News 7/10/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

Readers Write 7/8/09

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

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

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

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

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

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

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

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

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

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

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

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

Meaningful Use Criteria Comments
By Arlen Dominek

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

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

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

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

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

Hence, Meaningful Use criteria should:

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

Provider Profitability
By Dichotomous Dweller

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

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

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

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

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

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

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

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

News 7/8/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What are the secrets of implementing CPOE?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So you don’t think Amalga is that product?

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

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

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

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

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

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

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

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

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

Anything else?

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

Monday Morning Update 7/6/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HERtalk by Inga

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

CIO Unplugged – 7/1/09

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

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

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

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

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

But the operative word is proceed.

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

Why SN?

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

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

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

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

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

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

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

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

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

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

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

Readers Write 7/1/09

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

Hats Off to AMDIS
By Ann Farrell

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

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

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

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

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

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

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

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

An Alternative Desktop Standard
By Mark Moffitt, MBA, BSEE

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

The advantages of this configuration over a conventional PC are:

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

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

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

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

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

Physicians Using PCs
By Ben

I think you need additional inspiration!

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

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

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

News 7/1/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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HERtalk by Inga

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

Monday Morning Update 6/29/09

The Association of Medical Directors of Information Systems (AMDIS) files its response (warning: PDF) to ONCHIT’s proposal for the definition of “meaningful use.” Its recommendations:

• Rewrite the standards from the point of view of patients
• Clarify how ARRA payments will be determined
• Focus on consistent use to capture problems, meds, allergies, histories, prescriptions, and vital signs, plus having that information coded so it can be shared
• Defer quality reporting until 2013 to give doctors time to routinely collect the needed information
• Take out anything that requires CPOE because it’s loaded with the possibility of unintended consequences
• Hold technology vendors accountable for data exchange capability by making that part of certification.

Publicity-seeking missile Jesse Jackson, apparently fantasizing that he was there with Jackie, Tito, Jermaine, Marlon, and Michael as one of the Jackson 6, has insinuated himself into the limelight yet again, this time to dramatically repeat the obvious: the cardiologist who was in Michael Jackson’s house when he died needs to be found and interviewed (duh, Jesse). I’ve already made a bet at work that toxicology results will find at least one each of a narcotic, antidepressant, and stimulant, but the gossip sites say it will be more like a broader, Elvis-type blood-borne pharmacy since MJ was strongly rumored to have been a Demerol and Oxycontin addict in the past and, like a lot of celebs, had found himself some Dr. Nick-like docs willing to write anything he wanted even if it was likely to harm him (a Beverly Hills pharmacy sued him in 2007 for over $100K (!!) in unpaid prescription bills). Like former father-in-law, like son-in-law, sadly. Surely the tabloids are floating around offers to buy illegal copies of his medical records.

The final results of the HIStalk poll on HHS’s meaningful use draft: 20% think providers will achieve it too easily, 42% think the criteria are too hard, and 38% say they are about right. New poll to your right: do you think, as the technology journal article insinuated, that doctors and hospitals have intentionally resisted computerization to keep the public aware of how profitable their businesses are?

Also to your right, in Beta mode to see how many of you enjoy nerd humor like me: Dilbert. You can see the current strip, but also click the date link at the top to pop up a calendar and choose any date going back to 1989 or so (to the Phil, Prince of Insufficient Light days). My favorite is anything with Dogbert Consulting Company.

Justen Deal already told you this a couple of weeks back, but a new Canada Health Infoway report confirms: after eight years and $1.6 billion spent, EMRs contain information on only 17% of Canadians, far short of its 50% goal. Given its apparently failure to deliver what was promised, the organization’s response was: (a) we still might make it by the end of 2010, and (b) what the heck, it’s creating a bunch of HIT jobs, anyway. I guess our countries really are a lot alike. I was interested in the CEO’s educational background, but it’s never mentioned in his bio, which seems odd. 

Sentry Data Systems announces its new Claims Guardian application, which matches pharmacy procurement bills to charges for benchmarking, identifying missed billing opportunities, and documenting costs for submitted claims.

Cerner shares closed at $61.59 on Friday after hitting an all-time high, valuing the company at $5 billion and Neal Patterson’s shares at $344 million. Had you bought $10,000 worth of CERN in 1990, those shares would be worth $1.5 million today, for all us Neal-bashing losers (see stock chart above covering 1990 to now, with CERN in the blue and the Down in the red, no pun intended). Allscripts hit a yearly high Thursday and closed Friday at $14.74, but still way short of 2000 prices that were in the 80s. CEO Glen Tullman, predicting company growth, tells Jim Cramer, “we’re just getting started.” McKesson is in the 40s, way off its pre-HBOC prices in the 90s in 1998 despite paying massive CEO dollars.

But maybe your best HIT stock buy of all would have been NextGen parent Quality Systems. Your 1998 investment of $10,000 would be worth $627,000 today. The graph above shows the Dow (green), CERN (red), and QSII (blue). 

India’s national e-governance project will roll out Web-based telemedicine software called e-Sanjeevani, a .NET-based solution that’s claimed to be “the world-wide leading provider of connected medical devices or medical equipments, peripherals, and software used in telemedicine.” e-Sanjeevani was developed by CDAC Mohali, an ISO-9001:2000 certified R&D institute. I like its goals, which include “To provide multi specialty health care to the common man at the most affordable cost.” Maybe we should use it here to connect to specialists in India since our common man can’t afford it either. 

New York State Senator Pedro Espada owes the state and the IRS hundreds of thousands of dollars from the operations of his medical clinic/medical home, which gets funding from the state health department. The clinic paid the Senator $460K last year, but omitted that payment from its IRS filings. The clinic says it was promised $200K to convert to an EMR, but has received only half that amount. The Senator has been in hot water before, claiming a vacant apartment as his district residence and charged (but acquitted) of using clinic money to pay off his campaign debts.

China will restrict viewing of Internet-based medical research papers about sex starting next month, another step in a series of crackdowns that include requiring new PCs to have filtering software and requiring Google to block politically sensitive results from its searches. Medical information sites will be required to implement technology that will restrict sex-related medical research papers to medical professionals.

I’m torn: Microsoft is selling its Windows 7 Home Premium upgrade for $49.99 for a couple of weeks, temporarily discounted from its insane list price of $120 (Apple’s Snow Leopard will be only $29 and $49 for a five-license family pack, plus their stuff seems to be much less trouble–prone). Reasons against: (a) I have no unmet operating system needs since XP works fine for what I need, which is mostly to use Firefox to get to Google Apps and Gmail; (b) my Vista upgrade was a disaster, with all kinds of flaky behavior and lack of device support, (c) installing it requires a complete reinstallation of everything on the drive; and (d) I keep thinking of that Office 2007 ribbon bar, surely the stupidest and worst-designed software “feature” in recent memory, and wonder what similarly unpleasant surprises might have been tucked into Windows 7. I could load the release candidate version, but it’s just as risky in all those same ways except financially.

Speaking of Apple, I found its site for medicine and clinical practice. It’s a pretty short list of Mac-based EMRs, though, and I’d hope doctors wouldn’t choose a system just because it runs on a Mac. From the screenshots I’ve seen of some of those systems, they’re not much different from the hundreds of Windows-based apps out there.

Thieves in Canada who stole a truckload of computer monitors that a local hospital was donating to impoverished schools in Africa return them after finding out where they had been headed, attaching a note saying “sorry for the trouble, hope you forgive us, hope those kinds in Africa enjoy.”

Great news! Frugal politicians say they can try to fix healthcare for only $1 trillion. Let’s hope the government doesn’t run out of currency-printing green ink before it all turns to budget-busting red ink.

Jeff Amrein, who sold Advanced Imaging Concepts to Allscripts in 2003, moves on to his next venture: an online poker site called Hog Wild Poker Leagues. I thought the whole poker thing was as passe as swing music and pacifier-sucking teenagers, but maybe not.

Imaging vendor Merge Healthcare is added to the Russell 3000. Shares have been on a tear, jumping from around 40 cents in December to $4.30 now following major restructuring and a new private investment a year ago. Timing is everything, though: the share price was at nearly $30 in early 2006.

Odd hospital lawsuit: a heart surgery nurse sues her hospital employer, claiming she was demoted for complaining that a surgeon threw a 4-by-6 inch hunk of heart tissue at her during an operation and joked about it. His humorous line wasn’t mentioned, but I pictured him belting out Janis Joplin’s Piece of My Heart.

The surgeon general under the first President George Bush, who is now (but probably not for long) a VP of Florida Hospital in Orlando, pleads guilty of labor charges at her former New York health commissioner. She forced state employees to work overtime doing tasks such as having security guards move furnishings in her house and publicly chewing out state guards for mishandling her personal shopping bags. The inspector general’s report sand she added “new dimension to the definition of ‘arrogance’ and ‘chutzpah’." She’s also the sister-in-law of Father Guido Sarducci for you old school Saturday Night Live fans.

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News 6/26/09

From HIPAA Hound: “Re: interesting take on the resistance to electronic medical records. I have to say I agree with much of this reasoning, most especially where HC costs are increased by for-profit insurance companies looking to avoid paying claims by constantly moving the target for approved claims, thus sending admin costs for providers sky high, and the avoidance of any mechanism which might expose any of these practices to the general public. I am amazed that these practices have not been exposed already in our debate over HC reform.” Bet on it: whoever has the most lobbyists wins. This Technology Review (MIT) article is hardly complimentary: it says healthcare could have already gone digital if it wanted to, but resists to keep its lucrative business model out of the public eye. It also hints an another truism: it takes a lot of sick people to keep the big bucks flowing, so there’s not much incentive to lose customers by making them healthier.

From Bignurse: “Re: cheap technologies. I am using a free time clock software (Web-based) to keep track of time working on a part-time consulting job. Just click the timer while working and it records the minutes, later creates an invoice which can be e-mailed to the client. I can even put the timer on hold when the dogs need walking or to take dinner out of the oven. Love it.”

From Dr_Duped: “Re: HCNN. I signed up for a service at www.hcnn.net that promised an FDA targeted alert system based on my primary specialty. Sounded great. However, several FDA alerts did go out that would have been towards internal medicine and I did not receive a notification through HCNN. I called their listed number, and according to the gal that answered the phone, what I signed up for had nothing to do with the FDA. This company is trying to capitalize on the ‘Dear Healthcare’ letters we receive in the mail. The whole operation is deceptive and all my colleagues need to be aware. Those notifications go in the garbage for a reason – the medical community would prefer not to receive them by any communication method from Pharms companies.” I would hope the medical community pays attention, since those ‘Dear Doctor’ letters are related to patient safety, not drug company marketing (I think of them as anti-marketing). HCNN is non-profit and free, is clear about its separation from FDA, (it merely repackages paper FDA Dear Doctor letters into e-mail for faster delivery), does not share subscriber information, and has a ton of endorsements. I don’t know about the missed alerts and I’d keep an eye on them to make sure someone doesn’t try to cash in, but they seem on the up-and-up to me and a good service.

From The PACS Designer: “Re: iPhone. With the ever-increasing population of iPhones, it won’t be long before they are used in everyday hospital activities. The informatics program at Children’s Hospital Boston (CHIP) has embarked on a project to bring the iPhone application selection process into their everyday decision processes by mining their legacy databases to migrate the information to the web for iPhone access. They have listed ten features on their website for anyone to view that could lead to further information sharing in healthcare to improve patient care. Participants of their May workshop believe that an infrastructure based on ‘substitutable’ components is a highly promising way to drive down healthcare technology costs, allow flexibility, support standards evolution, accommodate differences in care workflow, foster competition in the market, and accelerate innovation. Thanks to John at Chilmark Research for the alert.” The NEJM article is here. I like the anti-certification jab in #10 of their platform principles, probably nurtured along by participant and EHR realist David Kibbe (click below to enlarge). Isaac Kohane and Kenneth Mandl (above) are the chief CHIP guys involved.

Misys announces its expectation of a 40% rise in sales for FY2009, although all but 3% of that came from the Allscripts merger and currency values. Allscripts says it expects to slightly beat full year revenue and earnings estimates after a strong Q4.

Farrah Fawcett and Michael Jackson die on the same day, ensuring that the rest of us who remember their 70s and 80s prime reflect on our own mortality. Apple CEO Steve Jobs lives on, meanwhile, although raising a lot of questions about how he was desperately ill enough to jump to the head of the Tennessee liver transplant line (and ahead of 16,000 Americans waiting for a transplant) yet the company disclosed nothing about his condition to shareholders to correct the fact that his claimed “hormonal imbalance” was actually “I’m in complete liver failure and will die shortly without a transplant.”

Some random thoughts as I endorsed the Declaration of Health Data Rights: (a) given the undecipherable nature of medical records to most laypeople, who’s going to explain them? Doctors won’t have time, so it’s a good business for a nurse to start. (b) It will be embarrassing how much misleading and plain wrong information they find there, kind of like when hospitals used to let patients see their error-filled charges and stopped because they couldn’t really explain them either; (c) Patients will be surprised at how much stuff is in there about them as a customer and not a patient (entries created entirely for billing purposes). (d) they may be surprised at the lack of continuity, especially with referrals and records sent from one provider to another.

From Weird News Andy: Reese’s Cups as health food? And, as he says, “a slide show for those not eating lunch” showing X-ray oddities.

I just remember that HIStalk is now six years old as of the beginning of the month. For the new folks, put your e-mail address in the Subscribe to Updates box to your upper right to get instant notification when I write something new (I don’t use that list for anything else, by the way, so it’s guaranteed spam-free). The Search HIStalk box invokes a Google site search to dig through those six years’ of stuff, looking for the name  of companies, people, or obscure rock bands. The sloppily designed Report a Rumor box in brilliant green asks nicely to be clicked when you’ve got something secretive to tell me (it’s secure, anonymous, and accepts attachments). Keep reading down the right column to see what’s on HIStalk Practice, to see what’s been posted to HIStalk Discussion or the Industry Events, and to see what comments have been recently posted.

Markle Foundation says 56 organizations have endorsed its PHR framework.

Inga interviewed QuadraMed CMO Joe Bormel on HIStech Report, covering a lot of ground including translational medicine and taxonomies along with the usual industry-type questions. 

A study finds that the Phoenix area has a high rate of EMR adoption, but also a high rate of EMR deinstallation due to inadequate training, missing functionality, or lack of affordability.

Red Hat’s Q1 numbers buck the tech trend with EPS up 7%, beating estimates.

Two laptops stolen from Alberta Health Sciences (Canada) contain some patient information, but are password-protected. Apparently no medical institution in the world enforces a policy of storing data only on the network, not on the local device where it can be stolen or lost (nobody backs up PCs across the network, either, although users always have some vague confidence that IT magic is going on in the background).

HIMSS may be non-profit, but it’s looking for a sales jock “to generate sales and achieve revenue objectives for the Organizational Affiliate program,” prospecting hospitals for its all-you-can-eat plan of unlimited individual memberships for one institutional price. Required: to “aggressively solicit new customers,” “be alert to competitive organizations,” and “understand the process or art of selling.”

Speaking of HIMSS, the local paper mentions its office in Ann Arbor, MI. I assume that’s where MS-HUG lives, but I don’t really know.

TriZetto founder, chairman, and CEO Jeff Margolis receives the 2009 National Human Relations Award from the American Jewish Committee for his healthcare and community service work.

Jobs: Healthcare IT Project Managers, Account Executive – South Central, McKesson SQL Consultant.

If you’ve got $4,000 to spend and want to hang out with Goldie Hawn, David Blaine, and some big-name healthcare people, you could go to TEDMED2009 in October in San Diego. It was dead for four years (reason not given that I could find) and revived this year in what looks like a business rather than a love-in, but at least there will be only 400 attendees. I bet the bloggers are falling over each other trying to nab a press pass so they can tweet their brains out to a breathlessly waiting world.

The head of Siemens Healthcare, like all device and drug makers, tries to convince Congress that the company’s technology actually saves patients and insurance companies money, also making the case that most doctors who order diagnostic tests don’t personally profit from doing so (he’s probably right about that, but that still leaves scumbag malpractice lawyers as a key reason for overuse).

Fairview Health Services (MN) is defending itself against a lawsuit over patient information posted on a MySpace page. A woman being treated in a clinic for a sexually transmitted disease was spotted by an employee related to the woman’s husband, who when told another relative at the hospital, who then told the husband. Both employees were fired, but a Web page soon popped up with the woman’s medical information, her picture, and claims that she cheated on her husband and was addicted to plastic surgery. The woman sued the hospital and the employees, but I’m not interested enough to try to understand all the other legal wranglings detailed in the article. What I did find interesting was a claim by the defense: that HIPAA pre-empts state privacy laws and therefore precludes private lawsuits.

Another odd hospital lawsuit: a patient at Memorial Hermann Beaumont Hospital takes a swing at a hospital employee, misses, and instead hits another patient in face, breaking the other patient’s jaw and requiring him to undergo surgery when infection sets in. The broken jaw guy is suing the hospital (but not the non-deep pockets guy who decked him, of course). Oddest of all, his lawyer is a former Super Bowl starting cornerback for the Buffalo Bills.

HERtalk by Inga

Nuance Communications recognizes 20 healthcare organizations for saving one million dollars or more in transcription costs using the eScription platform. Brigham and Women’s Hospital (MA) tops the list, having accumulated $10 million in savings since installing the product. eScription also reports that eight new healthcare organizations have gone live on their platform since the beginning of the year.

Sharp Healthcare (CA) selects Anakam Identity Suite to provide patient access to Sharp’s patient portal.

Nyack Hospital  (NY) chooses McKesson’s Paragon community HIS solution for EHR and financial management.

Medicity and Eclipsys announce a partnership to provide a HIE to Eclipsys clients. Eclipsys will leverage Medicity’s Care Collaboration platform to deliver its new HeatlhXchange solution.

Stephen P. Wood, a senior VP for Ingenix Consulting, is named a Top 25 Consultant by Consulting Magazine in the “Excellence in Healthcare” category.

RCM vendor Capario names Charles Lambert CFO, making him the forth former Misys executive to join the company once known as MedAvant Healthcare Solutions.

HIS vendor Healthland partners with Sentillion to resell its SSO solution expreSSO.

Greenway introduces a new program to extend discounted pricing to physician groups within HIEs. Qualified organizations can purchase Greenway’s PrimeSuite 2008 for discounts of up to 25%.

The state of Vermont was recently recognized by Surescripts as the “most-improved” state in terms of sending prescriptions electronically. Surescripts also honored the nation’s top individual e-prescribing physicians, include three using standalone e-prescribing software and three using EMRs. Interestingly, 44% of Vermont’s e-prescriptions were generated by Allscripts users, as were three of the six top prescribers. A fourth provider uses Eclipsys Practice Solutions.

A University of Iowa official admits that despite spending $55 million on an Epic system, the UI Hospitals and Clinics will not be able to communicate seamlessly with other hospital systems. It’s unclear whether this is a surprise to the school’s Board of Regents or merely to the reporter covering the story in the local paper. The officials also indicated that users have been required to go through an “onerous” training process, which consisted of 12 hours over the last fall and spring. (just 12 hours?) The  medical school representatives also praised the system for its flexibility and wide variety of features.

Opus Healthcare Solutions becomes the second company to receive CCHIT ‘08 Inpatient EHR certification, after Epic.

Diagnostic Center of Medicine (NV) selects Allscripts EHR/PM for its 16-provider, three-location practice, replacing Misys practice management and adding an EMR.

NCQA releases a reporting highlighting the important role of small medical practices, which provide almost three quarters of ambulatory care in the US. The report points out that smaller practices are more likely to lack the resources to improve quality of care, implement EMRs, and serve an increasingly diverse population.

Perhaps Rep. Kathy Dahlkemper read the NCQA report. The chair of a House Small Business subcommittee on health care proposes a bill to create a new SBA loan program to help doctors in small or solo practices to buy and maintain EMRs. The program  would rely on private sector loans of up to $350,000 and $2 million for groups, be 90% backed by the SBA.

And, the AHRQ is considering developing an electronic toolkit to assist small and medium sized practices change their workflow when adopting HIT. The AHRQ issued an RFI to gather information on how clinics and physician groups redesign their workflow when adopting technology.

I must say this report depresses me. Common Cause calculates that so far this year, healthcare industry participants are spending an average of $1.4 million a day to lobby members of Congress. That means lobbyists are on track to spend half a billion dollars this year. Half of the spend comes from the pharmaceutical industry; hospitals, doctor groups, and suppliers of “healthcare products” (which I assume includes HIT items) make up the balance. The reports also shows the amount of campaign contributions received from the health industry to each senator and representative. Arlen Specter wins that contest in a landslide;  Mr. H’s man-crush Senator Grassley is way down on the list. Meanwhile I’m trying to calculate how much healthcare we could buy with $1.4 million a day.

E-mail Inga.

Readers Write 6/24/09

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

What Interesting, Light, and Cheap Technologies Are We Using?
By EncoreDiva

We don’t have a single server of our own.  We use hosted solutions for e-mail and SharePoint. 

We have a Web-based accounting system, timekeeping system, and expense reporting application.

We’re experimenting with Yammer to encourage collaboration within a virtual organization (and to cut down on e-mail), we have a page on Facebook, we utilize the status feature on LinkedIn to update our network on what’s new with the company and we utilize Skype for IM and quick calls. 

We use www.freeconference.com for internal conference calls and www.dimdim.com for internal webcasts. We utilize Administaff for our payroll and benefits and they administer (securely) all employee information. Our recruiting system is Web-based and open source (www.catsone.com) and it’s easily accessible from an iPhone. From a desktop perspective, we’re playing with OneNote and so far I’m LOVING it!

Meaningful Use: A Brief History
By Dr. J

13,000 BC: Prehistoric humans decorate their caves with images of herbal remedies used for their medicinal purposes. Unfortunately, these primitive clinical information systems are not CCHIT certified and reimbursement for shamanism drops dramatically. Neanderthals go extinct.

2600 BC: The Egyptian Imhotep describes the diagnosis and treatment of 200 diseases. ICD-10 soon expands this list by nearly three orders of magnitude.

460 BC: Hippocrates, the “father of modern medicine,” writes the first draft of his famous oath. After an extensive public comment period, Hippocrates tones down his commandment to “first, do no harm by taking an extensive medical history, including prior medications, allergies, and surgeries and accounting for the patient’s renal and hepatic function” out of concern that this tough requirement may hamper widespread adoption.

150 AD: Galen of Pergamum, pioneering Roman surgeon, insists on using only papyrus. He refuses to implement parchment in his practice because he finds it so disruptive to his workflow.

1231: Theodoric, Barber of York, proposes standardized terminology for various forms of bloodletting, primarily so he can “upcode” to get increased reimbursement for using leeches.

1427: As the Black Plague sweeps through Europe, self-flagellation is lauded as a pioneering effort for health information exchange. Whole communities get into the act by burning sufferers alive, using the fiery glow as a novel public health reporting tool.

1601: James Lancaster proves that consumption of citrus fruits prevents scurvy in British sailors in the world’s first controlled clinical trial. Unfortunately, in a world without quality metrics for scurvy prevention, Lancaster fails to achieve his pay-for-performance bonus for the year.

1795: After a mere 194 years (and 1 million scurvy deaths), the British navy mandates lemon and lime juice as standard sailor’s rations. Next up, EHR adoption.

1816: Rene Laennec invents the stethoscope, which is subsequently rated “Best in KLAS” over the objections of the Open Source community.

1845: Surgical anesthesia is pioneered at Massachusetts General Hospital. The Federal government sets up “Regional Anesthesia Extension Centers” to assist in anesthesia implementations nationwide.

1854: Florence Nightingale begins a medication bar-coding initiative during the Crimean War, but then realizes it would be preferable to save lives by cleaning the army hospital’s sewage system.

1884: Robert Koch establishes his famous postulates to identify microorganisms responsible for various diseases. Privacy advocates successfully sue Koch, forcing him to go back and de-identify the pathogens.

1889: Sir William Osler creates the medical residency but completely fails to anticipate the headaches his other creation, the co-signature, will cause in 120 years.

1895: X-rays are discovered by Wilhelm Röngten, without the assistance of a PACS. Nevertheless, for years Röngten would claim that his images conform to DICOM standards.

1928: Alexander Fleming extracts penicillin from mold growing on a tablet PC he had forgotten to plug in for several days. He tries to e-prescribe the antibiotic for a patient, but the antibiotic is not in his “favorites” list, so he handwrites the prescription and gets the dosage wrong.

1967: Christiaan Barnard performs the first human heart transplant. No one ever hears about it because Twitter has not yet been invented.

2003: The human genome is completely sequenced. Instead of the expected ACTGs, the genome is apparently filled with strange acronyms like LOINC, CCD, CCR, and HL7.

2008: CCHIT is involuntarily dissolved for the first time.

2009: David Blumenthal, the National Coordinator for Healthcare Information Technology, delivers the government’s definition of “meaningful use” to an immense crowd of jubilant healthcare providers from the steps of the Lincoln Memorial, after an opening concert by U2. Healthcare in the US is saved! The rest of the industrialized world yawns while besting us on nearly every relevant quality measure for the tenth straight year.

The PACS Designer’s Review of Cloud Acronyms
By The PACS Designer

Illustration: Youseff, UCSB

The number of acronyms applied to cloud computing is growing, and even TPD is confused about what they really mean when it comes to providing users solutions for expanding the computing universe of an institution.

Even IBM has gotten into the marketing hype by calling their cloud offering Computing as a Service with their introduction of their Blue Cloud.

So let us look at what the Wikipedia has to say about the types of service renderings related to cloud computing solutions.

The most common term heard is Software as a Service (SaaS).  The Wikipedia definition is:

"Software as a Service (SaaS, typically pronounced ‘sass’) is a model of software deployment whereby a provider licenses an application to customers for use as a service on demand. SaaS software vendors may host the application on their own web servers or download the application to the consumer device, disabling it after use or after the on-demand contract expires. The on-demand function may be handled internally to share licenses within a firm or by a third-party application service provider (ASP) sharing licenses between firms."

Another cloud computing term is Platform as a Service (PaaS) which is defined as:

"Platform as a service (PaaS) is the delivery of a computing platform and solution stack as a service. It facilitates deployment of applications without the cost and complexity of buying and managing the underlying hardware and software layers(1), providing all of the facilities required to support the complete life cycle of building and delivering web applications and services entirely available from the Internet(2)—with no software downloads or installation for developers, IT managers or end-users. It’s also known as (cloudware).  PaaS offerings include workflow facilities for application design, application development, testing, deployment and hosting as well as application services such as team collaboration, web service integration and marshalling, database integration, security, scalability, storage, persistence, state management, application versioning, application instrumentation and developer community facilitation. These services are provisioned as an integrated solution over the web."

The next cloud computing term is fairly new, and is Infrastructure as a Service (IaaS) and is defined as:

"Infrastructure as a Service (IaaS) is the delivery of computer infrastructure (typically a platform virtualization environment) as a service. These virtual infrastructure stacks(3) are an example of the everything as a service trend and shares many of the common characteristics. Rather than purchasing servers, software, data center space or network equipment, clients instead buy those resources as a fully outsourced service. The service is typically billed on a utility computing basis and amount of resources consumed (and therefore the cost) will typically reflect the level of activity. It is an evolution of web hosting and virtual private server offerings."

Lastly, IBM’s term of Computing as a Service will most likely be used as a marketing tactic only as their already is a CaaS which stands for Communications as a Service!

Hopefully posting all of these terms in this entry will help users understand solution offerings by vendors, and be a guide to everyone contemplating using cloud computing structures as solutions.

(1) Google angles for business users with ‘platform as a service’
(2) Comparing Amazon’s and Google’s Platform-as-a-Service (PaaS) Offerings | Enterprise Web 2.0 | ZDNet.com
(3) IT as a Service is a model ripe for adoption
https://spaces.internet2.edu/download/attachments/8817/ComputingAsAService08.pdf?version=1
http://en.wikipedia.org/wiki/Software_as_a_service
http://en.wikipedia.org/wiki/Platform_as_a_service
http://en.wikipedia.org/wiki/Infrastructure_as_a_Service

News 6/24/09

From Don Duck: “Re: new CCHIT certifications. Does the EMR-S, which certifies home-grown, single-user EMRs, include groups that have developed an EMR and then sold or loaned it to other groups with common ownership or interest? It seems odd that some EMR companies might go out of business for lack of certification while homegrown versions could live on.”

Here are CCHIT’s slides (warning: PDF) on the topic. It sounds to me that EHR-S sites (which pay only $150-300 per licensed provider and are certified via a “virtual visit”) can be any provider group as long as their product meets requirements for federal standards, security, and meaningful use. The grid says even vendors of comprehensive EHRS with multiple customers can go the EHR-S route, although the per-provider cost would make that unattractive for all but the smallest vendors (although it would let them turf the whole certification issue off on their customers, assuming anyone would buy under those terms).

Microsoft signs with Sentillion to provide single sign-on and context management services for Amalga. Kudos to Microsoft for recognizing the value of offering that level of user experience integration early in the game. I interviewed Sentillion and co-founder Rob Seliger not too long ago (and my sixth question about vendors making their products CCOW compliant was especially relevant, if I do say so myself). My hospital has both SSO and context management in limited deployment, but has finally seen the light and is adding new apps. I’m pretty sure we will avoid some clinical mishaps my keeping the screen-fumbling to a minimum, not to mention improving clinician satisfaction. It’s a nice nod to Sentillion that Microsoft came knocking.

Healthcare Management Systems announces GA of what it says is its largest release, which contains functionality to meet figure CCHIT criteria and to qualify provider users under meaningful use.

A widely reported Cornell study finds that providers don’t tell patients about clinically significant lab and rad findings seven percent of the time. The study methodology isn’t the best, but it’s one of those “sure, it happens” issues in which results are lost in the shuffle or don’t raise the appropriate flags.

Sage Software India announces the launch of a couple of new products for hospitals in India. They have ERP in their name, but that must mean something other than Enterprise Resource Planning since the press release talks about bed assignments and physician notes. ERP sounds more like a product line, according to this page.

Listening: Eric Clapton and Steve Winwood, brand new on Live from Madison Square Garden and recommended by reader Bill. I’m not a fan (Cocaine and Wonderful Tonight are immediate dial-changers for me), but this one’s a keeper, a couple of guys in their 60s sounding better than they did in their 20s. Their cover of Hendrix’s Little Wing is about as good as music gets, with an old-school Hammond B3 keyboard and Clapton doing great stuff on the guitar instead of just noodling around.

Welcome to new HIStalk Platinum Sponsor Keane, more specifically, its Healthcare Solutions Division (HSD). The Boston-based company provides solutions to hospitals and long term care facilities all over the US, including Keane Optimum (hospital information suite), Patcom (patient management), and Keane NetSolutions (browser-based medication management). I’ll let them tell you more: “Keane’s solutions help U.S. healthcare facilities modernize their operations by using technology to prevent medical mistakes, provide better patient care, and implement the most effective treatments, while at the same time achieving cost-saving efficiencies and meaningful returns on health information technology investments. Keane Optimum is especially well suited to help healthcare facilities accelerate the adoption of EMRs in response to the Healthcare IT provisions in the recently approved American Recovery and Reinvestment Act. Specifically, Optimum allows providers to enhance quality, maintain privacy, support clinical decision making and begin to move to a more interoperable environment for improved health care delivery.” Thanks to Keane for supporting HIStalk and the people who read it.

Saint Vincent Health Center (PA) credits Sunrise Surgery (which I think is Surgical Information Systems when Eclipsys sells it) for its compliance with regulatory requirements and quality reporting.

HIMSS gets a page devoted to it on the Citizen Media Law Project for sending a semi-threatening letter to two bloggers back in February, demanding they take down unflattering comments left by an anonymous poster (and also asking them to turn over information that would help it identify that individual). Both bloggers declined to comply but offered HIMSS equal time, which it didn’t take advantage of. I still think HIMSS believes the poster was a former or current employee given that the lawyers doing the pressuring (respectfully, I should add) are labor attorneys. You may also remember that the comments that got the HIMSS corporate panties in a bunch made some pointed (and sometimes bizarre) comments about what the poster perceived as HIMSS influence over CCHIT.

From Weird News Andy: a man sent home on Tylenol from an Australian hospital with what its ED diagnosed as a headache turned out to have a broken neck. The patient said he was told they couldn’t do an X-ray because the radiology department was closed for the night.

I like this article, which says budget-strapped CIOs are turning to “lite” corporate IT using free Web-based tools, open source applications, and software from little-known vendors to meet IT needs. The article cites this blog, which says the average person has more IT capability in their den than at their job: “The new expectations of corporate IT should also turn into an opportunity. If you and I can buy storage at 10c a GB, why are corporations paying hundred times as much? If at any given time, if millions of consumers are talking to each other around the world on Skype for free, why are mobile companies charging you exorbitant roaming fees? If any one can call the Geek Squad and get a one time PC repair visit, why is your desktop outsourcer not charging you on a per usage basis, rather than some monthly charge? Why is your software vendor UI still so 90s – and why do they deliver a truckload of user manuals and documentation? And why do they still need schoolbuses of consultants to help implement? Consumerization of technology should be a broad manifesto for change in corporate IT and enterprise vendors. Let’s face it – we are  slower, uglier, exorbitantly expensive, obsessed with security and compliance. Time for a makeover. An extreme one.”

So, with that article as inspiration: what interesting, lightweight, and cheap technologies are you using? I’m really curious. If you’re a provider, what are you experimenting with?

And in that vein, know any CIOs or CMIOs who are innovative and interesting? We’d like to interview them, so hook us up if you can.

I admit it: I have a man crush on Senator Charles Grassley and his fearless probing into how government money is spent (and misspent). His latest target: UCSF’s medical school, of which he is demanding more information to determine whether taxpayer dollars are being wasted on research projects and mismanagement.

The Senator would like this: the VA’s $3 million combat-related brain injuries lab in Texas hasn’t tested a single veteran in its three-year history.

I endorsed the Declaration of Health Data Rights here. What it says: you have a right to your medical information, each data element should be tagged with where it came from, whoever has your information should give you a copy for very little money (and in electronic form instead of paper if that’s how they have it), and you can share your data with anyone you want.

The New York Times covers the medical home concept, highlighting a Duke University project that assigns a primary care specialist to coordinate a patient’s care, also providing a patient portal for making appointments and checking lab results.

Heart failure patient readmissions at Sentara Virginia Beach General Hospital were reduced by 74% by using a heart failure care plan deployed via GetWellNetwork’s interactive patient care system.

Apollo-Bramwell Hospital in Mauritius will be the first Indian Ocean hospital to go live on PACS.

E-mail me.

HERtalk by Inga

Right after Apple announced their new phone, I bemoaned the fact that I had JUST upgraded from the 2G to the 3G. Fast-forward (after lots of advice and  lots of time on hold with Apple and AT&T and never talking to anyone) to Sunday: I went to the Apple store and was told I was out of luck, there is no way to get the new phone without paying another $199. I suppose I could have argued the point further with some mensa (or whatever they call the managers), but I had no interest in standing in the 20-deep line just to attempt getting a new phone for a better price. If you purchased a 3G2, please tell me it really isn’t worth standing in line for two hours. I did upgrade to the 3.0 software and am SO happy to have search capabilities on my e-mail, cut and paste, and the ability to view email in landscape. I really am a low-maintenance kind of woman.

The Glacial Ridge Health System (MN) reduces its costs 50% by replacing its film-based PACS with 7 Medical’s on-demand PACS.

Baylor Medical Center at Frisco (TX)  selects Orchestrate Healthcare, in partnership with Vitalize Consulting Solutions, to perform a readiness assessment of their current systems, provide an analytical review, and present a roadmap for the strategic roll-out of clinical and technical architecture.

NextGen is now a CMS-qualified PQRI patient registry for 2009 and will help eligible physicians submit PQRI quality measures directly to CMS.

RelayHealth and LightHouse1 announce a new partnership to help providers automate payments for patients with healthcare spending accounts and consumer driven healthcare plans. RelayHealth will integrate its EasyCDH solution with Lighthouse1’s OnDemand  platform to create the SAS OneCard solution.

Medical tourism in Korea has grown 41% in the past year. Officials attribute the increase on new laws permitting aggressive marketing to attract overseas patients.

Massachusetts takes top honors at Surescripts’ Safe-Rx Awards, which recognize the top e-prescribing states. Massachusetts providers send 20% of prescriptions electronically, followed by Rhode Island at 17%. Vermont was named the most-improved state.

Sarasota Memorial Health Care System (FL) selects the Medicity Novo Grid solution to electronically exchange health information between the hospital and physician practices.

Contra Costa Regional Medical Center (CA) plans to replace its discontinued Mediware Information System with Unibased ForSite2020 periOperative Resource Management System.

Tufts Medical Center (MA) contracts with WaveMark to provide RTIM technology to track physician preference items in its Cath, EP, and interventional radiology departments.

KLAS churns out another report, this one entitled, "Infection Control: Improving Patient Care and Reimbursements.” The study highlights the leading infection control software vendors and their solutions. The featured products are the top-rated Cardinal Health MedMined, Premier SafetySurveillor, and TheraDoc Infection Control Assist.

More medical records are found dumped in the trash, this time finding their way to an Alabama landfill. It’s ironic how much attention is spent ensuring our electronic records are secure while paper medical charts continue to show up in public dumps and recycling centers.

The Trizetto Group introduces a free PHR available to qualified payer customers for providers.

E-mail Inga.

Monday Morning Update 6/22/09

From The PACS Designer: “Re: Ning. TPD was looking for a collaboration tool for a new project and came across Ning. While it is touted as a ‘New Social Network’, it still can be used as a collaboration network when participants are working from remote locations and need to remain part of a discussion process or work development activity that spans multiple locations. Even HIStalkers could form their own social networks based on HIStalk postings and topics!” I actually tried it awhile back and liked it.  

From Custard’s Last Stand: “Re: ‘I hate my job’ blog. Perhaps this kind of info could be off to the side somewhere, like a sub-blog? I do think there is some value in learning about company cultures, trends, how they treat employees, etc. BEFORE you apply for a job.” I agree, although the happy employees aren’t usually as motivated to post as the unhappy ones, so every employer looks bad. You also can’t tell if anyone is who they say (management? competitor? psychopath?) JobVent is the big one, but I’m pretty sure I remember that companies have successfully threatened the site and forced them to remove negative postings, so it’s still caveat emptor. Just to give you an idea of the scores: Cerner (-1326), McKesson Provider Technologies (-24), Epic Systems (152), Meditech (-234), and Perot Systems (-545).

From Ralph Hinckley: “Re: Orion Health. I’m a former employee, laid off in January. They had another round this week, at least eight in the US and unknown in New Zealand.” Unverified.

Listening: Dengue Fever, an LA band whose music sounds like something out of Vietnam in 1969: Cambodian pop mixed with US psychedelia. I cheerfully acknowledge that maybe it’s not for everyone. Also: The Sword, Austin-based Sabbath soundalikes.

I was reading about medical fraud in which low-paid hospital clerks sell copies of the insurance or welfare cards of patients, which are then used to submit fraudulent bills (which, surprisingly, are usually paid). The article made an interesting point: welfare patients don’t get any kind of receipt that shows what has been paid on their behalf, so they couldn’t detect the fraudulent use of their credentials even if they wanted to. We’ve really made it too easy: someone else not only pays for the care, but the recipients never even see a bill.

Three Cleveland community health centers will get $2.7 million in stimulus money next month, with an EpicCare-compatible EMR on the list of projects to be funded.

Don’t forget the HIStalk Events Calendar, where you can post your HIT-related conference or Webinar for free. A couple of new conferences have been added.

Parkland goes live with its inpatient EMR (Epic, if I remember right and always a safe guess if the hospital is > 400 beds).

The New York Review of Books covers Healthcare, Guaranteed: A Simple, Secure Solution for America, by Ezekiel Emanuel. A good quote: “To remain competitive, many not-for-profit hospitals promote their bottom line just like their for-profit counterparts, vigorously advertising their facilities and services to the public. No other health care system is as focused on generating income as ours, and in no other country is medical care marketed and advertised so aggressively, as if it were just another commodity in trade. This increases health costs, while hospitals concentrate on the delivery of profitable, rather than effective, services. It also favors those who can pay over those who need medical care but can’t afford it … In 1980, after medical organizations lost some costly antitrust trials, in which they were accused of such offenses as limiting doctor fees or denying staff privileges, the AMA changed its ethical guidelines, declaring medicine to be both a business and a profession. This lowered the AMA’s barriers to the commercialization of medical practice, allowing physicians to participate in any legal profit-making business arrangement that did not harm patients.” The answer he’s proposing sounds like the Mayo (and Kaiser, Marshfield, Geisinger, etc.) model, with multispecialty group practices made up of salaried doctors.

Mediware announces the price it paid for BI software vendor SciHealth: $2 million, plus potential incentive payments.

Sentry Data Systems announces that it has added wireless scanning to its Sentinel RCM hospital pharmacy management system (procurement, operational visibility, financial management, and department management). They’ve also created a site that covers the Deficit Reduction Act that mandates true NDC number reporting on Medicaid drug claims (a good reminder that despite good intentions, the government is clueless about how healthcare is actually delivered). Sentry’s DRA white paper is a great intro, including why it’s hard to comply.

Good thing I got the Mac and iPod Touch when I did: the lines at the Apple store are back, this time for the new iPhone 3G S (or maybe the $99 basic iPhone). And speaking of Apple, The Wall Street Journal says CEO Steve Jobs received a liver transplant two months ago in Tennessee, where wait times are short. Only two hospitals there do adult liver transplants and Vanderbilt denies it was them, but I wouldn’t bet on that.

Louisiana passes a bill that will set aside $5 million to provide EMR loans to providers (or more accurately, to give the state access to stimulus money).

Dennis Quaid and his wife settle the lawsuit of their heparin-overdosed children against Cedars Sinai for $500K.

Oracle buys drug industry manufacturing software vendor Conformia Software.

I admit I’m stupid: I don’t see how it’s possible for a company to buy its parent like WebMD did (and for stock instead of cash at that).

eClinicalWorks signs a partnership deal with Scantronix, which converts paper medical records into digital ones.

Texas billionaire Allan Stanford, whose Antigua bank is the primary shareholder of healthcare software vendor Health Systems Solutions, is in US custody and charged with a $7 billion Ponzi scheme that could put him away for 250 years. Antigua’s bank regulator has been charged with accepting bribes from the bank. His bigshot lawyer defended Enron bankers, cult leader David Koresh, and former House Majority Leader Tom DeLay.

E-mail me.

News 6/19/2009

From Chuck Ponozzo: “Re: latest EMR developments. I attended via phone and Webex both the HIT Policy Committee call and the CCHIT Town Call meetings over the past two days. First I was a little disappointed in the Policy Committee and ONC for not having some of the discussions hashed out prior to the meeting and that nothing was approved to move forward. ONC let the media hype up this meeting as the place where meaningful use is going to be defined, and yes we have some idea, but we are all left sitting on the edge of our seats for another month before anyone makes a decisions. Even more concerning to me, though, is the way CCHIT is going about their business without any regard for the fact that they haven’t been identified as a certifying body and the folks on the Certification / Adoption Workgroup didn’t seem like they were ready to anoint them.”

From Former Sunquester: “Re: reports. The fact that you are squashing reports from current and former Sunquesters is disgusting.” Someone claiming to work for a couple of vendors keeps sending anonymous hatergrams with unsubstantiated claims about employee discontent in various forms. Employee-employer squabbles, even real ones, are not interesting to anyone else, so I’m not likely to run them here. I complained bitterly and regularly when I was unhappily working for a vendor several years ago, fantasizing that an outraged world would rush to my side if I kept moaning about it. I finally grew up and realized that (a) people had their own problems and didn’t care about mine, and (b) I looked stupid for whining instead of doing something about it. If  it’s that bad, leave. If you can’t do better, be grateful they’re paying you when nobody else wants to. That’s the harsh lesson I had to learn.

From Lemmy: “Re: Harvard Vanguard. Anne Fitzgerald, co-chief of operations and former CIO, is leaving on July 15. From the e-mail announcement: ‘Under Anne’s leadership, we completed major upgrades to Epic, launched three other Atrius Health groups on Epic, designed and built CHAPS (Community Hospital And Physician Systems Initiative) which can identify our patients when they arrive at a community hospital’s emergency room, increased the visibility and support for our ancillary and specialty services with investments such as the Central Lab move, PACS selection, pain management service and others, began the Site Councils as a way of moving to more local decision-making, and undertook a major investment in improving job do-ability.” Sounds like a mutual admiration society, other than the fact that she’s leaving. Maybe she took my advice above.

Physician warning: someone is faxing practices claiming to be with Medicare (and sporting its logo) and asking to have account information faxed immediately to prevent payment delays. It’s a scam.

New poll to your right: are the meaningful use criteria contained in HHS’s preliminary matrix too easy, too hard, or juuuuusssst right?

Cerner shares hit a 52-week high today. I’m squinting at the historical chart and it looks like CERN share prices just missed hitting an all-time high.

HIMSS says hospitals will spend over $14 billion on IT systems in the next five years.

Meditech gets a 6.0 sale to a 700-bed hospital in England, with Perot part of the deal for implementation consulting.

CalPERS, Anthem Blue Cross, Medco Health Solutions, and Blue Shield of California launch a big e-prescribing project.

Here’s something I bet you can use: Google Forms, called a SurveyMonkey killer by some, lets you create online forms that can collect Web-based responses by e-mail or in a Google Docs worksheet, making it perfect for doing polls or surveys. You just go to Google Docs and click New, then Form. I’ll be putting it to a couple of immediate uses, I expect.

Noteworthy Medical Systems announces the release of NetPay, a Web-based application interfaced to its practice management system that lets doctors collect patient payments as they leave the office.

An oncologist arrested on national TV’s “To Catch a Predator” for soliciting what he thought was a 13-year-old girl online says he should go free because alleged explicit chat room logs were lost when the hard drive of a Perverted Justice investigator failed. The prosecutor says it doesn’t matter since he has a saved copy, but the defense is arguing that there’s no chain of custody. The prosecutor counters with what sounds like a clincher: the doc showed up to have sex with a child and was caught on national TV, hard drive or not. Doh!

South Carolina, like other cash-strapped states, holds a health IT summit with the objective of getting federal money (EMR Welfare, I’m going to start calling it) and maybe even helping a patient or two in the process if the cards are right.

A company called Clear Innova implies that it has launched a new radiology information system, but it appears to be a marketing company pitching Origin from Medaxis.

A former Army surgeon and assistant medical professor at Washington University in St. Louis is implicated by major newspapers as having been paid $800K by medical device maker Medtronic for fabricating a favorable study of one of its devices.

Halifax Health (FL) chooses Meru Networks as the wireless network provider for its new 500,000-square-foot building.

So whatever happened with the April DoD raid on Siemens in Malvern? You would think they would have announced something if they found it.

University of Iowa Hospitals will lay off 130 employees.

Jobs: Senior Developer, VP Sales – Healthcare Software, Cerner eMAR Project Manager, McKesson PACS Administrators.

The gossip site paying OctoMom to follow her around with cameras is charged with violating California labor laws, leading to its defense that it’s a “news-gathering organization” not subject to entertainment industry laws.

I told you a few days ago that hospital IT people see this depressingly regularly, but here’s a new example: an employee of a Florida hospital is arrested for using his work PC and printer to print child porn. I guess site-blocking software isn’t working or isn’t being implemented.

Unibased Systems Architecture opens a demo center in Chesterfield, MO.

PACS vendor AMICAS will join the Russell 3000 stock index.

Informatics Corporation of America markets its ICA CareAlign as a “green” solution that leaves legacy systems intact, reduces paper and duplicate work, and reuses patient information.

Michigan’s medical society, Microsoft, Covisint, and PBM company MedImpact Healthcare Systems announce a collaboration that will give users of the medical society’s portal access to the HealthVault information of patients.

Interesting lawsuit: two male nurses sue their former hospital employer claiming they were illegally discriminated against since only they, not their female colleagues, were called when patients got violent. They say they were fired for complaining and want money for medical expenses, injuries, and emotional pain.

E-mail me.

HERtalk by Inga

From No satisfaction: “Re: Healthcare reform and insurance for all. This op-ed piece in the WSJ is a ‘must-read,’ suggesting that our failing healthcare system is also the fault of bloated Medicaid, Medicare, and other public programs that have strained state and federal finances. In my opinion, it’s time to move towards a free market. This much government in the middle adds cost, and long term means more people with less or no coverage. In all of modern history, no central government has ever succeeded in controlling a nation’s economy or managing its industries. This noble experiment will be no different. Start getting rid of insurance and let people pay for their care out of pocket — that way, they can truly compare prices and quality. Adding more government to something the government is already running that isn’t working isn’t going to fix anything!”

From Winnie Ryder: “Re: Hospital embezzlement. Thought you’d like this article.” Winnie forwarded a story that claims that women over the age of 45 are most likely to commit inter-office fraud and embezzlement in hospitals. Reasons include the need for money, revenge, and the the thrill of the challenge. My take: it’s best to take care of the mature women in your world.

And obviously hospitals in Czechoslovakia have figured that out. The nursing shortage there has led some institutions to offer creative perks to attract workers. Candidates seem particularly attracted to offers of free plastic surgery, including tummy tucks, remodeled breasts, and face lifts. I think I’d like to hang out with Nurse Petra, who’s quoted as saying, “I would rather have plastic surgery than a free car.” Heck, if the shortage is that bad, why not ask for both?

SCI Solutions announces the signing of 22 contracts during the first half of their fiscal year, ending on March 31.

An Alabama judge orders HealthSouth founder Richard Scrushy to pay shareholders almost $3 billion in damages after being found guilty of liable in a shareholder lawsuit. He denies any knowledge of the fraud scheme that nearly bankrupted HealthSouth.

The state of California files suit against six Target stores, alleging the illegal of dumping hazardous waste, including medical waste, into landfills.

MGMA reports that the starting salaries for physicians in many specialties are on the rise. Neurologists saw the biggest gain, from $200,000 to $230,000 a year, up 15%. Those earning the highest specialty salaries were neurosurgeons ($605,000), while pediatricians started at $132,500.

GE Healthcare’s CTO is named leader of the company’s $6 billion health care initiative. The “healthyimagination” program focuses on improving healthcare for people at a reduced cost.

Congrats to eClinicalWorks CEO and co-founder Girish Kumar Navani for winning the E&Y Entrepreneur of the Year Award for New England in the healthcare technology category.

MedCentral Health System (OH) implements Siemens Soarian Quality Measures to automate chart abstraction and help expedite the submission of quality measures.

WebMD and HLTH Corp. resurrect their merger deal, with WebMD purchasing its parent company in a $2.31 billion, all-stock deal. The transaction is scheduled to close by the end of the year pending regulatory approval.

Ingenix introduces Ingenix Revenue Manager, a new suite of software applications to assist hospitals with RCM activities. The suite includes three separate modules that can be purchased separately or together: Denials Prevention, Appeals Automation, and Denials Analytics.

Hayes Management Consulting just published its summer 2009 issue of the Hayes Review Newsletter. Included in the issue: tips for interoperability design with Ensemble and details on Red Flag Rules.

U.S. News Media Group releases its second annual rankings by specialty of America’s Best Children’s Hospitals. Rankings were based on  reputation, medical outcomes, and care-related indicators.

Heritage Valley Health System (PA) selects Allscripts Enterprise EHR for 150 of its employed physicians.

E-mail Inga.

News 6/17/09

From Scot Silverstein: “Re: your idea of ‘on a less contentious level, at least fully defining the extent of practice variation in real time and alerting physicians of areas for improvement.’ That was an approach suggested over 20 year ago: Perry L. Miller [Yale Center for Medical Informatics}, Expert Critiquing Systems, Springer-Verlag New York, Inc., Secaucus, NJ, 1986. Your ‘anon-a-doc social networking’ idea is interesting, but then how to differentiate advice from good docs and bad docs” I wasn’t necessarily picturing that the docs would be anonymous, so their advice could be evaluated in the same way as Amazon and Citysearch reviewers. And like those sites, I would assume that since good docs vastly outnumber bad ones that an aggregated set of opinions would lean heavily toward the best answer.

From Pharmacist H: “Re: Pittsburgh medication system problems. Whoever wrote about the electronic medication problems of an unnamed vendor is shouting fire in an inferno.”

From HITMan: “Re: physician variation. I am a non-clinican IT guy and CIO. I am constantly amazed by the quality care that my clinician colleagues deliver, but I also keep in mind the point that the most significant healthcare advances in the past 80 years have been driven not by physicians but by public health initiatives (think immunizations). I still think, however, that physicians think too highly of their own value and the quality of their EMR progress notes. Ask some nurses — they would probably have good insight about who really brings value to the health system equation.  Nonetheless, I stand by my comment that variation is the enemy of perfection and that by forcing physicians to deliver care in an evidence based-way (mon dieu!) and standardizing the care they deliver that we can improve the care that we deliver to our customers (I mean patients).” I agree with nearly everything you say, especially the primary role of public health (and not medical treatments) that have extended life expectancy. However, good doctors have told me this: evidence-based medicine works for 80% of the people, but it doesn’t allow physician discretion in identifying and managing the other 20%. Maybe docs ought to be able to justify and exclude those exceptions, which is what all of us would want if we were one of those patients. My working assumptions are (a) doctors don’t go to work each day with the intention of harming patients; (b) they will do the right thing if they know what it is; and (c) the view from the cheap seats is different (sometimes better, most often worse) than from the playing field. Evidence-based care is fine as long as it has been developed and vetted by practicing doctors, which isn’t always the case.

From Mr. Pepperton: “Re: Fletcher Allen. They have gone live with Epic and the project was a huge success.”

Thanks to DrLyle for his HIStalk Practice writeup on the President’s speech to the AMA yesterday.

HHS publishes its meaningful use matrix (warning: PDF) with these priorities:

• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and families
• Improve care coordination
• Improve population and public health
• Ensure adequate privacy and security protections for personal health information

My first impression: excellent. Some of the criteria will be a bit soft to measure and validate, but most of them are not only solidly thought out, they are objective and absolute. They are ratcheted in through 2015. What do you think? Better or worse than you expected? Inga weighs in below as well.

Nurse Deborah Leyva and a technology attorney (her husband, I think) have put together the HIPAA Survival Guide, which includes a section on HITECH.

McKesson says it won’t raise base salaries of its executive officers in 2010. It also claims it will raise the bar on executive bonuses. That may not have been a coincidental announcement: it hit the wires at about the same time as stories about CEO John Hammergren’s FY2009 compensation: $29.7 million, including a $12 million bonus. That’s damn generous considering the company’s stock dropped 33% over that same period, shafting those worker bees who invested their rather more modest proceeds in company stock. Doesn’t anyone in healthcare work for a reasonable wage any more, other than the few nuns left?

Sarasota Memorial Hospital (FL) is using social media to communicate with the public, including Twittering its $49 heart disease checkup special.

GE has set aside $100 million to loan new customers  its EMR systems who don’t have the upfront cash to benefit from ARRA, rather like those used car dealers that offer to use your yet-unreceived tax refund as a down payment. Everybody rides!

Vanderbilt clinicians and informatics professionals are testing what they say is the first real-time sepsis detection system, to be followed this year with decision support tools to guide its treatment. Their description of a “state-based decision engine” is interesting: “Essentially, this involved breaking down the guidelines into a series of independent processes that can take place sequentially or simultaneously. ‘This really captures the way doctors work. If we see low blood pressure, then we think of one set of treatments. If we see low blood sugar, then we think of another set. If we see the two together, then we consider a third set of possible measures we can take.’”

Sentara Healthcare (VA) works with Picis to integrate its LYNX Medical Systems ED revenue management system with Epic’s EDIS. Sentara says it has gained millions of dollars in revenue from the integration. Picis also announces LYNX C/Point, a revenue management system that reduces the risk of recovery audit contractor (RAC) penalties.

Nuance releases the results of its EHR Meaningful Use Physician Study, which found that more doctors (75%) want a better way to document care than with a mouse and keyboard than want stimulus money (69%).

The AMA adopts principles for EMR breaches: (1) tell the patient; (2) follow appropriate procedures for disclosure; (3) place the interest of the patient first; and (4) give the patient information to mitigate the consequences.

Orlando Portale, Chief Innovation Officer of Palomar Pomerado Health, and Jonathan Bush, CEO of athenahealth will speak at the Fortune tech Brainstorm 2009 next month in Pasadena, CA. Also on the dais: Barry Diller, Robert Iger, Ashton Kutcher, Mark Hurd, and bunch of other business luminaries. Registration costs $3,500 and the hotel is $260 a night. The conference offers press passes, so maybe I’ll show up.

New hospital software: Hysteria Hospital: Emergency Ward, a game for the Wii and Nintendo DS systems.

Followers of a saint-like woman named Amma who dispenses hugs and runs charitable hospitals says her methods will be replicated on a larger scale. Among her organization’s projects is healthcare IT. “Amritanandamayi’s volunteers have made significant contributions to various programs in India, including telemedicine and electronic medical records. Gottsegen helped develop a computerized record-keeping system that is now used in all of Amritanandamayi’s medical centers throughout India. He and a team of volunteer software engineers from India and California are adapting it for use in the U.S. health care system. If they can win a piece of the federal stimulus funding earmarked for electronic health records, they hope to compete with other top developers.”

Here’s an interesting quote: “It is no more practical to have ‘health insurance’ to pay for prescription drugs and routine doctor visits than it is to expect your auto insurance to pay for your oil changes and tire rotations … Health insurance does not insure your health, nor was it ever intended to. Health care insurance, formerly called ‘medical insurance,’ is merely an instrument of neutralizing risk … As a strictly financial planning endeavor, the issue never seemed to be discussed in terms of being ‘a right’ or in terms of ‘compassion.’ But ‘medical insurance’ as a component of financial planning has morphed into ‘health care’ as a right for everyone in the new political parlance.”

There’s a nasty brouhaha brewing over at AuntMinnie.com. Dr. Dalai tells me, involving an Ohio hospital group’s decision to replace its local radiology group with a national firm. I couldn’t follow it all on the forums, but it involves back room deals, accusations of shoddy work, tie-ins of the new company with Mass General and at least one executive of the American College of Radiology (to which the displaced rads pay dues), and clueless hospital administration. It’s not IT related, but if you want to witness the squabbling that happens when a healthcare provider’s income is threatened (both the hospital’s and the rad group’s, in this case) it’s worth a look as a picture of things to come.

Inga ran an old commercial in which doctors extolled the virtues of Camel cigarettes. Interesting: this article points out that JAMA accepted tobacco company advertising starting in the 1930s, although that has now replaced by the drug companies that fuel 20% of its budget. And this quote might be apropos about HIMSS and HIT vendors if you swap the words: “… the AMA has found that it can’t rely on membership dues to generate the kind of revenue that the AMA leadership is looking for. Instead, they’ve turned to corporate sponsorship—businesses with money to make by casting a veneer of medical respectability around their pursuit of profit find a relationship with the AMA to be useful.”

AMICAS pays off patent troll Acacia Research, which if I recall, claims a few generic patents it bought means it owns the concept of PACS.

Weird News Andy, an artist whose medium is obscure news stories, has been at it again:

• A hospital nurse in London is fired for shutting off a baby’s heart alarm so she could continue chatting with another child’s parents.
• Also in the UK, a nurse is fired for complying with the wishes of an elderly patient’s family to perform no aggressive measures on her.
• A British female athlete dies in a private hospital when doctors bungle a surgery to reduce sweating of her hands and feet.
• A Polish woman wakes up in a morgue body bag after being declared dead.
• A new study says finds that men are 40% more likely to die of cancer than women because they refuse to see their doctor.

E-mail me.

HERtalk by Inga

Full disclosure: I did not sit in on the HIT Policy Committee meeting today, though I did read through the “meaningful use matrix” and other documents listed on the ONC website. I realize the document is still in draft mode and these are not the final definitions. However, I’m not understanding how some of the stated “policy priorities” match with the measurements and objectives. For example, one of the stated policy priorities is to improve quality and efficiency and to reduce health disparities. To prove “meaningful use” as it relates to this priority, a provider must generate quality reporting measurements (e.g, % of diabetics with A1c under control and % of hypertensive patients with blood pressure under control, etc.) For this same quality priority, the listed “objectives” for 2011 include maintaining current medication and problem lists and incorporating lab results into EHR. In other words, there is no clear tie-in between how meaningful use will be measured (by producing reports) and the policy priority (improving quality). The assumption is that if a provider maintains a current medication and problem list, care will improve. But does that correlation really exist? Admittedly the connection between some of the priorities and measurements seem more straightforward than this one. Regardless, if we are going to be handing out millions of dollars, I want to feel assured that my money makes a difference. Simply being able to create a report does not mean a doctor is necessarily providing better care.

Should you be looking for a job change, Computerworld just announced its Top 100 Best Places to Work in IT 2009. If you would prefer working for a health system, try Lehigh Valley, Cedars-Sinai, Texas Health Resource, HCA, VHA, Norton Healthcare, or Adventist. Lehigh Valley earned the highest spot (43), largely because of its strong commitment to employee feedback. Over 200 IT staff receive annual reviews that include personalized comments from a team director CIO Harry Lukens, plus an annual review meeting also attended by the CIO. Employees also have a chance to participate in a "Wild Idea Team” that is tasked with finding new technologies for the organization. The  best HIT vendor employer: Cerner. Perks at Cerner include work-out facilities, including an indoor pool, a Montessori school, and an on-site primary care center. Free pizza was not mentioned. Quest Diagnostic, Compuware, and Red Hat also made the list.

Virginia is the latest state to formally announce plans for a statewide HIE. Governor Timothy M. Kaine says the Virginia Health Exchange Network will connect health plans, health systems, and state agencies.

KLAS releases its annual rankings for best-performing medical equipment vendors. The research company assigned Best in KLAS honors to six companies across seven categories.

A judge sentences a former Cedars-Sinai Medical Center employee to four years in prison after he pleaded guilty to stealing patient information to defraud insurance companies of $354,000. The former billing department employee billed insurance companies $1.3 million for treatment never provided. He gas to repay the $354,000 plus $62,000 in back taxes and penalties.

QuadraMed’s Affinity Revenue Cycle Management M8 software is now available for general release. QuadraMed also just introduced its Quantim HIM Workflow solution.

New Island Hospital (NY) names Larry Maggiotto its new AVP and CIO. Interim CIO Chris Cody is promoted to assistant director of health information management.

Certify Data Systems closes a round of Series B funding led by Ziegler HeatlhVest Partners LP.

Geneva Medical Center (OH) launches its EHR June 30th. Geneva is the first University Hospital system facility to go live on the $100 million system.  

Newly live on EHR: Fletcher Allen HealthCare (VT). The hospital is in the midst of a $57 million project that includes automating its 750 affiliated medical practices.

PatientCompass, RelayHealth’s online business office solution, achieves Level 1 Service Provider Certification and has been validated as PCI DSS-compliant.

The CEO of the 15-bed Drumright Regional Hospital (OK) reports their Cerner-hosted EHR is fully operational and helping increase revenues.

As evidenced by the recent departure of Andy Eckert at Eclipsys, non-virtual organizations may be returning. Eckert chose not to leave California to live in Eclipsys’ Atlanta headquarters. Experts are now seeing more workers returning to traditional offices, particularly senior managers. I suppose if you have been working virtually for years and have to return a “real” office, at least you have a big shopping spree to look forward to.

HIT Ladies: we are not alone. Researchers find that women are an increasingly important market for technology brands and that an estimated 45 million of us bought a digital product in the last six months. Sexy iPhones are just as much a fashion essential these days as the perfect shade of lipstick, and, of course, sexy pumps.

E-Inga.

McKesson Announces New Technology Solutions Head

McKesson announced this morning that Patrick Blake, 45, has been promoted to executive vice president and group president of McKesson Technology Solutions, effective immediately. He replaces Pamela Pure, who left the company in March 2009, with responsibilities over McKesson Provider Technologies, McKesson Health Solutions, RelayHealth, and McKesson’s International Operations Group.

Blake was previously president of McKesson Specialty Care Solutions, its specialty drug distribution services division. He joined the company in 1996 and held previous roles in the company’s drug distribution businesses. He will report to CEO John Hammergren and serve on McKesson’s executive committee.

CIO Unplugged – 6/15/09

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

Meaningful Meaningful Use?
By Ed Marx

I ran a ‘night before vacation’ errand to Loews. As I completed the purchase, the store manager interrupted on the overhead, “employees and customers, head immediately to the break room. A tornado has been spotted and is headed our direction.” The tornado never materialized and we were cleared to leave. The rains were torrential, coming in successive waves, each one more violent than the previous. The storm died down but then kept returning. Over the next 24 hours, we had enough rain and lightning to shut down the airport for several hours, delaying our trip…which gave me time to create this post. We may have set a record for precipitation. I don’t believe we will need to water our lawn for the rest of the summer.

There is another type of watering that does not saturate but dilutes. We use concentrates that require adding water to dilute the mix, making it less powerful. Coffee is a good example. I like strong coffee, so I often add more grounds than required. Others like to pour half a cup and then fill with water. This dilutes the intent of the coffee, and as a card carrying Starbucks aficionado, I find the practice almost heretical.

The official definition of “meaningful use” will emerge this month. As a healthcare executive and tax payer, I will be offended if the clarified meaning waters down the intent of the original language. Indications are that, as a byproduct of our political process, the official definition will lack the intended punch that could truly advance the adoption of healthcare information technology to improve outcomes. In other words, it will be watered down. Given the incentive nature (increased payments) for meaningful use, it’s hard to understand why anyone would set the bar so low. If the goal is to accelerate change, we need to shake off the political pressures and do the right thing.

Contemplate the following. CPOE would not be required for a couple of years. Initially, a 50% order rate would be considered meaningful. Health Information Exchange is considered achieved if you are able to send and received scanned documents. Clinical decision support, arguably the “holy grail” when it comes to clinical benefit realization, may not be required until 2015. That’s 6 years away! Incentives should be a stretch goal, not something already achieved by a majority of hospitals today.

I recommend taking an activist approach and pushing for higher standards. Do we want change, or not? As healthcare executives, we can exert profound influence in our communities, professional societies, affinity groups, and government to ask for more meaningful meaningful use. Let’s push ourselves and our broken healthcare system to accelerate the adoption of healthcare information technology. Who drinks watered down coffee anyway?

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.”