HIStalk
I still have some Kaiser information, so this edition of HIStalk will
be normal stuff first, then Kaiser.
From
California Dreaming:
"With all these Epic
problems coming to light (no surprise to me), one wonders if Sutter
Healthcare is still going forward with their already-behind-schedule
Epic migration project?"
From HIT Veteran: "Re: Epic/EMR. Most issues
I've seen with EMR solutions are purely related to the management of
the software engineering process. The ability to define the functional
requirements and follow an interative delivery process is key, versus a
waterfall delivery approach."
From I Can't Stand the Rain in Seattle:
"The two founders of
Phamis, Dr. Mark Wheeler and Dr. Malcolm Glaser, both of whom have been
trying to keep LastWord/Carecast/Centricity Enterpise going, have
decided to call it quits at the end of the year. Mark will probably
focus his time and energy on his vineyard, and with Malcolm, who knows?
I know that you don't have a lot of respect for the product brought to
market, but there are good folks in the IDX Tower who are still trying
to manage to all of the customer commitments." It's not a
bad product, it's just outdated. But, then again, so are most of the
products it competes against. I'm sure it's hard trying to keep the
lights on while waiting on GE to either pee or get off the pot with IHC
and unknown outcomes. Supporting an orphaned legacy product is
not fun and it's hard to escape the label of being as outdated as the
product you work on. Now's the time to develop your skills, educate
yourself (reading here, of course!), and volunteer for projects that
might give you some non-CareCast credibility, just in case.
From PTSD: "Mediware to sign Baptist
Health? BHS in Birmingham was a battleground for Care Fusion, Bridge,
and Mediware. Bridge and Mediware did lab days last week after
referrence calls and demos. Care Fusion must have been preoccupied due
to the Cardinal acquisition and was almost disinterested in the
business. Looks like the Baptist folks and leaning towards Mediware as
a Bar Code Positive Patient Identification system."
From Anonymous: "Re: Scott Sanner Looks like
he'll be working for Marc Winchester. Maybe they can use Skelton in the
PR Dept."
From Anonymous: "Re: Scott Sanner. After
Scott Sanner was pushed aside due to poor sales performance on the
ambulatory side of Misys, he moved into a role overseeing the Amicore
product. It will be interesting to see if Amicore is the new
initiative that Scott was referring to. I wonder how Misys customers
that have just purchased legacy technology for PM/EMR will feel if
Misys goes full force with the Amicore product?"
Background: Amicore sold an ASP-based PM and EMR system emphasizing
tablet PCs. The company was originally started in 2000 by Pfizer,
Microsoft, and IBM. I know next to nothing about them otherwise, but it
sure sounds like Misys may look at its technologies as the basis of
something a lot more competitive than Tiger on the low end of the
PM/EMR market.
From OutsideIn:
"Re: Raleigh1776 and
Sanner. While Scott may have felt free to speak given his
relationship with Tom, others who challenged Mr. Skelton were
fast dismissed (eight company presidents and over 12 VPs in the last
five years.) The way you stay alive in Misys is to get behind the
Pittsburgh crew or simply lay low. The employees at Misys are great,
the leadership is not. Misys HR has benefitted from Nortel's lackluster
performance and can only hope the IT/Telecom sector doesn't
turn-around. Mike Lawrie, if you are reading, stick to your 'purpose,'
get rid of the the steel curtain, talk to customers, talk with staff
(both there and some good ones that recently left, not just the
executives in place), and help Misys achieve the success it long
deserves and our customers are asking for. A change at Misys is long
overdue. Our road to success and customer satisfaction is shorter than
you think."
From Anonymous Hawkeye:
"Re: University of
Iowa Hospitals. There have been several references to the clinical
information system selection of Epic at the University of Iowa, in
particular, implying Cerner was not selected because of a poor
executive presentation. In truth, this was a 12-month process examining
every aspect of the vendor solutions. Epic was selected because the
Epic solution was a better fit for University of Iowa." I
should have been more clear in my comment about Neal's presentation
since several sources have told me it was a done deal for Epic long
before the final pitch. Cerner supposedly had no chance unless
the hospital was willing to replace the many physicians who swore
they'd quit if Cerner was chosen over their strong recommendations.
It's rumored that Pathnet and Pharmnet are used at Iowa, but are not
all that well thought of, supposedly being a negative rather than a
positive for Cerner in the broad clinicals RFP. Maybe Cerner was
brought in just to put some negotiating pressure on Epic. It wouldn't
be the first time they were short listed with a zero chance of being
chosen just to get the other guy's price down.
From Anonymous: "Re: Parkland's Epic outage.
It was not related to any software issues. They've been
working with Epic and their outsourcer to repost journalled data and
should have the system up and in catch-up mode as you read this."
Rumors reported here previously are that Parkland
recently brought IT back in-house from Perot.
From Anonymous:
"Re: Parkland.
Here’s what we know so far: looks like a computer
operator with root permission (god-like to the computer) accidentally
copied some files over the top of the running system’s files.
Bad, but normally one could overcome it quickly, except the online back
up was overwritten at the same time and they had to go to tape backups.
Things get confusing from there. Ended up not having good computer
backup tapes and had to go all the way back into mid/late October to
find a good back up tape. Then they had to load it and apply updates
(journal files) from each day to bring the system back to current. Then
they had to get the patients who had come in during the outage loaded
back up. Parkland, Perot and Epic staff have all been pitching in and
working round the clock to help get back to normal." They were lucky all the
journals applied since I've been involved in episodes where they
wouldn't. Explaining that to users isn't much fun, especially knowing
your future prospects probably just took a hit from some unpredictable
systems quirk. Backups just don't always work - that's a good argument
for ditching tape and going disk-to-disk if you ask me. I'm sure it's
been a rough week at Parkland.
From PTSD: "Re: RXHub and Siemens. Rumor
is that Siemens is talking to RXHub a la McKesson/Per-Se deal. (BTW,
they are a HL7 interface, not NCPDP like Per-Se.) Think Cerner or Epic
would make a run at Allscripts?"
From Duuude: "Re: Rich Tarrant's election
bid. You know, I was going to throw out a rant a couple of months ago
that even though I am a Republican, if I was in Vermont I would rather
vote for a pinko commie bastard than Rich. Wow, the people of
Vermont felt the same way. If I was the RNC or a major contributor to
his election bid, I'm sure that Dubyah's dog Spot would have done a
better job than Rich to pick up votes for the GOP." At least Rich wouldn't hump
your leg.
From The Pacs Designer: "Re: PACS/RIS Primer. TPD
gave HIStalk readers the non-technical DICOM web address of the RSNA to
view Dr. Steven C. Horii's viewpoint from his post at University of
Pennsylvania Medical Center in a recent post. If you are a beginner in
the PACS/RIS arena, please read that post first. It is important for
newbies to know what DICOM does as a communications
tool. Secondly, it is equally important to note that no two
PACS systems are alike, so implementing a new PACS for the first time
can be extemely challenging for the institution. To overcome
these challenges requires a team effort on the part of both the
institution and the selected supplier of the PACS or PACS/RIS.
Selecting a PACS/RIS from the same supplier can reduce the risk of
failures during the implementation process. Also, each institution
needs to evaluate their 'plumbing,' so to speak, and do a complete
review of their communications network as well as their electrical
support sytem and its backup capabilities. The next post will be about
the types of PACS systems that can be deployed, so come back again to
enhance your education, courtesy of HIStalk." I
appreciate TPD's bringing good PACS information to HIStalk. That kind
of education is always welcome from volunteers, people I've never met
who are nonetheless willing to help HIStalk's readers.
Thanks and welcome to new HIStalk Gold Sponsor
SCI
Solutions.
They've got products that handle all kinds of pre-hospital functions
like scheduling, eligibility checking, reminders and notifications,
pre-registration, web ordering for office-based physicians, web
scheduling for patients, medical necessity, and referrals. It's
fascinating how far we've come from patients just schlepping over to
the hospital unannounced with poorly copied or handwritten orders, very
likely to lose the hospital money due to inefficiencies, no
pre-determination of eligibility, and inefficient scheduling,
especially for multi-entity organizations. I
interviewed
CEO John Holton awhile back.
"With
the ASP model, they don't have to stand in line for IT. They can be
live and rolling 14 weeks after they sign the agreement and solve so
many of their front-end revenue cycle issues. Our payback time is a
joke, probably about three or four months and the system has paid for
itself. You're only paying a few thousand dollars a month to run this."
SCI has smoking-hot KLAS scores, by the way, with a 96% "would buy
again" and landing in the Top 20 rankings of all products overall.
Please welcome them
to HIStalk by checking them out.
Gold Sponsor
Inside
Healthcare Computing is sending out some promo material
featuring Guest Editorialist Yours Truly. They're offering
great subscription discounts and "The Best of Mr. HIStalk," a
collection of the aforesaid editorials that their subscribers get
weekly. I've received some very nice comments from
their readers, which I really appreciate. Apparently my font
of opinionated snickering won't run dry any time soon.
Listening to now:
Sprites.
If you're tired of the same old songs about love and loss, how about
titles like "Joel has a Hole in his Eardrum","Things are Looking Up in
Lebanon", "Overclockers of the World Unite", or my favorite, "I Started
a Blog Nobody Read", with lyrics like:
"I started a blog, but nobody
came; No issues were raised, no comments were made; I started a blog,
which nobody read; I’ll admit that it wasn’t that
great; But if you must know, here’s what it said; One hundred
of my favorite albums; Two hundred people I can’t take; Four
hundred movies I would like to recommend; Ten celebrities, four of whom
I might assassinate."
The Madison paper picks
up the Kaiser story. "In
an interview with the Times, Deal said that cost overruns were common
and that data showed the new Epic-based software system breaking down
so frequently that doctors and patients were often left for long
periods without access to medical records. He told the Times that 'the
company is wasting hundreds of millions on the project and should
consider scrapping it for a better one that can handle the scale of a
company like Kaiser.'"
What's at 1979 Milky
Way? Epic's new Verona digs.
Interesting tidbits: their sign says Intergalactic Headquarters; the
price tag for the six buildings is $150 million and rising; a 5,000
seat auditorium will be added; each employee has a private office; and
art includes caves, fireplaces, sunflowers, Cat in the Hat,
and The Simpsons. The treehouse, yet to be built, will seat 16. Maybe
they could install Mr. HIStalk in there as the offbeat company blogger,
holding court amongst the tragically hip youth eating tofuburgers
between MUMPS coding marathons.
Raleigh's paper talks
to Tom Skelton of Misys. He didn't tell them much new beyond what he
said in my interview.
Big law firm Duane Morris gets
spanked in Georgia after McKesson complains that the company
was simultaneously litigating both for and against McKesson in two
legal actions involving different offices of the law firm.
Talys, a Bellevue, WA vendor of hospital medication barcode
labeling and packaging systems, gets
$20 million in venture capital. The company, formerly known as
Integrated Healthcare Systems, has 200 hospital customers that include
the VA. Cardinal Health also resells its AutoPharm system under its
Pyxis name.
Jesse Trujillo, formerly of HCA, is named
CIO of St. Marks Hospital, Salt Lake City, UT.
The nurse involved in a Wisconsin medical error made
her first felony court appearance Thursday, with 100 nurses rallying to
support her outside the Madison courthouse. All agree she made a
terrible mistake, but few believe errors without intention should be
considered criminal acts. SEIU weighed in, arguing that the
union has banned mandatory overtime and staff shortages at other
Madison hospitals that can contribute to errors.
Odd: an American woman, whose prescribed overdose of steroids caused
depression leading to her attempt to hang herself with a computer
cable, wins
a lawsuit against the pharmacy that dispensed the medication. She's
already sued the doctor and won. The woman, described as "a priest and
corporate lawyer," earned $550,000 per year and wants $10 million for
the collapse of the consulting business she was setting up. I believe
she's the first person pictured on this page.
Here's another.
She had her own church in England. Other than the lawsuit thing, she
sounds like a lot of fun, although I don't get the priest-lawyer
connection.
Nuance Communications, which bought Dictaphone earlier this year, files
a patent infringement lawsuit against SoftMed Systems.
Even doctors are
using Google to make difficult diagnoses. A journal article
found its accuracy as 58% when Googling 3-5 search terms from each of
26 hard cases. I'm surprised someone hasn't worked out the
legal clearances to supply full-text medical references with a Google
Search Appliance as a searchable medical library.
Merge Healthcare releases
terrible Q3 numbers that were at least filed on time: revenue down 60%,
EPS swinging big into the red at -$0.32 vs. $0.28, much worse than
estimates. Shares dropped 18% Friday after the announcement.
A UK agency announces
IT specifications for blood tranfusion as part of its "Right patient,
right blood" project.
MedQuist announces
Q3 numbers and a slew of legalese. Looks like revenue was down,
earnings into the black to $5 million, but I'm not interested enough to
really pore the press release. Here's
Linda Reino's bio and pic on their site.
I've summarized some of the purported facts about Kaiser and the Justen
Deal e-mail that have been mentioned in HIStalk comments. If you can
verify these or provide others, please
let me know.
- On George Halvorson's first day, he cancelled
KP’s existing $442 million KP-CIS project to implement
electronic health records.
- Mr. Halvorson had also pushed through the selection of Epic
at the health plan he previously had led, in Minnesota.
- KP's CEO and CIO ignored internal engineering
reports which said Epic software would be unreliable for
KP's size and difficult to adapt to KP's scope.
- Mr. Dodd brought in a company called Tanning Technology to
give an opinion on the viability of Epic within an organization as
large as Kaiser Permanente. Mr. Dodd, while serving as an officer of
Health Plan, also simultaneously served as a director for Tanning.
Ignoring this significant conflict of interest, Mr. Dodd paid nearly $1
million dollars for Tanning Technology to give a favorable report on
his and Mr. Halvorson’s predetermined plan to shift
KP’s business to Epic.
- George Halvorson's previous employer, HealthPartners of
Minnesota, has faced significant problems with its Epic project, and,
so far, the Epic software has only been able to completely cover about
half of HealthPartners members.
- A decision was made to replace almost all of the KP home
grown systems ... with one "integrated" system and do it in three
years. Those making the decision had no concept of the real scope this
project or the expertise required to do it. Epic is a good
product whose average client was no bigger that 2,500 users
running on one instance. Kaiser retooled it to scale to 150,000 users
and 20 instances using the same building and configuring
techinques as the average client, which is manually
building and configuring again and again.
- KP-CIS (the homegrown system that Epic replaced) was not a
$400 million loss for KP, it was much more. Somewhere around $4-5
billion. In 2000-2001, KP-CIS was spending between
$500,000 and $750,000 a day.
- One of the major problems with KP-IT stems from the
continous turmoil in the organization.
- J. Clifford Dodd was soon discovered to be on the board of
directors of one of the companies he was outsourcing to. He first
resigned from Kaiser (in an e-mail) and then said that he really meant
to resign from his outsourcing company.
- Epic outages called "Code White" have increased
from just over 9,000 user hours per month in June to over 59,000 last
month. When the system is down, no paper or locally stored data is
available, so treatment decisions are made without any previously
recorded information.
- The 26,500 concurrent KP users figure isn't anywhere near
accurate - it's more like 9,000 to 13,000, on average. Saying 24
hospitals are live on "several apps" means they're live on check in and
registration, and maybe a few people are echarting. Those two hospitals
that are "completely rolled out" regularly (at least every few days)
drop to Code White (back to paper).
- Bruce Turkstra is interim: as soon as they can find someone
outside who will take the job, Bruce is gone, too.