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  • 5 yrs 5 wks 0 days old
  • Updated: 15 Jul 2008
  • 915 entries
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HIStalk Quotes

Monday Morning Update 11/13/06

posted 11/11/2006
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 It's not a bad product, it's just outdated.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 Supporting an orphaned legacy product is not fun and it's hard to escape the label of being as outdated as the product you work on.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.



1. Disgruntled Ex-Epic Employee left...
11/12/2006 10:58 am

To PTSD's comment: Epic won't acquire any other company (that's one of Judy's "principles"). They find other people's good ideas and then build them for themselves. Less cost, more control.

To everyone else: Alleging that Epic is an inferior product is barking up the wrong tree (and makes me a tad suspicious that you're a Cerner employee). The reason to hate Epic is their lousy treatment of their people and their violations of WI labor law. From their mandatory 45-hour work week to their age-ist and racist hiring practices (Epic does not generally hire anyone over the age of 25 and it rarely hires African Americans or Hispanics) to their union busting, Epic is a blemish in the cradle of the Progressive Movement and the US union movement. It amazes me that the land of Fightin' LaFolette allows them to do what they do, but I suppose that Verona doesn't want them to pull up stakes when the tax-breaks Epic got to build out there expire. Face it, Epic makes WalMart look like an employee-friendly company! And regardless of your politics, exploiting your workforce will eventually come back and bite you.


2. FormerMisysMgr left...
11/12/2006 2:13 pm

I concur with much of the comments from OutsideIn and Raleigh1776 about the limited ability of the middle managers within Misys to freely voice opinions that were unfavorable in the eyes of Tom Skelton and other senior executives. There was rough going for those who found fault with the wavering PPO initiative, the mind-numbing overuse of the“geese” video, the lingering Lean Six Sigma projects (DNA, end-to-end sales), project Viking or a number of other items. The comments of OutsideIn and Raleigh1776 are spot on and those still remaining within Misys would be wise to keep that in mind! In his posting, Scott Sanner noted to Tom Skelton was to busy to be concerned with "sniffers". I agree…Skelton himself didn’t put the sniffers onto the network. Still, when the need for information about a failing partnership arose, that information on what was communicated, who was involved and how this information got out of Misys was “miraculously found”. Isn’t that brilliant to imagine even though those directly involved had deleted their files or no longer had copies of the information? Hmmmm? Dirty work such as uncovering these types of communications, chat, etc. is often carried out by underlings. That gives distance and deniability to senior managers.


3. Gadfly left...
11/12/2006 2:40 pm :: http://corphq.livejournal.com

I wonder if Kaiser reviews the *employment practices* of their vendors before choosing them? If we ask companies to look at whether they are condoning a sweatshop or upholding a dictatorship in some other country, isn't it just a matter of business ethics to look at how potential U.S. partners treat their employees as well? Also, this looks to me like Epic could be a lynchpin in examining the "all work with computers is exempt" policy of the DOL.


4. Works More Than 40 Hrs Regularly left...
11/13/2006 12:05 am

Re:Disgruntled Ex-Epic Employee. Reading your comments about Epic and looking at your handle makes me wonder if your comments are truly objective. 45 hrs a week isn't that uncommon for most professionals these days. I'm sure others who read this blog (docs, consultants etc) work long weeks themselves. Are you sure it was mandatory? Or maybe you are just taking the "working 9-5" expectation too literally? As far as the labor practices etc comments from you and also by Gadfly, just read the link that Mr.Histalk posted to the story about Epic's new campus. Sounds like a pretty sweet place to work to me! Regardless I hope that after you left Epic you found a job that met your work hours expectations and are happy with it.


5. +40 hour worker left...
11/13/2006 8:17 am

I would have to agree with the comment above about it not be uncommon for people in this industry to work more than 40 hours a week. The thing about software is that there is no light at the end of the tunnel; there will always be something more to do and if you are someone who can't prioritize, say no, or delegate, then you'll find yourself in your office very late at night indeed.


6. anonymous left...
11/13/2006 9:26 am

Epic's also not in the habit of sending out anything resembling a "tick tock" email. Let's be fair here before you start throwing about the computer exception to the labor laws.

Also, when a fair percentage of your employees are just out of college or grad school and are used to working 12 or 13 hour days every day of the week, a 45-hour M-F work week seems like a dream in comparison. I know I've worked places where they require you to "volunteer" for Saturdays and have extra time on busy days like Mondays - turning your 40 hour week into a mandatory 50 hour week. Epic sounds pretty darn nice.

From what I've heard from friends who work there and as it's been mentioned in HIStalk before, Epic hires young because it's easier to train new habits than untrain old habits. There are plenty of new hires over the age of 30. As for "racist" hiring practices, I wonder how closely the various hiring rates for different racial backgrounds corresponds to the applicant rate?


7. Former Kaiser IT Manager left...
11/13/2006 3:51 pm

I worked at Kaiser IT on several projects over a twelve year period. The problem is not just Epic. It is the overall tribal culture at both the IT and Call Center departments. Mediocrity is rewarded, talent is fired, and God forbid if you have a disability or are the wrong religion.

I speak from experience. After four successful long-term projects, I was contracted to work on a large implementation project at an executive level. While there, I began undergoing a problem with my eyesight. This, in no way, impacted on the quality of my work, though it was a difficult personal experience.

It became a professional problem when one of the other executives took to approaching me rom behind at meetings, clamping her hands on my shoulders which caused me to jump, as I did not have the peripheral vision to see her approach -- something I had informed her of. She would then complain loudly throughout the meeting that I had a tendancy to overreact.

When I brought this to my superior (who was at a high executive level), he told me she had been complaining for several weeks that my personality was not suited for Kaiser, calling me too 'excitable' (not a description anyone who knows me would apply). When I pointed out the quality of my work and that I got along with everyone else, the executive confided that the woman was a personal friend of the head of the call center and that the head of an IT area I was in charge of converting had made comments about my religion and did not want me there, either.

As I was not an employee and could tell this executive would not risk his job for me, I had no recourse but to move on.

I have not worked since.


8. Anonymous left...
11/13/2006 9:33 pm

To the person who commented on Epic's campus, that's exactly the impression it wants to create. The reality is, it's much more like a normal company than it cares to admit. Which doesn't make it bad, it's just that a lot of people resent the propaganda once they realize Epic isn't really what it says it is in terms of the work environment. The other factor is the much-discussed cult-like mentality at Epic. It's not just the hours, which are sometimes long but not always. What gets to people is the implicit expectation that you buy into the job with mind body and soul. And related to what another person wrote, it's easier to get new grads to do that, and if not, they're easily replaceable.


9. FromOneAnonymousToAnother left...
11/14/2006 9:12 pm

To all the CEOs and executives of companies out there today, how many of you would like your employees to buy into the vision and goals of your company with their mind and soul. Or would you prefer that your employees be half committed to their jobs and not be willing to do their best, and that they're just there for the benefits and paycheck.

Microsoft has a culture, Google has a culture and Disney has a culture, to those who like it those corporations are brilliant and to those who disagree it's cult-like. I say to each his own, Epic employees I'm sure are smart and bright (esp if they all graduated from college), they can make their own decisions on whether they like Epic or not and obviously move on if they don't ... no different from any other job out there.