Intelligent Healthcare Information Integration 10/31/09

Meaningful Ewes

What’s all this fuss I hear about the government trying to define “meaningful ewes”? What in the world could they be thinking? Now, I’m not exactly a farm boy, but I am small town born and raised and have been on enough of my friends’ farms to know a thing or two about ewes. I think this whole conversation about trying to define the meaningfulness of ewes is just downright silly.

I mean, aren’t all ewes – be they Massese Ehrs or Elliottdale Emrs or Padova Pdf/hs – meaningful? Why would anyone buy one of these creatures to be anything other than meaningful? Goodness knows adopting even one of them creates an entirely new set of tasks and major changes in workflow around any farm. I find it hard to believe that any farmer in their right mind would spend the time and effort it takes to own one of these, no less suffer the upfront expense, if they weren’t planning on putting them to good use. Really, why would anyone buy one of them just to have them around? It’s not like they jazz up the joint just by standing around baaing and bleating.

If I had a farm and I was thinking about getting ewes on it, I can guarantee you that I would make sure they were meaningful. I would spend some time up front to make certain that whichever breed I bought had some real viability for my farm. I’d study up on how to care for my particular variety and maybe even have a professional ewe-ser teach me how best to shear so that I got the greatest yield possible from my efforts and investment.

I just can’t imagine anyone going into ewes without making sure they were doing it meaningfully. What would be the point? Just to have a ewe is a waste of money that no farmer can afford. It is, by definition, the meaningfulness of the ewes that provides the value. Otherwise, the drain on the farm’s resources and operations would make owning one counterproductive, or at the very least, improvident.

While it may take time for any farmer unfamiliar with them to learn all the best ways to keep and care for them, I firmly believe we don’t really need some governmental committee of big city boys (or girls) trying to tell end-ewe-sers how to make our ewes meaningful. Honestly, guys, don’t you think we have enough brains in our little country heads to figure that out?

Instead of offering us money if we follow your definition (if you ever figure that out) of “meaningful ewes,” why not help us up front to fill our pens with stock and have a little trust that we’ll ensure that every ewe is meaningful. What would be so wrong with…

…What?…What’s that you say?…Ooooohhh, meaningful use. Well, well, that’s a lamb of an entirely different color. Never mind.

From the trenches (with a tip o’ the sheepskin hat to Gilda Radner and Emily Litella)…

“It is useless for the sheep to pass resolutions in favor of vegetarianism while the wolf remains of a different opinion.” – W. R. Inge

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.

News 10/30/09

From Sherman’s Auntie “Re: data breach. I read your bit about CalOptima and found this article. Read carefully this line: ‘The data is used in performing internal matching analyses to compare BCBS provider networks to the networks of other health plans for employer groups’. Boy, if the docs did that, the FTC would be on them in a heartbeat! Talk about possible price fixing 10 different ways.” AMA President J. James Rohack, MD posts a note to on the AMA website, assuring members they are doing all they can to help CalOpima rectify its recent “lost claims” issue. Did he really mean to suggest BCBS is doing some price fixing?

Chip Hart sent over a link to the Office Practicum blog. Take special note of the October 23rd and 24th posts, which detail how Dr. Greg Anderson and one assistant dispensed 112 H1N1 flu vaccines AND fully documented the patients’ charts in a mere four hours. He estimates that without EHR, the same process would have taken about 18 staff hours to complete.

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Mednax pays an unnamed cash amount for a two-physician neonatology practice in Louisiana. The purchase marks Mednax’s ninth medical practice acquisition this year.

St. Paul Eye Clinic (MN) selects SRS EMR for its 15-provider group.

GE Healthcare’s Medical Quality Improvement Consortium (MQIC) is submitting anonymous clinical data to the CDC to provide H1N1 tracking information. MQIC is a repository of de-identified clinical data captured from GE’s Centricity EMR users. MQIC sends updated data collected from 14 million record patient records to the CDC every 24 hours. Great use of EMR data, though I wonder if the patients are aware their de-identified clinical data is being used for this purpose. Or, if they need to know.

Healthcare ratings company Health Grades reports a 33% rise in quarterly revenue compared to last year to $13.3 million. Net income grew from $1.3 million to $1.8 million.

John Tooker, executive VP and CEO of the American College of Physicians, announces his resignation. He will stay on the job until a replacement is named, likely within the next six to 12 months.

If you are looking to purchase an EMR, sell an EMR, or simply want to know more about the subject, here is a must-read guide. The Texas Medical Association, in cooperation with the Physicians’ Foundation, releases Electronic Medical Record Implementation Guide: The Link to a Better Future, 2nd Edition. The comprehensive report includes EMR readiness assessments, details on ARRA, factors to consider in the selection process, sample pricing, recommended contract wording, implementation suggestions, and more. Don’t miss this if are searching for an EMR. And if you are a selling EMR (especially if you are a newbie), this should be a must-read.

Finding a one-size-fits-all Meaningful Use definition seems to be quite a challenge for the Health IT Policy Committee. Members realize that many of the clinical and quality measures that are appropriate for primary care physicians are not applicable for specialists. So, the wait for final recommendations continues. Meanwhile, there are plenty of providers content to maintain their wait and see stance.

Coming up with recommendations for iPhone applications is definitely less complicated. Here’s nice list, complete with product summaries and pricing.

Our friends at Hayes Management just posted their fall newsletter, full of solid HIT recommendations for practices and hospitals. I checked out the article entitled  “Scanning Solutions for EMR Implementations,” which provides an extensive scanning strategy checklist, as well as guidance on different ways to organize the scanning process. If you need a chuckle, peruse the article on HIT System Selection, which includes one of Mr. H’s typically irreverent quotes.

E-mail Inga.

Joel Diamond 10/28/09

Yet More Controlled Medical Terminology

It’s been over 20 years since I read Samuel Shems’s irreverent and frighteningly realistic portrayal of medical training, House of God. It was unofficial required reading back then, and my fellow residents would quote lines as frequently as my teenage sons do from Judd Apatow movies today.

Shem referred to chronic, demented, elderly patients as GOMERS (Get Out of My Emergency Room), and Rule #1 was “GOMERS don’t die”. (Other rules were, “There is no body cavity that cannot be reached with a #14 needle and a good strong arm”, and “If the radiology resident and the Best Medical Student both see a lesion on the chest x-ray, there can be no lesion”.

I wonder how many current medical residents have read this book, and if so, does it still seem realistic? I trained near the tail-end of the days of legendary 36-hour shifts, unrestricted moonlighting, and unsupervised care at VA hospitals. The phrase “watch one, do one, teach one” was not a metaphor, it was a mandate.

Those days are gone. The tragic and famous Libby Zion case changed all that. For those who don’t remember, this young woman suffered and died as a result of a fatal medical error, allegedly due to unsupervised house staff weary from long hours. (Perhaps advanced decision support technology would have changed things … but I digress.) Her parents’ relentless publicity and appropriate legal proceedings brought much-needed reform to medical education by limiting work hours and requiring that attending physicians actually be present.

Despite this, many of us old-timers nostalgically look back to those days and sometimes wonder if current trainees lack the volume and richness of encounters that we find so invaluable in our current practices. Certainly, the gallows humor remains. So without further ado, more widely used medical terms that you won’t find in the books.

• Positive O Sign. Exhibited by an unresponsive, elderly patient. Characterized by their perpetually wide open mouth.
• Positive Q Sign. Similar to the O sign, but much more ominous, as their tongue is hanging out (thus resembling the letter “Q”).
• Throckmorton’s Sign. Experience clinicians would always point this out to naïve medical students. When looking at a male pelvic x-ray, the shadow of the man’s genitalia always points to the side of pathology (advanced research has confirmed its 50% predictive value).
• Emmerson Biggens Syndrome. Also used to to bewilder innocent students who could never find this condition in textbooks. Actually a misogynistic comment when looking at the chest x-ray of a well-endowed female patient (i.e. “‘em are some big ones”).
• Code Brown. As opposed to the better-known Code Blue, a true emergency where a patient has fecal incontinence, overpowering other disgusting odors usually present on wards.

While many of you laugh nervously at the apparent lack of compassion behind these references, remember that it often reflected an outlet for those dedicated clinicians on the front lines, toiling under unimaginable stress, which was frequently unappreciated and often futile.

Medical education has dramatically improved. More importantly, patients are rarely used anymore as mere training tools for inexperienced doctors-in-training. No doubt today’s tech-savvy residents (as well as increasingly complex patients) benefit from readily available medical information and computer-aided monitoring and support. Let’s not forget this as we design healthcare IT systems.

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.

News 10/27/09

It’s situations like these that give insurance companies a bad reputation. CalOptima loses claims data for 68,000 members, including substantial identifying information. An HIStalk reader tipped us off on to the letter posted on the CalOptima home page. CalOptima says its scanning vendor sent an it unencrypted DVD that was never received. A PR nightmare, not to mention a huge privacy mess.

Here’s a figure I haven’t heard. On average, a breached medical record costs $211 to remediate. We’ll see whether or not CalOptima’s mess costs north of $14 million to resolve.

Virtua, a multi-hospital healthcare system in New Jersey, selects NextGen EHR for its Medical Group network. In addition to implementing NextGen across its 23 locations, Virtua will offer NextGen EHR to its community-based physicians.

Don’t know why this random thought came into my head recently, but while at MGMA this month, I sat through a few demos. I recall asking the young man (why do they all seem so young?) showing me the product if the software could do a certain function. Instead of a simple, “Yes,” or even, “Yes, would you like to see how?” he proceeded to give me a long drawn-out description of the company’s philosophy and history as it related to this particular function. At some point, I zoned out and was ready to go to the next booth. The point here is: if you are the one demonstrating software, and someone asks you what time it is, it’s rarely necessary to explain how a clock works.

Florida physician Dr. Edgar R. Blecker goes live on PWeR, the first doctor with Renaissance Health System to do so. The press release says Renaissance has over 2,000 affiliated physicians, but there’s no mention of more doctors going live on the EHR.

EndoSoft jumps into the physician EHR market with its launch of EndoVault EHR.

Rhode Island becomes the first state to use e-prescribing records to track the spread of swine flu statewide. A brilliant example of using HIT to improve patient care (although the tracking is based on prescriptions of Tamiflu and other antivirals). Maybe things are different in Rhode Island, but in many parts of the country, physicians are reluctant to prescribe antivirals, so maybe the data isn’t all that helpful (although the directional trend may be valid). Still, I like that someone is at least trying to use that data for more than tracking prescribing trends.

Zydoc Medical Transcription launches its MediSapien automated appointment reminder service. MediSapien is available in multiple languages at a flat rate of $.20 per connected call.

MedAssets Supply Chain Systems will distribute the MedAppz iSuite EHR to the non-acute, ambulatory healthcare provider customers of MedAssets. The multi-year agreement will allow MedAssets to offer the EHR as a SaaS solution.

With new players expanding into the EHR market and established hospital-system vendors trying to make a mark, one has to wonder how some of these tiny EHR vendors can survive. For example, Waiting Room Solutions just announced a couple of new sales. I went to their Web site and learned that for as little as $429 per month, you can purchase a Web-based EMR & PM packaged solution, which includes maintenance. Training is available via Webinar or with a self-guided video and demos are available via the Web. The site says nothing about a leadership team, suggesting little deadwood at the top. I suppose when you don’t have a lot of overhead from sales, training, and management you can operate on a slim margin, but will they be around in five years?

RelayHealth says its new TestTrack 5010SM for Payors tool is available.

Sequel Systems introduces an integrated patient portal application that will work with its existing PM and EHR solutions.

E-mail Inga.

Intelligent Healthcare Information Integration 10/23/09

From the Pediatric Trenches

“Dit, dit, dit, dit…dit, dit…dit, dit, dit…fresh from the front lines of the world of pediatric HIT, this is your humble grunt in the trenches reporter, Gregg Alexander, with breaking news.”

That is how I was going to start this offering. However, after traveling to Dallas to give a talk for Eclipsys’ EUN and flying directly from there to direct the “Pediatric Office of the Future” exhibit at the American Academy of Pediatrics’ National Conference and Exhibition in Washington, D.C., somewhere en route I encountered a virulent little chest-congester, sinus-stuffer, feel-like-heller of a cold germ. While very grateful it isn’t the H1N1 variety virus, it is nonetheless one powerful little booger. Thus, my writing has been delayed by both overwork and, now, by oversnot.

Here in HIStalk Practice land, I’d like to share with you what I recently experienced at the above-mentioned AAP Peds Office of the Future or “POF.” (I’d give you a bigger picture view, but the work kept my leash pretty short, thus keeping my view of anything beyond the exhibit hall quite limited). It was not the experience I expected. Let me explain…

As many of you know, with the economic downturn, many conferences are experiencing reduced attendance and diminished vendor participation. The American Academy of Family Practice (AAFP) held their annual conference up in Boston just before the AAP show and, by all the reports I received, had a decline of around 30% in attendance. (Unconfirmed.) I was worried we would experience the same. However, much to my most happy surprise, pediatricians and their entourages turned out in record numbers! From all around the globe, the pediatrically-inclined came and saw and conquered … OK, maybe the only thing they conquered was the dreary D.C. weather, but they for sure turned out.

View from the ceiling during set-up. POF is white-canopied booth in front.

Top off a record-setting attendance with an exhibit hall floor which, to my completely subjective view, was one of the most broad-swept product and informational offerings I’ve ever seen and you have a real event. Our POF exhibit also had a nice breadth of sponsors. With your indulgence, I’d like to take a moment to gratefully acknowledge them here: athenahealth, Doctations, Eclipsys, Sage, Medicomp, PediaPals, QuickMedical, and (a special thanks, Mr H.) HIStalk Practice. I also would appreciate your forbearance while I acclaim the good folks who represented each of these companies: I cannot begin to describe the wonderful efforts of every single one of the representatives from each of them. Each was more pleasant and more enjoyable with whom to work than the next.

If you didn’t make the AAP show this year, you missed out. Well done, AAP. If you did, and if you happened to come by the POF, I’d certainly appreciate your input on how we can make it better for next year in San Francisco (woo hoo!) Please send along your thoughts in an email to me or add them to the comments section after this post. We already have some great plans and sponsors, but want your ideas.

For all you vendor types who are reading along, take note: pediatricians are showing up, despite the economy, and their interest in moving forward with HIT has finally started to ascend. (We’ve been a bit behind the learning curve, but it’s looking like we’re about to play some catch-up.)

One last thanks: Mr. H sponsored a very informal meet-and-greet happy hour which I admit I didn’t really advertise to any extreme. (I think I was a little reluctant from a “who’d care about meeting me” perspective.) While I didn’t think anyone would show up, actually a nice little smattering of folks made it by, some friends, some now-friends, and I learned some good stuff and had some great chats (despite feeling like warmed-over death from the bug.) Thanks, Mr. H … and thanks to all who stopped by.

From the (pediatric) trenches …

“I believe in equality for everyone, except reporters and photographers.” – Mahatma Gandhi

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.