News 12/14/07

From Diablo Cody: "Re: HITSP. Does anyone expect interoperability in that real world on which HITSP touches down infrequently? In a recent presentation, there was a massive number of acronyms, 250 organizations involved without any real accountability, conflicting agendas, and success that depends on volunteerism. They must have got their advice from HIMSS, who has a lock on the well-paid generals and a volunteer army."

From TheInsider: "Re: Azyxxi. I believe Azyxxi is playing 'hard to get' for a good reason. I hear Azyxxi is only a work in progress that's not ready for delivery. If you offered to pay the full price for having it delivered tomorrow, Microsoft would probably not be able to deliver. The announcements about new 'clients' are basically development partners which are not paying for the product (and might even be getting something in return for their participation in Redmond's productization efforts). BTW, this is not a new approach for MS. In other industries that they entered as an ISV, they usually created premature hype to slow down the market (put it into a kind of holding pattern) as a strategy to hamper their potential competitors' efforts before they actually have a product to deliver."

From Betty Grissom: "Re: Meditech with another vendor's clinicals. This idea floated for a decade, with vendors starry-eyed about 25% of market share in the US and 40%+ in Canada. At least three vendors tried. Eclipsys had a dedicated team for several years, working with Osler and SHAMS group. They branded the solution ECA (Eclipsys Clinical Advantage) and gave it a big marketing campaign and sales blitz. They didn't get a single sale. Plus, the price points couldn’t work. 90%+ of the Meditech base bought integration (not interfaces), low cost, and simplicity and would have lost all three. Clinicians may be frustrated with Meditech’s 'good enough' approach to clinicals in a CFO-driven selection, but ECA was actually the worst of both worlds, losing most of Meditech's good points with the work and cost of a bolt-on."

From The Shadow Chancellor: "Re: Linux. Looks like McKesson is planning on jumping off the Microsoft bandwagon and on to Linux for its users as well as for its backend applications." Link. McKesson VP Michael Simpson says hospitals will be ready to run Linux on the desktop in 3-4 years, following good success with McKesson's Red Hat Linux server option for most of its apps.

From Fish n' Chips: "Re: Sutter. Sutter nurses on strike again. Management's solution? Free food (breakfast, lunch, dinner)for those who don't strike." The two-day strike started today, but some hospitals will lock nurses out for three more days afterward. Interesting: full-time nurses at Marin General earn $104K a year, but 96% of the nurses aren't full-timers. Part of their beef seems to be a health questionnaire, which the union claimed could be sent to the employees' insurance carrier without consent.

From Rhio D. Dollaro: "Re: tanking RHIOs. HIMSS disbanded its RHIO committee and turned it over to eHI, which has completely different goals, to wither. The techies were running the asylum. When asked about business case, all they could come up with was, 'it's good for all'.

From Art Vandelay: "Re: RHIO failures. I attended a set of meetings for our local health information exchanges (HIE). The first stumbling blocks were the politics and the leveling of the data competitive advantage a few organizations experienced. These issues weren't resolved before the lack of a sustainable business model and funds for initial investment seem to have really impacted the project. We never really got around to the privacy concerns. Without a government mandate or a realignment of incentives, this just isn't going to happen soon. I see this concept coming-back in about 5-10 years, once the vast majority of the country has baseline clinical data repositories installed and functioning and the standards committees have had time to meet and align. Very localized initiatives where hospitals exchange data with their affiliated physicians' computerized medical records are likely to start springing-up in the place of HIEs. This scope can be managed. Vendors to watch include Novo Innovations, Medicity, MedSeek and dBMotion. The technologies and services of these vendors seem to set them apart from others in the pack."

From LW: "Re: selling patient data. One of your readers posted that Paul Tang keeps talking about vendors doing this, but there is no actual evidence. There actually is. At the August 2-3 meeting of the NCVHS Ad Hoc Workgroup on Secondary Data Uses, a testifier (Dr.Jeff Goldwein, from an oncology software vendor) said, 'We also have external commercial partners that take the scrubbed de-identified data and sell to, and these are consulting and health care research firms that have significantinterest in real time patterns of care and the management of cancer patients. And our program members are cognizant of this, and they fully participate in this partnership. Since Dr. Tang sits on that committee, it may be exactly this that he apparently keeps referring to." Link. I'm beginning to worry less about sellers of de-identified data. All that's lost there is a chance to share profit with those selling it, but I expect that's minimal since, as a reader commented, standalone data of uncertain quality isn't worth much. I'm not really appalled by the practice, although I'd still insist on careful contractual wording. Since no one has mentioned selling identifiable data, I'm assuming that's not happening. Maybe we should be most upset that physician prescribing data is sold to drug companies with doctor information intact, allowing target marketing by Pfizer Barbies for questionably cost effective drugs.

From Pat Watusi: "Re: barcoding. The new 2D imagers can parse through the mishmash of data held within the bar code. Given a little effort, the new readers can parse and display the desired information. Additionally, by implementing a bar code solution in association with the existing pharmacy or CIS application, adverse drug events can be reduced to zero."

From Dingus McGee: "Re: barcode editorial. Your recent entry made me think of the attached article from Paul Harvey." Interesting! I couldn't find any reference to it on the web, so I copied the clip below that Dingus sent in. No copyright infringement intended in running it because I can't even verify that it's real. I didn't see it before I wrote my editorial, but we make similar points.



Listening: Crash Kelly, new, 70s-sounding arena rock.

A reader sent a link to a good editorial by Ian Morrison called The Doctor Conundrum, which deals with unhappy physicians. "Let’s start at home. Consultants and futurists are paid four to five times what they would be in other countries; hospital CEOs, three to four times; administrators of all types, two to three times; and so on. CEOs of health plans who rack up $100 million-plus in compensation over the course of a career are well ahead of the cumulative earnings of all the ministers of health in the developed world. And then there are the sales men and women of America. I want my son to be a salesman because America rewards sales more than almost any other profession. There are armies of sales people in American health care, many of whom are making much higher incomes than the doctors they are calling on. These are just estimates: I urge someone with access to all these numbers (such as the compensation consultants) to publish them. Just wait and see how angry the doctors will be then." Say, sounds like something a muckraker like me would enjoy running.

A couple of readers also sent a link to this piece, The Checklist, from The New Yorker. Peter Pronovost of Johns Hopkins created a simple checklist for preventing line infections, containing the same stuff everybody knows already, with miraculous results. "Within the first three months of the project, the infection rate in Michigan’s I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero. Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative’s first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist ... I asked him how much it would cost for him to do for the whole country what he did for Michigan. About two million dollars, he said, maybe three, mostly for the technical work of signing up hospitals to participate state by state and coordinating a database to track the results. He’s already devised a plan to do it in all of Spain for less. 'We could get I.C.U. checklists in use throughout the United States within two years, if the country wanted it,' he said. So far, it seems, we don’t. The United States could have been the first to adopt medical checklists nationwide, but, instead, Spain will beat us. 'I at least hope we’re not the last,' Pronovost said." This is a great article. Those of use who believe that the greatest value of CPOE is simply getting doctors to agree on order sets and common doses before arriving at the point of decision will be thrilled at the power of simply making and using checklists, the kind we IT types use all the time (anybody ever think of doing formal change management for patient care? I just made it up, but why not?) The list idea isn't anti-IT, either. Why couldn't systems link to Web pages on which lists (with visuals) are maintained to provide just-in-time advice and reminders? There's an HIStalk interview slot waiting on Peter if he's interested.

Add to the list of Computerworld's 100 Premier 100 IT Leaders for 2008 Phil Chuang, CIO of Telecare Corporation. I missed him on the first pass because the company name didn't register as being healthcare-related, but the company does behavioral healthcare. Congratulations.

Serial entrepreneur and visionary Scott Shreeve, now serving as CMO of MyMedLab, asked me to try the company's services and report back. Now I'm not going to trundle off to get phlebotomized for just anyone, but in the interests of participative journalism and since Scott is a darned nice guy, I signed up on the site to have a General Health Screen done. It was slick: you choose the tests you want from a list of what's offered, check out and pay online by credit card ($54, in this case, but Scott comped me), and then print out the lab requisition, instructions, and directions to the draw station. Off you go to Labcorp to get stuck, which in my case involved a short drive and exactly 19 minutes from leaving the car to getting back into it. The next day, your test results are online in a PHR-type application. Minuses: you don't get an e-mail notice when your results are ready and the PHR application is pretty basic. Pluses: you don't need a doctor's order, it works just like you're used to, Labcorp is everywhere, and the results display has some very good info on what your results mean. I don't know how large the market is for people who want (or should have) a serum creatinine or drug level without a doctor's involvement, but the price and convenience should make self-payers pay attention. Verdict: it was easier than I expected and with no drawbacks, with the added benefit of getting your own results and explanation for online access at any time.

Delano Regional Medical Center (CA) goes live with Sentillion's Vergence Clinical Workstation.

NextGen announces its business service division, which will offer revenue cycle management services to physician practices via web-delivered software.

Catholic Health Initiatives chooses PatientKeeper's physician system.

MedAssets raises $213 million in its IPO, selling at the top of the announced $14-16 range and popping up another 30% in today's first day of trading.

Osler Health Centre installs Swisslog's PillPick drug management system.

Medsphere finishes its OpenVista implementation at two state hospitals in West Virginia.

Some of the 119 jobs on HealthcareITJobs.com: Director of Clinical IT (MA), VP of Research Services (NC or PA), VP of Informatics and Reporting (FL), CDR Manager (CA), Pharmacy Clinical Support Manager (CA). Employers can post listings free through January.

ABC News does a story on the VA's IT systems. "This hi-tech care isn't just a godsend for patients; nobody loves it more than doctors. So why do VA hospitals, even with all their challenges, do this and private hospitals don't? The difference is the VA's life-long relationship with patients. It gives them a strong financial incentive to invest in technology that aids preventive medicine." It says that only 5% of hospitals have electronic medical records, which is surely a mistake (sounds more like the CPOE or ambulatory EMR percentage).

Odd story: Easton Hospital was going to lay off its chaplain, but decided not to.

A Florida State University study says that IT-using community hospitals have better patient outcomes.

Ron Latta is named IT director at Rockingham Memorial Hospital (VA).

E-mail me. Where do you think all those cool reader comments above came from?


Inga's Update

I loved Mr. H’s “Want To Anger a Nurse?” piece. I agree with Anonymous that the issue is less about how much more difficult it is to be a nurse than a grocery clerk, but how little hospitals and technology have done to make their jobs easier. Never having worked in a hospital, I learned a bit about some of the minutiae nurses must deal with. I bet they don’t teach a lot of that in nursing school to the wide-eyed youngsters who think nursing is all about saving lives. No wonder nurses get burned out so easily and we have a shortage.

Henry Ford Health System will use eHealth Global Technologies to digitize medical records and images from referring providers.

The VA places a $21.8 million order with QuadraMed to renew its Encoder Product Suite license plus training services.

The New Mexico VA Health Care System selects Picis perioperative automation. Picis president and CEO Todd Cozzens says the company is “quickly becoming the de facto standard for automating high-acuity areas of Veterans Affairs hospitals.” 

From JimMac: “Quick thought on the Mac mystique you mention in your HIStalk posting today. If you've never used a Mac - especially Mac OS X - you can't really be expected to understand it. It is kind of like walking around town in a bad pair of shoes with a pebble in one. Sure, it's uncomfortable, but you don't know any better. You figure that everyone has that discomfort. That's Windows! Now, suddenly someone gives you a pair of shoes that are as comfortable as slippers, perform like the best running shoes, and look as good as a pair of Pradas. That's the Mac.” You had me at Pradas.

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