This bit of brilliance comes from Ministry’s Northwoods region (yes, we have a Northwoods region – how cool is that?). The supervisor of our desktop support team has three simple goals for every project his team works on:
I wish I would have come up with that. Simple, memorable, powerful.
I used to think about the day when I fixed everything so we would stop IT outages. Of course that is silly. Like other healthcare organizations we are adding applications to the portfolio every year as new solutions address previously under automated areas. Most of these are not core parts of the IT architecture, but they are supplemental such as documentation systems for clinical departments (e.g., rehab) and contract modeling systems.
With the increase in the number of applications in the portfolio comes complexity. In addition our infrastructure is becoming much more complicated including a more sophisticated network; changing virtualization technologies; and complex storage.
So, our IT Operations philosophy is to perform a Root Cause Analysis on every critical service interruption. Our Root Cause Analysis asks three things:
The second two questions are important. Even if the cause of the service interruption is as simple fix, sooner or later stuff is going to hit the fan. We want our IT folks to see that it has when it does and already be communicating to our customers how we are fixing the problem before they call us.
Dr. Michael Koriwchak writing for the Wired EMR Practice blog:
“And our EMR use, our quality of patient care and our practice efficiency is for the most part no better. In some ways it is worse. As a result of MU”
I can see how that can happen. It is important that we hear the skeptical and the inspiring. The post is worth the read and the author’s candor is important.
Somewhere along the way the word consulting in our field changed. Today consulting is about finding available freelancers on a just in time basis. The “consultant” is nothing more than a recruiter with a billing back office. Some consultants claim they screen the candidates, but there is no way that can be done effectively given the turnaround time to place people.
Furthermore, the consulting firms take very little accountability for the consultants they place. But, how can they when their experience is so varied and there is no standard for good service?
When I hire a consultant, part of what I am looking for is a well defined way of doing various types of work. I want the consulting group reviewing each engagement and revising their approach to work based on the lessons learned from each engagement. If I am going to hire a project manager, I want that person trained in the firm’s project management approach. If I hire someone to assist with a selection, I want that firm to have a clear written means to conduct IT selections. I don’t want someone that might have participated in one of these activities a while back and will try to mimic one the way a child mimics an adult.
Of course that means a large investment in people that develop these methodologies and take the time to train permanent staff. That seems to have gone the way of the dodo bird. Nobody has staff, they have home-based employee people working the phones looking for talent to place.
Update: In re-reading this post I recognize that it is too general. There are a lot of consulting groups that bring intellectual capital to the table. When I am introduced to a new consulting group the first thing I do is categorize them as a traditional firm with an investment in their staff, or a recruiter of free agents with no connection to the people they place.
Update 2: Too frequently someone claiming to represent a consulting firm, is really with a staff augmentation firm. There is a big difference between the two and I wish the staff augmentation firms understood this.
A couple of years ago we separated our “technology division” into two groups: IT Engineering and IT Operations. The dividing line between the two is the production environment. Any new technology is architected by our Engineering group before it goes into production. Once something is in production it belongs to IT Operations and it cannot be touched without going through the change management process.
Here is an example of the IT Engineering group doing a good job:
All IT organizations are seeing a mounting desire for employees to use their own devices (especially iPads) in the workplace. When I recognized that this demand would be huge, I began advocating to connect Android and iOS devices to our Exchange Server via AtciveSync I went to the Engineering team, who is charged with evaluating new technologies before they go into production.
To their credit they said that the vanilla approach to device connectivity would not meet our security expectations. They told me that the only way we could safely manage employee owned devices would be through a device management system that would sandbox the organization’s data, protecting it from security flaws, malware and poor user security practices. They also told me that this would only cover the Exchange connectivity use case and that any other use cases would require further analysis (and perhaps additional expense).
I was disheartened to learn about the added cost, but I would much rather surface that with our executives so we can make a fully informed decision rather than spring a surprise expense on them later.
Radiology IT is a more challenging area than other helathcare IT systems. The Radiologists (and cardiologists) rightly want to be very involved in the selection of the systems that they interact with. Many of them sit in front of these computer systems all day and something as nuanced as the placement of a button can have a great impact on their productivity and overall satisfaction. In this regard, trying to select a mutually acceptable Radiology IT system is much like standardization of orthopedic implants or surgical sutures.
I received several items in my email regarding different organizations’ proclamations for 2012. Most of them predict that 2012 will be the year for mHealth to ‘break-out.’ Here are 5 examples:
One might ask, what is mHealth? It has many different definitions and from a product offering perspective could range from texting information on a mobile phone to a provider and/or specifying a provider geographical location to a patient to bi-directional interaction with a medical device to/from an electronic medical record application via mobile phone or telecommunications frequencies (or the medical device could be embedded with the mobile telecommunication appliance). As with the traditional Healthcare industry, as one progresses up the interaction functionality chain, the design and interoperability gets more complex. Most of the latest news items I read about successful mHealth applications describe the ‘easier’ applications: texting, scheduling, location, etc. There is still growth and development in the marketplace for interactive medical-device integrated/connected products. Additionally, from a market perspective, most of the current product offerings are proprietary in nature and vertically integrated.
Mobile telecommunication vendors are keenly interested in providing for the healthcare market. They are closely watching as well as working to influence the regulatory environment. From a provider perspective, this means adding another large player to the mix. You may already provide some internal mobile telecommunications support, but providing healthcare monitoring over that infrastructure changes the rules of the game. In addition, the mobile telecommunications market plays to the consumer market, which has faster turnaround times, and higher customer expectations. The consumer market expects the ability to smoothly transition service when changing a ‘product provider.’ In addition, with social media, the pressures are higher; witness the recent policy and product turnaround of Verizon to a charge for customers using a specific billing mechanism. The healthcare provider is not used to this type of oversight or pressure yet.
Down in the healthcare provider trenches, testing remote monitoring and the use of mobile telecommunications offerings continues. Here in Europe there are two larger projects that are interested in demonstrating the efficacy of remote monitoring. One, the Whole System Demonstrator based in England and their National Health System (NHS), has just published its preliminary results. Another, Renewing Health, is based on a nine European country pilot for remote monitoring of chronic diseases. In the case of the Whole System Demonstrator, initial results have been very positive for the clinical outcomes regarding the use of remote monitoring models for chronic disease management with a “15% reduction in A&E visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a 14% reduction in bed days and an 8% reduction in tariff costs” along with a “45% reduction in mortality rates.”
Renewing Health is still in its trial period, however, the initial technical results have been published. A basic summary of the technical aspects of the nine solutions follows:
This project will be ongoing until 2013 and at the end the results are hoped to strengthen the hypothesis that well designed remote monitoring programs for chronic disease management is as or more effective than care delivered in the traditional manner. There should also be some interesting results from a technical perspective. The market is slowly moving towards providing more standards-based products, however, for the purposes of this project, timing did not allow more adoption of those types of products.
So, with all of the activity described above what should healthcare providers do? I suggest the following:
So is 2012 the year of mHealth? Perhaps. If anything, it will be another exciting year for mobile technology and the convergence of the consumer and healthcare industries. It will be bumpy, but in the end, it should be better for the consumer who usually also happens to be the patient.
A recent Class I recall (not pictured) of a medical monitor with a hospital network connected central station stimulates some generalities about software, “fixes”, and connectivity. (Class I recalls are defined by the FDA as a situation in which there is a reasonable probability that the use of, or exposure to, a violative product will cause serious adverse health consequences or death.)
The use of the product in question was given as:
Curiously only one customer was identified as having received the product, or at least this particular version of the product. While the manufacturer and product in question is a matter of public record, and available at the link, I chose not to include it here because my objective is not to repeat the recall information, but to suggest the reasons for the recall, an associated labeling issue, and offer some general lessons.
The reason given for the recall had two seemingly separate parts. The first is that “The weight-based drug dosage calculation may indicate incorrect recommended values, including a drug dosage up to ten times the indicated dosage”. This sounds like a software problem yet the fix was not to “upgrade” the software but to suggest a workaround. (I love the term upgrade to when applied to fixing something that doesn’t actually work!) According to the FDA the firm’s letter stated that “users should enter the patient’s weight by way of the admin/demographics screen to ensure the drug dosage is calculated as intended.” (I did not find the firm’s letter on its website, but it might be one of those hidden page situations since I did find, with a struggle, two other recalls, though using the search term “recall” produced no results). Again speculating, the workaround sounds like a user dependent way to do something that was supposed to happen automatically. At least part of the value of automation is largely diminished, and opportunities for use error increased, when such additional demands are placed on the user.
The second reason given for the recall was that there may be a 5-10 second delay between the electrocardiogram and blood pressure curves (waveforms) at the central station. This is an interesting technical issue that may be related to software and/or communication protocols. In either case it illustrates that multiple data streams may only be useful if they are properly timed stamped, and then properly aligned at the receiver. Out-of-sync data when subsequently processed either by eye, or automatically, can give erroneous and misleading results that might appear to be correct, i.e. the results could be in the category of erroneous but believable.
For one or both reasons the FDA found that, “This product may cause serious adverse health consequences, including death.” Yet it should be noted that this was a voluntary recall, as most recalls are, despite the fact that people who surely know better reported this as “FDA recalls…”
The FDA announcement goes on to say that the company pointed out that the instructions for use state that: ”For primary monitoring and diagnosis of bedside patients, use the bedside monitor. Use the…Central Station only for remote assessment of a patient’s status.” This sentence seems to be illustrative of the fundamental problem of remote information receivers and integrators that carry a disclaimer that in sum says that you shouldn’t rely on them. But isn’t the ability to rely on it exactly why you bought it? Moreover, promotional materials available on the web do not appear to echo this disclaimer. For example it is stated that ”Applications…enhance patient care management by providing rapid assessment, decision support and clinical reporting.” Does that sound like it isn’t for primary diagnosis? Or does “Data accessible from the…Central Station includes real-time waveforms” sound like those waveforms shouldn’t be used for primary monitoring? For one more example it is said that “arrhythmia events are detected with an unprecedented degree of accuracy.” Accuracy is certainly a good thing, but detecting arrhythmias at the central station when only the beside monitor is to be used for “primary monitoring and diagnosis” appears to be less than highly useful.
Furthermore the statement that the central station is only for remote assessment seems both definitional and contradictory. It is obviously for remote assessment–because it is a central station and thus remote! But then what does “assessment of the patient’s status” mean if not monitoring and diagnosis?
The disclaimer game has been addressed in these pages before. Here it seems to involve a product that is being marketed, sold and bought for exactly the reasons that the manufacturer is saying it shouldn’t be used. I didn’t spot the disclaimer language in any of the promotional materials, but maybe it is there somewhere.
So, we have here an apparent example of software driven miscalculations, network transported data that is not time synchornized, and a reminder not to use the central station for primary assessment. Important examples to remember as we charge ahead with software driven networked solutions.
[The products in the photo with this post above are not associated with the recall discussed, and are for illustrative purposes only.]
The issue of the EHR relative to safety and effectiveness has again made the news with the November 7, 2011 pre-publication (and downloadable) release of an Institute of Medicine report on EHR safety, commissioned by the U.S. Department of Health and Human Services (HHS). This report expands the discussion beyond the EHR (used henceforth for both EHR and EMR) to include other related electronic information tools collectively called health IT.
The potential for health IT to improve both the quality and efficiency of medical care has been much noted to include more complete and timely records, ready exchange of information between providers, clinical decision support, and in turn a reduction in errors associated with the quality and availability of patient information. Efficiencies may arise from electronic capture of data which would eliminate manual entry, and time savings in accessing and reviewing patient information, and perhaps in passing information to third party payers. Additional public health value might accrue from the enhanced searchability of electronic records with respects to trends, treatments and outcomes. These benefits assume well designed, user friendly, compatible systems not withstanding that the U.S. model is to allow for numerous independent products that may or may not be able to exchange information nor display it in a consistent manner. Not surprisingly the report notes that the IT imperative will likely not be fruitful without associated attention to the people and the clinical system they work in.
However there is also the potential for health IT to add to, rather then reduce complexity; misplace, lose or garble patient information, and to provide clinical decision support that is incorrect or unreliable. Thus health IT itself has risks that the IOM found have not yet been adequately addressed or monitored. The IOM also cites the lack of an effective health IT problem reporting system compounded by contractual language that may actually impede such reporting. In addition some vendors include disclaimers as to their responsibilities even for software defects and errors. The latter suggests the all purpose liability disclaimer language: “Notice-this product may be badly designed and therefore not suitable for its intended purpose.” Alternatively one could try: “Due to software defects the information in this EHR may or may not be complete and/or may not pertain to the patient of interest. Do not use this information for medical treatment”. The value of such disclaimers will no doubt be tested.
Of course it is not only coding defects that can make heath IT less than effective. The well established issue of usability, or user friendliness, lives on, as does interoperability, training and workflow design. In this regard it might be noted that user friendly features such as pull down menus also facilitate quick but erroneous entries. Thus while an IT product might be theoretically capable of being used properly and effectively, whether it will achieve that goal in the real environment of use, when used by real people, is a separate matter. In this regard when faced with use issues and adverse events vendors will want to say that their product could have provided the correct functionality if only it had been used correctly–and don’t forget our disclaimer. The counter argument is that it was badly designed to the degree that “correct” use was predictably not likely to consistently occur. There are many anecdotes in this regard. A favorite of mine was an order entry system to which was added a physical sticky note on the monitor that read “Do not press Enter to Enter”.
Actual health IT hazards are at least in part separate from the questions of privacy, hacking and other mischief.
It must also be remembered that quantitative data (e.g. lab results and other medical device data), or reasonably well standardized data (e.g. images) are potentially much easier to capture, transmit and display than narrative information. The selection and arrangement of information on a display can also be a significant challenge with respect to density, utility and how many pages the clinician has to look at to get all the information needed–and you can’t spread those pages out. There is also a significant issue with the lack of standardization of “look and feel” factors. In this regard it must be remembered that clinicians of various types, working in multiple environments, might see multiple systems during even a single day. This is analogous to the reality of nurse use of infusion pumps. Ask the nurse if they know how to use an infusion pump and they will most likely say yes (and be insulted). But then ask them if they know how to use a particular infusion pump and they might say, no, I’ve never seen one of those before. In this regard a health IT application may be plug-and play, but that isn’t the same as plug-and-effectively-use.
The report has several specific recommendations:
Readers familiar with the FDA regulation of medical devices will recognize many of these items as standard fare. These include registration and listing, quality systems, and problem reporting. However since the FDA has not asserted that EHRs are medical devices, and the IOM elected not to make that specific recommendation.
Record-type health IT products remain in a regulatory vacuum–except with respect to acquisition funding subject to the meaningful use requirements. In this regard the report includes a dissenting statement from Richard Cook, MD (director of the Cognitive Technologies Laboratory at the University of Chicago) who asserts that health IT products should not only be declared to be medical devices, but that they should be Class III, the most stringently regulated device classification. In this regard he includes the following quote: “Medical and diagnostic devices have produced a therapeutic revolution, but in doing so they have also become more complex and less easily understood by those who use them. When well designed, well made, and properly used they support and lengthen life. If poorly designed, poorly made, and improperly used they can threaten and impair it.” While this quote could appear in nearly any one of the posts here, it actually dates to 1976 as part of President Gerald Ford’s signing statement for the Medical Device Amendments that ushered in the modern era of medical device regulation. While these amendments are often thought of as the beginning of FDA medical device regulation, such regulation actually stems from the 1930′s. What did start in 1976 was before-marketing restraints as opposed to the FDA’s prior post market authority. (And no, 1976 is not ancient history. Some of us actually remember it.)
Health IT is caught in the corn maze of promise vs usability and hazards. With quality design and thoughtful implementation the exit may be found before nightfall. Without it someone is going to have to call 911.
A recent NY Times article reported that hotel Wi-Fi capacity was again being challenged, this time by iPads and other tablets, or more specifically, tablet users. The Times notes that these users may have a smart phone and laptop going at the same time they are sucking up streaming video. The high bandwidth demand of these devices, or more specifically, their uses, is said to be reducing download speeds back to the good old days of dial-up connections. A likely solution will be a tiered charge structure, similar to the newest cellular data plans, with the result that you can waste bandwidth if you don’t care what it costs. A more general report on current and future wireless demand versus capacity has been produced by the Global Information Industry Center at the University of California San Diego. A less foreboding report on medical uses of Wi-Fi has been produced by the Wi-Fi alliance.
Smart phones have a prior history of overwhelming cell phone networks, such that in dense environments someone can’t make a phone call because too many other people are watching reality show reruns and bad movies. Now some cellular devices have been looking at switching to Wi-Fi when it is available, as explained here. This leads to the conflict ridden situation of cellular wanting to use Wi-Fi to solve its capacity problems at the same time that Wi-Fi is being over loaded by other devices. Cellular resistant building structures, which are increasing, also can create a desire to shift to Wi-Fi.
Now think about hospitals. Tablets are surely making inroads here as well, along with smart phones and in house wireless VoIP. Medical devices are also increasingly wireless as has been noted in these pages before here and here. There is also the smart phone wireless app arena (which may or may not be regulated medical devices) as discussed here and here.
Certainly the public access side of a hospital’s wireless network can be limited and segregated. However prioritizing between multiple medical applications is far more challenging both clinically and technically. It must also be remembered of course that lost medical data or lack of clinical telephony can be life threatening, as opposed to merely annoying.
In this demanding arena few wireless medical systems are at least initially tested in a fully functioning environment. Yet there is a vast difference between whether the wireless capability (as well as the wired) is able to function when tested alone, and whether it is capable of functioning around the clock and throughout the year in an actual hospital when static and when roaming. In the latter case when roaming across access points, drop-outs may result in data loss and may not respond well when access is restored. While the link may recover critical information such as which patient is involved may not be available.
In addition it may be possible to add one wireless application today that works in the current environment, but which may not work when the next one or ten or 100 other wireless applications are added later, and perhaps not much later. In this regard vendor assurance, if ever fully believable, cannot be accepted outside the context of the wireless system and devices currently deployed. (By way of bad analogy, such an assurance are like a car salesperson telling you that with this car you won’t have to worry about highway traffic.)
In this regard the effective hospital application has been summarized as requiring ”assurance” which includes coverage, signal strength, capacity, and certainty. The “utility” analogy is often used here, i.e. the wireless service should operate in the background and be something I don’t ever have to think about, just give me more and more wireless devices and they will all play nicely together. (Those who have been through electrical blackouts and brownouts may have a different perspective than others on the reassurance provided by the utility analogy.)
It is clear that wireless and wired capacity have to both be actively controlled and monitored. Besides being totally logical, this is consistent with IEC 80001 (discussed here) which addresses hospital network risk management. This active control requires a centralized coordinator who has the authority, knowledge and system resources to not allow any new wireless application to be deployed without specific consent based on appropriately rigorous tests. There must also be complete inventory of all approved wireless users so there is a record of who is using the system. New systems or upgrade designs must also take capacity seriously (see here for example).
Certainly wireless, using Wi-Fi or otherwise, offers advantages in health care, although perhaps not, wireless will need to be limited to those applications that really need it. In any case, capacity is a challenge that is likely to get worse before it gets better.
Pictured above are Philips’ Intelliview Cableless Measurements wireless SpO2 sensors that use the same ISM band frequencies as Wi-Fi. This photo was taken at the Philips booth at HIMSS 2010 with their permission.
Today I was contacted by a social media marketing firm working for a major MDDS vendor with an offer to contribute content that’s on topic for this site (that last part is important). I’m interested, and I imagine a lot of this blog’s readers will be too. As I will likely take them up on their offer, I want everyone to understand that there’s not any favoritism that plays into who gets to post on this site. So, the following describes the ground rules, the benefits of contributing, and issues an open invitation to contribute posts.
We’ve been fortunate to have a number of terrific contributing authors over the years, and some of them have written posts that continue to be popular to this day. On the About This Site page is a long standing open invitation to anyone who wants to climb up on the soap box and
spout off contribute to the conversation about medical device connectivity. I’ve also made contributing author offers personally to many folks on both the provider and vendor sides of the table. There are so many people who have incredible knowledge and experience to share. And most of these people don’t have the time or inclination to create their own blog. Now you have an outlet.
Increasingly companies are adopting social media policies that establish ground rules for employees posting to blogs, Twitter, Facebook, etc. Besides benefiting your employer, contributing posts also benefits the writer personally with increased awareness and respect among your peers. Contributors also get an author’s bio like this one for current contributor, William Hyman:
Writers that want to remain anonymous can do so, to a degree. You can be anonymous like the blogger Tim at HIStalk. He doesn’t disclose his identity on his site, but he is not legally anonymous. This means that you can chose to not disclose who you are (or your employer), but if I’m legally compelled to disclose your identity I will. Some employers will appreciate this kind of anonymity because there’s little chance the writer’s opinions will be associated with the employer. Of course many employers, especially the smart ones, will want that employee-employer association to be known so that all the insight and intelligence the contributor demonstrates in their posts will rub off on them!
In the connectivity segment of the market, there are a lot of new entrants and many established companies flying under the radar of broad market awareness. Contributing blog posts about your experience or perspective (nothing too commercial please) is a great way to establish credibility and get the word out. The most effective use of blogging is engaging in a long term conversation with your readers. Most of my consulting business comes from this blog, in addition to the usual word of mouth and repeat projects. You put your content out in the blog, and readers come back with questions and requests for help with problems, advice, referrals to fill new positions, you name it. And I can’t tell you how rewarding it is to meet people at customer sites or events who are readers of this blog.
Unlike a magazine article, press release or white paper, contributing to a blog is typically not a one shot deal. A series of blog posts that address a body of topics or frames an issue gets read when it’s published – and after that – via search engine queries (that’s why it’s important to identify and use the right key words in your blog posts). Ideally, potential contributors will look at this as an extended conversation, or at least a series of posts that will span several months, if not indefinitely. Individual contributions are welcome, but they will have to be particularly thought provoking, entertaining and/or informative.
Why contribute posts to this site? Well, the site gets about 300 unique visits per day (less on weekends) and has hundreds of subscribers to the RSS feed (the funny orange square icon on the right). Readership is evenly split between providers and manufacturers. As a contributor you will get access to the sites statistics where you can see how many times your post is accessed and by who (or at least their IP address or domain name).
So, if you’re interested in contributing, let me know. And if you’re a reader, here’s your chance to leave some feedback – what would you like to read more or less of on this site?
As an aside, if you’re interested in the blogs and news sites that I read, keep an eye on the Connectologist’s Shared Items box in the right hand bar. This is a list of shared items from my Google Reader. If you’ve got a blog or news site to suggest to me or your fellow readers, leave it in a comment to this post.
[Flickr photo of Selma by Netzanette]
The fact that connectivity, and perhaps wireless connectivity in particular, allows for hacking for mischief, theft, politics, social protest and other forms and varying degrees of evil should surely come as no surprise. In turn, that a wireless medical device might be hackable should be somewhere on the mind of developers, users, and regulators. Thus the report from the recent Black Hat conference that someone hacked an insulin infusion pump, and in so doing was then able to alter its settings, should also not be particularly shocking, but should serve as yet another reminder, that security associated with connectivity has been and continues to be an issue, as was addressed by Tim back in 2006.
The report in this instance came from Jay Radcliffe who hacked his own insulin delivery equipment. In this instance the hacking avenue was the wireless remote that was part of the device. Perhaps the idea that a wireless remote could be emulated is even at the ultra low end of surprise. More generally, the multiple discussions of this report (e.g. here and here) have suggested that the technology being used by at least some medical device manufacturers does not offer an adequate array of security safeguards. Or the manufacturers haven’t fully utilized what is available in terms of alternate hardware, or they havn’t fully utilized the security features that were available even in the hardware that they were using.
Not surprisingly medical device manufacturers have downplayed the risks of hacking. The manufacturer of the pump in question, Medtronic, responded through a diabetes oriented web site, but apparently not through an actual press release of its own. The responses included that Medtronic does take device security seriously (would you expect them to say otherwise?), and that no real-life events have ever reported. Of course a problem with the later is that stealth hacking, as opposed to announced hacking, could cause harm while going unreported. This is to not say they have, but only to note that “reported” is a limiting case.
Medtronic is quoted further as saying “Our job is to incorporate information security measures into our designs, vigilantly monitor potential threats and to always be proactively finding ways to make our devices more secure for you. That is what we have done and what we will continue to do.”
A curious post in response to this expected response from Medtronic was “Security violations are caused by sloppy implementation. The systems themselves are very secure.” I’m not sure how much better that is supposed to make us feel. Equally curious was that this response referenced RSA as a security authority, with other posters then pointing out that RSA was itself hacked.
Hypothetically (that means I made up the following) assorted glitches and could-not-duplicate service events could be the result of hacking, i.e. if the hacker hacked, and then stopped hacking, whatever the effect of the hacking was could well stop also, and therefore be un-findable. Which reminds me of a hospital wireless interference anecdote I heard about bursts of interference, almost always during the night, and almost always for one or two minutes. The culprit was an old leaky microwave being used in quick mode. And why only at night? Because the cafeteria was closed then and therefore the microwave was a primary food resource.
The bottom line is that security is an ongoing issue that must be rigorously addressed by manufacturers, and in turn by the FDA who has to at least ask the what-have-you-done-about-connectivity-security, and insist on a firm answer. Further, I will ask the question that I asked about the challenges of hospital networking at an AAMI session last June in San Antonio. My question was, “Is the problem getting easier or harder?” The answer was a laugh.
[Thumbnail photo above (used with permission) shows the various sites used to inject insulin over a period of time - one month if I recall correctly. In the lower right corner is the Medtronic insulin pump dangling from a tube. - Ed.]
Those who fail to learn from history are doomed to repeat it, or so the saying goes.
My controversial piece on Silicon Valley missing the point of healthcare last summer doesn’t seem so controversial now, as I recently got some validation from others closer to the action than I am. First, reDesign Mobile analyst Rocky Agrawal wrote in VentureBeat that Silicon Valley might be “too smart for their own good,” building products more suited for highly educated techies than for the masses. Last week, former Apple and PepsiCo CEO John Sculley suggested at the Digital Health Summit at 2012 International CES that technology for its own sake is rather useless if you don’t understand the market you’re targeting.
“”The thing that is missing is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services,” Sculley said, as I report in InformationWeek Healthcare and in tomorrow’s MobiHealthNews.
After raking Rock Health over the coals in my commentary last summer, I offered qualified praise to the San Francisco-based investor/business accelerator for healthcare start-ups last month on this blog. “I was pleasantly surprised to see that the majority of the 15 companies are aimed at either healthcare providers—an important constituency largely missing from the first Rock Health class—and on treatment of truly sick patients.” I wrote.
“I never thought I would say this, at least not before the end of 2011, but kudos to Rock Health for making a real effort to figure out the complex healthcare industry and to add some substance to what heretofore had been all style.”
Tomorrow, I am planning on attending the kickoff event for Healthbox, a similar healthcare business accelerator that differs from Rock Health in at least one key way: it is not in Silicon Valley, but right here in down-to-earth Chicago. Does that make a difference? Well, the kickoff isn’t at a hotel ballroom or Healthbox’s office, it’s in an artsy space called the Ivy Room, in the heart of River North, an area usually populated by more tourists than locals.
I sure hope I’m not in for an over-the-top extravaganza that will highlight cool, direct-to-consumer apps with a snowball’s chance of catching on with the entities that actually pay the bills for healthcare. I want to believe there’s something real here, which is why I’m giving up at least a couple hours of my time to see the presentations. Please tell me that Chicago isn’t becoming a Silicon Valley clone, but rather the hub of health IT innovation it could be.
For what it’s worth, here is the list of companies scheduled to present tomorrow: UnitedPreference, DermLink, SwipeSense (“a comprehensive hand-hygiene solution,” whatever that means, The Coupon Doc, CareWire, Iconic Data, PaJR-Patient Journey Record (helping hospitals avoid 30-day readmissions, potentially making it a Big Deal), CareHubs, Corengi (linking diabetics to clinical trials) and PUSH Wellness. I see real potential in at least four of those, possibly more.
Other locales may get more press in this industry, but the Chicago area has a surprisingly strong community of health IT vendors.
It is well known that Allscripts is headquartered at the Merchandise Mart. GE Healthcare, while based just outside Milwaukee, maintains a large IT center in northwest suburban Barrington, Ill. CDW, based in Vernon Hills, Ill., runs its healthcare division from a downtown Chicago office. Numerous smaller vendors dot the area, too. And then there is Merge Healthcare, a medium-sized firm that historically has specialized in software for medical imaging.
Last week, I visited Merge’s home office in the Aon Center, an iconic skyscraper previously known as the Amoco Building and, before that, the Standard Oil Building. There, CEO Jeff Surges gave me a history of the company and talked about changes in the company and in the health IT field in general. Then, I turned on my video camera so Surges, sporting an orange necktie, could explain why Merge has adopted orange as its company color.
Following my interview with the CEO, Gilbert Gagné, also wearing an orange tie, gave me a demo of Merge iConnect Access, an image viewing system than works through any Web browser. I got the iPad portion of the demo on video, too.
I shot this in 720p high definition, but only uploaded it at 360p to save time. Let me know if you want HD so the iPad screen appears a little sharper.
As I first mentioned in August, John Lynn and I had the thought that it would be great if Twitter co-founder and HIMSS12 keynote speaker Biz Stone would show up at John’s 3rd annual New Media Meetup. Stone didn’t respond to our halfhearted attempt back then, but now the conference is less than two months away, and I have to imagine he will be making his plans soon, if he hasn’t done so already.
HIMSS social media guru Cari McLean also would love for Stone to meet and greet conference attendees at the HIMSS Social Media Center after his keynote on the morning of Tuesday, Feb. 21, per her tweet in response to one of mine:
That means that now is the time to put social media to work to get Stone to make a couple of appearances. Stone’s Twitter handle is @Biz. Tweet away, using the hashtag #BizatHIMSS12 and perhaps add #hcsm (for healthcare social media). Blog about this effort. Post on LinkedIn, Facebook and Google Plus. I may even make a YouTube video. Let’s impress Stone with the power of social media and get him to mingle with the masses in Las Vegas.
Have you made your reservations for HIMSS12 yet? If you’re just starting to plan, you might not have noticed some quirks with the schedule and the venue this time around.
For one thing, the mega-health IT conference in Las Vegas is not at the massive Las Vegas Convention Center, but rather at the Sands Expo Convention Center and the adjacent Venetian hotel. Remember, the 2012 HIMSS conference was supposed to be in Chicago, but the organization switched it to Sin City a couple years ago after vendors complained about high costs at Chicago’s McCormick Place for HIMSS09. (The defection of HIMSS and one other large trade show actually prompted the Illinois General Assembly to legislate changes to some of the work rules at McCormick Place, after which HIMSS agreed to hold its 2015 and 2019 conferences there.)
The last-minute nature of the relocation is changing a lot of the dynamics.
I know that HIMSS has outgrown most of the convention centers in the country, to the point that only Las Vegas, Chicago, Atlanta, New Orleans and Orlando can accommodate it, but the Sands was a surprising choice. Believe it or not, the Sands-Venetian claims to be the third largest convention facility in the nation, with 1.8 million square feet of exhibition and meeting space. However, many exhibitors will be put in Hall G, on the lower level, a 380,000-square-foot space with just a 13.5-foot ceiling height. The upper halls have 32.5-foot ceilings, so I’m guessing the downstairs space is going to seem awfully claustrophobic.
(On the other hand, the Venetian is a lot more luxurious than your typical conference hotel. Plus, I once saw Chuck Norris and his brother playing craps there. He graciously did not injure me.)
Also, HIMSS12 ends on Friday, Feb. 24, instead of the usual Thursday. When I booked my travel last week, I thought this meant HIMSS was adding an extra day to what already has become an endurance test. But I looked again today and noticed that everything has been moved back a day. The freakshow otherwise known as the vendor exhibition runs Tuesday-Thursday instead of Monday-Wednesday, and most of the preconference events, typically held on the Sunday prior to the start of the main conference, are set for Monday, Feb. 20. Alas, I’ve already booked my travel to arrive Saturday, and who knows what it will cost to change my plans? On the other hand, it gets me out of Chicago for an extra day in the winter.
Does anyone have any insight about this scheduling shift? Is it because of the venue change, or a result of the fact that Vegas hotels normally jack up the rates on Friday and Saturday nights?
Of note, though, the HIMSS travel service is a better deal in 2012 than in most years, based on my experience. Go through the official channel and you won’t pay more for staying a weekend night. You also won’t have to pay any resort fees at the many properties now adding this mandatory charge, and they’ll throw in free Internet access, too. That sealed the deal for me.
My first impression of healthcare startup incubator/accelerator Rock Health was not a favorable one. I wrote in MobiHealthNews last July that the San Francisco-based organization founded by some hotshot, young Harvard MBAs demonstrated “yet another example of Silicon Valley arrogance.” I said that Rock Health was mostly targeting the young end of the market with cool, fitness-oriented apps, not the elderly and chronically ill who account for the bulk of the nation’s $2.5 trillion annual healthcare spend. That group wants things that are easy to use rather than fun and hip.
Needless to say, I was not invited to Rock Health’s Christmas party. I did share a quick “hello” nod with Managing Director Halle Tecco when I saw her in a meeting room at the mHealth Summit last month, though.
Even then, I wondered if Rock Health had changed its attitude at all, seeing that even the executives were outfitted in company t-shirts in the buttoned-down world of (just outside) Washington, D.C. (I once had a Capitol Hill press pass early in my career. The rules require members of the media to conform to the same dress code as members of Congress. That means a coat and tie for men, while women have to have jackets if they choose to wear slacks. An unwritten rule of D.C. in general calls for women to wear stockings if they go with a skirt, even if it’s 95 degrees and humid, which it frequently is in the summer.)
Today, though, I saw a clear sign that Rock Health is starting to learn from its earlier mistakes. MobiHealthNews reported on the incubator’s class of 2012, and I was pleasantly surprised to see that the majority of the 15 companies are aimed at either healthcare providers—an important constituency largely missing from the first Rock Health class—and on treatment of truly sick patients. One startup, for example, helps people being treated for breast cancer prepare for doctor visits, while another produces an EHR for home-health agencies. Good stuff in my critical eyes, though really, enough with the social networking to get people to exercise. There are too many of these platforms and apps already.
I never thought I would say this, at least not before the end of 2011, but kudos to Rock Health for making a real effort to figure out the complex healthcare industry and to add some substance to what heretofore had been all style.
Now it makes sense.
A couple weeks ago, I got the latest update from fictional EHR vendor Extormity:
Extormity to Federal Health IT Leaders – ‘Take a chill pill, fellas.’
Brantley Whittington, fictional CEO of make-believe electronic health record vendor Extormity, is urging Aneesh Chopra, Farzad Mostashari and Todd Park to tone down their optimism and exuberance about the clinical benefits and cost savings associated with implementing health information technology.
Whittington, speaking to reporters from the offices of a K Street lobbying firm in Washington, D.C., expressed dismay at the unbridled enthusiasm exhibited by White House, ONC and HHS officials. “For years, vendors like Extormity have worked hard to cultivate a healthcare IT culture that combines complexity with closed-mindedness, creating a pervasive and stifling sense of futility.”
“Instead of the sober and staid leadership we are accustomed to, these gentlemen are inspiring new models of industry development,” added Whittington. “The Direct Project is a great example of supercharged public/private collaboration designed to simplify the flow of health information without spending a dime of taxpayer money. This may benefit patients and providers, but the lack of convoluted infrastructure does little for the Extormity bottom line.”
“While I have been known to muster up some counterfeit fervor for shareholder meetings, the consistent passion and zeal demonstrated by these officials is proving disruptive to those of us dedicated to proprietary and expensive solutions,” added Whittington. “I suggest dialing back the levels on the gusto meter to preserve the status quo, stifle meaningful innovation and ensure consistent and sizable returns to a handful of large healthcare IT vendors.”
Chopra, Mostashari and Park are exuberant, that’s for sure. The first time I saw Park and Chopra share a stage together, I labeled them the “anti-bureaucrats.” I have since added Mostashari to that category. But it was only over the weekend that I learned that Mostashari and Chopra were getting down to the “Meaningful Yoose” rap from Dr. Ross Martin at a recent ONC meeting.
Perhaps this is why Mr. Whittington wants the anti-bureaucrats to tone it down. Or perhaps (more likely) extormity feels threatened by innovation. Yeah, let’s go with the latter.
N.B. I am writing this while 33,000 feet above northeastern New Mexico, just about to cross into the Texas Panhandle, on a flight from Tucson to Chicago. I love me some Wi-Fi in the sky!
(via IBMLabs) IBM is enlisting some of the company’s leading scientists and technologists to help medical practitioners and insurance companies provide high-quality, evidence-based care to patients. As part of this initiative, IBM is collaborating with clinicians in numerous medical institutions and hiring medical doctors to work alongside its researchers to develop new technologies, scientific advancements, and business processes for healthcare and insurance providers. Dedicating $100 million over the next three years, the initiative will draw on IBM’s leadership in systems integration, services research, cloud computing, analytics and emerging scientific areas — such as nanomedicine and computational biology — to drive innovations that empower practitioners to focus their efforts on patient care
IBM is enlisting some of the company’s leading scientists and technologists to help medical practitioners and insurance companies provide high-quality, evidence-based care to patients. As part of this initiative, IBM is collaborating with clinicians in numerous medical institutions and hiring medical doctors to work alongside its researchers to develop new technologies, scientific advancements, and business processes for healthcare and insurance providers.
Dedicating $100 million over the next three years, the initiative will draw on IBM’s leadership in systems integration, services research, cloud computing, analytics and emerging scientific areas — such as nanomedicine and computational biology — to drive innovations that empower practitioners to focus their efforts on patient care
To support those physical solution centers we launched the Analytics Virtual Center (AVC) at the start of 2010, and welcome you to visit it, especially as we come up on the one year anniversary of the launch of our business analytics initiative.
The AVC underscores a central tenet of Smarter Planet — how digital and physical worlds — databases and drydocks, petabytes and powerplants — are weaving themselves together. Through it, people can extend their physical presence, voice and ideas to a new digital dimension that isn’t constrained by geography.
The AVC is a web-based and voice-enabled collaboration complex that we built on the web.alive platform, which is now part of IBM partner Avaya’s portfolio. It features a simple set of intuitive controls, quick avatar customization and 3D spatial audio. Many of the hundreds of visitors have found the environment easier to use than other virtual worlds. In fact, most people find themselves “in world” and talking naturally with others within minutes.
While the environment’s navigation and architecture are purposefully minimalist, the facility supports some sophisticated tools, including a full-function “web surface” that can display any web content, including video, animation and Web-based services such as writeboards. Additional wall surfaces can display presentations, documents, photos and graphics.
In addition to an auditorium and six meeting rooms that can be made private for confidential discussions, the AVC includes a rooftop “garden” with six kiosks for different displays, projects or topics. We’re also using the rooftop for an “innovator in residence” program that is open to analytics-related projects or initiatives from academia, startups, NGOs and other organizations seeking to innovate around analytics.
Of course, the AVC is also available for business development and client meetings. And we expect to also put it work as a vehicle for recruiting new talent to IBM, especially for people with expertise in various areas of analytics, simulation, predictive modeling and other aspects of “big data” innovation in areas including energy, smarter cities, healthcare and transportation.
To discuss or schedule a tour, meeting, event, the innovators-in-residence program or how you might like to work with us via the Analytics Virtual Center, we’ve set up a tool with the new Tungle.me appointment service.
You can also leave us a voicemail via Skype.
The following is a guest post from Lonne Jaffe, Director, Public Sector Solutions, IBM Software
This Smarter Health video describes some of the benefits of connecting electronic medical record systems with each other and with other healthcare software systems. Technology like the IBM Health Integration Framework that brings all these systems together can enable a better patient experience, improve treatments, lower costs, and allow scientists to confidentially use data for disease research. That’s health information working together.
As healthcare software becomes more sophisticated, security and privacy remain a priority. IBM helps protect patient information and helps healthcare organizations comply with government privacy regulations while achieving the extraordinary benefits of smarter healthcare.
Minnesota’s attorney general sues revenue cycle vendor Accretive Health for losing a laptop last summer that contained patient information from two hospitals that had contracted with the company. The unencrypted laptop was stolen from an Accretive employee’s rental car. The lawsuit demands that the company inform patients in the state what information it keeps and how it uses it, saying the company “showcases its activities to Wall Street investors but hides them from Minnesota patients.”
From MountainMan: “Re: Pre-HIMSS insanity. Here is a picture of the first of many to come ridiculous invitations, overnight letters, and expensive marketing crap that will be headed my way. ‘Tis the season to determine the vendors with more money in marketing than in development!”
From WorkingGirl: “Re: Manager Systems. Love this graphic– makes me think of managers with weird heads in charge of the place. One (red) is totally defeated, head hung. The yellow head is going along to get along (the ‘whatever’ approach,) and the blue head is ‘blue sky thinking’ or ‘head in the cloud.’ I have worked for them all and more!” The logo is for Manager Consultoria em Informatica LTDA EPP, a Brazilian company recently acquired by 7 Medical Systems. The blue one actually looks like a dunce cap, which might be apropos for some managers.
From Otoscope: “Re: Epic. I hear that Epic is competing for a deal in NYC. I wonder if the puff piece in the Times about how cool their campus is and Judy Faulkner giving them a rare interview isn’t an Epic marketing push to win over some decision-makers struggling to find a reason to pay Epic’s exorbitant asking price? Maybe there’s a pattern of newspaper exposure where Epic had other high-profile deals on the table.” The article also claims that Epic steals the best programmers who would otherwise be working for Google or Facebook, which seems a bit of a stretch given Epic’s reputation for hiring new grads with no experience. I doubt many world-class programmers are torn between working with cutting edge technology for Facebook in the Silicon Valley vs. moving to chilly Wisconsin to write MUMPS just because Epic’s campus is cool (not that there’s anything wrong with that, especially if they’re doing it for the satisfaction of helping patients.) The article was a bit fawning, but it was a business feature, not a hard-hitting expose’.
From George: “Re: your question about the systems used by the Thomson Reuters Top 15 hospitals. Check this out.” It’s almost all Cerner and Meditech, with only one Epic customer in the bunch. Only a third of the Top 15 are at EMRAM Stage 6 or 7, and of those, Cerner has three customers and Meditech has two. I like to think these facts prove my oft-stated points: (a) it’s not the IT you have, but how you use it; (b) IT can make good hospitals a little bit better, but it’s not going to transform low-performing hospitals into stars; and (c) your mileage will assuredly vary, so just as buying a toupee and a flashy Corvette won’t make you as popular with young ladies as your 20-something nephew, don’t put all of your organizational eggs in the IT basket in hopes of a miracle. And to cap it off with my most annoyingly repeated tagline, plenty of incompetent carpenters own great hammers.
HIStalk Announcements and Requests
Some goodies you might have missed this week on HIStalk Practice: Greenway Medical sets the target price of shares for its upcoming IPO at $11 to $13 per share. Physicians who have an ownership interest in their practice are more likely to think their EHR implementation is difficult. Telemedicine enhances dermatology care. Upcoming Meaningful Use deadlines for eligible providers. Smaller practices may have more difficulty with the 5010 transition than their larger counterparts. Dr. Gregg explains why he isn’t satisfied with the market’s EHR options. Thanks for reading.
We’re sponsoring something new for HIMSS conference attendees: the First Annual HIStalk Booth Crawl. We’ll be sharing more details as the conference gets closer, but here’s the big one: we will be giving away over 40 iPads generously donated by sponsors. We’ve canned the silly stamp cards, eliminated the reviled “must be present at the very end of the conference to win” restriction, and improved the chances of winning by offering dozens of cool iPads instead of one motorcycle or set of steak knives. Contestants just need to visit some booths or Web sites to be in the running for one. It will be fun, especially for the winners. It’s fun for our sponsors as well, considering that some companies have charged vendors up to $20,000 to participate in similar events and we’re charging nothing just because we like seeing readers get iPads.
Another super HIStalk-sponsored event: a shoe drive benefiting Soul4Souls, a charity dedicated to the distribution of new or gently worn shoes to people in need across the world. A couple of HIStalk sponsors will have drop off boxes in the HIMSS exhibit hall and we’ll also accept shoes at our HIStalkapalooza event (sorry, you still need an invitation.) The terrifically creative folks at Friedman Marketing Group presented the idea a few months ago and of course I fell in love with it. The curmudgeon Mr. H doubts that people will be willing to lug an extra pair of old sneakers all the way to Las Vegas to donate; however, I seek to prove him wrong. I know there are enough shoe-loving HIStalk fans that appreciate the joy of a newish pair of shoes and who would find some room in their suitcase in order to assure the world is a more joyful place. I might even wager Mr. H on this since I so sure he’s wrong.
Welcome to new HIStalk Platinum Sponsor Fulcrum Methods. The Oakland, CA company provides tools and expertise that help providers manage projects, programs, and change initiatives: work plans, guidebooks, and electronic document and worksheet templates. For hospitals or EPs interested in Meaningful Use, the company offers a structured approach and SaaS-based tools for evaluating EHR capabilities, tracking met and unmet requirements, and assessing resource needs for compliance (notable users include Lucile Packard Children’s Hospital and Maine Health, to name a couple.) It’s EP Tracker allows easy MU oversight of affiliated EPs, making sure they are ready to attest, tracking their attestation, and managing the result flow of funds. An interesting service is Pre-Attestation Compliance Services, providing a defensible, documented review that proves to potential CMS auditors that the attestation was legitimate. Other tools and services cover Program Management Office methodologies, change management, long-range planning, and vendor selection and system implementation methodologies. Good IT departments often need nothing more than proven tools, processes, and structure to boost their own proficiency and that’s what Fulcrum Methods offers. Thanks to the folks there for supporting HIStalk.
If you agree that mobile health in its various forms is important, you might want to drop by HIStalk Mobile and sign up for the e-mail updates there. Travis is really good at understanding that market and he’s not shy about saying which products he likes and which ones he doesn’t (and as a doctor and a mobile health startup guy, he’s plenty qualified to offer his opinion.) Read his latest post and I bet you’ll find at least a handful of items that are interesting and useful.
On the Jobs Board: NextGen Go-Live Support, SCM Go-Live Support, and Cerner and Epic Resources. On Healthcare IT Jobs: Implementation Consultant, Epic Willow Consultant, IT Interface Analyst, Epic Certified ASAP Builders, and Senior Applications Programmer/Analyst.
Want to support what we do and make Inga happy? Here are some ideas: (a) stick your e-mail address in the Subscribe to Updates box to your right so you get the news before everybody else, at least everybody other than the 7,800 readers who preceded you in signing up; (b) support our delusions of popularity by connecting with us on LinkedIn and Facebook; (c) while you’re on LinkedIn, sign up for the HIStalk Fan Club that Dann started long ago that now has 2,089 members – when people ask me for something, that’s the first place I look to see if they really are fans; (d) send me news, rumors, pictures, music recommendations, or anything else that might tickle my fancy; (e) peruse with ill-concealed wonderment the roster of fine companies who support HIStalk, perhaps clicking an ad or two, checking them out on the Resource Center, or using the Consulting RFI Blaster if you need consulting help; and (f) look squarely into the mirror and give a world-weary nod to the person who makes it easier for someone who’s already worked a long hospital day to come home to another five hours’ worth of HIStalk work – that would be you, thanks.
Acquisitions, Funding, Business, and Stock
Private equity firm LLR Partners acquires Paragon Technology Group, a provider of strategy technology solutions to the public sector, including HIT. LLR appointed former Xerox and GTSI executive Scott Friedlander as president and CEO.
The healthcare merger and acquisition market generated 980 deals worth $227.4 billion last year, of which 435 involved the technology segment.
Release of information vendor HealthPort has retained Credit Suisse to find a buyer for the company, reports suggest.
UnitedHealth Group reports Q4 numbers: revenue up 7.9%, EPS $1.17 vs. $0.94, beating consensus expectations by $0.13. Its Optum unit was credited for contributing to the insurer’s $1.26 billion in quarterly profit.
Arnot Ogden Medical Center (NY) expands its relationship with Surgical Information Systems (SIS) by selecting its anesthesia module.
Nationwide Children’s Hospital (OH) renews and expands its five-year licensing agreement with Streamline Health Solutions, adding additional document management and workflow solutions.
HealthGrades announces that its founder and CEO Kerry R. Hicks will assume the chairmanship of the company’s board of directors. The current chairman, Roger C. Holstein, will assume the CEO role.
The Federation of American Hospitals promotes Samantha Burch from director of healthcare policy and research to VP of quality and health information technology.
CollaborateMD, a provider of PM and billing software, hires former Lockheed Martin executive Stephen Hightower as chief strategy and technology officer.
Mobile app provider Happtique names Ben Chodor CEO. He was formerly with InterCall.
Peter Longo has joined Predixion Software as global sales leader. He was previously VP of sales with Allscripts.
Netsmart Technologies hires Dennis Morrison PhD as chief clinical officer. He was previously with Centerstone Research Institute.
Announcements and Implementations
Sharon Regional Health System (PA) unveils its new $3 million, 5,000 square foot IT department that will connect to the health system’s 18 facilities.
QuadMed, which operates 22 on-site primary care clinics in 12 states for large employers, adds telemedicine to its slate of services.
Westchester Medical Center (NY) selects QuadraMed’s identity management solutions.
TELUS Health Solutions launches MyHealthReference.com, a health reference portal for Canada.
The GAO reports that the National Quality Forum (NQF) failed to complete five of its eight projects promoting EHR on time. The GAO blames both NQF and HHS for “overly ambitious deadlines, given the scope and complexity of the work.”
Titus Regional Medical Center (TX) fires a nurse looking at medical records she was not authorized to view. The nurse claimed she only looked at the 108 charts because she was “curious.”
The teen who made headlines last year for impersonating a doctor in a Central Florida hospital is arrested again, this time for pretending to be a police officer. The 18-year-old was driving with a sheriff’s badge, a pistol loaded with hollow-point rounds, a Taser, handcuffs, a police radio, police lights, and a dash-mounted laptop. He got caught after advising a motorist stopped at a traffic light to fasten his seatbelt, unaware that the drive was coincidentally an undercover detective.
I’m excited to report that the pre-HIMSS advertising schmooze-fest has started. I was getting a little worried since I hadn’t seen anything yet – not even a post card. The first e-mail came from Hyland Software, which will again be at HIMSS with their OnBase Sports Bar & Grille, offering three daily happy hours. As for other exhibitors, they’re still pretty quiet. One thing is for sure though – I’m hoping that the always-delightful IngaTini will return.
American Medical News advises small practices to guard against security breaches amid concerns that basic security is taking a back seat to the focus on Meaningful Use. I’ve experienced data breaches personally: the Veteran’s Administration; my bank; and now Zappos has notified me of “illegal and unauthorized access” to my account. I’m sure they were after credit card information, but I hope they find humor in the sheer variety of shoes in my account history.
Speaking of credit card information, a recent article spotlights physician offices that require patients to provide credit card information, calling the practice “jarring.” One reader comment states:
When I sit and wait past my appointment time, I always send the doctor a bill by registered mail. I charge $100 an hour for wait time. If I have to wait a half hour, I send him a bill for $50. I have done this three times in California. Each time, they refused to pay the bill. It cost me, but I take them to small claims court. In California, no attorney can represent you — the doctor has to defend himself. They always pay the $50 or $100. They won’t take a day away from the practice to go to court. I had to find another doctor, of course. There are more doctors than attorneys. But I cured them of sucking eggs.
I hope this guy doesn’t show up in my practice. I also hope he never has an emergency medical problem or crisis that causes his physician to run late for the next patient.
E-mail of the day from the AMA: last fall, physicians had the opportunity to seek hardship exemptions and avoid penalties for failing to successfully participate in Medicare’s e-prescribing program. The Centers for Medicare & Medicaid Services (CMS) is reviewing each hardship exemption request on an individual basis and has not yet completed its analysis. Therefore, it is possible that some physicians will be subjected to a 1 percent Medicare payment penalty inappropriately until the backlog of exemption requests is reviewed. Ultimately, CMS will reprocess the claims. No mention of how long it will take or how much CMS is spending on the review.
USA Today reports that 1% of Americans are responsible for 22% of healthcare costs in 2009. Nearly half of health care spending can be attributed to just 5% of patients. The data is from the Agency for Healthcare Research and Quality, but most primary care physicians could tell you that just from gut feelings.
I was initially sad at hearing that a researcher at UConn who has published several articles on the health benefits of red wine apparently falsified his data. It’s unclear whether the data manipulations affected study outcomes. Reviewers have been combing through his research since an anonymous complaint in 2008. The list of deceptions found in the research are almost unbelievable – I’ve judged elementary science fairs with more integrity. My spirits were bolstered, however, by a recent article in the Journal of Women’s Health sharing a recent study finding that red wine has activity similar to a group of medications called aromatase inhibitors which are used to fight breast cancer. White wine drinkers take note – this is strictly an attribute of the reds.
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 and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!
The EHR Bubble Will Pop—To the Victor Go the Spoils
By Evan Steele
There is no question that the EHR incentives have created a frenzy of EHR purchasing and that the trend will intensify in 2012 because this is the last year to qualify for the full $44,000. As I look at what’s happening in the market, it becomes apparent that at some point in the not-too-distant future, the EHR bubble will pop and many vendors will face financial challenges that will lead to their demise.
Despite the surge in EHR purchases in 2011 and 2012, it is important to recognize that there will be some unintended consequences of the rush to meet the government’s deadlines and requirements. Many physicians will be unhappy with their newly acquired EHR because, in their haste, they made a poor product choice. Others will face a rude awakening as they are forced to use their EHR in ways they never have before, and discover that it does not support their workflows. In the rush to market, there will also be some products that, while certified, are of inferior quality—possibly developed offshore.
Vendors will be backlogged and unable to manage the surge in new purchases in a timely manner due to insufficient staffing levels. Many will come to market short of the necessary educational resources to help physicians navigate the complexities of Meaningful Use, and physicians will find themselves victims of inadequate, rushed EHR implementations by green, wet-behind-the-ears trainers. Other vendors will be so overwhelmed that they will fail to keep to their promised implementation schedules, preventing their new clients from meeting the government’s timetable entirely.
In the years following the initial boom, many physicians will become disillusioned with the EHR Incentives Program. There will be too many requirements that will seem either burdensome or irrelevant to their practice—or both. As the increasingly stringent Stage 2 demands are weighed against the drastically decreasing dollar value of the incentives, physicians will either abandon the program or trade the EHR they originally purchased for one that supports not only the government’s needs, but also the workflow needs of their practices.
To see what will happen to many of the EHR companies, it is important to understand how they are financed. In order to raise money, companies had to show investors a story anticipating significant new client acquisition. Initial funding for EHR companies was based on “hockey stick” growth projections, fueled by the availability of government incentive money. Each individual company’s projection anticipated rapid, accelerating, and long-term growth in EHR demand.
The first thing to recognize is that these projections were overly optimistic. In fact, if you add the projections of all the EHR companies together, they would grossly overstate the total potential market. To excite investors, a typical start-up EHR company seeking funding was likely to predict that it would have 5,000 customers within five years.
With a population of approximately 600,000 physicians serving the ambulatory market — 25% of whom may never adopt an EHR due either to approaching retirement age or doubting that the penalties will ever be imposed –there is a potential market of 450,000 physicians. ONC’s Certified Health IT Product List (CHPL) website currently lists 472 vendors that offer at least one “Complete EHR” product. A conservative assumption that the top 20 vendors will together secure half of the physician market leaves the other 452 vendors competing for their share of the remaining 225,000 physicians. This represents an average of 498 physicians per vendor—not even a paltry 10% of their projections.
The circumstances described above present a textbook case of a dramatic bubble followed by a dynamic shakeout. Whether at the end of 2012 or in 2013 (when the bulk of the incentives are no longer available and physicians will have to focus on the conversion to ICD-10), the bubble will pop, and the financial fallout will be significant. Missed growth projections, government money drying up, and mounting physician dissatisfaction will leave many companies unable to find investors willing to fund their future growth. Scores of companies will face a cash crunch as revenue growth slows, or revenue declines, in the face of continued and significant expenses for implementations, support, ongoing upgrades and certification requirements, etc.
As in the dot-com era, strong companies will survive. Those that generate other sources of income from a deep set of products that offer alternative growth opportunities will be around to take advantage of the second EHR bubble that will be fueled by the looming EHR penalties, the development of ACOs, and new pay-for-performance programs, among other factors. There will be a trend toward consolidation, and financially strong companies will acquire distressed companies for pennies on the dollar, reaping the benefits of their unique technologies and/or their customer bases. To the victor go the spoils!
Evan Steele is CEO of SRSsoft of Montvale, NJ.
HIMSS Prep: Get Inside the Head of Your Customer
By Rosemarie Nelson
How much is it costing you to exhibit at HIMSS? It’s all about making a connection, developing a relationship, and delivering results. That’s why you’re exhibiting. These are my tips for vendors on the trade show floor.
First, Do Your Homework
What do you know about HIMSS? How many members? How many are attending? How many physicians are in those organizations? What else is important for you to know?
Who is walking the floor? You expect to see the C-level. The significant physician. Directors, administrators, and managers. Those from the academic world of academics. And “other.” Other means influencer. Think of the impact of the media, consultants, attorneys, accountants, and spouses. They know, work, eat, and maybe even sleep with the purchasers. Smile and greet them all.
They’re smart. Chances are they are graduate level. They are ready with questions that delve deeper than your elevator pitch. Prepare your answers.
They are boomers, more than any other generation. Are you Generation X or Y? How do you relate to the boomer’s characteristics? How does the boomer relate to you? Regardless of generation, the attendees will fall into one of the following cohorts:
Like a Boy Scout, be prepared. Engage the enthusiastic, be cautious with the cynic, curb the chatty, appreciate the customer, and WALK AWAY from your smart phone while you’re in the exhibit hall.
Next, Know the Buzz
Then, Know the Trends
As the population statistics change and the baby boomers age, health care costs rise. Telemedicine, smart phones, direct-to-consumer marketing and the economic constraints on organizations’ fundraising efforts are all opportunities and threats to the traditional methods for delivering health care.
Mobile Technology Trend
Reduces need for hospital admissions and physician office visits. 40% of physicians say they could eliminate 11% to 30% of office visits through the use of mobile technology (PWC Health Research Institute, Sept. 2010). Why would providers accept technology that hurts incomes?
Insurance and Coverage Trend
Medicare spends more than 25% of its budget on patients in their last year of life. As a society, we can’t keep up with the growing needs for coverage and care: state budget constraints, federal budget pressures, and unwillingness to raise taxes. By increasing the preventive services and by monitoring key measures specific to chronic diseases, payers expect to improve health outcomes and reduce overall costs based on reduced hospitalizations and additional procedures.
The costs of transition are almost as much as the costs to acquire an EHR.
And Finally, The Bottom Line
Does your solution address one of these trends? Why does what you do or provide matter to the exhibit hall walker? Each buzz signals a reduction in costs to the health care system, which means reduced income to those delivering the service. Are you signing up for a reduction in your income? No one wants to do that. How can you improve that income picture for your potential client?
“How does this solution/product help me?” is running through the mind of that exhibit hall walker. Do you know enough about them and their issues to answer that question? Challenge the conventional thinking in your sales process. If you keep doing what you’ve always done, you’ll keep getting what you’ve always gotten. Is that really what you want from your investment in HIMSS 2012?
Rosemarie Nelson, MS is principal consultant with MGMA Health Care Consulting Group of Englewood, CO.
The Biggest Mistakes Companies Make in the War for Healthcare IT Talent
By R. Gaines Baty
“War” is officially declared and the healthcare industry is the battlefield. We speak of “The War for Talent” in healthcare – the perfect storm at the intersection of ballooning demand, limited supply, and mandated urgency, with no viable solutions but to accept mediocrity or fight for the best.
This is not a new phenomenon, nor is it unique to the healthcare industry. Similar forces were at play in the IT industry leading up to Y2K. We in healthcare, as a result, now find ourselves in a candidate-driven “seller’s market” for executives.
No organization can excel without great leadership. Most chief executives agree that for an entity to ascend to and perform at an optimal level, it must attract and retain the best leaders possible. Some, however, don’t align their own recruiting processes with this fundamental truth.
We’ve pinpointed several of the more common and detrimental mistakes potential employers make in the pursuit of great executive talent. Of course, relevant candidate flow is crucial (and the reason good search firms are in business.) This said, the following issues can derail the pursuit of excellent potential leaders.
1. “Perfect Profile” expectations. It is advisable to first seek the perfect match. However, recruiting is not pizza delivery. When a comprehensive search is producing quality candidate flow, the market will reveal the caliber of talent and credentials available to the company. If and when the elusive “perfect person” does not appear, organizations may be best served by evaluating through a different lens. Prioritization and flexibility are required in this approach, with due credit given for transferrable skills and a recurrent track record of success. The operative question must become, “Can she do the job?” Strong performers come in different packages, and may not appear perfect at first glance. One can find something lacking with anybody, even a candidate fully capable of achieving an organization’s objectives.
2. Failure to “sell” the candidate. Excellent candidates typically have multiple suitors and are not necessarily looking for a job. Therefore, everyone in the recruiting process should reinforce consistent and inspired organizational vision, importance of the role, opportunity for success, potential for recognition and reward, and future career opportunities. Undoubtedly, effective candidate evaluation is paramount. Simultaneously, however, a consistent and compelling value proposition must also be perceived by the candidate. This should be complemented by a prompt decision and an appealing compensation offer. Candidates should be treated like prospective customers. We must bring our “A” games to the interview room.
3. Poor communication, indecision and ineffective processes. Organizations frequently drag out hiring decisions nonchalantly for months; communicate inconsistent visions; utilize inconsistent or ineffective evaluation criteria; inadequately communicate with sponsors or recruiters; conduct distracted or unprepared interviews; and generally create unimpressive or sloppy candidate experiences. This same process may be a candidate’s only window into the soul of a potential employer. In contrast, competitive suitors with crisp, clean recruiting processes will quickly eclipse others for this top performer’s services.
In summary, big game hunting for high quality leadership can reap huge rewards. However, the real stars are rare and may appear differently than we first imagined. Competition is stiff. The hunter only has one shot at the target, before it disappears.
R. Gaines Baty is president of R. Gaines Baty Associates of Dallas, TX.
Thomson Reuters names its Top 15 Health Systems that have achieved superior clinical outcomes based on quality, patient perception of care, and efficiency. If anyone knows how many are Epic, that would be interesting given all the lofty ambitions expressed by customers trying to justify their expensive projects. Or for that matter, how many are HIMSS EMRAM Stage 6/7 since HIT cheerleaders are always trying to make the connection between HIT and outcomes.
From Barefoot in Vegas: “Re: Trade show shoes. AMAZING TOPIC!!!!!!! Please send me your show list.” I love people who don’t chinch on exclamation points, so I was happy to share my shoe brand tip with Barefoot. I admit I was amazed (!!!) how many people were interested in my footwear insights. It made me feel a little like Oprah.
From Social Profiteer: “Re: pimping HIT tweets. Apparently so-called news organizations, especially those owned by HIMSS, are willing to sell out their readers.“ I can’t decide which is more interesting: (a) charging vendors $10,000 for a couple of tweets, or (b) vendors thinking that barraging a news site’s readers with unwanted Twittermercials is actually hip, progressive marketing that will benefit those companies. It seems kind of unsavory and reader-insulting for a company with “news” in its name to be doing this kind of revenue augmentation without regard to the potential damage to whatever reputation it has, but it’s really none of my business – that’s between the publication and its readers.
From Harcourt: “Re: inpatient MU attestation. Please post this graph. I believe the huge gap between Cerner, Meditech (including its contribution of HCA’s attestation), and Epic would create interesting discussion.” The graph is here. As with EP attestation numbers, I would be cautious about trying to apply client MU figures to the likelihood of a given customer earning MU money. Meditech has more live hospitals than anyone, so I’d expect its numbers to beat those of other vendors. In fact, I’m slightly surprised that it doesn’t have a wider lead over Cerner and especially Epic (Epic’s number suggests that 50% of the hospitals it has ever sold to have attested, which I would think trounces both Cerner and Meditech if you’re calculating odds). I can’t say I’m really interested in any of this information, since any vendor with even one successfully attesting client has proven that its software has the capabilities needed. Beyond that, much of the required effort belongs to the customer.
From HITEsq: “Re: Girard Medical Center (KS). Really doesn’t like Cerner – suing them for breach of contract. Among the interesting tidbits, Cerner staff apparently though that Cerner was able to get the hospital to agree to an agreement as a result of ‘concert tickets and booze’ and that the Cerner staff was only there ‘because [they] drew the short straw.’ Apparently, Girard feels like it paid $1.3M for nothing.” The 21-bed hospital says it has paid $1.3 million of the $2.9 million total without receiving “any tangible work product” and that the time and attendance system that it thought it was getting wasn’t included (they claim Cerner helpfully suggested using an Excel worksheet instead.) The hospital also claims that Cerner assigned “incompetent staff” to implement the system. That’s all fun to read, but (a) this is one side of an argument that has two; and (b) some of the claims fall between irrelevant and desperate. There’s a good lesson here for customers: don’t let your buddy-buddy salesperson talk you out of getting an expert in contract law to insert protection into the agreement that covers whatever you are (or should be) afraid of as a customer. Once it gets to the lawsuit stage, there’s a good chance that nobody will be happy with the result except the hourly-billing lawyers.
HIStalk Announcements and Requests
Listening: reader-recommended Turisas, epic pagan battle metal from Finland, like a band of Vikings hit Kerry Livgren over the head with a mace in 1975 and took over prog band Kansas, then merged it with Green Carnation and Muse. While I acknowledge that most folks won’t like it, I definitely do.
Acquisitions, Funding, Business, and Stock
7 Medical Systems, a provider of on-demand digital imaging, EMR, and RCM solutions, acquires Manager Consultoria em Informatica LTDA EPP, a Brazilian company that offers similar services to hospitals and clinics in Brazil.
Elsevier purchases QUOSA, a provider of life sciences content management and workflow productivity solutions.
VeriTeQ Acquisition Corporation completes its acquisition of PositiveID Corporation’s VeriChip implantable microchip and Health Link PHR.
The DOD’s Military Health System awards Planned Systems International a five-year, $96 million contract to provide code maintenance services.
Putnam County Hospital (IN) announces plans to implement CPSI.
Prevost Memorial Hospital (LA) selects CMR EDIS version 3.3 for its emergency department.
Home health provider RBA Texas selects Axxess’ Agencycore home health software.
Nashville General Hospital signs a multi-year agreement with Sectra for its integrated RIS/PAC solutions.
Baylor Health Care System (TX) adopts technology from strategicplanningMD, a provider of strategic planning software for the healthcare industry.
IASIS Healthcare LLC (TN) selects NextGen Practice Management and RCM for its 19 hospitals across seven states.
Ellenville Regional Hospital (NY) selects Healthcare Management Systems (HMS) EHR and financial applications.
The Premier Healthcare Alliance awards a contract to UltraLinq Healthcare Solutions for its Web-based imaging system.
Mercy Medical Center (IA) selects MedVentive’s Population Manager and Risk Manager products to facilitate management of its accountable care contracts.
Massachusetts General Hospital chooses Voalté’s consolidated voice, alarm, and text communication system for nursing communication.
Aria Health (PA) appoints Brian A. Hannah MD as CMIO.
OB fetal monitoring software vendor PeriGen names former Allscripts SVP Matthew Sappern as its CEO. He replaces Donald Deieso, who retired at the end of December to join Arsenal Capital Partners.
St. Joseph’s Hospital Health Center (NY) appoints Michael A. Spurchise director of enterprise and ambulatory systems.
Chris Caramanico joins SCI Solutions as SVP of marketing and business integration. He was previously SVP of new business enterprise applications for Allscripts.
Cornerstone Advisors names Gregg Fajkus as VP and Epic practice director. He was previously with Encore Health Resources.
Pamela Lane, formerly VP of health informatics with the California Hospital Association, is appointed deputy secretary of the health information exchange at California’s HHS.
Steven Arnold MD is named chief medical officer of surgical implant management solutions vendor MediQuip.
Announcements and Implementations
Human capital management software vendor API Healthcare announces strong growth for 2011, including the best quarter in its history.
Stockell Healthcare Systems announces GA of its InsightCS Business Intelligence Suite 2.0, which expands its revenue cycle management system with executive dashboards that include days in AR, cash receipts, collector productivity, denial rates, clean claim rates, and coder productivity.
In England, six hospital trusts say they’re saving $12 million per year by operating a telestroke program based on Polycom’s RealPresence video collaboration solution.
Misys Open Source Solutions grants exclusive Swiss distribution rights for its Misys Connect XDS registry and repository to Switzerland-based enterprise content management vendor Uptime Services AG.
A data entry error creates grossly inflated bills for hundreds of Bronx-Lebanon Hospital (NY) patients. The hospital blames its billing company for inserting invoice numbers in the space designated for the amount owed.
The local paper profiles Beacom Health, one of six practices that have taken advantage of subsidies from Fremont Area Medical Center to implement eClinicalWorks.
I couldn’t help think of Mr. H when I read this since I know he enjoys both his music and his exercise. Between 2010 and 2011, 47 people were killed or seriously injured while walking and wearing ear buds or headphones. I predict a few lawsuits against Apple for allowing the music to play so loud.
Weird News Andy says he’s excited at the news that a pill may replace the need to exercise, but he’d be happy with one that helps him remember where he put his car keys.
Commissioners of Bay County, FL discuss a settlement with chiropractic office management software vendor Redpine, which relocated to the area to take advantage of $750K in incentives and then closed its doors. The company has offered to sell its software rights to repay the incentives and claims it has several prospective buyers.
Jayne Gets Her Tweet On
During a recent e-mail exchange, a friend of mine repeatedly chastised me for not being on Twitter. He failed to see why someone who lives in the land of blogging and social media wouldn’t want to Tweet with the rest of the world. To be honest, I’ve been more than a little scared to take the plunge. Knowing all too well what an outrageous time suck Facebook can be, I didn’t want to get into something else that had the potential to further unmask certain addictive personality traits.
Nevertheless, I took the plunge. Signing up was deceptively easy, although I’m having a hard time deciding who to follow. I don’t want to overdo it with too much information. So far, I’m following HIStalk (of course), my BFF Inga, and my very public secret crush Farzad Mostashari (and his dashing bow tie.) You can follow my shame spiral @JayneHIStalkMD .
While I’m feeling social, I decided to share some reader correspondence. It goes back a bit, as you can imagine my inbox usually looks something like the hallways of a New Orleans emergency department during Mardi Gras (which incidentally is just a month away for those of you who plan to get your party on).
From Miami, My Amy: “I was at a physician office this week and they couldn’t get the right patient into the right room. They took me back twice and reseated me in the reception and did the same thing to another person. Made me wonder whose medical record they were viewing. I find I am becoming a “difficult” patient, bristling with all the paperwork to fill out time and time again… with the same provider.” I agree, this sounds pretty annoying and it’s also a significant patient safety issue. I do hope your physician apologized though. I that was happening in my office,I would expect my staff to make me aware so that I could say something to patients.
From Bama Bubba: “Your Curbside Consult today really charged up my growing OCD. Public restrooms never have commode lids, plus they often flush with a great torrent of surging water, not the home-based gentle swirl. This flushing surely raises huge clouds of nasty water droplets perfect for deep lung deposition. I had a remembrance of the huge toilet complex at McCormick Place in Chicago and literally dozens of commodes in narrowly separated stalls, used by folks from all over the world, being flushed at the same time. Whoa! Talk about a toxic cloud of international viruses. Excuse me, I have to go wash my hands again.”
From HealthNut: “Re: shift work food options. I worked 11-7 for a stretch and our food options consisted of coffee, colas, cigarettes, and vending machine staples of sandwiches with greenish mystery meat/cheese, lukewarm canned chili or Beanee Weenee, peanut butter crackers, candy bars, and gum. The only thing that kept us from morbid obesity was bring broke all the time because we were students.” Yeah, that and the fact that we had to run arterial blood gas samples to the lab in styrofoam cups of ice chips and run to radiology to look at actual x-ray films all night long. At my hospital, our vending machines were just updated with a new item: White Castles.
From Golfing Great: “Regarding your recent post on technology as the new scapegoat. It’s not only the users who operate the systems, but also the folks who create and maintain the systems, the training they receive, their proficiency, and their ability to anticipate — or at least understand — the needs of those users (which I try to do by subscribing to HIStalk, so thank you very much!) When problems occur, there is usually more than enough blame to go around. It’s a shame the time spent deflecting isn’t devoted to planning, training, and coordination instead. It is important to keep in mind that systems are comprised of technology, people, and processes, all of which must function properly for the system to succeed. I’m not sure that any system will ever be able to address the intentional ignorance demonstrated by people in some of the scenarios you quoted, certainly technology alone cannot. I couldn’t agree more that culture is key, particularly when, even in spite of best efforts, systems are inadequate.” Thanks for that feedback. If I could convince organizations of the need to do one thing prior to and during implementation of any health IT system, it would be this: change management.
From Mr. Clean: “What is the evidence base on best way to sanitize tablets and (especially) keyboards? Inquiring minds want to know!” There’s not a ton of data on this. Personally, I use the same wipes that we use in the emergency department, which are a healthcare-grade sanitizing wipe for hard surfaces. Low-level cleaning requires keeping the surface wet for at least thirty seconds; higher-level disinfection requires keeping the surface wet for at least three minutes, which is a little harder to do with a keyboard.
Just a few days ago, the FDA cleared a self-sanitizing hospital keyboard with the bargain price of $900. The solution uses UV light to eliminate bacteria. Another reader suggested the WetKeys Washable Keyboards, which actually look pretty cool and have much more accessible pricing. It would definitely be easier to keep those wet for three minutes than a traditional keyboard. I really like the looks of their washable flexible keyboard. Too bad Santa has already come and gone — he could have rolled one up and left it in my stocking.
Have questions about ICD-10, the most common injuries seen during Mardi Gras, or whether you should order your White Castles with double pickles? E-mail me.
From Barry Goode: “Re: 5010. I’m glad to dish out all the dirt I know as a vendor. Big picture, it’s been a LOT easier and less troublesome than we expected. Most of our payers and intermediaries have been really good. Our clients have a 99+% clean claim rate. The clearinghouses have been far more troublesome than the payers as a rule, which is pathetic because it’s their primary business. A good clearinghouse having trouble with a particular payer should be able to EASILY resubmit claims in the 4010 format in order for the practices to be paid while issues are worked out. The deadline was moved! Although the clearinghouses are to blame for some of the trouble, the real culprits will soon be the state Medicaids. Some of them have yet to even indicate when they will be ready for testing.”
From Rumble: “Re: Partners. Heard they’re making that big decision by April 1. Why use that date? Push it out a day or two, jeez …”
From HIPAA Hound: “Re: how doctors die. Here’s another article, a tad longish, but interesting. My wife and I are both of this mind, and we have our living wills/advance directives on file and our durable POAs ready if necessary. In my opinion, too much technology in the hands of the uninformed or emotionally involved (that’s not the right word, but I can’t seem to call the correct one to mind) is what runs US healthcare costs out of sight. My two cents.” I’m no expert, but Americans seem to be uniquely culturally incapable of accepting death. We’re so used to endless opportunity (at least until recently), unlimited science, and never-ending self-actualization that to just admit that your number is up never happens. It’s not just the elderly – every hospital I’ve worked in spends millions saving wildly premature babies weighing a pound or two. My conscience hasn’t resolve the question of whether that’s the best use of increasingly limited healthcare resources, especially when you look at some of the families and try to decide what that baby will be going home to after unbelievably expensive months in the NICU.
From The PACS Designer: “Re: iPhone’s 5th. It’s had to believe, but the iPhone just celebrated its 5th anniversary. When it was first released, virtually no one predicted it would dominate the marketplace and outdo other smart phones in popularity. Healthcare has always been a sweet spot for Apple products, so that’s why there’s always a place for almost every new Apple product introduction. The first iPhone was 1.16 cm thick and had a 3.5″ widescreen touchscreen display with multi-touch support, 8GB of RAM, Bluetooth, WiFi, and a 2 megapixel camera.” I couldn’t easily find the link, but an HIStalk poll I ran when the iPhone came out found that readers mostly thought it would have little influence on healthcare. As a vendor, how would you like to have a product that’s in such high demand that Chinese consumers are willing to attack humorless police and criticize their government when the local Apple store doesn’t open on time? Maybe financially irresponsible countries should consider slapping on iPhone tax like the cigarette tax, knowing that people are addicted. I floated a similar to proposal to a slightly interest audience (Mrs. H) while in the airport this weekend – revenue-happy airlines that are even charging passengers for boarding ahead of their assigned zone should charge the idiots that congregate around the boarding lane before their turn, blocking the path of those trying to board as called. You can sit for free, or obstruct for a fee.
I’ve whisked Mrs. HIStalk away for a rare long weekend as I attempt to temporarily recover from the onslaught of HIMSS-related HIStalk work (not to mention work at my hospital) that has been testing my mental and physical capabilities. I’ll keep this post brief rather than just bag it completely or dump it on Inga to write, pecking it out on my small HP laptop on modestly good hotel wireless. Your regularly scheduled verbosity will resume Tuesday evening. In the mean time, Mrs. H and I are tooling around in a really cool Mustang convertible (a rental – something I’ve always wanted to do), eating in good restaurants, working out, and relaxing. Then it’s back for the final assault before the conference.
I’m fascinated with Vince’s HIS-tory this week because he gives some rare and fun background on a couple of industry long-timers: Judy Faulkner and Frank Poggio. His series always reminds me that it’s about the people more than the companies.
Here’s my final thought on CMS’s Meaningful Use numbers. I’m pretty sure ONC’s point was to show what a great job it’s been doing in getting providers to use EHRs, and their information (not surprisingly) seems to support that. I’m not sure why they included vendor information, though. They should have known that everybody would try to over-analyze and massage the skimpy data to gain competitive advantage. That focus has actually caused many folks to miss the point that the adoption curve is moving sharply upward, which is ONC’s real job rather than feeding the competitive EHR market frenzy. As a provider, your mileage will undoubtedly vary no matter what someone else’s numbers show. And the next set of numbers will provide a much-needed data point: does adoption seem to be increasing, or has it peaked?
I was interested to hear that Adventist Health is putting Cerner in its ambulatory locations. I didn’t know that, at least according to one reader, they’re displacing Epic ambulatory. That’s how it should work, of course – the hospital system generally drives the choice of the outpatient system, not vice versa, although Epic has benefited greatly from customers who don’t find that to be an acceptable choice given their incumbent vendors. I was thinking that Loma Linda University Medical Center might be impacted since they announced an Epic inpatient decision not long ago, but I guess they aren’t part of Adventist Health like I thought I remembered.
Thanks to everyone who signed up for HIStalkapalooza invitations. The signups have been closed and invitations will be e-mailed out shortly to the folks we can accommodate (we had around 1,000 invitation requests, so unfortunately we can’t send everybody an invitation.) Thanks, too, to everyone who voted in the HISsies – I’ve closed that voting as well.
The economy is looking better to a good number of the folks responding to my most recent poll. New poll to your right: CMS released Meaningful Use numbers. How are attestations running compared to what you expected?
The New York Times writes up Epic in its business section. It’s not a particularly insightful or in-depth piece, but they did apparently interview Judy although the article has few quotes. It does include some interesting statistics: Epic has 260 customers, 35 of which signed on last year. Their software will cover 127 million patients next year. The company has 5,100 employees and will hire another 1,000 this year. Revenue for 2011 is expected to come in at $1.2 billion, up 45% from 2010. It also mentions a retired UW professor of psychiatry who was an original Epic investor and who sits on the company’s board, the first mention I’ve seen that the company has investors or a board. It would be interesting to know what she invested and what that investment is worth now, although obviously private company shares are illiquid, making valuation (and selling) tricky.
Cerner hits the 10,000 employee mark.
This week’s employee e-mail from Kaiser Chairman and CEO George Halvorson talks up walking, with nearly 30,000 of KP’s employees enrolled in its walking programs. KP has developed an EveryBody Walk! app to help people develop a walking plan and find walking routes.
Just in case you’re Googling for old HIStalk posts prior to 2007, they’re gone, at least temporarily. The blog service I used for HIStalk from 2003 until 2007 has gone belly-up, which isn’t surprising since it was really run more like a geek’s electronic bulletin board than a professional service, so WordPress killed it off easily (that threat and a couple of issues I had led me to abandon it years ago). I have an XML backup that can supposedly be imported into WordPress, so if I see benefit to putting the old stuff back online, I’ll hire someone to port it over. I feel some loss – I spent a ton of time and energy crafting those old posts.
Akron Children’s Hospital names Amy Maneker MD as CMIO to oversee its Epic implementation. She previously held a similar role with Rainbow Babies and Children’s Hospital in Cleveland.
Inga ran across this on Facebook. RelayHealth donates its $50,000 prize for winning the VA’s Blue Button for All Americans contest to the Wounded Warrior Project, which helps wounded service members.