An HIT Moment with … Dave Dyell

An HIT Moment with ... is a quick interview with someone we find interesting. David Dyell is founder and CEO of iSirona of Panama City, FL.

Everybody’s talking about EMRs. Should they be talking more about integrating device data with them?

In a lot of ways the conversation should be one and the same. When you consider the HIMSS EMR Adoption Model, it shows that any Stage 3 hospital or above has implemented electronic nursing documentation. What it doesn’t show is that much of the data, including device data, is still written on paper to be transcribed into that electronic chart later. Meaning that a physician could be looking at physiological data that is 3-4 hours old by the time it is available in the EMR. I believe the latest data shows over 70% of the market has reached Stage 3, yet most facilities we speak with are still writing vitals on paper and transcribing them later.

We believe that part of the EMR adoption model should be to automate as much of the point of care workflow as possible and thereby truly create a paperless EMR. Its also important to note that device integration is not exclusive to the EMR. Many departmental systems have nursing documentation modules and integrating devices to those can provide a similar value proposition to integrating to the EMR. Examples are ED, Critical Care, OR, Anesthesia, OB, etc.

You’ve worked with integration engines for many years. Those tools opened up entirely new product possibilities for hospitals without requiring major internal or external IT resources. How is that like and unlike tools like iSirona’s that integrate devices?

While there is an aspect of what we do that provides interface engine-like functionality, device integration is really about automating the workflow at the point of care. The bits and bytes of managing data from the device and translating to a format needed by the EMR is engine-like, but interface engines never really touched the workflow directly. They were and still are for the most part a back-end, lights-out kind of tool that only interacts with other IT systems.

In order for a device integration solution to truly impact the workflow it must provide integration points to the end user, the clinician. Whether that be positive patient ID functionality to tie the patient to the devices being integrated or an authentication system that allows the caregiver to review all the collected data prior to delivery to the EMR, it must integrate to the workflow.

Let’s say a hospital’s chief medical officer wants 2-3 examples of real-life major care improvements made possible by your products. What examples would you cite?

A great example is the ability to help reduce in-house codes. More accurate and timely information clearly enables the physician to make on-the-spot decisions and better identify those patients trending towards a code. The average length of stay in the ICU to recover from a code is 14 days and the daily cost per patient is over $5,000.

Another example would be supporting fall prevention protocols. By integrating smart beds to nurse call systems, caregivers can be made aware when a patient that should be stationary is attempting to exit the bed. Along the same lines, the bed can tell us when a ventilated patient’s bed has been lowered below the recommend 30-45 degrees, thereby alerting a caregiver to help prevent ventilator-associated pneumonia.

Considering that these types of incidents are being considered for inclusion in the CMS “never-event” list and thereby would not be eligible for reimbursement, this can have a definite impact financially on the organization.

How fast growing is the volume of electronic data sent by medical devices, how can it be used, and what changes should clinical systems vendors be considering to use that information effectively?

Traditionally the amount of data captured by clinicians related to what the devices can actually output was very small. Some of the data is not necessarily clinically relevant, but the larger issue is there is just not enough time for a single person to collect all of the data potentially available from the devices. A single medical device may be capable of generating 300+ pieces of discreet data, while a given EMR flowsheet may only require 8-10 of those to be typed in.

When you remove the manual data entry task, which is so time consuming, you can then expand that data set to something that is much richer and can have a very positive impact on patient care. As the acuity of our patient population has grown, so has the use of medical devices and the sheer amount of data our caregivers are required to capture. A recent study showed nurses having spend an average of 147 minutes per nurse per shift on documentation, much of that from devices.

Many of the EMR and CIS vendors have decision support algorithms that analyze this data to help provide guidance to caregivers. Having that data set automated ensures the accuracy and timeliness of the data and gives the algorithm a richer set of data to work from. Using solutions like ours that provide positive patient ID ensures the data is charted to the correct patient, giving the caregiver comfort that the guidance being provided is for the correct patient. Clinical staff are then better able to predict and prevent adverse outcomes such as in-house codes, sepsis, and ventilator-associated pneumonia. We have multiple clients and other industry experts that tell us repeatedly that one of the problems with failure to rescue or recognize deterioration of patient conditions is poor quality of data.

Over my years of working with interfaces, we watched the laboratory industry push CIS and EMR vendors to the point now that we can see lab results even from outside reference labs back into our systems within seconds of the analysis on the specimen being completed. That gives our physicians great access to the chemistry of their patients. As we have discussed today, much of the physiology is still written down and typed in later, meaning that a physician logging into CPOE is faced with current chemistry, but potentially 3-4 hour old physiology. This forces a call to the floor to request current vitals, etc. and thereby devalues the CPOE experience to the physician. It is important that IS and EMR vendors recognize the workflow around device data capture and ensure their systems support the automation of this important part of the care process.

iSirona is a small company with at least one well-known competitor. How will you differentiate your offerings and compete with an established player?

I am glad you finally asked a sales question. Product, product, product. We built our product with the help of clinicians to ensure that we solved their needs. Just automating a clinical step was only going to bring marginal value to our customers. Automation alone saves time and allows for greater accuracy, but that has to be countered by associating the device to the correct patient to insure data is documented to the correct patient. Also, iSirona was built with a patient’s mobility in mind. iSirona’s system architecture ensures continuous data capture across multiple care environments and even through ‘cold spots’ in the hospital’s wireless network.

Additionally, we want the caregivers, regardless of EMR, to have the ability to view, select, and comment on the data they are charting. Our clients have the choice between using iSirona or the core clinical system for data authentication and charting additional required documentation. For clients choosing to use the core clinical system, iSirona provides and embedded solution for minimal impact to clinical workflow.

Our goal is to assist our clients in simplifying patient data collection while improving the quality of care and patient safely. We will continue to listen to our customers and prospects and ensure that we remain the visionary in this space.

Monday Morning Update 5/18/09

From JB Good: “Re: Adena. Do you know who Adena went with for an EMR?” Meditech, I believe. They must not have used the HIMSS Online Buyer’s Guide or done their tire-kicking at HIMSS since Meditech doesn’t play there.

From The PACS Designer: “Re: Windows 7. TPD has posted previously about some key new features of the upcoming Windows 7 release. Now, Dr. Bill Crounse’s Microsoft blog has a post on the Windows 7 platform and it appears to highlight some additional features when it comes to its potential use in the healthcare process.” I dunno … if Bill wasn’t drawing a Mr. Softy paycheck, I’d swear he was pitching Apple. “you just want your computer to work … works better … visually pleasing … graphics are simply stunning.” Windows? Seriously? It’s always mixed news when a vendor tells you how great their new versions are, implying that what you originally bought wasn’t so great. They weren’t saying that when you first forked over the cash for Windows ME … err, Vista. Personal users only have to pay and install, but for corporate users, it’s a major, non-strategic IT project to replace everybody’s desktop OS and train people to support it. I’m still fumbling around with that damned productivity-sapping ribbon bar on Office 2007 at work (no way I’d install it on my home PC), so I’m waiting for Microsoft to convince me that they have a clue.

From Neal’s Pizza Guy: “Re: UK. Redundancy plans were announced at yesterday’s Cerner UK town hall with 20-100 associates to be future endeavoured. Those in the firing line include Solution Delivery Consultants, System Engineers and Learning Consultants.” Unverified.

From Ukelele Bill: “Re: Stanford’s Epic implementation. It’s been mentioned before. How much are they spending and what are the problems there that anonymous posters have mentioned?”

An Eclipsys spokesperson disputes the comments left earlier by Eckert’s Sweetheart Deal. In summary: (a) ECLP shares rose from $16 when Andy Eckert started as CEO, rose to $26, and ended 2007 there. Shares have declined this year, but still outperformed the S&P 500. (b) KLAS scores for Sunrise Clinical Manager rose from 5th to 2nd place during his tenure. (c) Eclipsys has more clients and a larger market share than in 2005 and continues to win new business. (d) the company had 2,000 employees when Andy took over as CEO and now has 2,700, of which 700 are in India, so the company’s presence there was additive. (e) Phil Pead and the BOD asked Jay Deady to stay on and he has agreed.

Here’s the five-year chart of ECLP (blue) vs. the S&P 500 (red), just in case you’re scoring at home. From the day Andy Eckert took over as CEO until now, shares are down 12%. How does that compare to its main competitors? Non-conglomerate, publicly traded HIT vendors are as scarce as hen’s teeth, but Cerner is up 33%, QuadraMed is down 19%, and CPSI is down 8%. McKesson shares are down 15%. NextGen parent Quality Systems is up 69% over the same period as an example of a vendor selling mostly practice-based systems. The S&P has dropped 26% since October 2005.

Cerner and its customer Mayo Clinic request a federal gag order against a former Mayo physician and professor, accusing him of violating trade secrets for speaking at a conference about natural language processing software he developed. Mayo says Peter Elkin stole a backup and offered to sell the software, while the Elkin says Cerner and Mayo just wants exclusive rights to sell his product without paying for it. Mayo says he signed over his rights, while the Elkin says the application isn’t part of what he signed over to Mayo and he hasn’t received promised royalty payments anyway. Elkin left last year to become VP of Biomedical and Translational Informatics at Mount Sinai Hospital (NY).

St. Mary’s Hospital (MD) goes live on Cerner CareMobile bedside medication scanning.

Several of my reader survey respondents asked to hear more from provider IT shops about innovative things they’ve done, little-known systems they are using successfully, and ways they are responding to organizational demands. Inga and I would enjoy hearing from hospital IT people. Reluctant to go on record? I’ll leave you and your organization anonymous (places I’ve worked don’t want employees out there giving interviews either, so I understand that). E-mail me.

GE Healthcare has another round of layoffs, but doesn’t release numbers.

Children’s Boston announces a biomedical technology development fund to underwrite technology commercialization research projects at the hospital. The non-profit is hooking up with a bunch of drug and device vendors, which I admit confuses me (research universities and hospitals dabbling in for-profit industries makes me uncomfortable). Community hospitals and colleges deliver services to patients and students, respectively, without having that other cash cow, which I admire since it forces them to execute their primary mission well.

More EMR-related music humor, this time by Dr. Sam Bierstock and his An Introduction to the Electronic Musical Record. You won’t get the deadpan humor until halfway through or so. His upcoming release: Sorry, Man, but Your Bypass is Considered Cosmetic. His video with the Managed Care Blues Band is here and a tribute to veterans here.

Kaiser Permanente is fined $250,000 after 21 employees and two doctors inappropriately accessed the electronic medical records of Octo-Mom in January. Kaiser had already fired 15 people, reprimanded eight others, and self-reported the violations to the state, so it was surprised by the fine. I don’t get it myself: is that really going to diminish the chances of it happening again compared to firing the transgressors?

A new Washington Post article called The Machinery Behind Health-Care Reform says HIMSS successfully maneuvered public policy to benefit its members. “It also represented a triumph for an influential trade group whose members now stand to gain billions in taxpayer dollars … Corporate members include government contractors such as Lockheed Martin and Northrop Grumman, health-care technology giants such as McKesson, Ingenix and GE Healthcare, and drug industry leaders, including the Pharmaceutical Research and Manufacturers of America … runs a trade show for technology vendors, publishes a health technology newspaper and operates a research unit to help members find new markets …” Also mentioned: Steve Lieber admits that HIMSS had to lobby hard to get then-President Bush to include his one line about EMRs in his 2004 State of the Union speech. Now I’m feeling stupid for being a HIMSS member – I’m just giving its vendor lobbying work credibility by boosting the headcount.

OK, I’m going to acknowledge the elephant in the room and say this out loud. It’s time to split off the provider part of HIMSS into its own organization or form a new provider-only group. HIMSS is deviating further and further from my interests through its pro-vendor lobbying and its glitzy trade show that charges vendor members to connect with provider members. I like vendors just fine, but we each have our own agendas. I resent it if even a little of my paltry $140 in dues was used to convince a struggling administration to use taxpayer money to goose sales of HIT products. HIMSS took up the membership slack because TEPR was lame and AMIA was academic. It would be nice to have an alternative for us provider people, like women who just want to go out to dinner together without feeling like they’re being hit on constantly. Maybe it’s just me since nobody else is complaining.

Uh oh … President Obama publicly hailed the $2 trillion of healthcare savings over the next 10 years offered by industry groups, but he misunderstood. Those groups now say they did not pledge specific cuts. Obama’s healthcare reformer Nancy-Ann DeParle said “the President misspoke,” but then changed her own story, saying he cited their offer correctly. Does a “target” of raising the “rate of increase” to 1.5% within ten years really count as reform? The American Hospital Association was appalled at the thought that struggling hospitals can afford a reimbursement decrease according to its president, who made $1.5 million last year, and its executive VP, who took home $822K. UPMC President Jeffrey Romoff, who made $4.5 million last year after taking a pay cut, was not quoted.

Video game Hysteria Hospital is coming to the Wii. “Hysteria Hospital challenges players to race up and down hospital floors, treating testy patients with crazy ailments while saving your emergency room from turning into mass hysteria.” Now if someone would just create actual hospital software for the Wii …

E-mail me.

CIO Unplugged – 5/15/09

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

Accelerating Healthcare IT Adoption
By Ed Marx

To Teach, To Heal, To Discover—Six words that captured the essence of the mission of the academic medical health system where I served as CIO. Along with our affiliate Case, we consistently ranked in the top 10 of NIH grant awardees. We had the infrastructure, bench, and leadership to move quickly on opportunities and maximize value. Non-academic centers attempting to secure grant funding faced incredible odds against giants like us. We grew at their expense. Grant-funded organizations are well-oiled machines.

Today, I serve in a largely non-academic, community hospital based environment, but our vision is equally compelling. As ARRA/HITECH releases numerous incentives and billions in grants, academic centers are best prepared to apply for and secure those dollars. They have the infrastructure, primary investigators, and experience that granting organizations look for. But are they the venue best for accelerating innovation? I’d argue that community hospitals are the “new” best venue for taking ideas from bench to bedside.

Community hospitals don’t have costly infrastructure, professional staff overhead (whose sole focus is securing grants and conducting research), nor the incentive to keep applying for grants. Rather, community hospitals operate on the frontlines. They can accelerate the pace of change by bringing forth products based in the reality of where the majority of care is delivered—the non-academic settings. Am I saying that great contributions from academia are futile? Never! But, it is time to purposely expand grant opportunities to include community hospitals.

Shortcomings in the community hospital model are easily overcome by forming collaboratives with other members of the healthcare community. For instance, in our market, we have created joint applications with area universities, vendors, and governments. Where we are weak, our partners are strong, and vice versa. Our broad-based applications include multiple stakeholders. Grants pursued will lead to a practical application of technology that can be adopted universally, not just in one particular institution.

Community hospitals are leaders in the adoption of modern HIT. At Texas Health Resources, we have surpassed many academic contemporaries in areas such as CPOE and quality outcomes. Davies and Baldrige winners are largely non-academic. HIE leadership in our area is driven by community hospital management, not academia. While “rock star” CIO’s often come from academic institutions, they largely play symbolic, albeit, important roles. Traveling, speaking, and creating vision. Whereas community hospital CIO’s are typically close to the ground dealing with the practical realities and bringing translational research leadership to bear.

Both types of organizations have an important place. As government and non-government agencies begin the arduous process of selecting grant applications, my hope is that they will understand the importance of funneling some of the dollars towards community hospitals and accelerating HIT adoption.

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

News 5/15/09

From Eckert’s Sweetheart Deal: “Re: departure. According to Eclipsys records, Mr. Eckert will reap $6-9M for achieving numerous operational goals. Let’s see: ECLP stock price is lower than when he took over in December 2005 (not that); Eclipsys KLAS scores are lower across the board (not that); ECLP has fewer customers today (not that); customers are leaving in droves and are unhappy (not that); a quarter of the company has been outsourced to India (maybe that?) Guess it’s not just financial companies that overpay their CEOs.” Jay Deady: stay or leave?

From The PACS Designer: “Re: Adena Health System. TPD congratulates Marcus Bost, CIO of Adena Health System, for the successful completion of an EHR system as it is never easy when attempting to transition an organization from paper to digital record keeping through EHR implementation.”

From Kid Schlock: “Re: Kadlec Medical Center’s prom setup. Lovely story, and not to minimize the positive impact on the patient and family – but – this was done on an episode of Grey’s Anatomy a couple of seasons ago. Life doesn’t always imitate art, sometimes it just imitates cheesy TV.” I’m convinced that everything you need to know about life can be found in Lonesome Dove.

From Slap Maxwell: “Re: Omnicell. If Omnicell is dedicated to customer service, why did they lay off so many nurses? In fact, all of them, I think.”

From SmallTown CIO: “Re: HIMSS. In the latest HIMSS Weekly newsletter, the new HIMSS Online Buyer’s Guide Ideal Database for Providers is unveiled. It may be me, but I can’t locate Meditech in any of my searches. Give it a shot and see if you have better luck. How good could the database be if a major vendor has been left out? Hmmm … Meditech pulls out of the HIMSS show and now mysteriously disappears from their vendor database – coincidence?” No coincidence – check out the Become a Listing Company page, which basically says, “For a price, we will pimp out our provider members to our vendor members.” HIMSS exhibitors get a free listing. So, my reaction: (1) I’m not surprised since HIMSS is one big sales job, conveniently enabled by a 50:50 provider-to-vendor ratio that provides ongoing matchmaking income, at least until providers get tired of being sold like meat and walk; (2) the site is “powered by” HIMSS Analytics, which apparently in this case “analyzes” only those companies that pitch cash into the kitty (so much for objectivity); (3) I would hope that there’s no CIO dim enough to look to HIMSS to provide suitable vendors; (4) how the hell much money does HIMSS need to rake in, and for what? The shilling never stops. Meditech has 25% of the hospitals in the country, something like 2,000 of them, with 98% customer retention, affordable products, and the cojones not to exhibit at the boat show just because their competitors do. I just might spring the $395 to put my own caustic message in their “database” since HIStalk should qualify as a publication.

From ORISpilot: “Re: Toronto. The eHealth office in Toronto, Ontario was held to task on the consultants that they hired to help build the Pan-Canadian EMR are paid from $650 to $1000 per day. Here’s a quote: ‘The one-year consultants’ tally for 2007-08 was $32.9 million, rising to $34.3 million between April ’08 and March ’09.’ They hired MBAs and networked linguistics graduates. Guess what? They have virtually no clinicians working in that office.” All those hired guns despite having 166 of its own employees being paid over $100K. The CEO blames competition from stimulus-frenzied US companies, no different than hospitals that lamely say they are forced at gunpoint to pay $2 million CEO salaries because the market demands it (which, as I always say, must mean that they are real dumps if nobody will come for less).

Listening: Hard-Fi, excellent, highly original British indie (Clash meets Elvis Costello and a dance beat). Brilliant marketing: they record every concert and sell it as an autographed CD.

And this: HITECH: An Interoperetta in Three Acts by Ross Martin, MD. Brilliantly conceived, written, and performed. Not to mention acted: watch his expressions throughout, remembering that this appears to have been filmed straight through with no flubs. Don’t dare stop listening until the big finish, which I won’t spoil (I’ve watched it like 10 times and I’m mesmerized). He would be a great pairing with Dr. Sam and the Managed Care Blues Band. I need to give him some kind of HISsies award to coerce him into performing at the next HIStalk event at HIMSS.

You have hopefully noticed that I have acted on a reader survey suggestion and added underlined links.

Who knew that Andy Eckert didn’t even live in Atlanta while serving as president and CEO of Eclipsys? He was in California while the rest of the company was in Atlanta or Malvern or Pune or wherever. Note to companies: if the hotshot you’re recruiting to run the place won’t even move to your town, keep looking. That’s just nuts (but not unique to Eclipsys in HIT-land, unfortunately). The stock dropped a little on the news of his resignation, but not much. Reader Cam Winston called his shot on February 25 right here in HIStalk: “I’ve heard a rumor that Philip Pead, former CEO of Per-Se, has joined the board of directors of Eclipsys and that he ‘may’ replace Andy Eckert by year-end. As CEO of Eclipsys since 2005, Andy has failed to turn around this second-tier HIT company.”

I will immodestly boast that I was the first to post the Andy Eckert news just after it came out at 7:00 a.m. Eastern (thanks to ECLP for sending over the announcement) while the pro journalists were tucked away in their beds. I checked a couple of minutes later and the site was groaning under the load – who knew people would be up and reading at that hour? I can see only minimal info about who’s on, but here are some interesting ones. Countries: India, Dubai, Israel, UK, Germany, Canada and Australia (tons from India, so hello to readers there). Organizations included HHS and NIST. Companies: Eclipsys (duh), Perot, Picis, Allscripts, and GE (industrious early risers all). Schools: Duke, Penn, Hopkins, U. Chicago, Michigan State. Money people: T. Rowe Price, JPMorgan Chase.

Jason Dvorak, formerly of TeraMedica, has joined Sage Healthcare as SVP of sales.

A biomedical scientist in a UK hospital is accused of pursuing recreational human anatomy: he supposedly hooked up a Webcam in a room where on-call nurses slept and stored porn on hospital PCs.

This Hong Kong CIO who has worked in US healthcare IT takes a dim view of bloated hospital IT departments that buy big packages that take lots of people to install and manage. “Are they really doing that much? I would say here in Hong Kong we do much more per dollar spent. One of the Adventist hospitals in the US has more than 100 employees in IT and more than 30 of them are implementing and maintaining Cerner.” He also says that HIT systems are relatively easy to develop, vendors don’t know how to turn one implementation into an off-the-shelf package, and systems aren’t designed with user customization in mind.

Genesis Health Clinic (IA) chooses the hosted PM/EMR from Waiting Room Solutions (odd name: sounds like something to entertain patients). Never heard of it, but it looks kind of cool (you can upload audio files to it) and the price runs from $49 to $600 per doc per month. I’m suspicious that they don’t list the names of anyone involved on the site (I always assume it’s Chinese hackers in disguise). Being a pretty good snoop, I tracked it down to Lawrence Gordon, MD, medical director of a reference lab in New York.

St. Joseph’s (AZ) signs for Clinical InfoNET videoconferencing from Clinical Information Network, which they’ll use to provide communications between consulting and community docs.

Wireless health monitoring vendor MedApps signs a deal with Microsoft to provide device data to HealthVault. 

What’s keeping Google Apps from dominating the office software world? It offers only remote storage that may not comply with the privacy requirements of businesses. And, people trust the company less than they once did. On the other hand, it just signed a 30,000-user deal, its largest yet.

Being cynical, I like this article that says interoperability initiatives provide bigger bang for the buck. “I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the Earth. —-President John F. Kennedy. Imagine if President Kennedy in his famous speech didn’t stop at this point. Instead, he started describing the rocket. Assume he demanded a rocket with only two, or maybe four stages; that he insisted on a specific type of fuel, or certain weight and speed. Would the American space program have succeeded? I doubt it, and you should too. The Obama administration’s plan to spend $19.2 billion on electronic medical records as the sole path to achieve health care automation is the equivalent of Kennedy dictating to NASA the specifications of the rocket carrying Neil Armstrong to the moon.”

This makes encryption look cheap. Non-profit hospital operator Health Quest, stung by an ED laptop theft that triggered an Office of Civil Rights corrective action plan, will spend $50 million to change its software and improve security.

Online systems vendor A.D.A.M., which provides reference libraries and patient education material in its healthcare product line, creates a CTO position and hires Keith Cox, formerly of Microsoft, to transform the company into a cloud-based computing solutions vendor.

Hospital layoffs: Park Nicollet (MN), 240; Loyola (IL), 440; Geisinger South (PA), 179.

Johns Hopkins Hospital expects that a former patient registration employee will be charged with the fake driver’s license scheme in Virginia.

Police in Mt. Airy, NC say a Russian hacker got into the business computer of a local drugstore.

E-mail me.

HERtalk by Inga

From Patrick Henry: “Re: healthcare reform. Regarding cutting healthcare costs, here is a suggestion: if politicians at all levels were required to have healthcare and retirement benefits that were adjusted each year to match the average of every American, then we would see a lot more movement. It would still be motivated by self-interest, but that self-interest may start looking a lot more like what the rest of us are interested in.”

From An Interested Party: “Re: meaningful use. I am inviting you to view www.meaningfuluse.org as your one-stop resource for the national dialogue around the stimulus package. Please join me in this critical discussion.” I got this message in my email via a LinkedIn message. I am trying to decide if his approach belongs in the category of creative marketing or just plain old spam. In any case, www.meaningfuluse.org is a new site sponsored by Compuware and AMDIS. As is obvious from the name,  its focus is on “meaningful use” discussions and the impact of the HITECH legislation.

ProMedica Health System selects Sectra as its RIS provider. ProMedica will integrate the RIS with their existing Sectra PACS solution.

Fifteen hospitals are currently participating in the Louisiana Rural Health Information Exchange telemedicine initiative, including six running Healthland EMR.

Following a $10 million operating loss in the first quarter, Hennepin County Medical Center (MN) announces plans to eliminate 75 to 100 FTEs by the end of June. The hospital employs about 5,000 people.

Orion Health appoints Anna Theriault Vice President of Alliances for Orion Health North American and Europe Middle East and Africa. I think that her title must set some sort of record for its length. Clearly she’ll need a really big business card. Theriault was most recently the Healthcare Services Sales Lead for Cisco in the US and Canada.

Seven AT&T employees in San Jose are sent to a hospital for nausea and vomiting and another 21 are treated at the scene, after becoming sicken by an overwhelming stench. The culprit: decomposing food left in an office refrigerator. Apparently one brave employee (who had poorly functioning nasal passages) began cleaning the common refrigerator, using a 409-type cleaner. Another employee tried to combat the odor with a different chemical spray. Before long, the fumes overwhelmed several workers and 325 employees were evacuated from the building. Rescue came in the form of the fire department’s hazmat team, who were summoned to snuff out the scents.

Allscripts announces a technology coalition designed to educate physicians about opportunities aligned with the ARRA. The EHR Stimulus Alliance includes Allscripts, Cisco, Citrix, Dell, Intel, Intuit, Microsoft, and Nuance. The Alliance is sponsoring The EHR Stimulus Tour, which includes “hundreds” of virtual and physical events for physicians. While I am sure the educational offerings will be of excellent quality, the whole program seems like creative marketing to me. (Have I been hanging with Mr. H so long that I am turning cynical? Or perhaps I’m just reading too many press releases from too many companies announcing how they are helping providers benefit from ARRA.)

The folks at SCI Solutions passed on that their client Flowers Hospital (AL) was named the top performing hospital based on CMS quality of care data. The Commonwealth Fund sponsors a site named www.whynotthebest.org, which includes a list of the hospitals scoring in the top 1% for quality measures.

The local paper provides an update on University Hospitals’ (IA) Epic implementation.The switch started in December and doctors began CPOE this month. Despite a few complaints from doctors wanting their paper back, Hospitals’ VP for information systems Lee Carmen says things are going pretty smoothly. The hospitals reduced the number of clinic visits for a couple of weeks in order to adjust to the new work flow. So far, 1,200 system issues have been noted. Carmen claims the system is working exactly as they expected.

Blogger Doc Gurley addresses the age old question: how to ask a doctor out. She advices that you don’t ask out your own doctor; points out that just because a doctor doesn’t wear a ring doesn’t mean he/she is not married; and warns that just because your crush is a doctor, that he/she is rich. I remember once thinking a particular doctor was pretty hunky and I was curious of his status because he didn’t wear a ring. A bold friend of mine called up the office and said she was with the local medical auxiliary and needed to know his wife’s name for a party invite. I was bummed when the receptionist supplied a name. Just as well. He probably had a ton of medical school debt.

E-mail Inga.

Eckert Steps Down as Eclipsys CEO

Andy Eckert has stepped down from his role as President and CEO of Eclipsys and will leave the company, Eclipsys announced this morning. He has been replaced by Philip M. Pead, an Eclipsys director and former chairman, president, and CEO of Per-Se.

According to the announcement, Eckert "has decided to leave the company after accomplishing a number of important operational goals." A quote from Eckert also cited his family ties in California as a reason for his departure.

Pead joined the Eclipsys board on February 17 of this year.

News 5/13/09

From Louis Crabb: “Re: acronyms. This site is useful.” Link. It sure is. I tried some fairly obscure healthcare IT acronyms and they were all there. Some cool tools are bundled with the search, too. Industry noobs should look there for starters when facing an unfamiliar acronym. Good find.

From Dean Sittig: “Re: tagging articles by vendor. Why not just have them use the Google site search option, or go to Google and enter: topic site:histalk2.com. I’m a big fan of search, not a big fan of human-curated site indexes. That is what killed Yahoo.” I agree, but I’m not quite sure why Google doesn’t seem to index everything on the site. It also doesn’t separate interesting stuff from trivial mentions. I suppose it would be like indexing the newspaper – technically correct, but still only somewhat useful in trying to locate useful content.

From The PACS Designer: “Re: CCR. Since the Continuity of Care Record (CCR) created by the ASTM International E31 Healthcare Informatics Committee has been out for awhile, it was great to read that Microsoft has incorporated the CCR into their Amalga Unified Intelligence System offering. TPD was a member of the E31.28 Technical Subcommittee for Electronic Health Records that created the CCR document for caregivers and patients.” Link.

From Stifler’s Mom: “Re: Wal-Mart. I thought you’d appreciate this article about a reluctant Wal-Mart clinic visit.” Link. It’s a fun story by an admitted anti-Wal-Mart bigot who left its contracted retail clinic impressed. “As I head out into the brightly lit parking lot, I realize that this has been the easiest, most gratifying (and sociologically fascinating) trip to the doctor I’ve ever experienced. I realize that when it comes down to it—it being my thin wallet, of course, and, well, my health—there is really no way of getting around the truth. Wal-Mart did not save my life. But damn if it didn’t give me what every hard-working American deserves. And damn if I didn’t feel, dare I even say it, lucky.”

Pretty good Q3 numbers for Mediware: revenue up 4%, EPS $0.06 vs. $0.04, which the company attributes to its Hann’s On acquisition and its partnership with IntraNexus.

Welcome to new HIStalk Platinum Sponsor e-MDs of Austin, TX. They’re new to HIStalk, but are also a Platinum Sponsor of HIStalk Practice, which we appreciate. They have the coolest-looking Web site I’ve seen, which includes an EHR Discussions blog with a lot of ARRA information. Here’s Dr. Eric Fishman’s interview with founder David Winn, MD, FAAP, who says he wrote his initial product in Paradox and PAL (we old-timers know about that). Thanks to e-MDs for supporting HIStalk.

Four hospitals and 15 clinics in UAE are live on Cerner Millennium.

In Australia, the New South Wales Department of Health announces a $74 million statewide health information exchange.

This is a good interview (in six parts) with Omnicell CEO Randy Lipps. Talking about his experience with his hospitalized child: “I was looking at a nurse who was highly paid and highly trained, and it seemed like 75% of her work was what a clerk would do. Because my daughter was on a ventilator there were a lot of disposables. My daughter had dedicated nurses, and I saw the entire cycle. When the next nurse came in she would start fumbling around the drawers, looking for stuff. I would tell her where the previous nurse had stored her stuff. The each had their own secret stash of supplies because the supply chain within the walls of the hospital was so broken. They all had their own system to make sure they had the materials they needed for their jobs.” And speaking of competitor Pyxis: “Pyxis was a Street darling before they were acquired by our big competitor. They are a division of Cardinal now. They are a great company and I wanted to mimic them so much. When they got taken over by a large company, they stopped investing in R&D, and they stopped investing in customer service. In healthcare, especially with hospitals, it is not about selling product but creating a partnership.”

OK, so the big healthcare lobbying groups offered to cut healthcare costs. Sort of. Or, maybe cut the rate of rise a little (like me saying I’ll take less of an annual increase if you’ll let me keep goofing off as an employee). They agreed to everything, but nothing. They offered self-serving reform to make sure real reform doesn’t flare up. Remember Medicare Part D, the drug company windfall profit assurance act, that was pushed through by Congressman Billy Tauzin, who immediately quit to become the president of PhRMA, the drug company lobbying group that benefitted most from his political maneuvering? Those reform-minded folks are at the table, of course, with newfound heartfelt concerns about Joe Sixpack. There’s a long history of scumbaggery by some of those groups and the politicians who take their money. Want real reform? Impose it without their involvement. If they offered $2 trillion, $20 trillion should be about right for starters.

Massachusetts tried and failed to curb medically unnecessary ED visits, apparently, as the 47% rate of inappropriate utilization hasn’t changed, but costs have spiked 17% over two years.

Don’t forget that you can see recent comments on this page I created.

Jobs: Cerner CPOE Activation Support, IMPAC Mosaiq Consultant, SVP of Sales.

Michael William Freeman, son of Medicity RVP of sales Bill Freeman, has a role as Morgan Gutherie in the season finale of The Mentalist. Check him out next Tuesday at 9 Eastern.

McKesson is interested in acquiring more medical device companies from Israel, saying that country has companies that excel at linking medical devices with information technology.

A Cerner software guy invents Web Bootstrapper, a technology used in Cerner’s PHR that tailors a Web site’s display based on the speed of the device connecting to it, such as smart phones.

McKesson’s practice management people are staying in Dubuque, the GM says, now that the company’s office has moved to a technology park after leaving downtown Dubuque and laying employees off.

Famous neurosurgeon Ben Carson of Johns Hopkins (mentioned by Hopkins CIO Stephanie Reel when I interviewed her and holder of an amazing 50 honorary doctorates) is on the board of Physician Capital Group, started by a friend of his. Doctors input their fee-based activities into a BlackBerry or iPhone and the company pays immediately, but takes 12% as a commission while it waits on its own check from the insurance company.

Open source software is touted as a good solution at the first Philippine eHealth and Telemedicine conference. I tracked down the company of one speaker, myCare2x, an Germany-based open source system (PHP, Apache, MySQL) that has a fully online live demo.

Nuance Communications files its Q2 report: revenue up 13%, EPS $0.03 vs. -$0.13 (and $0.24 not counting asset amortization).

You knew it was coming: the husband of the first US resident to die of H1N1 is suing pork producer Smithfield Foods, whose Mexican farm is where “some believe” is where the virus originated.

E-mail me.

HERtalk by Inga

Johns Hopkins Hospital is the latest medical facility to warn patients of potential data theft. The hospital sent a letter (warning: PDF) dated April 4 to the Maryland attorney general’s office alerting them that a former employee was suspected of fraud involving fake Virginia drivers’ licenses. The hospital first learned of potential problems on January 20 and notified 10,000 patients of their suspicions April 3.

Kathleen Sebelius names nine staffers to the Office of Health Reform. This is the office tasked with spearheading HHS’s efforts to pass health reform this year. A quick glance at the list suggests the staffers are mostly political appointees (former Obama campaign staffers and the like) along with one doctor.

Our HIStalk Hero of the Week is Medicity, which donated $5,600 worth of IKEA furniture to help Ronald McDonald House Charities furnish a new wing at Cincinnati Children’s Hospital Medical Center. The sofa and assorted tables and chairs were originally acquired and used to furnish Medicity’s booth at HIMSS.

Even in a recession, vanity prevails. The number one surgical procedure nationwide last year was breast augmentation and the top non-surgical procedure was Botox injections. Over 355,000 breast augmentations were performed in 2008 at an average cost of $3,900. That’s a lot of implants.

Shareholders of HealthSouth file a civil lawsuit against founder Richard Scrushy, asking him to pay $2.6 billion for his alleged role in a HealthSouth fraud scheme. Shareholders are asking Scrushy to repay salary, bonuses, and stock deals, as well as personal plane flights and breast implants for a singer he was promoting. Regardless of how the suit is settled, it’s unlikely Scrushy still has much money of his own. He’s in prison on a state bribery charge.

Merge Healthcare aligns with Shanghaie Kingstar Winning Co, a Chinese healthcare IT company serving over 800 hospitals. The arrangement allows Kingstar to offer its clients Merge’s document imaging solutions.

UNC Hospitals (NC) select MediClick to provide its Contracts & Analysis solution to manage supply contracts and purchased services agreements.

The LA Times releases an interview with Farrah Fawcett, which includes plenty of criticism for UCLA Medical Center’s failure to protect her privacy. When details of her cancer appeared in the National Enquirer, Fawcett was convinced the leaks originated from UCLA. She and her doctor eventually set up a sting operation, which led to an investigation by UCLA officials, who tracked the leaks to one particular employee. At the same time, UCLA repeatedly asked Fawcett to donate money to the hospital for a foundation to be set up in her name.

AMICAS posts $11.3 million in revenues for the first quarter, compared to $12.8 million the first quarter of 2008. Net loss for the quarter was $1.2 million, or $(.03) per share, compared to last year’s loss of $467,000 ($.01) per share.

An English plumber visits his GP’s office after experiencing tremendous pain and bleeding from his belly button. The GP removes a 4 cm fetus, which was determined to be his parasitic twin – an identical twin brother that had died in their mother’s womb. Here’s the really icky part. The plumber had his brother’s fetus placed into a jar and took him home.

E-mail Inga.

2009 Reader Survey Results

Thanks for participating in my reader survey. Here are some high points that I took from it.

• A little less than half of readers have ever posted a comment to an article. (Try it! Everybody has something to say or share.)
• The most important elements of HIStalk are news (4.61 on a 5.0 scale), rumors (4.44), humor (4.31), and Inga (4.30).
• 95% of readers say HIStalk influences their perception of products and companies.
• 77% of readers say they have a higher interest in companies mentioned in HIStalk.
• 79% of readers say HIStalk helped them perform their job better in the past year.
• 99% say HIStalk has influence on the industry.
• 92% said the HIStalk’s posting frequency is “about right”.

Here are some specific comments and suggestions I pulled out as representative of what readers provided. The most common comment was “don’t change a thing,” which I appreciate as well. Your feedback on any of these is welcome.

• It’s more important about NOT changing your basic tenets: provide an accurate, concise summary of what’s happening in the industry, sorting out the rumor mill facts, letting us hear from interesting people in the industry and the new ideas and people in the industry. You are the only one providing this unbiased service and I really appreciate it. Thank you.
• The site is pretty ugly and difficult to read. Us vendor folks could mentor you in design if you ever asked 🙂 I know, but I like it amateurish because, well, I’m an amateur. I admit to having zero aesthetic ability.
• Too many Flash ads. Several readers mentioned that the animated ads are distracting. The immediate solution was to offer the View/Print Text Only link at the bottom of every article that shows only the article itself. I will also pass the suggestion of static-only ads along to the sponsors, although it’s their call.
• More writing about smaller companies. I would love to, but it’s hard to separate the PR from reality sometimes. I’ve been burned before about what I hoped would be an honest appraisal of a technology or company only to have the marketing people swoop in to spin the facts.
• Don’t run unsubstantiated rumors. I like the dichotomy that a few readers made the same comment, yet rumors are the second most popular feature. I try to get confirmation and often do, but not always. I don’t run all the rumors I get, so I have to walk a line between what sounds likely but with the understanding that sometimes the rumor is wrong. The good thing is that if it really is wrong, someone in the know will usually correct me quickly and I always run those corrections.
• I would like to change HIStalk discussion forum. I’d like to see it used more, but I’ve learned to live with the fact that HIStalk readers just don’t like posting to a discussion board. They are doing better in posting article comments, though.
• HIStalk is Mr. HIStalk’s unique thing; don’t change anything because I trust Mr. HIStalk’s judgment. Thank you.
• Paragraph headings with vendor/site/technology/main-topic keyword, to allow skimming. That’s really hard since we cover a lot of ground in one posting (that would be a ton of headlines). Other readers suggested some kind of online compendium of items grouped by vendor, provider, or product, which would be pretty cool but a big of a pain to maintain. Thoughts? I’m sure I could find some cheap labor to pick through each HIStalk post, cull out items by company or person, and then add them to a specific page for that company or person. Would anyone find this useful enough to be worth the expense?
• Have scheduled online chats. I’ve tried those and participation wasn’t very good. I’m not sure people like chats in general, plus their synchronous nature requires being in front of a PC at a specific time.
• Don’t let your "interviews" be PR spots for their products or companies. I try, but it’s sometimes hard to derail the subject from their agenda.
• Do a podcast version, e.g., interviews with actual HIS users with experiences to share. I’m not a fan of podcasts, but I’m looking at recorded Webinars as a good alternative. Stay tuned.
• Make it your full time job as it should be netting you around $2 million a year by my estimates if you were charging what it is worth. This would allow you to do a better job building your portfolio by extending your brand. Of course you would have to ‘out’ yourself which won’t be a bad thing. OK, I admit I included this reader’s comment here just because it flatters me.
• This is a hard question because you do such an incredible job. The only change I can think of to more strongly encourage people to do reporting ("it takes a village to make a great blog even greater"), especially from conferences that everyone does not have time to attend, and coach people on how to develop pithy content vs. vague comments, "here’s three things I hadn’t heard before" vs. "the conference was ok, but fewer vendors were there.” That would be great, although I’m always wary (from experience) of assuming that good readers will happily transition into good writers. I respect the fact that some folks just want to read and leave, but having a few more readers who are more involved would be super.
• If you comment on someone else’s dialogue, make your comments a different color, or make there’s different all of the time so it is easy to tell who is "speaking." Man, I have struggled with this one. I post reader comments in blue, but that still leaves quotes from articles. I’m open to ideas.
• I would look for success stories in healthcare delivery (the real stuff, you know, when a doc/nurse and a patient interact, and that interaction is enhanced by technology); we all need to see them and remind ourselves why we do what we do. That would be great. I wish I got more of those stories.
• Resolve the HIStalk-HIStalk Practice weirdness. They seem to repeat some information, and they don’t apparently link to one another. HIStalk covers everything, while HIStalk Practice covers physician practice technology. Sometimes the same item appears in both, but only when it’s appropriate. The idea was that HIStalk Practice would cultivate a new audience interested in ambulatory topics and not the more hospital-centric topics that appear on HIStalk. We interviewed individual doctors about their EMRs, for example, for HIStalk Practice, something we probably wouldn’t have run in HIStalk. While some readers follow both, we expect each to have a majority of readers who don’t look at the other. It will take some time to figure out if that’s indeed the case.
• Give yourself a break–you must work enormous hours. I do. I need to quit my day job one of these days, but I would need to find something that would offset the income I would lose using the time I would gain. And, some activity that would keep me in the industry since there are plenty of bystander writers out there, but not as many participant ones.
• Might be interesting to profile healthcare providers and hospitals more to get a feel for what’s happening out where systems are used. You’ve done it occasionally, but most of your interviews and profiles are from vendors. That would be great, assuming provider people would participate. We will try to get more of those.
• Do more for job placement or available positions. Maybe by region? I’ll consider that.
• Still don’t understand the difference between Inga’s section and Mr. HIStalk, except for the footwear comments. It’s only to let you know who is writing, especially if we express an opinion. Inga often writes first, so if she covers an item, it goes in her section. Since we’re kind of chatty and personal, there would be “weirdness” (to use the reader’s word above) if you didn’t know who was “talking”.
• I use IE6 w/ virtually no security, but I still never see any "…on your right" columns/content. Vendor ads are on the left, your editorial paragraphs are in the middle, blank space on the right. How about a "setup your browser for this site" FAQ link? I’m always the last to know about IE problems because I don’t use it. Readers e-mail fairly often saying that something is wrong with HIStalk’s layout, ads, or signup forms. Invariably they are using IE. If someone readers HIStalk on IE6 or 7 and everything works like it does in Firefox, let me know what settings you’re using (screen shots?) and I’ll pass it on.
• HIStalk is a fantastic contribution to the industry – someone should write a "good guy" story about you! Please keep it coming!! That one was me preening again. I’d rather be anonymous, though. As the very few people who have known me for years as Mr. HIStalk will attest, I’m uncomfortable talking about it.
• Having Deb Peel pose as Inga in Chicago was a scream. I agree. She was fun, as were our other sash-wearers.
• You’re a game-changer… many people I know don’t pick up the trade rags anymore. Thank you. I haven’t read any of the glossies for years, so it isn’t just me.
• Because I am new to this site and HIT but interested in learning as I go (you are my tutorial) I would love a decode area where I can find out exactly what acronyms like CCHIT and HIMSS stand for, etc. I figure I can start with a glossary and then take it from there. It would help me if users would provide some of the definitions.
• Since I am new to healthcare (vendor side), HIStalk has been VERY instrumental in helping me learn both sides of the industry and issues. I would like an occasional "101 learning piece" for the newbies- maybe in the form of a subject and the Seasoned folks can comment. "What I wish I knew when I was new…" or something like that. HIStalk has been like being the new kid in school but the cool kids still let you hang out with them. Thanks SO much! Best of luck! That’s a fun idea. If I could ever get people to read and post to a discussion form, that would be a perfect vehicle. Maybe I need a redesigned forum, although you wouldn’t believe how hard it is to keep spammers out.
• Do you have a day job (I assume the answer is yes), a family, hobbies? Yes, yes, and yes. Well, OK, I really don’t have any hobbies other than HIStalk.
• Thank you for including peer-review journal articles in your analysis and not limiting your reporting to just the commercial press. Happy to do it. If you see something interesting that I can get full text for, I’m happy to critique it.
• You can get started on vendor-independent Webinars – specifically to cover new technology usage in real hospitals/practices, and provide business cases that others could emulate. These would have to be done by healthcare providers. Working on that. I agree completely.
• The work you guys do has been invaluable to my career. I reference your work often (and give much deserved credit), and you have provided keen insight into the industry’s inherent complexity and overarching issues. My time as a journalist taught me a lot about the value of curating and meaningful dispensing content, and I can recognize editorial value when I see it. You guys nail it. Thank you.
• Some of the questions in this survey seem more commercial than the tone you have historically taken with this blog. Please don’t tell me you are being seduced by the money available for more directly pushing sponsors or others products! It’s the same old survey. I have plenty of sponsors and make zero effort to get more, other than writing HIStalk as usual. I’ll be honest: it’s great to not have to worry about that.
• Brilliant job, don’t know how you do it, but so glad you do, I am completely your fan! Keep going and add more contributors to write guest columns like "Being John Glaser". Expert judgment is one of our best assets. The washout rate for guest columnists is high, but I would like to have more of them since I enjoy what they have to say as well.
• Make links easier to see in Firefox. Working on that now.
• Put up an industry events page or calendar. Working on that now.
• You provide the conscience to this crazy business. If you’ve made one person in power a more honest person, then you’ve done a great service to us all. Thank you.
• A great job. I’ve gotten our CMIO and our CIO to read it. Of course, when his name appears in a report he’s not too happy, but hey, at least the stuff is usually accurate, even if we can’t figure out who named names.

Monday Morning Update 5/11/09

From Stan van Man: “Re: Sage. I just got an e-mail from one of the people who was cut at Sage who told me that Sage Healthcare RIF (don’t you love that acronym) was 500.” My company contact tells me that Sage North America reduced headcount (employees plus open positions) by 500, but that’s throughout all of Sage, not just Healthcare (which took a relatively minor hit).

From Dr. Lyle: “Re: Cerner MPages. I’m a long-time Cerner user and have many bruises to show for it. However, I am cautiously optimistic about MPages as it appears to be what many of us have been asking for: a Web-like front end to the data and functionality in the system. At the very least, it allows users to use HTML and similar programming to create a user interface which displays disparate data in the way they want, such as creating a diabetes screen that brings together meds, labs, physical exam findings, and evidence-based findings. At the very most, there may be some opportunity for interactivity via data input (e.g. change a variable to see how it affects the data) and ordering (e.g. meds, tests) on that very screen. In other words, they are beginning to go down the road of separating the data from the application and interface and allowing end-users to create the displays and customized functionality we believe will work best for us. While this might seem like common sense, most EMR vendors continue to work in a closed, three-tier system (data, application, and interface) that does not allow for this level or ease of customization. It could lead a new paradigm of what an EMR is and does, shifting EMRs to become a platform that holds the data and applications, but allowing interfaces to be in the hands of the users.” Dr. Lyle refers to his blog entry on EMR usability. I liked that idea going back to the mid-1990s, when vendors or users of character-based systems turned them into something that looked slick and brand new by using screen-scraping tools like Attachmate or Seagull to create GUIs that could even tie multiple applications together under the covers. It would be cool if a vendor app could provide functions and tags that would work like ColdFusion or PHP, giving users control of the display and maybe extending its functionality by doing lookups into other systems, links to Web content, or databases or running self-developed functions. Customizing screens, screen flow, and reports is most of what users want to change, not the underlying database or internals, so that would be powerful.

Speaking of MPages, I found this site, run by techies at UW, Stanford, and UAB, which is trying to build an open community of MPages developers.

From Josh: “Re: reusable components. I thought it was worth reiterating a point in your 5/6 update: ‘What healthcare needs are small, specialized systems that interact.’ This diametrically opposes the notion of ALL of the major HIS vendors to date. The idea of small, standards-based reusable components rather than monolithic, interconnected systems is called Service Oriented Architecture (SOA). There are a number of successes in other industries and the core notions (Enterprise Service Bus, Agile development, composite views, etc.) are readily understood in the software development community. What seems not to have been done is the transformation of provider requirements to force deconstruction of these systems. I’ve long been flabbergasted at the interface inflexibility in most commercial HIS offerings and the uselessness of data we generate in applications not intended by the designer. It’s time that the providers start dictating detailed requirements to our vendors – and SOA may be the mechanism to do that.” That is an interesting paradigm – CIOs have pushed the “off the shelf” idea to the point that prospects rarely put system design issues into their contracts, either accepting the product as-is or choosing a different one. When I worked for a vendor, I hated the idea that we couldn’t do something specific for a customer unless we rolled it into the base product, which either meant we had unhappy customers or a Frankensteinized product with a bunch of jerry-rigged bolt-ons added just to make some weird customer happy (usually one of our biggest customers, no surprise there, who bring both unreasonable influence and illogical processes to the table). I like where this discussion (and the one above) are going. If software could be customizable while remaining supportable, everyone wins.

I just posted a summary of the 2009 HIStalk reader survey. I didn’t e-mail blast it since not everyone cares about it, but if you’d like to know what readers suggested and what I think I can accomplish, check it out.

England’s Department of Health gives BT $150 million in advance payments despite what the Guardian says is “years of delays, system failures, and overspending …” and a temporary government ban on Cerner rollouts because of system problems.

I’ve hosted a visit by Traveling HIT Man, my new BFF (that’s him, helping me edit today’s post). He’s looking for the next stop on his HIT tour (see the pics of where he’s been), so if you’d like to have him come to your place, let me know and I’ll send him your way. 

HHS announces members chosen for the Health IT Policy Committee (advises ONCHIT on interoperability) and Health IT Standards Committee (advises ONCHIT on standards and certification). Both committees hold their first meetings this week in Washington.

Odd: two motorcycle riders in India, one of them a Dell software engineer, ride around pulling the scarves of girls for some reason. Locals caught them and beat up one of them, but the Dell guy escaped, only to be arrested later and charged with criminal intimidation and assault with the intent to outrage modesty. His punishment is to sweep the floors of a local hospital for one hour per day for a month.

Patient Safety Technologies, the sponge counting system company, names board chair Steven Kane as CEO following the pursuing of other interests of David Bruce, former president and CEO.

Cooper University Hospital (NJ) gets a local newspaper mention for going live on its $30 million Epic project.

The swine flu is coming and humanity will be wiped out! Old-timers have heard this before, in 1976, and we even had a vaccine then (although it had a couple of minor problems: it didn’t work and people who got it sometimes died. But hey, some people died who didn’t get it, so evidence is inconclusive.) Concerned Americans who heard about today’s crisis on celebrity gossip sites have responded to this serious risk to their health by drinking, speeding, smoking, having unprotected sex, chowing down on superhuman junk food portions, and taking a bottomless pharmacopeia of dangerous prescription and illicit drugs. 

President Ford — uhh, Obama — has a great health care plan, other than it will cost $1.5 trillion. I’ll let Sen. Ron Wyden of Oregon speak for me: “You go to a town meeting and people are talking about bailout fatigue. They like the president. They think he’s a straight shooter. But they are concerned about the amount of money that is heading out the door, and the debts their kids are going to have to absorb." The article wisely observes that “one person’s wasteful spending is someone else’s bread and butter,” saying that doctors, hospitals, and drug companies are going to raise holy hell about any attempt to pay them less, even for good reason.

Chinese hackers break into Cal-Berkeley’s health sciences servers, giving them access to the health data of 160,000 students and relatives. Nobody noticed for six months.

The UCLA Medical Center employee who pleaded guilty to selling celebrity medical records to the National Enquirer has died of breast cancer.

A university does the “buy some old drives from eBay and see what’s on them” test. What they found: Lockheed Martin ground-to-air missile plans and its personnel records, medical records, pictures of nursing home patients, correspondence from a Federal Reserve Board member about a $50 billion currency exchange, and security logs from the German Embassy in Paris.

Speaking of which, thanks to the reader who reminded Inga about the need for offsite PC backups (since my trusty USB hard drive sits two feet from the PC, giving it little chance of selective survival in a fire or disaster). I’m doing a 15-day free trial of Carbonite.

Here’s what I love about hospitals: a 17-year-old high school athlete goes to the ED of Kadlec Medical Center (WA) with a shortness of breath. She is correctly diagnosed by the ED staff as having a pulmonary embolism, almost unheard of in young, healthy patients. The next night was prom night, so the peds staff brought in her dressed-up boyfriend and classmates, made her up in her prom dress, took pictures, set up a CD player and disco ball in her prom-decorated room, and provided a candlelit dinner for the couple (with Jello for dessert, of course, since it’s a hospital). “We are totally blown away by what they did,” the mother said.

E-mail me.

News 5/8/09

From Ellis Dee: “Re: ARRA. A hospital that has a large outpatient makeup but very little inpatient appears to get significantly less ARRA reimbursement for EHR since the calculation only mentions inpatient. I’d be curious if this is just a legislation snafu that will generate enough complaints to include outpatient. It seems EHR investments and continuum of care applies even more so to outpatient.”

From Roy G. Biv: “Re: HHS. Is it me or is the new health IT web site a little thin? For some reason, they also changed the domain from www.hhs.gov/healthit to healthit.hhs.gov. My take is they implemented a new portal vendor, while the last site was home grown and content managed by HHS directly. I included a link to the Internet Archive ( Wayback Machine ) of a cached version of the site a year ago – a lot more content – and bigger print.” Before, after. It looks like it might be portal software from the former Plumtree Software, which was bought by BEA, which was bought by Oracle (the software version of a Matrushka doll).

From Looking for Answers: “Re: Cerner. What is Cerner’s MPages, why are people so excited about it (to make a video), and does it give Cerner an edge?”

From X-Sage: “Re: layoffs. 1,000 layoffs announced by Sage in England during briefing on six-month financials earlier this week, with Sage Healthcare getting hit once again starting on Tuesday.” One reader put the healthcare cuts at 200 people with more to come. In the mean time, one stock analyst likes Sage stock OK, but says getting into healthcare was a mistake, especially now that Allscripts and Misys have merged to create a formidable competitor.

From Revenue Randy: “Re: Sutter EMR project. Get ready for Son of Sutter … Stanford Medical.”

If you’re a doctor shopper looking for OxyContin in Virginia, now’s your chance: the state database that hackers hijacked is the one that healthcare professionals check to identify drug-seekers. It’s now offline. Mr. Limbaugh, your prescription is ready.

Porter County, Indiana was sued last year for $3.4 million by a management software vendor that claimed Porter Hospital used its software without permission after the hospital was sold to for-profit Community Health Systems. The county argued that the new owner should have worked out a deal with the vendor, so they paid $200K to get out of the suit. Now the hospital has countersued the county, claiming a contract clause makes it the county’s problem. The county is threatening to counter-counter-sue the hospital for the $200K.

I’ll say this, having worked for a non-profit hospital bought by a chain: a former non-profit’s employees sleep behind enemy lines because everyone in the community suddenly hates you, even though you’re going to work in the same building with the same people. Appropriately so in my case: the company running my hospital was a truly impressive bunch of sleazebags and scoundrels who gravitated to healthcare only because the money was good and fraud wasn’t often detected. A classic line from our brand new 24-year-old hospital president in his first real job, speaking to our long-time CFO who predated him by decades: “We need to use less oxygen.” We snickered at his stupidity, but he went on to make dozens of millions running the slimeball organization, somehow avoiding jail time unlike many of his peers. If you were a patient in our hospital back then, I am truly sorry our management brought in clearly incompetent doctors whose only attribute was that they would take orders from a 24-year-old MBA using patients to rise through the ranks. I have a lot of stories, unfortunately.

The State of Massachusetts is considering ditching fee-for-service payments to doctors and hospitals and instead giving them a capitated yearly payment. This is an interesting thought: “… because doctors and hospitals would have to work together more closely to manage the budget, the hope is they will better coordinate care for patients, which could improve quality.” Catfight!

A WHO advisor provides an opinion on the US healthcare system, one question being what advice he would have for the President: “My advice would be to avoid a search for villains (e.g. insurance or pharmaceutical companies) or panaceas (e.g. the electronic medical record), neither of which will be very productive.  Instead, Americans need an intelligent public policy debate that both builds strong consensus for the goal of universal coverage and fosters understanding of the consequences of the structural fragmentation of the existing system and why this has to be addressed.  Expanding coverage without tackling this underlying problem will be very costly, so equal attention needs to be given to both fairness and efficiency if the U.S. is to move towards a system that is both universal and affordable.”

Non-profit Global Patient Identifiers, Inc. and software vendor MEDNET announce a partnership in which MEDNET will issue cards with GPII’s Voluntary Universal Healthcare Identifier and also donate in kind to GPII.

Not satisfied with wasting your personal time Twittering? Now you can reduce your company’s productivity as well with the aptly named Yammer, a near-clone of it aimed at private networks (it reminds me of the old Groove before Microsoft bought it). It might be useful, although I don’t see much benefit over a decent e-mail and IM system (why does everyone fret about blocking unnecessary e-mails when most people just delete them anyway?) The New York Times kind of liked it. It’s free to join, but to get more control and security features costs the employer $1 per user per month (so unlike Twitter, it might actually have a business model other than being sold).

Cambridge Consultants rolls out a Bluetooth-enabled inhaler that follows Continua standards in allowing inhaler usage data to be collected and placed into PHRs.

This sounds interesting: a Silicon Valley startup called PreviMed starts a Healthcare Innovations Lab to evaluate HIT innovations from the user perspective.

This is a big deal: Citrix announces the availability of its free Citrix Receiver for the iPhone, which allows running XenApp hosted applications (Cerner, McKesson, Microsoft, Oracle, and SAP are specifically mentioned).

Microsoft lays off another 3,000 employees with the likelihood of more to come.

Listening: Catatonia, alternative rock from Wales, defunct since 2001, with a startlingly pretty lead singer.

Two New Jersey men plead guilty to making $300K by stealing medical equipment from New York Presbyterian Hospital and selling it on the Internet. One was a hospital equipment specialist.

Like an ED on diversion, I’ve been too busy to accept new e-mails (or at least to reply to them). I always catch up eventually, though, even with the equivalent of at least two full-time jobs that are wearing me down steadily.

I think this is new, but I can’t tell since HIMSS doesn’t date its news items (damned annoying). They’ve got a simple online estimator of Medicare incentive payments under ARRA (if you’re a member, anyway).

I goofed: I said the Kingdom of Jordan is a Medsphere customer that was recently quoted a saying open source would cost them at least as much as commercial applications. I knew they were implementing VistA and found 2,000 Google hits linking Jordan with Medsphere (Medsphere proudly ran press releases announcing that the Jordan people were considering them). Medsphere lost that business to Perot.

Interesting details on the GE-Intermountain partnership. Development costs of whatever they’ve been working on since February 2005 are $300 million, with Intermountain paying $100 million and GE chipping in $200 million. Intermountain gets royalty payments (that makes them a vendor, so keep that in mind as they hit the presentation circuit and offer site visits). Brent James is a smart guy, but I would question whether this quote reflects reality: “"It means our ability to deliver good care is going to explode at the same time the costs are going to drop profoundly.” Duly noted: I will be watching for Intermountain’s quality numbers to ramp up and their costs (and charges) to fall precipitously. If either happens, that will be the first time an IT system ever had that kind of effect.

SAIC gets a $158 million contract to maintain and enhance some aspects of AHLTA and CHCS for the Department of Defense.

A security company sues the SEIU healthcare worker’s union (you Easterners know them as 1199) for not paying its $2.2 million bill. The surveillance and counter-intelligence group, made up of former FBI and CIA agents, was hired to spy on the union’s own members: to conduct surveillance of the union’s offices, to intimidate union members coming and going, and to protect SEIU’s visiting executives while they secretly met with hospital CEOs and legislators. At least that’s what the National Union of Healthcare Workers, a newly formed competing union, says (also accusing SEIU union bosses, shockingly, of pillaging union assets). SEUI is suing them, of course.

E-mail me.

HERtalk by Inga

Allscripts announces Cardinal Health is its latest Allscripts MyWay reseller. Interesting move on Cardinal’s part, especially since the spinoff of CareFusion suggested Cardinal was restructuring to increase focus on its core drug distribution business.

A psychiatry fellow blogs on East Coast versus West Coast medicine. She observes that medical hierarchy is more obvious on the East Coast, e.g., doctors wear one color scrubs and nurses another. Though East Coast doctors are more blunt, they are not necessarily "meaner" than their West Coast counterparts. The most important observation: psychiatrists on the East Coast dress significantly more fashionably than those on the West Coast (see above – not a psychiatrist, but definitely one nicely dressed East Coast doctor.)

Eclipsys reports a first quarter loss of $.9 million or $.02 per share compared to last year’s $.3 million/$.01 share profit. Revenues came in above Wall Street expectations, however. Quarterly revenues were $130.2 million, with is above analysts’ $125.5 million estimate and about 5% higher than last year.

The 40 doctors at Lenox Hill Interventional Cardiac & Vascular Services implement Professional Intelligent Charge Capture by MedAptus.

This week I was having a battery problem with my laptop, so I gave Dell a call to diagnose the issue. While running diagnostics, we discovered that in addition to a failed battery, my disk drive had some serious errors and needed to be replaced. So, I pulled out the external hard drive that I have had for a year and half and never used – it was still nicely shrink-wrapped in its box. I feel as if I dodged a bullet and wondered how many times a day consumers and businesses lose precious data to hardware failures because, like me, they are too lazy to back up data?

API Healthcare announces three new hospitals and health systems are now utilizing its human capital management solutions.

An Australian hospital bans the use of its new EMR system after its second failure in three days, including a two-hour outage. An official is quoted as saying, "Staff report the electronic medical records system is so cumbersome that senior medical officers who previously saw 8-10 patients in a shift, are only getting through 5-7 because they spend so much time trying to access or enter information."

GE announces plans to invest $6 billion by 2015 on its "healthyimagination" initiative, aimed at delivering lower-cost medical equipment and care around the world, while increasing earnings at its medical systems and bioscience division. The strategy includes $3 billion in R&D on new medical systems and services, $2 billion in financing, and $1 billion for GE technology to support HIT and heath in rural and underserved areas. GE’s big plans for improving healthcare around the world almost makes me feel guilty for complaining about the $350 I just shelled out to GE to fix my broken oven.

Bridges to Excellence publishes a study entitled Physicians Respond to Pay-for-Performance Incentives: Larger Incentives Yield Greater Participation. And we needed a study to figure this out?

Healthvision adds 10 international clients in Q1.

Cedars-Sinai Medical settles Ed MaMahon’s malpractice suit from last year in which he claimed doctors failed to diagnose his broken neck, discharged him without taking an x-ray, and later botched two spine operations.

Content management vendor Open Text enters into a purchase agreement for competitor Vignette. The total transaction price is about $310 million.

Perot Systems announces plans to lay off 450 employees to offset lower project-based revenue. The reduction is expected to save $30 million annually.

QuadraMed reports a first quarter net loss of $200,000, less than the $1.1 million loss reported for the same period last year. Quarterly revenue was flat at $35.1 million.

The Ohio Department of Administrative Services selects APS Healthcare to manage the provision of disease management and health and wellness services for 50,000 state employees.

As Mr. H recently pondered, had did we survive in the olden days when we only had three network channels to keep us amused?  For the curious (and non-squeamish) you check out Wired Science’s 10 best surgical videos. Really now, are our lives more complete once we can observe a a sex-change operation?

E-mail Inga.

News 5/6/09

From Seth Hazlitt’s Nephew: “Re: Sutter. The Sutter project situation reminded me of your Universal Rules for Big EMR Rollouts™, specifically number five: ‘All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and […] will vanish without a trace at the first sign of trouble, like when […] the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.’ Is Jerry Padavano still with Sutter? How long until Jon Manis vanishes without a trace? A year and a half ago, Sutter said it had already spent $500 million, up from the original projection of $150 million. By early this year, it was up to $1 billion. As of this point, what exactly did Sutter get for their $1 billion+ investment?” My Universal Rules piece was a pretty big hit, I have to say. As for Sutter, it’s hard to say other than I was incredulous when they first announced how much they were planning to spend, which turned out to be a small fraction of the final estimate. What healthcare needs are small, specialized systems that interact, but that can be customized and managed locally and individually without making the whole enterprise-wide deployment as vulnerable and as unintelligent as the lowest common denominator of the systems that make it up.

From Pat Cremaster: “Re: Sutter. They couldn’t fund the EMR because of stock market losses and the decision to fully fund employee pensions (too bad other companies make similar promises to employees, but rely on government intervention when their pension goes belly up). It’s also a shame that our healthcare delivery industry requires investment income to fund it.”

From Ian Miller: “Re: e-prescribing. DICOM and HL7 standards are available as free downloads, but the specification of NCPDP SCRIPT Standard for e-prescribing medication costs $655. Wouldn’t it increase adoption to let anyone (like an open source developer) take a shot at creating the e-prescribing killer app by offering the NCPDP SCRIPT specification for free?” I’ve never understood why organizations charge for that kind of documentation when e-mailing out a PDF costs nothing. I admit I’m suspicious about non-profit motives when I see that.

From Lisa Lopes: “Re: HIMSS conference proposals. It is a shame that one must submit them so far in advance. You really have to be thinking about it. So much can change in a year. I always liked roundtables, but there aren’t as many of them anymore. Panel discussions allowing for interaction between panelists themselves and with the audience, I think, are superb vehicles for communication of issues that healthcare IT professionals are dealing with.”

From Lazlo Hollyfeld: “Re: ARRA. After all of the talk about ARRA boosting health IT purchases, clinical spending looks like it will be slowing since everybody is waiting to see what happens over the next 9-12 months. On the other hand, waiting to purchase an EMR system until next year is going to cause some potential difficulty in getting up and running to get paid. Talk about your unintended consequences. Meanwhile, the revenue cycle management vendors just keep humming and moving along as profit margins continued to get squeezed along the entire provider spectrum.” 

From Tom Servo: “Re: Pam Pure. I heard she got a hefty severance package, like $6 million, and new bedrooms and a security system for her horse farm. Meanwhile back at the employee ranch, merit increases were eliminated, profit sharing was eliminated, hours were increased, the fear mentality set in, and people were replaced by terrible Indian outsourcing. Shades of the finance industry.”

From The PACS Designer: “Re: HIStalk’s top 2% ranking. TPD found a website called /URLFAN that rates the popularity of Web sites. Happy to report to Mr. H, Inga, and HIStalk readers that our Web site is in the top 2% of over 3.7 million websites at #80,672. Thanks go to every one of you who contribute to HIStalk to make it the site to go to for the latest health care information and reader comments and writings!” Link.

To think we missed narrowcast content like this when there were just three networks and no Internet: this Web page deals exclusively with hospital food around the world. You will be shocked that most hospital food is dietician-approved, yet thoroughly unappetizing. Captive employees, of course, are shafted by their hospital employer on overpriced cafeteria meals (and the minuscule employee discount is one of the first budget cuts made). The most heinous act you can commit in a hospital, other than abducting a newborn, is daring to refill your $1.75 waxed paper cup from the soda dispenser like every fast food restaurant lets you do, thereby costing a billion-dollar hospital operation a budget-busting three cents. Boot camp recruits and prisoners eat the same prepackaged food from the same soulless food service outsourcers, so it’s about what you would expect (maybe openly rebellious employees and doctors should be punished with a Nutriloaf diet).

Since we’re on the “how fancy do your hospital buildings need to be” debate, this story from India is interesting: Lessons From a Frugal Innovator, subtitled “The rich world’s bloated health-care systems can learn from India’s entrepreneurs”. Example: heart bypasses are done under local anesthesia, but they have triple the IT adoption of US hospitals. Columbia Asia, a US company mentioned here before that operates hospitals in poor countries, is featured. “Columbia Asia … left America to escape over-regulation and the political power of the medical lobby. His model involves building no-frills hospitals using standardised designs, connected like spokes to a hub that can handle more complex ailments … Its small hospital on the fringes of Bangalore lacks a marble foyer and expensive imaging machines—but it does have fully integrated health information-technology (HIT) systems, including electronic health records (EHRs).”

I doubt Medsphere will include this quote in its marketing materials even though it’s coming from a high-profile OpenVista customer. Jordan’s technology minister, when asked about using open source, said this: “It will cost you more, by the way. We are working in the hospital sector, using open source. I think that in the beginning, the cost will be higher. In the long run it could be better. You have to develop software to interface with the open source, which will cost you more.”

Shareholders of IBA Health approve changing the company’s name to iSOFT Group, reflecting the brand name of the product and company it acquired awhile back.

A newspaper editorial observes the institutional nonsense that pervades every hospital. “Part of the problem is the computer. If the medication isn’t listed there, you don’t get it. It might just need to be renewed or re-entered, as meds have a sort of built-in renewal date. ‘Would you please call the doctor and check?’ you ask. ‘I will put a call in,’ is the reply, which is code for you won’t be getting that medication for a good long time. If you hear, ‘the pharmacy will have to be called,’ then you might want to call a friend and see if they can bring you some Tylenol … Something has taken a nurse’s good judgment away and has allowed a computer to trump it; has allowed her to look directly at a new IV line and conclude, beyond reason, that there is no IV medication prescribed. Something has forced doctors to have fewer firsthand conversations with their patients, for shorter periods of time, and to share less information.”

John Halamka got a ton of press that proclaimed him a visionary for having a VeriChip implanted in 2005, but he finally admits everyone who hooted and howled back then about the lack of utility in having under-the-skin medical data was right. “As a technology it’s dead. Use the network, use the cloud to store your personal health records. Or in a pinch, use a USB drive. But the implanted RFID chip is not as a society where we’re going.” One of my satirical news item on April Fool’s Day 2006 was this: “CIO Logs Full Year Without Showing Up at the Office. (BOSTON, MA) John Halamka, Chief Information Officer of CareGroup Health System, did not spend a single day at work in 2005, according to a Boston Globe review of expense records. Health system officials had no comment. ‘Check my vitae – I hold six positions in five organizations, plus I do a lot of speaking,’ Halamka stated in response to a reporter’s question. ‘I can’t say I started out planning to miss all of 2005 in that one job, but it just worked out that way. What I give them in quality more than makes up for any perceived shortfall in quantity.’ A CareGroup source told the Globe that discussions are underway to track Halamka’s location by the identity chip implanted in his arm last year. ‘I’d rig the damn thing up to a doggie fence and give him a few volts when he wanders, ‘ said the source.”

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HERtalk by Inga

Perot Systems releases its first quarter earnings: EPS $.24 vs. $.23 on $621 million in revenue, down from $680 million.

Harvard Medical School closes temporarily after a probable case is identified, an MIT student who picked up the virus while in Mexico and possibly shared it with colleagues at the Harvard Dental School.

SCI Solutions announces it has signed an agreement with Saint Thomas Health Services (TN) for SCI’s Schedule Maximizer and Order Facilitator solutions.

Medical transcription company Administrative Advantage selects the ZyDoc Medical Transcription platform.

Final attendance figures from HIMSS: 27,429 total registrants, down 6% from last year, and 907 exhibitors, down 4%. Over a fourth of attendees were first-timers, indicating a high churn rate.

The 60-bed Bates County Memorial Hospital (MO) selects the MedGenix financial and patient management system.

Authorities investigate a $10 million extortion demand for the safe return of over 8 million patient records and 35 million prescription records that were allegedly hacked from the Virginia Department of Health Professions computers. The FBI is assisting Virginia state officials investigate the incident that came after hackers infiltrated the Health Professions computers last week. They posted this boast on the home page: “I have your [expletive] In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :(For $10 million, I will gladly send along the password.” This fool is going to be so easy to catch that it isn’t even funny. Hey, we’ve got your $10 million – where can we meet you?

The Robert Wood Johnson Foundation awards Project HealthDesign $5.3 million. The project, whose mission is to support the creation of a new generation of personal health records, is based at the University of Wisconsin.

MEDITECH adds Vitalize Consulting Solutions to its list of approved advanced clinical consulting vendors.

Virtual Radiologic receives FDA clearance for vRAD RACS, Virtual Radiologic’s own PACS solution. The company will roll out the software to its affiliated radiologists over the next several months, replacing the commercial software it licenses.

Some news in honor of Cinco de Mayo: thieves in Mexico realize that everybody is wearing blue surgical masks because of H1N1 fears, so they’re donning their own to blend in with the crowd when making their getaway.

E-mail inga.

Being John Glaser 5/5/09

One of the greatest inventions of all time is the three-by-five card. Compact. Sturdy. Lightweight. Portable. Blank on one side. Lines on the other side. The three-by-five card has many uses.

The three-by-five card is at the core of my efforts to organize my work life. This card lists those things that I need to pay attention to, or ask about, or do in the next one to two weeks. If you were to look at my three-by-five card today, what would you see?

• Budget. I think this entry is permanently on the card since it seems we are always dealing with the budget – putting it together or monitoring it. Our operating and capital budgets have to be flat next year. At this time, our managers are making good progress on achieving this target. But our hospitals are not finished with their budgets, so they may cycle back in the next couple of weeks and ask us to make further cuts. Terrific.
• COMPASS. COMPASS is the name for our major revenue cycle initiative. We are working with Siemens and Accenture to standardize our revenue cycle processes and data and implement the systems needed to support that standardization and improvements. Like the budget entry, COMPASS will be on my card for years to come. We are moving well. Good progress is being made on the Newton Wellesley Hospital (our first implementation) plans. Progress continues on developing the governance and new management models that are integral to the project and are a big change for our hospitals that are used to autonomy. And outreach efforts are doing a nice job of helping people understand the capabilities of the Soarian system and the new processes. As is true for any large project, there are always issues and challenges that need attention from time to time.
• NWT Frm. I have no idea what this means. I apparently had something in mind when I wrote this, but I have forgotten what it was. If I haven’t figured it out in two weeks, I will presume that I took care of it and cross it off the list.
• Clin Ops Agenda. Clinical Systems Operations is a meeting of several IT leaders who discuss major clinical systems issues and strategies. We have a meeting in a couple of weeks and I’m trying to line up the agenda. While still in flux, it looks like we’ll have discussions about (a) the effort required to close the gap between our current clinical system features and the features we think we will need to qualify for Stimulus financial incentives; (b) an overview of our strategy to enable medical record coders to code entirely from the EHR and not need to pull the paper record; and (c) a discussion of the project demands for our Clinical Data Repository team – we need to help them prioritize.
• Common clinicals. It is time to return to the strategic conversation of how common should our clinical systems be and, given whatever degree of commonness we choose, how should we go about making that plan happen? We last had this conversation three years ago. In many ways we are making good progress towards that goal of commonality – our EMR implementation will be completed this calendar year, progressive adoption of services (in the SOA sense) continues, and the Brigham and Mass General are working together on Acute Care Documentation (ACD). However, we need to step back and broadly consider our current approach, which is best characterized as incremental and progressive homogeneity. We need to frame some overarching questions that need to be addressed, e.g., should we view this as a catalyst for broad transformation of care at Partners or will we focus largely on reducing the complexity of our portfolio of clinical systems? And we need to define the process for answering those questions. While we need to return to this discussion, we have to moderate the pace. The Brigham and Mass General will be consumed by the ACD and Medication Administration projects for a couple of years and we need to be careful that we don’t unnecessarily distract those efforts. And in many ways, the COMPASS project is plowing the ground for are still under developed organizational prowess at broad standardization of data and processes.I expect that FY10 will be spent developing and revisiting our common clinical systems plans with execution of the resulting plans beginning in FY11.
• Staff e-mail. Every month I write an e-mail to the IS department. This e-mail is a combination of news, strategic outlook, and overview of major initiatives. I have been doing this for nine years. I need to write this month’s e-mail. I haven’t figured out a topic. Presumably having this entry on the card will lead to a burst of inspiration at some point.
• Agility. We had an IS team look at improving our agility. They did a great job and I want to implement a number of their recommendations and advance the work that they started. But I haven’t gotten to it. This line has been on my three-by-five card for a long time. I need to get off my butt and do something about it.
• Jess – yard. Our middle kid Jessica lives in a condo (two units total) with two buddies in South Boston. My wife and I own the condo – rent more or less equals mortgage payment. But this does mean we are landlords, and as landlords, we need to deal with the tiny back yard. The plan is to turn the back yard from a sea of mud and weeds into somewhere young ladies and their boyfriends (assuming they pass the background checks) can hang out. Some yard plans have been developed. I need to let Jessica know which one we will go with. I’m OK with putting in a patio. The water fountain that spouts a 20-foot tall “geyser” every hour on the hour will get wacked from the plan.

There are other items on the three-by-five card, but I have probably bored you by now.

For those of you who have yet to discover the three-by-five card, I encourage you to check it out. No batteries. No worries about an operating system crash. Easy to read. You can drop it down the stairs and it doesn’t break. And you don’t need to stay in the lines when you write on it.

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

Monday Morning Update 5/4/09

From Deborah Kohn: “Re: Kaiser’s PDF formatted PHR. PDF Healthcare is a Best Practices Guide (BPG) and Implementation Guide (IG), published in 2008 by two standards development organizations (ASTM and AIIM). PDF Healthcare is not a vendor, product, or service, nor is it another standard. PDF Healthcare describes little known attributes of the Portable Document Format, an international, open, ISO-ratified and published standard that is freely viewable on almost every laptop/desktop around the world, to facilitate the capture, exchange, preservation, and protection of health information, including but not limited to personal, handwritten documents, structured or unstructured clinical notes, structured laboratory test result reports, (unstructured) word processed reports, electronic forms, scanned document images, digital diagnostic images, photographs, and signal tracings. Until members of the PDF Healthcare Committee were told by HIMSS09 staff members that as an ‘unsanctioned HIMSS09 event’ our PDF Healthcare demonstration in the Hyatt Hotel McCormick Place had to ‘cease and desist’, PDF Healthcare was successfully demonstrated to an enthusiastic audience. One demonstration showed how clinicians in Southern California securely exchange patient health information with only a 3G phone, encrypted USB drive, and a printer.” I found the above participant slide on the AIIM site, so maybe someone can chime in as to whether it’s going anywhere.

It really bugs me that HIMSS locks up every possible meeting venue so that nobody can do anything without HIMSS approval anywhere near the conference site, the one time a year where people can connect without add-on travel costs (I’m pretty sure the most interesting events would be unsanctioned). I still say there needs to be a conference designed for the benefit of attendees, not exhibitors, with more and better educational sessions that are cutting edge, not submitted a year in advance with occasional unvetted conflicts of interest. A non-profit or small company shouldn’t have to spend GE-like dollars just to get a once-a-year audience in Neon Gulch.

From Curiously Underfunded: “Re: stimulus. Does anyone know how the physicians will go about collecting the stimulus funds? I keep reading about the qualifications, etc. but have not been able to find anything about how to apply!”

Jon Manis, CIO of Sutter Health, posted a comment in the HIStalk Forum about its Epic project. Not to be outdone, Neal Patterson (or so he says) posted the full text of Jon’s e-mail to staff (thanks to the readers who sent a copy of the e-mail to me as well). The original post by Francisco Respighi was a bit more speculative, inferring mass layoffs, which may or may not be the case. None of this is to cast judgment on Sutter, of course, but to call attention to what’s going on in the industry in general. Sutter has to run like a business, so if they are forced to make tough decisions that change long-term plans, then they probably aren’t the only one.

Speaking of Sutter, it signs a contract for Ingenix Impact Intelligence, giving doctors in the Sutter network access to metrics, utilization, and disease management information.

EHRtv posts its HIMSS interview with Jonathan Bush, conducted at the HIStalk reception. I’m really impressed with the video quality of what Dr. Eric Fishman has put together – it’s like watching TV, complete with high-quality titles, transitions, and great audio. Many people think YouTube is the standard for Internet video, not realizing how bad their proprietary compression and streaming technologies are (great for putting up cell phone video of a dog chasing its tail, but not great for anything you want to watch or listen to for more than 60 seconds). Some others of the many interviews he’s posted: David Winn of e-MDs, Tee Green of Greenway, and former Congressman Richard Gephardt. It’s really interesting to see and hear these folks directly. I saw Dr. Eric and he was working his butt off at HIMSS, seemingly everywhere with his camera crew. I think EHRtv is brilliant. I keep bugging him about how it works technically, so he’s probably pegged me as a fanboy stalker.

Thanks to everyone who completed my reader survey. I’ve already got a to-do list of reader-stimulated ideas that I’ll be putting in place. One expressed concern that the survey implied big HIStalk changes, even though it’s the same old survey I’ve been using for years. Not so — I’m not looking for new sponsors, planning to make any part of HIStalk a fee-based subscription, or adding new kinds of advertising (to answer specific speculation). I’ve been extremely fortunate that companies e-mail me saying they are interested in sponsoring, I e-mail back a rather primitive information sheet on page views and all that, and they either sign up or I never hear from them again. Probably 90% of those who get involved do so simply because they derive value from reading HIStalk and want to give something back (I know that sounds hokey, but I’m happy to report it’s absolutely true). Anyway, if you like HIStalk in its decidedly amateurish form, you will be pleased to know it’s not going to get any slicker (but you will like a few tweaks that were suggested, I think). I sent Inga the results Friday evening and got her “wow, they really like me!” reply minutes later, so she’s happy she scored well in the “what parts of HIStalk do you like” question (I rated her highly myself). And the question that had us both preening: “Over the past year, reading HIStalk has helped me perform my job better.” Those answering yes: 79%. That’s the ultimate metric and I’m really proud of it.

One other item from the survey. I’m surprised at how many industry newcomers read HIStalk to learn about healthcare IT (a third of readers have been in HIT for less than 10 years). I’m going to do whatever I can to better serve that audience. Some folks said they are ashamed to admit that they don’t know some of the acronyms or products I mention, while others said they would find great value in having HIStalk content segregated by topic (so if you wanted to see everything about Cerner, for instance, you could look in one place). I don’t know where I’ll find the time, but I may try to put together something like that in some kind of encyclopedic format, maybe with reader contributions (that screams Wiki, doesn’t it?)

People have asked about being able to view article comments easier. Options:

1. Click the Show Comments link at the bottom of an article to display the comments posted for it.
2. The Recent Comments list in the right column shows the most recent commenters and which post they commented on.
3. I just added a new Comments Page that shows the first few lines of the 30 most recently posted comments. If you see one you like, you can click the title to jump to the article, or click the commenter’s name (below the blue box) to jump directly to that comment (this is a new WordPress plugin that I installed to try to address the reader’s comment question).

Picis is offering a free Webinar called Best Practices to Help Improve Clinical and Financial Performance in the ED on May 12.

The local paper covers the ED computerization of A.O. Fox Memorial Hospital (NY). It’s McKesson, I believe.

Most of you (60%) don’t know or don’t care about Oracle’s acquisition of Sun, according to the last poll I ran. It will be a good thing for HIT, said 22% of respondents, while 18% said it will be bad. New poll to your right: if you are in hospital management, is the financial mood better or worse than it was in early winter when both the economy and the weather were bleak? Some say it’s looking up in general, so I’m interested in what’s going on at your place.

Someone posted a YouTube video of a demo of Cerner PowerChart using MPages at Lucile Packard Children’s Hospital at Stanford. MPages allow creating scripts or Web pages (including AJAX apps) that launch from tabs on the Millennium application screens. It’s pretty cool to see information widgets being dragged and dropped to create a custom Web page like iGoogle.

On HIStalk Practice: Dr. Lyle on information overload, Dr. Gregg Alexander on the creatively maladjusted, and our usual medical practice-related news and snark. If you want to be a guest author, either one-time or ongoing, let me know.

Markle Foundation releases its report (warning: PDF) on “meaningful use” and “certified or qualified” EHRs. Its seven principles: clear metrics are needed; use of information and not software alone should be the goal; use of existing electronic information such as medication lists and lab results should be rewarded first; ambitious goals should be phased in; EHR certification must include capability to achieve meaningful use and to also address security and privacy; ARRA support should include lightweight, network-enabled systems and not just big iron EMRs; and patients and families should be able to put their EHR information in whatever personal health record system they like. A bit different from the HIMSS “buy more stuff” approach, although both emphasized outcome metrics. The gripe with both: representation was heaviest from vendors and high-profile nonprofits whose people have the time to spend on non-revenue generating activities (unlike the average small-practice doc who’s trying to survive and, despite the preponderance of healthcare they deliver, who is also minimally represented by all these thought leader think tanks proposing their future).

Jay Parkinson gets more press than anybody else who’s running a three-doctor practice for primarily healthy, young, cash-paying patients, so it’s not surprising that Newsweek picks up his story, complete with the requisite hipster fawning (although at least omitting the usual GQ-like stubble-and-black-pants photo shoot), but also pointing out that his radical model benefits himself as a capitalist more than society in general. He follows the usual script, bashing insurance companies, EMR vendors, “old people” (meaning anyone on the wrong side of 40, apparently), and anyone who doesn’t spend their day on Facebook (“We’re starting with those who get it. Facebook started in 2004 at Harvard. It wouldn’t have started with old people. But you know what sucks? Now your mom is friending you.”) You know what sucks? Having a problem like a heart attack or chronic illness and learning that your franchised 2.0 photogenic IM-and-Facebook doctor doesn’t want anything to do with you. That’s where most of the value (and expense) of the healthcare system exists, not in having someone willing to bike over to your loft to prescribe sore throat ampicillin before your midnight poetry reading.

Hospital layoffs: Metrohealth Medical Center (OH), 270, Reading Hospital (PA), 106.

The former IT director of a Houston non-profit organ donation center pleads guilty to deleting its electronic data (including backups) after she was fired in 2005. She’s facing up to 10 years in jail.

Where will this fit in the PHR and financial responsibility market? Quicken Health Expense Tracker, a free, Web-based tool available for customers of a few insurance companies.

Number of hits Googling “swine flu”: 263 million. Number of deaths of US citizens from it: zero. Value to TV stations, newspapers, and J&J, the makers of Purell: priceless.

EMR vendor MedLink International says it has signed a deal with CBS Radio to develop what it seems to think will be a WebMD competitor, a revenue sharing portal tied to six New York affiliates of CBS (formerly Infinity Broadcasting, currently in near-collapse after Howard Stern left for Sirius). Unlikely. In the mean time, the one to beat might be Everyday Health, a mashup of several other sites that bought Revolution Health’s old site and draws more traffic than WebMD.

Odd: an illegal alien who gave up custody of her severely brain-damaged four-year-old daughter while fighting a drug charge and being evicted for not paying rent is fighting deportation and trying to regain custody. The daughter is a citizen since she was born here; at stake is the potential multi-million dollar proceeds of a lawsuit against Vanderbilt University Medical Center, which the mother claims caused her daughter’s problems by puncturing a vein.

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CIO Unplugged – 5/1/09

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

Do You Have What it Takes?
By Ed Marx

I landed on the bottom of the ocean, staring up at the surface. Before I could process what happened to me, I was ripped out into the watery abyss. I paddled toward the light, broke through, and gasped for breath. Only seconds before, I’d been standing high upon a rocky outcropping along Kauai’s Na Pali coast

Spring Break of ’88 began well. Free tickets to Kauai to visit my in-laws and introduce them to our baby boy. During his grandparent cuddle time, my wife and I made our way down Kauai’s north shore to get an intimate look at the magnificent Pacific. We took advantage of a photo op before heading back up the lone path. I stood at the edge of the rock several meters above the ocean surf. I smiled, said “cheese,” and a second later, we were both overcome by a wave that took me out to sea.

Bloody knees, winter surf, rocky shoreline, I was in danger. Swimming parallel to the shore while outmaneuvering the breakers was not easy. Pummeling waves and the force of the undertow zapped my energy. I was scared. Gradually working my way closer to shore, I prayed the waves would not crush me against a wall of boulders lining the island. Three to four people met death that way every winter on Kauai. After much prayer, my feet touched solid ground. I scrambled up cliffs before the tide reclaimed me.

Although I’m an active tri-athlete, I’ve purposefully avoided the ocean. I’ve tackled lakes and rivers but never the open sea. I’m still afraid. Then an opportunity opened up for me to race in one of the sports foremost events, Escape from Alcatraz. I considered passing it up but instead said yes. If I didn’t face my fear, it would own me. On June 16, I hope to make swim way across the San Francisco Bay, avoiding all sharks and undertows.

I once feared public speaking, too. Now I love it. Despite a familiar nervousness that arises before each gig, I press on. To practice and hone the skill, I now look for speaking opportunities.

I feared challenging business peers, respectfully, of course. After I overcame that, I conquered a fear of challenging my managers. Iron sharpens iron, as they say. We experience growth by pushing each other onward toward a greater purpose.

Many who feel “stuck” in their careers are likely limiting themselves out of fear. Are you afraid to rock the boat? Do you comply dutifully with every request even though you know a better way? One way to accelerate your career is to continually pursue growth; second, is a willingness to combat fears—not letting the own you.

Do you fear getting fired for speaking up? How about being wrong or laughed at? I’ve been there, too. Others fear success and the additional performance expectations that come with it. Embrace your fears. Confront them. Then experience freedom.

One of my present fears is dancing an entire song with our Argentine Tango instructor. I can handle learning an individual move, but the pressure of a complete dance with an expert just kills me. I sweat. I forget how to speak. I even forget the move we just learned. But I’m smart enough to understand that unless I tackle this head on, my skills will not grow beyond what I know today. And that is unacceptable. I won’t tolerate complacency. You shouldn’t either.

Reflect and write down your fears. Be brutally honest with yourself. Then attack them one-by-one, with purpose. You will be amazed at the results. And I’ll bet you’ll find you’re not alone. Not only will you grow, but so will your family and employer.

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

News 5/01/09

From Francisco Respighi: “Re: Sutter. Massive layoffs soon to be announced (by mid-May) at Sutter Health Information Services. According to an enterprise-wide communication today from Sutter CIO Jon Manis, the poor economy is to blame for the layoffs and the de facto termination of the Epic project. The economic downturn has in turn meant that affiliates cannot fund the adoption of the Epic EHR (an interesting spin, since it was Sutter Corporate, and not the affiliates, that mandated adoption in the first place). Officially, the Epic project is merely delayed at Sutter. However, the announcement then goes on to say that nearly all Epic staff will be terminated. Nowhere in the communication from Mr. Manis is the enormous cost of the Epic project itself cited as a root cause of the current fiscal crisis at Sutter.” Unverified. If you can confirm (say, with an electronic copy of the e-mail) then talk to me.

From Del Fuego: “Re: CCHIT. Bobbie Byrne has updated her LinkedIn profile to indicate that she works for CCHIT now.” Link. The pediatrician and former Eclipsys SVP is now clinical director at CCHIT.

From The PACS Designer: “Re: Twitter brain waves. Mr. H is skeptical about the usefulness of Twitter, so TPD wants HIStalkers to judge and comment about a University of Wisconsin participant in Epicland who used his brain waves to complete ‘GO Badgers’ by focusing on the R and S on the screen to complete the Badgers cheer! To complete the assignment, the participant focused on the letter N to complete the statement ‘Spelling with my brain’. The messages can be sent by focusing on ‘Twit’ at the bottom of the screen. Next, TPD wonders if he can spell a brainy ‘Faulkner’?” Link. At least we now know at least one Twit who thinks before Tweeting.

From Bogo Pogo: “Re: HIStalk. Any plans for a mobile version?” I confess that I don’t exactly know what that means. I can read HIStalk on the BlackBerry Bold and it reads fine, so I assume it’s hitting the WordPress Mobile plugin that’s been in place since the beginning. Is there something else needed to support mobile devices? Say, I could write the whole thing as a series of Tweets!

From James: “Re: Kaiser flash drive. The USB drive is password-protected (I got mine today) and the clerk gave me a wireless keyboard to enter my password twice. The data file is a PDF so almost anyone can view it if you have the password.” I’ve always been a big fan of using scanning and PDFs as a simple but highly cost effective (and paperless) electronic medical record. I like Kaiser’s approach.

Listening: great surf music from The Neptunes.

Just announced: athenahealth’s Q1 numbers: revenue up 41%, EPS $0.12 vs. $0.09, hitting earnings estimates.

Doylestown Hospital is featured on Apple’s iPhone 3G page for rolling iPhones out to docs, including giving them mobile access to Meditech. I got my Consumer Reports today and was amazed at how well Apple did in the computer reviews: #1 in all three laptop screen size categories, #2 in desktops, and #1 in support in both desktop and laptops by far (81% and 84%, respectively, blasting the #2 vendor with 55% and 61%, respectively). Of course, Apples cost twice as much, so you could buy two of anybody else’s and keep one as a spare for the same money.

Medicity and Intermountain Healthcare will host a free Webinar called “A Data-Driven Approach to Improving Hospital and Physician Care Collaboration” on May 14. And speaking of Medicity, the company’s new CMO, Gifford Boyce-Smith, will speak on translational medicine at the Delaware Health Sciences Alliance research conference next Wednesday.

McKesson employees in Carrollton, TX spent time putting together care packages and notes for wounded veterans in VA hospitals last week. Nationally, 14,000 McKesson employees created 16,000 of the packages.

David Blumenthal follows the current administration’s mantra: we believe in the free market in theory, but sometimes it doesn’t work and the government can manage it more efficiently (which generally means: Bush and his cronies were dangerous fools and anything Republicans advocated must be repudiated by expensive and massive retaliatory government intervention). Speaking Thursday about healthcare technology, he said, “It is clear that this field has not advanced (enough) … when left exclusively to the private sector so there is a public role” Sounds good, except when surveyed, the public didn’t give a whit about healthcare IT. Your benevolent government knows best, as it constantly reminds us.

I just realized that it’s almost the end of the month as I write this, so I checked the HIStalk stats (that’s Inga’s territory, so I generally stay out of it). Shazam! Over 90,000 visits and 126,000 page views for April, breaking the record set in March by over 15% and up 66% from a year ago. I can only say thank you for contributing to that number by reading. I can’t imagine the stats going up since surely it’s at the saturation point, but I was saying that a year ago. Maybe the industry is bigger than it looks sitting here alone and staring at a keyboard and monitor for hours.

CERN shares hit a 52-week high today, topping at $54.71 and closing at $53.80. Above is a five-year stock chart that you can’t read because I had to shrink it to fit, but it shows Cerner share price (blue), McKesson (green), Eclipsys (gold), and GE (red). Go Neal (he’s not just doing it for you – he owns $303 million worth himself).

Bored at work? Try Internet sensation Swinefighter. It’s lame, but addictive.

Jobs: Senior VP of Sales, Technical Project Manager, VP, Finance and Administration.

Consumer Watchdog says it has proof that Google used paid lobbying firms to try to influence the government on the economic stimulus act, which it speculates (without proof) means the company wanted the right to sell medical data. Google says it was lobbying to support healthcare IT standards and to protect consumer privacy. Consumer Watchdog says fine, prove it by releasing your lobbying records. End Act 1.

It’s like one of those cheesy used car companies that offers to loan you down payment money until your tax refund comes: IBM makes $2 billion available to customers who don’t have the patience for their government checks to arrive. Come on in, everybody rides!

Siemens announces Q2 numbers, with revenue and profit up big.

Another doctor criticizes electronic medical records in a national publication, Time in this case in a story called How to Fix Health Care: Four Weeds to Remove (Larry wasn’t one of them). One of the four weeds identified as choking off the medical garden is Computerize Everything. “It’s a complex topic that boils down to this: If we who do the medicine thought more computers would save us money, we’d buy them ourselves. In fact, sometimes we do. But the federal mandate to computerize and centrally connect the entire country’s medical records has little chance of saving money for anyone except the lucky insiders who sell the computers, software and support. Aside from their costs to us, electronic records are time-consuming — a constant distraction from patient care. They also put doctors on a slippery ethical slope; it’s pretty easy to bill more for the same services with a good EMR program. They are a dangerous weed being advertised as fertilizer.”

Sams’s Club says it’s ready to sell eClinicalWorks (although it manages to spell the company’s name wrong in the headline, putting a space before the “Works” part). I did a Google site search to find the page, which doesn’t come up in the site’s own search.

In Europe, Ronald Verni, former CEO of Sage Software, is named non-executive director of charge master software vendor Craneware.

An Ohio State University medical professor and cervical pathologist says his employer demoted him, cut his pay by 60%, and took away his laboratory after he publicly accused the university of botching tests for human papillomavirus. He’s concerned about the incorrectly diagnosed women, but the $100 million he’s suing for will apparently assuage his anguish. Since every TV addict in America feels qualified to judge people based on a superficial knowledge of whatever’s being judged, I’ll side with him since he sounds sincere and is amply qualified.

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HERtalk by Inga

From Newlywed: "Re: Nobel Prize winner’s survey on women and mood lifting. Heck yeah … I think he is dead on. For me, sex and eating … helllooo? Unfortunately, I travel for my job, so I don’t spend many nights at home for the sex with my perfect, divine husband. But man, do I get to eat!"

From Lynn Vogel: "Re: MD Anderson and facilities. Appreciate your comments re: importance of facility ambiance to patients. Cancer patients face significant challenges and in many cases truly ‘life or death’ choices. Notwithstanding Mr HIStalk’s views about the relationship between the egos of healthcare CEOs and their facilities, it is easy to dismiss the importance of surroundings in providing a supportive and comfortable environment in which such choices can be made. And I would venture a guess that those most critical of healthcare facilities are those who have not had to experience them from the patient’s point of view."

DocuSys and CPSI team up to install DocuSys’ anesthesia solution at at Muskogee Community Hospital (OK). I have actually been to Muskogee, the town that Merle Haggard was proud to call home. I am pretty sure I ate some ice cream from Braum’s. Ymmm.

Silver Hill Hospital (CT) signs a five-year agreement with Medsphere to provide implementation, training, and support of Medsphere’s OpenVista EHR.

Froedtert & Community Health (WI) signs up for Epic Systems’ Care Everywhere network. The Care Everywhere network is designed to connect EMR information between different Epic systems and as well as third-party EMRs. Froedtert & Community Health is the second health system to sign up for the network, which the health system claims cost them $60,000.

McKesson promotes Randy Spratt to the newly created position of Chief Technology Officer. Spratt will also maintain his current role as executive VP and CIO.

Note to all you road warriors: while in a plane, experts recommend you sanitize your hands before eating and drinking, after retrieving something from the overhead bin, or after returning from the restroom. A little Purell and you cut your chances of getting infected by at least 40%.

Virtual Radiologic posts first quarter net income of $1.39 million ($0.09 per share), compared to $2.00 million ($0.12 per share) in the prior year period. Adjusted net income was up 40% from last year, coming in at $2.51 million, compared to 2008’s $1.88 million. Revenues rose to $28.6 million for the quarter, up 23% from last year.

Online learning and survey vendor Healthstream releases their Q1 financials showing net income of $878,000 versus $66,000 last year. First quarter revenue grew 19% over the previous year to $13.6 million.

If you are considering bariatric surgery, here’s some good news. Individuals with bariatric surgery reduce the prevalence of disease by 25%, compared the morbidly obese. Also, the rate of post-surgical complications has fallen 21% since 2002. Overall complication rates have also dropped (from 24% to 15%). Fewer complications also translate into lower cost of care.

Merge Healthcare announces its third straight quarter of positive net income. For the first quarter, Merge had net income of $2.8 million compared to a $7.9 million loss a year ago. Revenue was up 11% from 2008.

Researchers at Brigham and Women’s Hospital (MA) and Massachusetts General Hospital find that the use of integrated computerized medication reconciliation tools and process redesign were associated with a decrease in the number of unintentional medication discrepancies.

E-mail Inga.

Readers Write 4/30/09

Submit your article of up to 500 words in length, subject to editing for clarity and brevity. I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Note to the US Healthcare System: Treat Me Like a Dog
By Peter Longo

I think everyone knows the US healthcare delivery system seems to have more challenges than solutions. From my vantage point, working in healthcare technology,I sometimes wonder if we can ever put all the crazy puzzle pieces together. I never thought that one day, soon after a long overdue physical and a trip to my dog’s vet, I would deem it in so need of repair that I begged to be treated like a dog.

Recently my beloved dog Hamlin’s digestive system grew tired of his “Cowboy Chow” dog food. Without a moment’s notice, my wife quickly went out and purchased him three other kinds to choose from. (I wonder if tonight I complain about dinner, will my wife run out to three different restaurants and find me something I prefer?)

Even the newly purveyed dog food did not settle Hamlin’s stomach. My wife, busy escorting three kids about town, informed me I had to take him to the vet. Since I work for a healthcare technology firm, I assumed going to a doggy doctor would be fun and enlightening; a respite from seeing human hospitals and doctor offices.

Hamlin and I eagerly pranced into the office with me ready for the inevitable “doctor wait”. Interestingly enough, I was greeted at the counter by a smiling receptionist calling out Hamlin’s name. But of course, they were expecting him because he had an appointment! Wow, novel concept here I thought.

Next I had my wallet out, ready to be accosted for money before I could even get a quick question in. Before I could eject my credit card, the side door opened and a smiling “nurse” asked Hamlin to come this way. (I assumed they were smiling because they were going to make a fortune out of me). Guarding my wallet, I followed our escort down the hall. I was still dazed from the fact they were expecting us and recognized Hamlin.

As we entered our exam room, I was perplexed to see a shiny new notebook computer on display. Before I could gasp in shock, the vet walked up behind me, introduced himself to Hamlin (the patient) first, then to me. Casually, he turned toward his shiny new laptop and within two key strokes had Hamlin’s medical record on the screen. My dog’s entire record. Looking like the complete geek that I am, I jumped at the vet asking to see everything on the system.

Eyeing me as though I might be in need of medical help myself, he leaned back to show me Hamlin’s electronic medical record. His life history, his owners, where he was born, any past medications he had, everything. Even his lab results were in there. The polite but guarded vet then showed me three other exam rooms, all equipped with shiny new laptops, all with Hamlin’s record available on them.

After a quick and thorough exam, the vet punched a few more keystrokes. He electronically ordered various lab tests — right then and there! I asked him about the firm that performs the tests and he told me the lab he uses provides great service and is top notch. He said the lab results will be sent back electronically and into Hamlin’s file directly! (In a moment of serendipity, I later discovered it was my company’s software providing the lab with the tools to accomplish this small miracle).

As I left the room and approached the front counter, a nurse had a prescription waiting for me along with three cans of super special dog food. Now I was really confused — is it not the patient’s job to walk the prescription and files to the front counter? Did my paper shuffling job just get outsourced to a computer? Adding to staff’s perception of my total geekiness, I asked how she did that. With a slight chuckle, she showed me the computer screen where the doctor requested it from the exam room. It just angered me to see such efficiency. I know my kids feel Hamlin deserves only the best, but better healthcare service than me? Adding injury to insult, I paid only $55 for the visit.

Hamlin’s enlightening experience really made me think of my own recent medical episode. A few weeks earlier, I went to my annual check-up. I scheduled the appointment and diligently showed up on time. As I checked in to see my doctor, one hand shoved a clipboard in my face, while a second hand went for my wallet. No verbal communication yet. Even though Hamlin theoretically can’t speak, he was treated to verbal communication and a custom greeting. I then proceeded to brush up on pop culture in a six-month-old People Magazine (I did not know Britney had a second baby and broke up with K-Fed?) while waiting 27 minutes for my appointment. If only someone told me how long my wait would be — but hey, that would take the fun out of guessing when I would be home.

I finally entered my exam room to be greeted by a nurse,a sheet of blank paper and a $.25 pen. She took my vitals. Later, my doctor sashayed in with that same high tech paper but a more expensive pen (with a drug company’s name on it) to drill me further. As all checked out fine, he indicated he needed some lab work to complete the exam. Amongst some forms floating on a table (uncomfortably near my half-clothed rear end) he found an order sheet. He checked a few things here and a couple things there then gave me the nod to transport the paper across the hall; then my lab orders and I waited some 18 minutes more.

A couple of weeks after my exam, I received my lab results “in the mail.” Next to each test result, the doc was kind enough to scribble an “OK.” Then a nice hand-written note claiming, “All looks OK, see you next year.” I put that report in a sophisticated manila folder and filed it. Why did I have to have this manual, impersonal, medical experience right before my vet visit?

Dazed and confused after leaving the vet, I wandered back to our house. Upon opening the door, my three kids showered Hamlin with love. They rubbed his back, gave him endless kisses and asked him easy softball questions. “Have you been a good boy?” My wife brought over doggie treats and “king” Hamlin relaxed on his back as the kids indulged him full of treats. My life quickly went to the store to find him “the best food money can buy.”

I was left standing at the door waiting to even be recognized. I sure did not get any kisses, let alone a back rub. I put myself on the couch and wondered if anyone was going to fetch me a treat. I would have been happy if one of my three kids just pushed the remote closer. As I stared at a blank TV screen, it dawned on me … I really need to be treated more like a dog.

News 4/29/09

From Ralph Curmudgeon: “Re: Kaiser’s flash drive PHR. Kaiser’s offer of the flash drive has the same inherent problems as shoving a stack of papers and an x-ray folder in the patient’s hands. Unless the drive is encrypted and the patients have the computer skills to use it, it’s effectively worthless. Besides, I’ll wager >50% of them end up getting lost – just like the paper records. The average Joe and Jane out there – particularly the elder ones – aren’t ready to haul around electronic records in the pocket or purse – heck, they can hardly understand their treatment bill. Now injecting them with a re-programmable chip in their upper back – like Rover – that’ll work.”

From The PACS Designer: “Re: Seesmic/TweetDeck. As Twitter gains more popularity, there are enhanced free applications that will manage all your Twitter favorites and also allow you to manage photos and videos to give you a ‘video Twitter’. One of them is Seesmic, created by a French company, which competes with another application called TweetDeck. TweetDeck has had some memory leak problems that are now supposedly fixed according to Adobe, so Seesmic appears to be the better choice to track Mr. H’s, the Candid CIO’s, and Labsoftnews’s Twitter posts along with others.” Link. At the risk of sounding tragically un-hip, I have to admit that I’m already sick of Twitter even though I do basically nothing with it. At least blogs required minimal effort to actually write and post the usual vapid, dull comments. Twitter makes it easy for Twits to expel a never-ending, 140-character flatus stream of “what I’m doing right now” self-indulgent babbling (as long as the activity allows keeping at least one hand on the keyboard) that puzzlingly finds an audience of people willing to read it. People complain that they have no free time, yet they apparently use what they do have screwing around with World Wide Waste of Time applications that provide the illusion of usefulness.

From Leon Poncey: “Re: cyber-attack. Thought this might be interesting to HIStalk readers.” Link. An interesting recap of an incident in California where unidentified individuals crawled into several manholes (they’re never locked, of course) and cut eight fiber cables, causing a loss of 911 service, cell signal, landline telephone, broadband, alarms, ATMs, credit card terminals, utility monitoring applications, and the hospital’s internal network (which apparently had some unexpected dependencies). Repercussions were fascinating: the hospital went to paper, stores accepted only cash, and employees were sent home. The only technology that worked was one of the oldest and least sexy: ham radio (I can say that because, being a nerd, I will admit that I was once a ham radio operator, at least until I noticed that it was like Twitter: the technology was ample to interconnect people from all over the world, but the people using it invalidated the entire premise because they had nothing interesting to say).
 
From Alter Ego: “Re: Halamka’s blog. I think he’s getting a bit egocentric, kind of full of himself. Does anyone really need to know about the details of his work spaces?” I already assumed he was full of himself, although I don’t know him. I actually kind of enjoyed the post that has pics of his digs at Harvard, BIDMC, and his home office, which is just a chair and a MacBook Air (I certainly enjoyed that post more than those Zen ones where he gets all moist talking about some bizarre flute he has dedicated his life to playing, his tea ceremonies, or climbing rocks). And, I have to defend us bloggers since there’s always some reader who launches ballistically when a couple of sentences didn’t hit his or her interests precisely. I get an e-mail something like this: “Oh my GOD I don’t read HIStalk to get (humor, music recommendations, guest articles, etc.) and I want the time back that it took me to read (the three sentences out of hundreds). Stick to the facts and leave that to the professionals (comedians, music critics, professional writers, etc.)” Apparently just skipping over those few words is too much of a challenge compared to writing out a complaint, so I have no idea how those folks can read a newspaper (“Oh my GOD I don’t follow stocks so please stop running that crap and stick with the sports and leave the investment talk to stockbrokers”). If Halamka wants to write about tooting his flute, then that’s his right, and anyone who can’t stand that should probably just read the personality-free trade rags.

From Deborah Kohn: “Re: HIPAA. I completely agree with your reply. Just a history reminder of this complex law. Prior to 1996, the public was demanding two things: 1) greater portability of health insurance between jobs, and 2) confidentiality protection of personal information and privacy protection of the individual – with a focus on health information. Consequently, the 1996 Kennedy Kassebaum Bill (K-2) or Public Law 104-191 or the Health Insurance Portability and Accountability Act (HIPAA) (and, given the 2009 ARRA HITECH Act, this 1996 law could be viewed as version 1.0 or 1.a), was introduced with the following legislative goals: Title I – Portability, which contains only one major component — ensuring that individuals between jobs are able to carry their health coverage forward or obtain similar coverage. Title II – Administrative Simplification, which contains four major components, which are the most publicized: 1) Unique Identifiers (for Employers, Health Plans, Health Providers, and Individuals); 2) Electronic Data Interchange and Coding Standards (the Transaction Set and the Code Set); 3) the Confidentiality and Privacy Standards for analog and digital records / documents (the Minimal Disclosure of Individually-Identifiable Health Information, the Control Over Sharing this Information with Outside Entities, and the Ability of Patients to View Their Information and Receive a Record of Access to Their Information); and 4) the Security Standards for digital records / documents (the Administrative, Physical and Technical Safeguards).”

The last plea of this particular telethon: if you haven’t completed my reader survey, would you? I’m already making my to-do list from the responses so far, but it’s not too late to register yours.

Not willing to take the chance that the government will define “meaningful use” of EHRs in a way it doesn’t like, HIMSS goes ahead and preemptively makes up its own definition and sends it off to CMS and ONCHIT for what they hope is rubber stamping. Its recommendations:

• Name CCHIT to be the EHR certifying body (no surprise there).
• Adopt interoperability per the specs of HITSP and IHE.
• Implement increasingly stringent metrics. For hospital systems, HIMSS wants metrics to be ratcheted down no less often than every two years to allow “health IT companies to make necessary modifications to their products, including the rewrite of legacy enterprise EMRs as necessary.” (Question 1: what enterprise EMRs are not legacy? Question 2: does anyone really expect products to be rewritten?)
• Evaluate best-of-breed and open source technologies fairly in their demonstration of meaningful use (note that HIMSS throws in a half-hearted but still eyebrow-raising acknowledgment that free software that competes with the products of its vendor members, saying “use of open source options can be cost-effective for some hospitals.”)
• For the first two-year phase (FY11), measures include use of lab, pharmacy, and radiology systems, along with a CDR (interfaced to “the patient accounting system” for some reason). Discrete clinical observations (allergies, problem list, vitals, I&O, flowsheets, meds) are recorded electronically, but electronic physician documentation is not required. Auto-capture of NQF quality measures is required. Hospitals exchange electronic information, but it can be in the form of scanned documents.
• For the second phase (FY13), 51% of orders must be entered by CPOE, e-prescribing to outside pharmacies must be in place, and systems follow whatever data output standards HITSP and IHE devise.
• For the third phase (FY15), CPOE goes to 85%, bedside eMAR/barcode verification is in place, evidence-based order sets and reminders are in use, and information exchange is underway with public health organizations and subunits of a statewide or national exchange. There’s a line about analyzing “pharmacokinetic outcomes resulting from patient medication interaction” that makes no sense to me.
• Most of the practice-based EMR recommendations are similar: clinical data display with CPOE capability and doctors entering their own orders, e-prescribing, and quality measures, followed by clinical decision support and interoperability.

My opinion: a pretty nice job. The standards are straightforward and measurable, although the practice EMR document doesn’t get specific about physician usage percentages like the hospital one does. It looks to me like they basically took the HIMSS Analytics EMR Adoption Model and made Stage 3 (minus the diagnostic imaging requirement) the first phase and Stage 5 the second (along with part of Stage 7 – capturing data in CCD format). Fairly ambitious, but it may go back to Obama’s early question about “what would it cost to get all hospitals to Stage 4”.

Microsoft creates a version of its Amalga data analysis tool for life sciences. They claim it connects information in ways that allow researchers to make new discoveries.

Cerner just announced Q1 numbers: revenue up 2%, adjusted EPS $0.52 vs. $0.47, beating estimates of $0.51 by the usual Cerner penny (but light on revenue, so shares are pricing down). Nobody I know is buying Cerner systems, but they are managing their business with great skill, working the recurring revenue stream and managing expenses to keep Wall Street happy. 

UK’s NHS threatens to give BT and CSC the boot if they can’t get their Cerner and iSoft systems, respectively, up and running in at least one large hospital by November.

Joel Selanikio of Georgetown University (and of his own company, DataDyne) wins a $100,000 Lemelson-MIT Award for Sustainability for developing the open source EpiSurveyor mobile healthcare survey software.

Continua Health Alliance wins the American Telemedicine Association’s award for innovation. The ubiquitous John Halamka’s quoted congratulations on behalf of HITSP are included for some reason.

Palomar Pomerado Health is offering, without a prescription, the personal genetic testing kits of Google-backed 23andMe.

Southeastern Regional Medical Center (NC) promotes Eric Harper to CIO.

Sutter Health is reluctantly turning Marin General Hospital (CA) back over to the county next summer, so that means it will need new information systems. ACS gets a $55 million contract to install McKesson Paragon and support it through 2017. Former El Camino Hospital CEO Lee Domanico is running the transition team that will take over. The hospital originally said it couldn’t afford to pay him more than $264K, but he will make up to $779K a year under his two-year contract signed in January, a large pile of money for running a 235-bed hospital.

The University of Nebraska and the technology transfer organization of its medical center are suing Siemens Healthcare Diagnostics for patent infringement, claiming that Dade Behring knowingly sold laboratory testing systems that used technology the university had patented and licensed exclusively to Abbott Laboratories. Siemens AG bought Dade Behring in 2007.

Kathleen Sebelius is confirmed to become HHS secretary, but none of HHS’s 18 other key positions have been filled. I want Obama to succeed, but so far he’s just a cooler version of Jimmy Carter – lots of lofty goals, but incompetent when it comes to execution (how many times has he apologized for one gaffe or another in just his first 100 days or so?) Anyway, she’s in, but without a team.

A new study published in Archives of Internal Medicine found that computerized medication reconciliation reduced medication errors by 28%.

Total margins for Pennsylvania’s hospitals have dropped 12% in the past two years to –6.3% due to portfolio losses and more uninsured patients.

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HERtalk by Inga

From Old Coot: “Re: John Wennberg. ‘Too much acute care today/wasted money spent at end of life – need to redirect those resources to community health initiatives.’ In other words, let the old folks die off peacefully – and quickly – and spend more money handing out condoms to kids who won’t use them. Wennberg, who is no spring chicken, better watch out. His kids will be slipping that potassium chloride mickey into his Metamucil one evening. I wonder how Wennberg’s parents are doing these days . . ."

From Hair on Fire: "Re: insecurity. Glad you got back at Mr. HIStalk for his snarky comments about your insecurity (or was it his?) with your comment about the Code Blue band :> We chicks need to stick up for ourselves – and one another!” Thanks for the chick support. However, Mr. H created his comments  after mine, so I didn’t really have a chance to get back to him, although I did chastise him for letting the world know I was insecure (am I insecure about that?) The secret is now out. Will the adoring fans be disillusioned?

From John d’Glasier: "Re: Twitter. Doonesbury says it all: Tweets for twits. Twitter is adolescent narcissism.You can’t possibly said anything worth reading in 140 characters unless you believe American Idol, Survivor, and Are You Smarter Than a 5th Grader? represents the zenith of American entertainment – preparing you well for pop culture acceptance of anything without meaning, gravity, or importance." Here’s the strip. I was totally with you, John, right until the subtle slam on American Idol, which happens to represent the most entertaining three hours of my week (after reading Mr. H’s posts, of course.)

From Lucy Padovan: "Re: shoes. At the height of the dot-com era, some well-meaning but alcohol-befuddled colleagues thought I should be nicknamed e-babe, odd since I’ve never bought or sold anything on eBay in my life. Nonetheless, a friend sent this link to me and I wanted to pass it on. This is just shoe lover to shoe lover." What is there not to love about sexy crocodile pumps that retail for $2,650 that you can steal for a mere $630?

Clara Maass Medical Center (NH) successfully implements Axolotl’s Elysium Exchange, enabling ER, inpatient, and outpatient records to be shared electronically across the health system.

I have enjoyed reading the various posts about fancy hospital building, bloated budgets, etc. Here is my two cents. I visited a friend once who was at MD Anderson. If one day (God forbid) I wind up with cancer, MD Anderson is where I want to go. It felt comforting, current, and everyone was efficient, friendly, and supportive. The pretty building made a difference. Another time during my traveling days, I had the unlucky chance to spend the night at a hospital in a major city. At the time I didn’t know this, but it this hospital is considered one of the best in the country for the type of emergency I was experiencing. While the staff was great, the hospital itself was old and tired-looking and my room was dreary. I actually knew enough about healthcare to understand that such things don’t affect the quality of care, but, the lack of aesthetics didn’t aid my overall comfort level. So I am of the mindset that if someone wants to donate millions on pretty buildings, I’d like to say "thank you" on behalf of all of us average patients who rather be sick in an attractive facility.

United Hospital System (WI) selects Eclipsys Sunrise Enterprise clinical solutions for its multiple hospitals and clinics.

Medfusion names Bill Loconzolo chief technology officer. Medfusion provides online communication tools for healthcare practices.

A Nobel Prize winner finds the top five mood-lifting activities for women are: sex, socializing, relaxing, praying or meditating, and eating. (No mention here if the Nobel Prize person is a man who believes in the power of suggestion, but it’s not a bad guess.) Exercising and watching television followed closely. Near the bottom of the list were cooking, “(day-to-day) taking care of my children,” and housework. If you are in need of advice on how to be happy, Dr. Lobe has some tips for you. And if you are a woman, let me know how well these these five activities are working to increase the joy in your life.

Hard to miss finding information on swine flu, especially with all the tweets, podcasts, and up to the minute postings by the CDC/HHS, WHO, and every news agency out there. Personally I prefer the Google map that displays confirmed outbreaks by location (helpful for planning my next vacation.)

MED3000 gets a mention in a Wall Street Journal article that looks at various tactics by employers and insurers to motivate people to make healthier choices. Money, by the way, seems to be a good incentive.

Picis announces that the VA has selected Picis Critical Care Manager for its Veterans Integrated Service Network 12, aka the Great Lakes Health Care System.

Let’s hope that the US health crisis never gets this bad. A Japanese woman with headaches during labor is turned down by 18 hospitals that refused to accept her due to overcrowding or overly busy doctors. She had a brain hemorrhage and went into a coma, but a hospital that finally accepted her delivered the baby by Caesarean before she died eight days later. The Japanese ER crisis is blamed on a number of factors, including the aging of the population, economics pressures, and professional and legal issues. ER doctors are overworked, poorly compensated, and risk criminal prosecution (not civil) over malpractice issues. The government estimates that currently Japan has half the number of ER doctors required to serve the population (about 2,500 to serve 127 million people.)

E-mail Inga.

Monday Morning Update 4/27/09

From 13th Floor Elevators: “Re: traffic tickets covered by HIPAA. The clerk must have consulted our hospital’s HIPAA officer, who says employees who have babies can’t use hospital e-mail to tell their colleagues as it would be a HIPAA violation. This HIPAA thing needs a lot of rework. And, when was the last time you heard anything about the ‘portability’ in HIPAA?” HIPAA was a pretty good 1.0 effort, but it’s hopelessly outdated, seldom enforced, and watered down by special interests. Pre-Internet privacy laws and information systems are relics that really should be rewritten. As for portability, I don’t see much improvement, especially if you have a pre-existing condition (does “pre-existing” mean before you were born?)

From KitKat: “Re: MD Anderson Cancer Center. Layoffs Monday, with 16 anesthesiologists getting the pink slip.” MDA is looking for $280 million in budget cuts and will start cutting employees within a month. The best thing about the article was this reader comment: “I’m STILL trying to figure out why the new buildings at MD Anderson had to be so over the top lavish; almost like a shrine to cancer.” It’s not just MD Anderson. Lots of hospital executives I’ve known love building fancy structures as a substitute for the imaginary careers they gave up in private industry, always daydreaming that they would be running big for-profit businesses and flying around in corporate jets if they weren’t so selfless. It’s always rationalized that the community wants those magnificent edifices, despite the evidence that suggests what the community really wants is easier hospital parking, reasonable rates, a chance to get in and out of the ED without taking six hours, and interacting with employees who at least pretend to be empathetic. Unfortunately, those big buildings seem to make all of those attributes worse. I would trade all that architecture for a couple of good nurses (especially since you can’t see that imposing facade from your room anyway). Like financial institutions, when you’re selling an intangible, you have to convince customers that it’s real by spiffing up the storefront.

That reminds me of that consumer survey early in the stimulus talks about where they wanted to see healthcare money spent. IT was dead last. Fancy buildings would probably have been there, too, if respondents were asked to rate their importance. So why don’t we give our customers what they want instead of what we think is good for them? Maybe that’s more of that good old paternalism, where you just tell the patient not to worry their pretty little heads because the doctor knows best. You and I are healthcare consumers and patients, so if asked what we would really like to see changed, I bet it would be the easy stuff like what I mentioned above and not buying new IT systems. We want to be respected, informed, consulted. We don’t want to be inconvenienced, harmed by medical error, or infected. We would like to be able to afford the care we need. If IT (and those fancy buildings) can do any or all of those things, consumers will love it, but just having the IT without delivering the results won’t impress anyone except nerds.

 

I think I need to write a novel since I have this great story idea stuck in my head. Here it is. A fictional foreign industrial conglomerate, despite a generations-long history of shameful behavior (using death camp labor, bribing prospects to get business going back 100 years) wins a huge government contract. Champagne corks are popped back in the home office, stiff executives clumsily attempt fist bumps. Now comes the key scene: at that moment, dozens of unsmiling federal agents crash through the office door, armed with search warrants and evidence boxes. The big government contract had been a sting operation! The conglomerate has been caught red-handed after decades of improper government contracting! I’m trying to decide whether to portray the company’s competitors has having set up the sting, but I need to give that more thought. I’m picturing Dennis Quaid as the humorless government agency head, Maureen McCormick as his love interest, and maybe Rod Blagojevich in his big-screen debut as the conglomerate’s ranking executive. I dunno … not very believable, I guess.

The new BusinessWeek says EMRs may be a waste of government money in The Dubious Promise of Digital Medicine. Points: evidence that EMRs improve patient safety is scant, vendors like selling off-the-shelf systems that are hard to implement and maintain, and HIT special interests have kept government oversight to a minimum. Individuals are called out: Newt Gingrich for playing a heartfelt futurist when he’s getting paid by vendors, Nancy DeParle for having high-dollar Cerner connections, Glen Tullman for working his Obama connection, and McKesson’s lobbyists pushing policy ideas on members of Congress and of the Administration to reward clients for using their aging systems. Several negative hospital EMR experiences are cited. Also mentioned: vendors are pushing for CCHIT as the certifying body, knowing that a group led by a former vendor executive and started by HIMSS will provide a friendlier audience than FDA. OK, the article is all over the place and certainly sought out whatever high-profile negative stories it could come up with, quoting only those who had a bad EMR experience (who never blame their own organizations for choosing or implementing it poorly, of course – everything is the vendor’s fault). Worth a read, but only because lots of people will see it. Its conclusion, however, is entirely reasonable: we’re spending billions on systems developed even before the Bush administration (HW, not Shrub) that haven’t exactly lit healthcare on fire so far. As a taxpayer, you’re taking a bet with billions that a prudent gambler wouldn’t. Water under the bridge, though, so there’s no point pontificating about it now.

Is Apple developing a Mac Tablet and would it be a great platform for EMRs? Good article, good reader comments.

An interesting article on 12-employee Precept Health, a New Zealand startup struggling financially but winning big business over companies like Philips for ICU monitoring.

New poll to your right: what’s the impact of Oracle’s acquiring Sun? From my cheap seat, it looks like the showdown to be king of the technology world will be between Oracle and Google. The worst aspect is that Oracle gets MySQL, Oracle’s main (free) competitor that powers much of the Internet (including HIStalk). Oracle hates Microsoft, which is already wheezing, and can inflict serious damage on it by attacking its Office and SQL cash cows with Sun’s free alternatives. Since Oracle is still buying everything in sight, what if it picks up Red Hat? (IBM better strike fast if it still wants to be a playa). Microsoft hasn’t made a good acquisition in years. Proclarity in 2006, maybe, but that’s niche; I can’t think of anything else other than Visio in 2000 since the Great Plains deal didn’t make sense to me. Everything else seems to be add-ons to fix holes in existing products, not anything innovative.

Interesting in the definition of “meaningful use” of EHRs? The VA will provide a live audio broadcast of Tuesday’s NCVHS meeting, which will attempt to create one.

Fujitsu announces its new EMR in Japan: HOME/EGMAIN-GX V2  (don’t they have marketing people over there who could come up with a name that might actually be remembered?) The only Web pages I could find were in Japanese, but it appears to do orders, meds, bed management, and diagnostic imaging.

Reader survey. Important. Complete, please. Thanks.

The economy may be wearing you down a little, but at least nobody’s moving you to a desert and planting bombs in your front yard. Major Patrick Baker is a citizen-soldier and chief nursing officer at Madison County Hospital in London, Ohio, deployed since January to Balad, Iraq as Flight Commander, Flight Clinical Coordinator Team of the 332nd Expeditionary Medical Group, the largest trauma center in Iraq. He organized a charity marathon in Iraq to coincide with one in his hometown, recruiting 400 airmen, soldiers, and sailors to help raise $8,400 for the American Heart Association in honor of his six-year-old daughter Ellie, who was born with multiple heart problems. Tired of manufactured “heroes” like shallow TV stars and exorbitantly paid athletes? You can e-mail a real one. HIStalk Practice contributor Dr. Gregg Alexander knows him and sent me a link to the video.

Senator Jay Rockefeller (D-WV), chairman of the Senate Finance Subcommittee on Health Care, introduces legislation that would create an HIT Public Utility Model that would provide grants to safety net providers that would cover the cost of implementing open source systems plus five years’ maintenance. It would also create a HIT Public Utility Board within ONCHIT to over see the program. He says, “Open source software is a cost-effective, proven way to advance health information technology – particularly among small, rural providers. This legislation does not replace commercial software; instead, it complements the private industry in this field – by making health information technology a realistic option for all providers.” I like it. Jay’s kind of doing his own thing here without being steered by lobbyists and HIMSS, proposing a solution that could put more HIT in the field without just dropping big dollars on private companies. I just wish that, when we talk about open source, it covered more application ground than VistA. It’s good, but not exactly cutting edge, and the number of potential community members is limited to those who happen to know MUMPS programming. 

Kaiser Permanente offers members a $5 USB flash drive containing their basic medical information and recent encounter data. A secretary downloads the patient’s data while they wait. But, they have to show up in person to get it. The article omits the most important fact: how do doctors access that data in case of emergency, which is the whole point of getting the USB drive in the first place? Hopefully it is easy, does not require loading anything on the doctor’s PC, and doesn’t require a password if the patient is brought in unconscious. Maybe someone should invent a hardware or software token that would positively identify a PC user as a doctor so they could be given elevated privileges to open the medical files of patients.

Forbes profiles Steve Schelhammer, a former teacher and yearbook salesman who formed disease management company Accordant Health Services, sold it for $100 million, and is now CEO of Phytel, which analyzes EMR data to find non-compliant patients and sends them messages asking them to schedule a visit. Practices pay for the service, but benefit from increased visits.

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