo: Charles Dharapak/AP

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Inga’s Update

CDW selects EnovateIT for its Sapphire Partner Program. Sapphire partners typically provide in industries that represent emerging trends in the technology marketplace.

From Wompa1: “I appreciate your defense of Dr. Peel. Why is it that privacy advocates and civil libertarians are always lumped in with the tin-foil hat crowd? Thanks for your rebuttal to the bleating of the sheep that don’t ever concern themselves with corporate or government entities accessing their private information. I understand that practitioners have a ‘work product’ that becomes the health record. However, the individual is paying for that work, either directly or through an insurance company. Should that individual have no say in how it is used? No one wants an employer having access to their health records, but this is a direct result of allowing the employer to provide your medical coverage. Would we rather have the government (at any level) providing that coverage and accessing the information? Dr. Peel is contributing to the discussion in positive ways, her detractors’ whining notwithstanding.” Wompa1 shares some additional thoughts on Dr. Peel, Matthew Holt, insurance, and discrimination on the Forum.

From Computer Nurse: “As a female and a nurse informaticist, I am concerned that this survey is billed as an ‘HIT’ survey, when in fact the survey population consisted of 633 readers of Health Imaging & IT and subscribers of Health Imaging News. The results are in no way representative of the vast variety of specialties involved in HIT, especially those in other clinical areas outside of radiology/imaging. The survey should be renamed ‘The Imaging in HIT Salary Survey’.”

EMR vendor Pulse Systems is a new reseller for Stratus Technologies and their 99.999 % uptime ftServer fault-tolerant servers.

Constellation Software increases its stake in Mediware to almost 14%, making it one of the company’s largest shareholders.

Troubled Merge Healthcare enters into a private financing deal with with Merrick RIS, netting Merge $16 million to be used to settle a class action securities lawsuit. Merrick RIS gets to replace five Merge board members with its own people.

The official definition of electronic medical record: "an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization." For more official definitions, check out the National Alliance for HIT’s report, “Defining Key Health Information Technology Terms.” Thanks to the OHC, who funded this multi-month project, no one should ever again be confused by the terms EMR, EHR, PHR, HIE, and RHIO.

Private equity firm Lindsay Goldberg is investing $75 million in Ambulatory Services of America for future expansion. Nashville-based ASA provides alternate-site health care services.

The federal government is spending about $2 million of our money on full-page newspaper ads to inform consumers of hospital satisfaction rates for more than 2,500 hospitals. The ads note patient ratings on two measures of quality of care, including the percentage of patients who always got help when they needed it and the percentage of patients who got antibiotics one hour before surgery. The rankings don’t include hundreds of hospitals who didn’t release patient satisfaction scores.

In case I get carried away sipping adult beverages on the beach this weekend and forget to send Mr. H an update, hope everyone has a happy and safe Memorial Day. And take a moment to memorialize those who have sacrificed to give the rest of us the freedom to play in the surf and enjoy our good lives.

E-mail Inga.

HIStalk Interviews Michael Blackman MD, CMIO, Berkshire Health Systems

 
Photo: Berkshire Health System

I read several articles about Berkshire Health Systems, Pittsfield, MA and their work with CPOE and other clinical systems. Michael Blackman is the CMIO there and is frequently quoted about clinical systems implementation and the value of CPOE. He agreed to be interviewed for HIStalk, which I appreciate.

Tell me about yourself and your job.

I’m an internist and med-peds trained. I’ve been at Berkshire pushing seven years at this point and have been CMIO for one. It was a new job for this organization.Berkshire Health Systems is two hospitals. The larger one is just over 300 beds and a teaching hospital. We have a few small residencies in medicine, surgery, pathology, and soon to be psychiatry, starting in the summer. Those are all UMass-affiliated programs. The smaller hospital is a critical care access hospital with 27 beds, 25 or 30 miles south of us. We also have 15 owned physician practices and  2,000 long term care beds in Massachusetts and some in Pennsylvania and Ohio.

We’re putting in a completely integrated record across that entire enterprise.

Did that project lead Berkshire to create the CMIO position?

We were doing so much in the space is that we needed more physician time than we had before. We needed a physician champion with a focus on getting the last pieces done.

What systems are you using and what projects are underway?

For projects, we have CPOE up and about 75% of our orders go through it. The goal is to push that to 100%. What we don’t have is eMAR, the electronic meds Kardex. It’s been a holdup for us getting CPOE pushed the rest of the way. We bought the systems up in a strange order, frankly, in part because of what was available at the time. We’ve had CPOE up in one form or another for almost four years.

Other big projects are getting the ED on CPOE and getting all of our outpatient practices up on the electronic record so they fully integrate with the hospital. Those are the biggest things at the moment. Also BMV – closed loop verification. How did I forget that one? It goes with the eMAR.

You’re all MEDITECH, right?

We are all MEDITECH.

How would you evaluate your success with it?

It works. I happen to like MEDITECH as a system. The pieces actually all really do talk to each other. The integration, certainly for an organization this size, is their problem, not ours. They make it work. We don’t worry about an upgrade and making sure that the orders from CPOE are still going to pharmacy the right way. We know that’s going to work and that makes a very big difference.

Most of your doctors are community-based, I assume?

Most are, but the hospital employs probably 80 to 90 physicians. That includes ED, outpatient, and hospitalists.

Is the majority of the 75% CPOE ordering coming from those employed physicians?

At the moment, it’s really the house staff and employees of the hospital. The reason is that we haven’t pushed it to anyone else. We’ve being waiting until we do eMAR. We definitely have some private physicians who use CPOE, but it’s them coming to us and saying, “We seen this and we really want to do it.” It hasn’t been me going out and saying, “OK, now you’ve got to get on.” We want to be sure they can go to one place and get everything they need before we do that. We want to get eMAR up and then we’ll take that step.

What is it they like well enough about CPOE to want to volunteer?

Some of them look at the hospitalists and say, “Wait a minute. They have these nice order sets they can just click through them and get their stuff in,” especially for specialties where the orders are fairly routine and standard. Orthopedics, for example, or OB. Admitting a pregnant woman for routine delivery is essentially the same every time you do it, so people that were really using order sets or felt they could … those are the groups that have stepped forward to say they want to do it. It will get trickier at the margins.  

The biggest challenge is always ED, ICU, and surgery. Will they like MEDITECH?

I think so. As is true with any system, none of them do everything you want them to do. The upgrade is always hopefully better than what you had. Even then, you find features, so, “Now that it can this, I want this as well.” While we’ve done rather well with the CPOE we have, there have been moments when we said, “We really need what’s in the next version.”

Our next upgrade will help us a lot in that regard, most notably in our ability to convey more context to people as they go through order sets. You think about order sets on paper – we use them a lot for teaching … “Here are the criteria for this.” It’s hard in our current system to present that information in conjunction with the order sets. The next version makes it quite possible to do that.

Is there enough CPOE value other than efficiency with order sets?

Order sets are faster than paper, but they’re still attractive for decision support, even if just allergy and drug-drug interaction and formulary compliance issues and cutting down on the calls from nursing and pharmacy to clarify orders. We don’t try to sell it because it to people as, “You should use this because it will make you more efficient” because we’re going to be wrong. It doesn’t always make you faster. It may make it safer or better, but not always faster. I think a large number of the vendors have done all of us a disservice by touting the fact that they think this thing is faster and it isn’t, always.What clinical decision support capabilities do you have turned on compared to when you first brought up CPOE? Most hospitals dial it back.

If you look at what we did originally, we said, “We have CPOE now and we should turn on all the decision support we have available.” Boy, was that a mistake. [laughs] We turned most of it off rather quickly. At this point in time, we have drug interaction checking, allergy checking at both the generic and ingredient level, and adverse drug reactions by class. We have a variety of rules around lab utilization, formulary compliance issues, and some financial rules.

We found that we were losing revenue from visits we could not bill for because there was no admit order on the chart. Somehow it got overlooked. They came up from the ER with holding orders and a continuation of those orders, but there was actually no order on the chart that said, “Admit to blank.” Without that, the payors were denying the bills. One of our rules for an inpatient is that you have to have an admit order before you can order medications or labs.

What devices are the physicians using?

People either use tablets or desktops. One of the issues we ran into as we rolled out tablets to the employed physicians is the lack of flat space to put them down on the units. People had a tendency to put them in front of their existing computer, which wasn’t the point. We were trying to free up computers for the nursing staff.

Did you encourage broad order sets but not personal order sets to avoid future maintenance and to reduce variation?

The process was really trying to keep them as evidence-based as possible using our existing structure of department-level order sets. We do currently allow people to save favorite sets. We don’t teach them how to do that, but a few have figured it out on their own. We’re looking at changing that as we move forward because the maintenance around personal order sets is an absolute nightmare.

On top of that, if you have evidence-based sets and you need to make a change in the drugs for some reason because of a change in the evidence or change in availability, we want to be able to push that out without worrying that some sets missed it. Depending on how people save their favorites, whether they built them on existing ones, that might or might not happen.

Have you done any metrics to determine what has changed since CPOE?

The good news is that our medication error rate has decreased. We’ve seen a definite drop in the med error rate every time we bring another group of users on CPOE. We’re looking at those errors and anxiously looking forward to how that changes when we get to eMAR and BMV. We think that will eliminate a good chunk of the remaining ones, with the goal of zero.

The incidental thing is that we saw an increase in the number of duplicate orders that had to be canceled by the lab. One of the things we didn’t pay enough attention to was, “What were we taking out of the system?” We took out the unit secretary from entering the lab orders and that human intervention of saying, “There’s already an order out for this” and how the lab functions. I’m not sure we weren’t writing as many duplicate orders, but they were just getting through to the lab. We put some rules in place to try to cut back on that and we’re about to re-study that.

I assume your biggest impact will be when you get BMV online. What challenges do you see with that?

We’re doing the eMAR and BMV together. We felt the workflow for nurses wasn’t appreciably different bringing them up together since we were training all of them at once and some of the efficiency came from BMV.We have a barcode packager, so everything has to go up to the floors in unit dose. We’ll have to repackage anything that doesn’t come in unit dose. We’re doing our best to keep the formulary as standard as possible. The other piece is the workflow one – making sure we check once a day or once a shift to make sure people are actually using the scanners and that they’re scanning the patient’s wristband and not some list on the wall.

Are checkguards against that built in?

We’re probably going to put a check digit on the wristbands or some of the labels so you won’t be able to interchange them.

Do you have informatics folks working with nurses?

We have a variety of people working with nursing, but it’s still me, going back and talking about some of these things. On our IT staff, we have several nurses who function as both analysts and liaisons to nursing. Plus, we tend to pull people in for these various projects from the respective departments and then backfill on the units.

What’s the plan for EMRs for the practices?

We’re going to use LSS, which is the MEDITECH-affiliated outpatient product, so we can get the real value of the seamless integration between the offices and the hospital. We have all of them up on billing and scheduling and it’s been that way for a couple of years. Now we’re ready to move forward in pursuing the clinical pieces so that if we make a change to the meds list in the office, we see it in the hospital and vice versa.

What’s the level of integration for allergies and updated information?

The answer is that it’s 100%. It’s the same allergy list, the same outpatient med list, the same problem list.

Does it handle medication reconciliation?

That’s something they’re still working on. We’ve done some things for med rec on the hospital side, mostly building reports that compare an electronically entered home medication list against the admission orders. We still drop the paper and the computers are lined up what’s a match and what’s not and someone reviews that to see what they want to continue and that the changes are correct. We have a physician and nurse review and sign it.But the biggest piece is that they look at that piece of paper and say, “This isn’t what I meant to do.” They don’t make the changes on paper, they go back and make the changes in the system and then reprint the report. We hope to eventually do all that electronically, but it’s not quite there yet.

Are you doing any interoperability projects?

I don’t know if you’re familiar with the eHealth Collaborative in Massachusetts, which was three pilot sites to do interoperability in the community. North Adams is 20 minutes north of us and they’ve done some things there and we’ve had discussion, but it’s not there yet what we can do to integrate the county. We haven’t done it, but we’ve definitely talked about it.

There’s a lot of MEDITECH in your part of the world, which should make it easier to share data.

Massachusetts is MEDITECH central. I think they have 70% of the market in Massachusetts or something like that.How well would you say that today’s systems align with contemporary medical practice?

One of the biggest struggles and the last piece for most people is physician documentation online. We haven’t done that yet, either.If you listen to the vendors and listen to the industry, there’s a big push to get as much stuff in structured data fields as possible. That’s great for reporting information, but it’s not how physicians tend to think. It also doesn’t lead to notes that really tell you what you want them to tell you.

If you take the structured notes at one end of the spectrum and the complete, dictated, full-text note at the other end of the spectrum … the other good piece about the structured ones is that they’re better for billing, but the free-text ones really tell you more about what’s going on the with the patient. I think the right answer is probably somewhere in between in making a note that gives you a good combination of structure where it’s appropriate and where you really need it for reporting, and allowing the free text to give you the full flavor of what the patient looked like so someone subsequently reading it can tell what happened. Often it’s fully templated and you can’t tell that.

The article that just came out in NEJM said that the urge to get information into a template hasn’t done the patient any favors because there’s no context.

The other piece about the NEJM article is that they said that people were committing clinical plagiarism, cutting and pasting large sections of notes that aren’t theirs without really reading them. This is a tool like anything else. You want to be able to pull certain things forward, but equally you want people to use the information effectively.

The best example I can give isn’t mine originally. You can pull enough information from the system that can create a template that starts with, “A 23-year-old female presents with left ankle pain.” You’ve got the age, the sex, the chief complaint, but there’s not a template in the world that changes that to, “A 23-year-old female Olympic figure skater presents with left ankle pain.” Those three words have dramatically changed the flavor of the patient and what you’re going to need to do and what the patient’s rehab course will look like. That little bit will make a tremendous difference to how people get their work done.

The other piece in this part of the world and the West Coast as well is pay-for-performance, PQRI, and a variety of other things that require capturing information in a way that’s reportable unless you have an army of people doing nothing but chart extraction.

Do you see any technologies coming up that could be useful?

It’s nothing in particular, but it’s mostly the things that focus on workflow. One of the things that a good chunk of systems today is that the workflow of how people get things done and think about things is sometimes missed. I’m not trying to suggest that you should simply take the current paper process and make it electronic, but there’s a thought process that goes about how you approach a patient and gather information together.

Perhaps looking at that better at work flows through screens … I actually had an IT physician we were talking about trying to reproduce a three-page, tri-fold flow sheet in the ICU. After we had a long discussion, he looked at me and said, “You know, perhaps now that we have all this information electronically, we don’t need the flow sheet in the same way we did before.”

I think that could be one of the changes – how do you look at the information differently and how do you best to reduce far more information out there than you can possible review? When everything was on paper and you had to get the five volumes of old medical records sent up, there was no expectation on anybody’s part that you actually read all five volumes. You may have peeked through to try to find what you were looking for, but nobody really expected you to look at it all.

Now that it’s all electronic and easy to get to, there is some weird belief that you’ve actually looked at it all, which you haven’t. So, how do we bring things that are important to people’s attention, the very complex decision like what do you put on the first screen to make sure people see? How do you alert them that there’s something in the system they should know about buried in that fifth volume of old charts that they never would have found before?

The other thing that will make a big difference is the electronic prescribing, especially on the outpatient basis. The lack of ability to electronic prescribe controlled substances is enormous. It has to happen. The question is what is the DEA going to require to make that happen? We’re working on a project around that now, so hopefully we’ll have some good news about that in the upcoming months.

What led you to leave medical practice and get into informatics?

I haven’t fully left the practice of medicine. I’m not doing as much clinical work as I would like, but I’m still seeing patients with the house staff and things like that. For me, it was an opportunity to make a bigger impact on how medicine is practiced as a whole and how we take care of patients as opposed to doing it one at a time. prior to medical school, I was a management consultant and a lot of that was information systems, so for me it’s turned full circle.

News 5/21/08

From Mr. Green Jeans: "Re: retail clinics. They are partnering with local health systems, like Wal-Mart with Memorial Hermann and Bon Secour. I believe CVS is doing the same in some markets. The slower uptake is due to the challenge they face in becoming profitable and having secure operational infrastructure in place to handle self-pay and the commercial carriers, which many are now accepting. This is why, in my opinion, you saw CVS/MinuteClinic (which has over 50% of the retail clinic market) select athenahealth to handle PM and billing a few weeks ago. Getting paid and not have billing nightmares for patients is key. The EMR play here is small, as they only conduct a finite number of procedures. The billing and back-office operations are critical to shorten the time between opening a clinic and it becoming viable. The big boys (WM and CVS) are figuring this out."

From K.K. Kallenbach: "Re: comments. Where do the comments in HIStalk come from?" Since this is your comment, now you know! Readers e-mail me or use the Rumor Report (to your right) to send news, rumors, comments, documents, pictures, etc. If they’re good, I run them here (anonymized, of course). Some folks click the Comment link at the end of an article and post their own comments (click the same Comments link at the end of an entry to show them). A very few messages are posted in HIStalk Discussion (usually idiot foreign spammers selling electronics whose messages I have to delete), but we always wish more folks would post there since reading and replying are easier.

From Dr. BeanTown: "Re: Google Health. Dr. Halamka has moved BIDMC live. Curious what your thoughts are." If PHRs have a chance of succeeding, it will be because hospitals allow patients to populate PHRs with their reliable data without it being burdensome (patient-entered data is not worth much in most cases). I like BIDMC’s willingness to lead the pack and I would trust Halamka more than almost anyone to be the patient’s advocate and to be honest in assessing how well it works. It’s slightly odd to use a patient-controlled technology as an intermediary between sophisticated practitioner IT systems (i.e., the patient as the interface engine), but maybe that will serve as a good privacy tollbooth (and Halamka seems thoughtful about privacy as well). With a few big places jumping on board, PHRs will either sink or swim quickly, I would think. If patients aren’t interested, expect the former, so part of BIDMC’s job, I’m guessing, is promoting it. It’s an Internet technology, so a quick market share grab is the main strategy.

From CareGuy: "Re: RHIO. Vermont’s only RHIO failing?" Link. State government wants Vermont Information Technology Leaders to reduce the size of its 21-member board, hire a CEO, and speed up its work. The state tacked on a medical claims fee that will give the private VITL $27 million over seven years, so they’re getting more involved. Doesn’t sound like they’re failing, though.

From Poo Flinging Monkeys: "Re: Misys. Layoffs Monday, almost a dozen folks in implementation, most with a least 10 years." Unverified, but reported by at least four readers.

From Madrigal: "Re: MEDITECH. Their new Southcoast office opened Tuesday in Fall River, MA. Picture attached." Thanks for the pic – nice building!

Listening: Under the Flood, hard-rocking newcomers from Charlottesville, VA.

Say hello to new HIStalk Platinum Sponsor Loftware of Portsmouth, NH. Its products include technologies to manage label printing, barcodes, RFID labels, and retail labels. They have a nice case study from Johns Hopkins on their site involving a lab management system for tracking research samples. Their VP of marketing has a strong healthcare IT background, including as a Health Language, Inc. co-founder and member of HIMSS, AMIA, and AMA. The company is the world’s second largest employer of RFID-certified staff. Welcome to Loftware and thanks for supporting HIStalk and its readers.

Tanya Townsend has been named shared services CIO at St. Mary’s Hospital Medical Center and St. Vincent Hospital (WI). She was at St. Clare’s when I interviewed her in November. Maybe HIStalk made her famous!

Shafiq Rab is named VP/CIO of Orange Regional Medical Center (NY).

Jobs: EMR Developer (FL), Clinical Applications Analyst Lab (WA), Senior Web Developer (DC), Pharmaceutical Informaticist (TX). You can sign up for a weekly e-mail since there’s too many jobs to list here.

San Francisco’s city attorney and a local health plan for low-income residents file suit against McKesson, alleging price fixing. It’s related the Massachusetts suit from 2005 involving average wholesale price of prescription drugs.

Wireless asset tracking vendor InfoLogix acquires Aware Interweave, a provider of mobile information applications for SAP users.

Quality Systems Inc. (NextGen) will acquire revenue management company Healthcare Strategic Initiatives of St. Louis, MO to augment its NextGen Practice Solutions revenue cycle management services business.

VISICU (aka Philips) announces the results of a 156-hospital remote ICU monitoring study: the mortality rate was 9.6% vs. 13.5% nationally, supposedly representing over 7,000 saved lives in the sample.

An Erlanger Hospital (TN) board member and former Tennessee senator walks out of a meeting of the board’s finance committee over an outsourcing proposal from PHNS. The CIO says IT employees favor the move (I’d be surprised if so) but another board member says the contract doesn’t adequately address their future. Says the hospital’s data center will be shifted to the one PHNS runs, which sounds great until the hospital decides to end the outsourcing arrangement (which nearly always happens) and they don’t have a data center or the capital to build one. Perot was also a contender for the business.

An e-mail making the rounds in Kansas City claims "a friend" became sick on soup from a local restaurant, which was analyzed (by a hospital … riiiiight) and found to contain body fluids. It’s surely an urban legend, of course, since hospitals don’t test soup for diseases. What’s interesting, though, is that the newspaper’s original version of the story (cached on Google) included this snip: "The e-mail chain lists smiles@cerner as one of the originators, but a spokeswoman for North Kansas City-based Cerner Corp. said it was not a valid Cerner e-mail address and the name of the e-mailer was not a Cerner employee," but the story was changed afterward – the current version is missing that sentence. That e-mail address may not be valid at this moment (or at all, actually, since it was missing the .com at the end) but the brochure (warning: PDF) for Cerner’s 2008 user conference lists that e-mail address (with the .com) and the employee’s name it belonged to — it was the contact person for canceling exhibit space. None of this matters one iota except I thought the changed story seemed sinister.

The Shared Health statewide information exchange in Tennessee will use software agent technology from Novo Innovations for integration.

Sentillion announces new Q1 customers that include Baptist Birmingham, Hawaii Pacific, UNC Health System, and University of Chicago.

Hey, thanks a lot for reading, e-mailing me, and recommending HIStalk to others. It means a lot to me. Without you, I’d just be downstairs pretending to be interested in watching Kristi Yamaguchi dance.

E-mail me.

Inga’s Update

I have been reading the comments bashing privacy advocate Dr. Deborah Peel and decided it was time to weigh in. I have talked to Dr. Peel a couple of times and was actually surprised she was not the crazy zealot I expected. Instead, she is passionate, well-spoken, and makes some good arguments. She is not against PHRs or using data for medical and genetic studies. She believes that health data belongs to the patient and they should decide who gets it. In other words, it is my decision whether or not everyone may look at all my information, or, whether no one can access my mental health records. Peel is a psychiatrist and became an advocate after having many patients pay for services in cash because they didn’t want their employers to know they were under psychiatric care. Peel also advocates a “break the glass” option should you end up in the ED. I understand that if patients must provide approval before anyone accesses their information (de-identified or not) then it complicates many things, but I can’t say I disagree that I should own my own medical information. I also agree with Matthew Holt and his suggestion that we should also be looking harder at banning discrimination based on health information—especially with regard to insurance coverage.

Speaking of privacy, I played with the new Google Health site and it seems quite friendly and easy to use. However, when you sign up you must agree to give Google “a license to use and distribute (your information) in connection with Google Health and other Google services.” The disclosure also reminds users that HIPAA rules don’t apply to them. I decided I need more warm fuzzies than that before sharing all my medical secrets.

I’ve been amused by how many readers have mentioned they share my shoe passion and have gotten some great tips for places to buy shoes! For example, Saturday morning I got this note from Marlo Thomas: “I thought about you on Friday afternoon. I was the new DSW at Cascade Station, down the street from the Portland airport. Other great DSW stores: San Fran, the store just off Union Square, and Cincinnati, the Rookwood location. Both these are multi-story facilities with ‘better than average’ brands and selection.” I must confess the e-mail sent me into deep shoe envy and I had to go to my nearby DSW to purchase this very sexy pair of black strappy sandals. I was going to take a picture of them to post but I decided Mr. H wouldn’t go for it since he is a sensible shoe kind of guy.

The Detroit News reports that Wayne State University Physician Group is cutting 80 clerical positions following its outsourcing agreement with athenahealth.

eClinicalworks announces a sale to Georgia’s second-largest GI group.

Collaborative Software Initiative (CSI) announces it has released the first open source, web-based infectious disease reporting and management system. The State of Utah Department of Health is piloting.

A federal appeals court upholds a previous ruling that a North Texas IPA engaged in unlawful price-fixing in its negotiations with various health insurers.

Compuware announces its Q4 and fiscal year earnings (ending March 31.) For the year, revenues were flat and income was down 15%. The better news was a 38% increase in software license revenues for Q4 and the overall better than projected Q4 numbers.

Tennessee Medicaid contracts with ACS for a five-year, $156 million deal to manage its data and ongoing systems operations.

Several people have indicated TEPR is on its last leg, but nonetheless, it has announced its 2008 Outstanding HealthIT solutions. Winners include CapMed (Best PHR), MediNotes Clinician Supply Chain Manager (Hot Products), and Doctations and eMedicalFiles (tie – EMR Systems Best Meeting Medicolegal Requirements). Does anyone select an EMR product because it best meets medicolegal requirements?

Valley Baptist Medical Center in Brownsville claims its cardiology and radiology departments are saving $28,000 a month since replacing film with digitized images on EMC systems.

UPMC CEO Jeffrey Romoff was paid $3.95 million in 2007, which is 20% higher than the year before. Not-for-profit UPMC actually paid 11 people more than $1 million last year. All I can say is that these numbers are staggering. Mothers, the time has passed for urging your daughter to find a nice doctor to marry – the real money is in administration.

On a not-totally-unrelated note, check out the results from Health Imaging’s 2008 HIT salary survey. Not surprisingly, CIOs earn the most ($180-200K) and system administrators the least ($40-50K). Interesting statistic: you could hire 100 system administrators or one Jeffrey Romoff for the same money!

E-mail Inga.