Monday Morning Update 12/05/05

From Anonymous Reader: "Can you give me the scoop on what the HIStalk CIO Enrichment Index is?" Welcome, new reader! It's the CIO's salary divided by total organizational revenue, multiplied by 100,000 just to make a nice round number. My idea in creating it was to assume that CIO salary has some relationship to the size of an organization, but is still comparable by expressing as a percentage, much like comparing IT spending as a percentage of revenue or expense. Anything between 20 and 60 is the sweet spot. Something over 500 is the record, meaning it sure looks like that CIO is overpaid.

Speaking if CIOs: if you're one, consider filling out the CIO Field Report (warning: .DOC file.) These will help HIStalk readers understand what's going on with providers. You'll be anonymous, of course. Carrot: if you'll complete one (CIOs or IT directors only, please) I'll give you a gratis copy of the HIStalk Yearbook, your choice of 2003 or 2004 model. Thanks for your consideration.

I had mentioned the surprisingly large number of discussion board reads and now I know why. Matthew posted a link from his blog and an Epic insider said they did the same on the company's intranet. Anony-Mouse, you're a star now!

I've enjoyed the discussion about databases. My takeaway: don't buy a system if (a) its vendor can't or won't give you the schema and dictionary; (b) if your techies look it over and say it sucks; or (c) if data elements of important, recently designed functions look haphazardly grafted on. One could make an argument that most product evaluations could have just two parts: a review of product documentation and a demonstration. All of the other stuff (site visits, references, RFI, etc.) is more a measure of services and other intangibles. The product is what it is, regardless of how other folks use it.

It just missed being my Quote of the Week: from Neal Patterson on Cerner's involvement in rodeos, "There's something odd but great about having your company's name on a bull chute." Now it makes sense ... all those comments I've heard about "Cerner bull chute" were about rodeos.

Speaking of Cerner, it lives! Neal's infamous "tick, tock" e-mail shot to ass-ociates heard 'round the world is revived yet again as a classic case of the downtrodden American worker in a new book about workplace shootings called Going Postal. Here's their take: "If you think the American worker has things easy, consider Neal Patterson, chief executive of Cerner who, in March 2001, sent his managers a scathing e-mail complaining that there weren't enough employees showing up at work before 8 in the morning or staying to work into the night. 'We have a big vision,' Patterson wrote. 'It will require a big effort. Too many… are not making the effort.' As part of a solution, Patterson urged his managers to 'call some 7 A.M., 6 P.M. and Saturday A.M. meetings with the EMPLOYEES who work directly for you.' Later, he wrote that he would be watching the parking lot, which 'should be substantially full at 7:30 A.M. and 6:30 P.M. The pizza man should show up at 7:30 P.M. to feed the starving teams working late.' Patterson's callous missive almost defies commentary, and Ames deftly allows him to speak for himself, throwing in a few good jokes along the way." The fifth anniversary of that blast from the past is coming up, so maybe a redux is in order, or maybe someone could perform an outcomes analysis (log the pizza man's comings and goings.)
 
QuadraMed signs a deal with kiosk maker and hot property Galvanon to remarket its MediKiosk product as TempusOne MediKiosk, in a startlingly unoriginal abutment of one equally unoriginal conjoined word set with another. Actually, it's a triple: QuadraMed TempusOne MediKiosk. DopeyMarketers, if you ask me.

And speaking of  liberal arts majors gone amok, check the "aren't we so clever" headlines at Health Data Management. Niagra Falls for Web-Deployed PACS? What a hoot those merry funsters are! Seriously, other than the blogs and newsletters, does anyone cover our industry well? (press release, ads, and fluff pieces don't count.) You never read anything other than slavishly loyal slop that proclaims how wonderful every vendor is and how successful every hospital's implementation has been. Mores sales (even of junk) means more ad spending, which obviously means a lot more to the rags than getting useful information in your hands via your free copy. I've been on the inside of some really bad hospital projects that suddenly became logical and enviable when recounted in those waxy pages. But of course, you're getting that sophisticated humor for free.

Children's Boston gives away 1,400 PDAs with Skyscape software to docs. I don't know how it is everywhere else, but at our place the only time I see docs using PDAs is to look up reference information. I never believed all those folks who thought PDAs would dominate healthcare (other than as dust-gatherers.) Too hard to read, no fast and inexpensive national wireless network, and too many security concerns. Luckily they're cheap enough to be used as an electric book reader. Remember HIMSS a few years back when all those PDA software companies run by kids thought they were going to take over healthcare? Almost all of them were one-HIMSS wonders.

Investor's Business Daily is rah-rah on healthcare IT (and heavy on the pun-slinging like HDM.) They point out the wonderful work being done by Sun and IBM on infrastructure projects. Here's a breezy summary: "There's no national framework yet for such a system, but a number of regional projects are working toward that goal. Several large hospitals have already set up systems that let patients see lab results and other records online. But digitizing records is the easy part. Setting up a universal network that links all parts of the health care system together — and standardizes medical information between all of them — is a much tougher task." Digitizing records is the easy part? Check out the quantity and quality of data available for those fancy networks to share. Hospitals can't even generate enough real information for themselves to monitor outcomes, costs, market share, and physician performance. Existing systems and optimal use of them will have to improve a lot to make shared data useful, although we're lucky that in healthcare, e-prescribing and e-mailing of PACS images is still seen as cutting edge.

Mr. HIStalk's Guide to RHIOs for CIOs, in easy steps:

1. Participate eagerly in meetings with your competitors as they talk about sharing data, making sure to speak in generalities and offering no participation beyond attending more meetings.
2. Go back to your co-workers and sneer at how stupid your competitors are and how backward their systems are compared to yours.
3. Report back to your fellow VPs that there's really nothing in it for your organization, but that you'll listen politely and avoid all commitments just so no one gets mad.
4. Respond to latest of 100 surveys asking about RHIOs, making sure to wax poetic about the wonderful possibilities that will result from the electronic hand-holding that RHIOs will bring, knowing full well it won't happen until benefits are offered to those involved.
5. Go back to your co-workers and make fun of all the folks who've forgotten CHINs and therefore are doomed to repeat history.
6. Ignore sales pitches from vendor RHIO participants who got involved only to troll for new business.
7. Go back to your co-workers and make fun of the IT organization of the local IPA or medical society, consisting of one doctor's brother-in-law armed with an AA degree and an A-Plus certificate.
8. Prioritize your IT shop's involvement in RHIO work somewhere between "get rid of all the cubes and give everyone an office" and "seriously consider moving all desktops and servers to open source operating systems."
9. Go back to your co-workers and explain to the bright-eyed among them who ask about RHIOs that it's "no margin, no mission" and that it will be a cold day in hell when you voluntarily share your exquisitely created and managed information with the clueless barbarians across town with their pathetic IT systems.
10. Get on the speaking circuit and HIMSS advocacy groups to make sure your attendance at RHIO meetings is rewarded with industry visibility as a RHIO thought leader.

Internet addiction is now a disease, with only ADA protection standing in the way of full stature. How is that different than someone who is a voracious reader or an athlete spending ten hours a day on their sport?

Jayant Patel, a former Kaiser Permanente surgeon on the run from Australian authorities and also known as Dr. Death, is spotted hiding out in his luxury home in Oregon. He killed 13 patients through incompetence after being recommended by Kaiser, for whom his wife still practices medicine. His record at Kaiser wasn't a whole lot better, but he was allowed to operate there with relative impunity for several years before the state finally yanked his papers.

Only in healthcare: everyone agrees that a Mississippi county with 82,000 residents and only 67 hospital beds needs many more. The good news: three groups want to build them. The bad news: none are expected anytime soon because the three groups keep tying each other up in court for fear of losing ground.

The first IDX system is brought live in London's NHS, a year late but no doubt a relief for primary contractor BT.

New York's Beth Israel Medical Center will pay $72 million to make Medicare fraud charges disappear, initially uncovered by a whistleblower lawsuit.

Strange: a hospital parking valet is found in a nurse's home under her bed, where he had hidden for up to two days with video equipment and condoms. He used a key from the woman's ring to enter her apartment, where he set up a video camera pointing at the bed he was hiding under. The man had been fired earlier after stalking complaints from the woman. A "male friend" of the woman heard movement under the bed early Sunday morning and beat the intruder with a flashlight.

Ray Shealy is named CEO of HealthCare Transaction Processors, a midwestern RHIO and claims software company.

From the stock message boards:

First Consulting Group
"Hostile takeover? Can I have some of your drugs? It was very encouraged on both sides and actually happened just days before Superior was supposed to close a deal with ISCG. Actually I think there was even a $$ penalty to pay. Jim and David hit it off famously, similarly philosophies, similar styles. Then we lost Jim, and all bets were off on making it work with other than the original 2 dealmakers who might have made it successful. While LBO was fighting for power, focus was lost, and so was hope. Who makes up this 'hostile takeover' stuff?"

Cerner
"First, the GE Medical acquisition of IDX hasn't closed and won't until January 2006. Second, what is GE going to install? Anglicise Centricity? No hospital in London want Carecast. This is a fact and there are no active deployments right now. Third, IDX already lost 1/2 of London when the PCT's went to local player Servelec. All they have left are the acute systems. Servelec is billed as an interim solution until 2008 but do you think cash strapped NHS hospitals are going to swap a major clinical system in 2 years time? No way. Review of the facts: IDX has already lost 1/2 of London (look it up), IDX has no deployments going in London cluster right now 2 years into the program other than the one that just went live, GE does not have an anglicised product.CERN on the other hand will have almost 20 LIVE sites in the south by the end of March. If you were BT what would you do? Continue to back a company that cannot deliver on the contract or go with a company that can clearly handle it? I bet the Cerner UK parking lot gets a lot fuller in 2006!!"

Eclipsys
"I was not there, but heard everyone is excited about Andy's plan of action. Gene got the ball rolling over the last few months by refocusing the company on customers and employee satisfaction. More has been accomplished in the last 6 months than the prior 4 years. Andy has the right message with a focus on winning and customer success. The company is reenergized."

"Pep talks are cheap. Either he cleans house of some highly paid failures, changes the culture and makes some real strategic decisions or he is just the latest empty suit scamming a big salary from this company."