Monday Morning Update 12/12/05

CIO Field Report

• Hospital type: Community, Single Hospital, 200-400 Beds, Midwest.
• IT Operating Budget: <2 million.
• Most important IT projects now underway: Electronic Clinical Charting, clinical equipment feeds to EMR, single sign-on w/ 2-factor authentication.
• Systems you’ll be buying within the next three years: E/R Management, CPOE (Clinical Provider Order Entry.)
• Best application vendors: MEDITECH, McKesson (Series), Arrendale (Transcription.)
• Worst application vendors: McKesson (Pathways & Horizon apps,) Dictaphone (a pain to deal with,) Dictaphone (they've earned a double entry.)
• Hottest IT skills in the market: Wireless network support & security. Professionalism is key.
• Hottest people in the  HIT industry: John Glaser (knowledge,) Dave Garets (influence,) Mr. HIStalk (realism.)
• Trends really heating up: electronic charting,, secure remote access, secure mobile access.
• Comments: Like a potential spouse, sex & glitter sells. However, if we are to have a long-term relationship with our vendors, we need to get to what's inside & lasting. I appreciate HIStalk's efforts to help us with that all too important detective work.

If you're an IT director or CIO, fill out the CIO Field Report form and I'll send you an HIStalk Yearbook 2004 ($40 otherwise, and worth it.)

One year ago in HIStalk: WRQ was sold, the VISICU-Cerner-iMDsoft lawsuits were flying, HIStalk featured an interview with Howard Messing of MEDITECH, and HIStalk was averaging 232 visitors per day (more than double that number today.)

SAIC gets a $68 million CDC biosurveillance system contract, bringing in subs FCG, McKesson, and Healthcare Enterprise Innovations.

Nurses at an Oregon hospital file a complaint over the hospital's new staffing model. State law requires hospitals to solicit input from nurses before changing nurse staffing.

Should the FDA regulate clinical information systems the same way it does other decision-making applications? Anonymous Reader checks in: "More scary than not having UI standards is not having a 'gatekeeper' or watchdog over clinical systems. Any programmer can code up anything and ship it to clients. The increasing norm is to cut testing, especially if the software contract contains penalties for late delivery. A classic example is at Gerber Alley in early 90s. Programmers (financial people transferred to clinicals) added a 'feature' to roll up baby weights to next pound, like pennies to the dollar on a balance sheet. The system would then recommended doses for a 1 pound, 1 ounce baby that were double the recommended dose. Is that any less important than FDA's oversight of lab interfaces or blood bank software?" Based on some of the stuff I've seen from the big-name CIS vendor at our place, I'm beginning to reluctantly agree that outside oversight (by someone other than surprised customers) would help. Vendors are kicking crap out the door that clearly couldn't have had even a minute of testing, like when the function locks up 100% of the time when you access it from the menu. I'm sure they understand the concept of testing and have the tools to do it, but you'd never know it. Sample conversation:

(Us): "After several days of testing, we've figured out the scenario under which doses of critical doses aren't being sent. It's complicated, but here's the way it happens."

(Vendor): "No need to tell us. We already know about that and have fixed it."

(Us): "You already knew about it and still risked our patients by not telling us, not to mention all the time we wasted tracking it down and figuring it out? That's disappointing. Well, how can we get it fixed?"

(Vendor): "It's in a future release." One we had no intention of applying anytime soon because of all the critical problems each release causes, which then makes us rush the next upgrade to get the fix, which then breaks new stuff, and ... well. you know the story.

A UK doctor makes a big mistake when he forgets his cell phone at a gay bar. Patrons trying to identify the phone's owner found child pornography and called police. The doc admitted that he had downloaded the pictures from the Internet and was arrested.

Who knew that chiropractors have EMR systems? Is anyone trying to lure them into RHIOs?

Looks like Tommy Thompson is welshing on his promise to have a VeriChip implanted. Flush with enthusiasm at being appointed to the board of Applied Digital, he promised to have the implant back in July, but now seems to be waffling. I bet the company just wished he'd kept his mouth shut since it looks fishy that he backed down after seeing things as an insider.

IDX says it has settled its shareholder class action lawsuits, filing requested information via SEC form 8-K. Divulged: 20 other interested companies filed confidentiality agreements to look IDX over and two of them (other than GE) expressed an interest in acquiring the company. Only one made an offer and it was for less than GE's bid. As I've said here all along, they were darned lucky to get that price just before their most recent quarter's poor earnings and prospects were announced.

Two New York city employees are charged with stealing more than $10 million in FEMA 9/11 money. The MIS director of the medical examiner's office, along with his main squeeze who was director of records in the same department, is accused of setting up phony companies to get FEMA computer bids.

Personal health records company Medecard announces that it's for sale, including its rather cheesy web site. Nothing on the site tells who is involved with the company, and the press release hints only at a mysterious "The Chairman." I wouldn't hold my breath for a lot of interest.

The LSU Hospital System lays off 2,600 employees. The hospital is still begging for federal money.

SEIU workers, including some non-exempt computer staff, will strike for 24 hours at Stanford (both the Hospital and the University) starting Monday morning.

Biased news example: KLAS-TV's story on a proposed clause allowing pharmacists to refuse a prescription on moral grounds. Note that objections of unnamed "critics" are summarized, multiple references to "your prescription" as though individuals are being singled out, and a statement that specific groups are "terrified." The idiot TV journalist was proud enough to put his name on this piece of biased, amateurish "reporting" that's poor even by low TV standards. There's never a time that I'm desperate enough for news to want to get it from TV since even the most incompetent local newspaper (or even blogger) will do a better job 95% of the time than those chatty talking heads.

$49 million of Best Buy money will fund bioinformatics research at Mayo.

From the stock message boards:

Cerner
"Respect your desire to spend time with patients and agree. 1)Need for regulation - oversight, know that strikes fear in hearts of many. But, with no mandatory EMR application testing for vendors or providers, we see compressed test cycles with miminal integration testing at vendor sites and hospitals, with resources short and schedules agressive on both ends. The consequences should be obvious. 2)CPOE doesn't save data entry time if you don't use standard orders or order sets, but should be close to a wash if complete orders are written. Time savings is in the whole process, e.g. lab order to lab, specimen drawn, diagnosis made, treatment initiated. You don't seem to value the safety checks. If I was your patient I'd value that in addition to your time at the bedside. There are hidden time savings in CPOE, e.g. much less phone calling (RN, MD and Rx)for order clarification, no delays due to incomplete orders, and removes legibility as an issue. NO WAY should it take 2 - 3 minutes per order - clear example of poor design and WF support, unacceptable I agree. 3)Many MDs are responding to deceased revenues by increasing patient visits per day, where markets support it. Worked recently with oncologists scheduling 70 visits per day, looking to add more. Most often seen use of any MD time savings I see used for more balance in work/life, or increasing visits to overcome less pay per visit, thus shortening even futher the time per patient average. Can you envision replicating FDB functionality for drug checking in a paper process? Apparently many other MDs share your perception re the lack of value of CPOE, based on adoption rates which while increasing, are still low."

IDX
"2 years after signing the contract they finally got a PIM live. Wonder how long it will take for GE to mothball the Carecast division in favour of their own EPR."

"Go back and count the cars and order the pizzas. IDX and Carecast weren't the only ones struggling. As well it's not all the fault of the software. Now, if BT and IDX would have done a better job in managing the client and their expectations, they probably would have been much further along than the one hospital."