Monday Morning Update 11/26/07

From Jay G: "Re. CIO's Healthcare CIO Summit. I got to attend the recent Scottsdale event. The resort location was quite impressive, but we didn't have much time to enjoy the surroundings. The organizers had things scheduled from morning to evening, with roundtable presentations during lunch and vendor presentations during supper. Vendors reportedly paid over $30K to sponsor (which works out to ~$2,000 per 45-minute one-on-one session with a CIO). At that rate, the organizers were pretty aggressive about making sure that the guests got to their sessions. Vendors ranged from hardware (UPS) to implementation consultants. I heard positive comments from guests ('learned about a variety of solutions') as well as negative comments ('waste of time'). Overall, it was an interesting example of how much vendors will pay for face time with a CIO."

From CIO Guy: "Re: HBR. ave you seen the Case Study authored by Glaser in this month's Harvard Business Review? It is a little quirky, but I think he did a good job overall. How did they choose the respondents?" I couldn't find the article by searching on their site, but I like quirky.

From Former Misys Manager: "Re: Misys. Sunquest Announces New Investment and Market Focus for its Radiology Information System." Link. Smart move. I expressed surprise that Misys sunsetted Flexirad and the PIM PACS broker in the first place. I expressed surprise once again when Sunquest re-emerged as a LIS-only vendor, having dumped rad, pharm, and clinical decision support apps along the way that were good, marginal, and immature but promising, respectively. The last radiology upgrade was in December 2006, so they can pick up the cycle pretty easily if they still have the right people. Their PE investors could consider acquisition targets that have complementary clinical offerings, like TheraDoc or E&C.

From The PACS Designer: "Re: what to read. TPD peruses the Ebling Library, Health Sciences Learning Center to find interesting reading material. Ebling is in Epicland at the University of Wisconsin-Madison, so it's in the right location for healthcare research devotees although you need a UW-Madison ID to access the library remotely. There are over 1,900 biomedical and health sciences journals in the online library. If you find something good that HIStalk readers may benefit from, please post a comment so we all learn something new." Link.

From Rich Kremsdorf: "Re: what to read. Here is a link to the reading list I maintain on my website. It was developed for MDs who find themselves in HIT leadership roles, but is more generally applicable." Link.

From Duuude: "Re: informatics programs. I recommend UAB, which has done a good job of training eventual directors and CIOs in healthcare IT. It misses its founder, Merida Johns, but still does a good job."

From The Shadow Chancellor: "Re: UK identity loss. This quote sums it up: 'Let us be clear about the scale of this catastrophic mistake - the names, the addresses and the dates of birth of every child in the country are sitting on two computer discs that are apparently lost in the post, and the bank account details and National Insurance numbers of 10 million parents, guardians and carers have gone missing." From this newspaper editorial: "Yet when asked if this fiasco effectively ends plans for identity cards, government ministers say no, still holding to a misplaced belief that ID cards will help make Britain safer. This is a contempt-ridden response. All politicians should be judged on their record. On anything to do with data and IT, this government has a woeful record, illustrated by the millions wasted on an NHS computer system that after years of consultancy fees still does less than a doctor with a notepad and a Biro. And the lessons learned here? There have been none. The plans for ID cards, with all the complexity of biometric data they are supposed to contain, are said to be still on course." Biro is apparently Britspeak for a pen.

Tim Belec, VP of IT at Wheaton Franciscan Healthcare, was shot in the parking lot of the organization's Glendale headquarters as he left work on Tuesday. A 17-year-old suspect approached Belec and robbed him of several items, then shot him twice in the chest with a .38 pistol. The 50-year-old Belec, a former police officer, gave authorities a description of the suspect and weapon, leading to his arrest. Belec was moved out of the ICU at Froedtert Hospital later in the week and no updates of his condition have been posted since, but he is expected to recover. Wheaton had recently increased security after vehicle break-ins and now plans to fence the property and hire additional security guards.

Bill Yasnoff sent over a link (warning: PDF) to a new report on health record banking called "Improving Health Care: Why a Dose of IT May Be Just What the Doctor Ordered", by The Information Technology and Innovation Foundation. I'm beginning to like the concept since it seems to address the major issues that are holding back information exchange (privacy concerns, technology challenges, business models).

I guessed wrong on the system used to inappropriately access celebrity medical records in New Zealand. Wrong Concerto - theirs was Orion Health's Concerto portal. Makes sense since both are from New Zealand.

I haven't heard a word about the recent Virtual HIMSS.

Everybody's read the headlines by now: the newborn twins of actor Dennis Quaid are given heparin 10,000 units instead of 10 units at Cedars-Sinai. They got a quick PTT and protamine doses and will probably be OK. I'm betting it was the same problem that happened in Indianapolis before, where pharmacy technicians loaded the wrong vial into the Pyxis dispensing cabinet and nurses didn't pay attention to the label on the otherwise nearly identical vials. Barcoding, people.

McKesson VP and former Per-Se chief accounting officer Richard Flynt joins Immucor as CFO.

Healthcare organizations in Maine get a $3 million FCC grant to bring in broadband connectivity.

Baxa signs on as the exclusive reseller of software from MedKeeper that tracks the preparation and delivery of drug doses packaged in the hospital pharmacy. Everybody involved in MedKeeper used to work for Micromedex.

A Berlin hospital is involved in testing a brain-computer interface that could help people who are  paralyzed. It uses EEG signals to control a robotic arm, in essence making it a thought-controlled device.

UMass Med Center uses RFID to track stents and other devices via smart cabinets that inventory their contents and update them as items are removed.

A Michigan woman faces fraud charges for continuing to use employer-paid medical insurance for eight years after she was fired, running up $230,000 in expenses. She got on the county-paid BCBS plan, was fired after 10 days on the job, but kept getting new cards because the county screwed up.

The guy who started Hotmail and sold it to Microsoft for $400 million uses the money to launch a free, online semi-clone of Microsoft Office. That's one irony; the other is that Microsoft itself set the legal precedent that may keep them from suing him over look and feel issues, from a 1994 ruling that Apple lost to Microsoft claiming that Mac graphics were copied for Windows. Trivia that I didn't know until now: they guy came up with the name Hotmail as the sounding out of HTML. Great quote: "We are just a few years away from the end of the shrink-wrapped software business. By 2010, people will not be buying software." I signed up for an invitation, so I'll let you know.

The New York Times magazine has a fascinating look at how drug companies get private doctors to pimp their wares to colleagues. $500 for a one-hour lunch chat, luxurious "training" (i.e., brainwashing) that includes Broadway tickets and cash, and buddying-up with the local drug reps who grade their selling performance. Startling: 25% of US doctors get paychecks from drug companies for pushing their goods. "Naïve as I was, I found myself astonished at the level of detail that drug companies were able to acquire about doctors’ prescribing habits. I asked my reps about it; they told me that they received printouts tracking local doctors’ prescriptions every week. The process is called 'prescription data-mining,' in which specialized pharmacy-information companies (like IMS Health and Verispan) buy prescription data from local pharmacies, repackage it, then sell it to pharmaceutical companies. This information is then passed on to the drug reps, who use it to tailor their drug-detailing strategies."

Doctors, when they are patients anyway, think doctors do a sloppy job with paper medical records. One doctor quoted had a cheek lump that went away, but his chart said he'd had a stroke.

Sumter Regional is doing great in the "Win an MRI" contest with 136,000 votes, well ahead of second place Lockport Memorial's 73,000. But, voting runs through December 31, so they would appreciate some clicks, I'm sure. While you're there, check out Othello Community Hospital's (WA) "MR Chick Magnet", which is pretty funny in the prevalent "we're hayseeds" genre.

What HIT people are reading:

Redefining Healthcare
The New CIO Leader: Setting the Agenda and Delivering the Results
Crossing the Chasm
The Innovator's Dilemma
How Doctors Think

E-mail me.


Art Vandelay on the Near-Term Vendor Frontier

We can see the intermediate strategy emerging for a number of vendors. Two strategies ago, vendors were working on a set of bolt-on applications targeted at work-queue and workflow enabling the old-and-tired applications in our environments. Some vendors elected to partner for bolt-ons, others elected to build them, and still others had a foot in both worlds. Representative strategies were to add billing and collection queues and registration and authorization queues for payer-rule intensive areas ( i.e., high-end diagnostics, surgeries). The next strategy was to provide visual workflow aids (i.e., bed boards) and visual integration of information (i.e., patient context enabling any best-of-breed applications in the environment, portals) as well as pursue the enhancement or re-architecture of general-use clinical systems ( i.e., systems supporting order entry, general documentation, not specific departments).

We are on the verge of another strategy shift, one back towards a focus on the functions enabling departments and the emergence of the next stage of integration with real-time location systems (RTLS). The major single-source clinical system vendors ( i.e., Cerner, Eclipsys, Epic) have poor capabilities that enable the workflows and effectiveness of "specific-use departments" or care delivery areas (i.e., cardiology, emergency department, lab, oncology, pharmacy, radiology, procedural medicine). As the deployments in the "general-use care delivery areas" ( i.e., ICUs, medical-surgical floors, ambulatory primary care) progress, the focus will turn back to the "specific-use departments" who "took one for the team" and are now swimming in the inefficiency of a single-source system. The single-source vendors can choose to address the issue and keep their customers happy and engaged, or they can continue to short-change these areas.

Vendors who short-changed these areas, or who can execute two major strategies concurrently, will likely focus on the acquisition of or partnering with vendors on RTLS. Health care, as an industry, is usually behind other major industries. Real-time feedback and visualization has been a focus of other industries for over 5 years now. We are just getting to this. The next stage of RTLS integration will involve the visualization of and enablement of tasks and workflows on a macro-basis, not just focused in a "specific-use department." This next stage of integration will involve visualization of orders, pending activities ( i.e., documentation, medication administration, transport), patient health status and staff workload. Beyond this, I can see the systems evolving to show or predict the picture hours in advance to help sequence future tasks and determine if additional staff are needed.

On the far horizon is the reinvigoration of revenue cycle systems, it is inevitable as the disenchantment with the broad yet not deep clinical systems will grow and the economic situation in the country becomes more challenged.  As always, the million-dollar question is, "Can vendors evolve or will there be more strange appendages and vestigial structures bolted-on to an inflexible architecture?"