If you are planning to attend HIMSS 2012, make sure to stop by the HIMSS Latino Community Workshop.

Learn more here

Also, Eduardo Gonzalez Loumiet, Managing Director for Uber Operations, is part of the host committee for the newly announced HIMSS Latino Initiative Workgroup reception, to be held on February 20th at the Orange County Convention Center.  This program, which has been in the works for close to a year, will finally get an opportunity to facilitate the efforts of health IT in the underserved communities. The event will include several health care leaders, including Antonia Coello Novello, M.D. .

You can register here

If you would like to meet during the conference, please feel free to contact Eduardo at: eduardo@uberops.com .

A longitudinal study of thousands of US hospitals suggests that increasing the levels of medical IT may modestly improve the quality of treatment, but it doesn’t actually help with costs, and may even make things worse in the short run as the current US healthcare economy is subverting any benefits it might otherwise provide.

By John Timmer | Last updated November 20, 2009 2:20 PM

Electronic medical records and the general digitization of medical data and practices are promoted as a way to slow the rapidly inflating costs in the US healthcare system. The push for expanded medical IT has come from the top, with President Obama extolling its virtues and his administration making funding for EMR deployments part of its stimulus package. But many have pointed out that simply throwing computers at a problem isn’t a solution unless the software and practices are also in place to allow the medical community to leverage the technology efficiently. A study of US hospital data suggests they may not be: computerization only had a mild impact on quality of care, and it didn’t seem to alter costs in any significant manner.

The study will appear online at The American Journal of Medicine Friday. Its authors combined three datasets that collectively track the computerization and outcomes at thousands of US hospitals. Data on the deployment of medical IT systems were obtained from an annual survey performed by the Healthcare Information and Management Systems Society. The survey contains over 20 measures of computerization, including both administrative and clinical functions.

Costs and quality of care were obtained from Medicare and Medicaid data, both obtained directly from the government and from a version compiled by the Dartmouth Health Atlas. The latter contains information such as whether the hospital is for-profit, the type of care delivered (acute, psychiatric, etc.), and its location. Quality of care scores were available for pneumonia, congestive heart failure, and acute myocardial infarction. The authors looked at the period from 2003 to 2007, during which time information was available for roughly 4,000 US hospitals.

During the time in question, there was a large increase in the use of computerized systems. By 2007, a typical hospital had implemented nearly two-thirds of the computerized systems covered in the survey, although there was a bias towards adoption of administrative systems. Less than a quarter of the hospitals, for example, had implemented a computerized ordering system for their physicians.

Despite the rise in computerization, however, administrative costs actually climbed slightly during the entire period. Part of this seems to be the costs of deploying the systems themselves, as hospitals in the midst of a major IT expansion had increased administrative costs during this period. Checking the data using a four-year interval, however, suggested that even once the systems are in place and in use, costs don’t start to decline. Still, none of the statistical tests performed by the authors showed a clear correlation between computerization and administrative costs.

The authors performed bivariate analysis to try to identify the factors most closely associated with costs and quality of care. Hospitals that did best on quality of care tended to be larger, nonprofit, and associated with teaching programs. Computerization tended to increase the quality of care for acute myocardial infarction, but not either of the other problems. Multivariate analysis suggested that the improvement may be correlated with the use of computerized systems that focus specifically on patient care.

"We found no evidence that computerization has lowered costs or streamlined administration," the authors concluded. "More encouragingly, greater use of information technology was associated with a consistent though small increase in quality scores." That’s not exactly a ringing endorsement of healthcare IT, and it’s certainly a far cry from some of the improvements promised by its proponents.

Why the disparity? The authors provide three potential explanations. One is simply that the cost of purchasing and supporting IT equipment and software offsets any savings they produce. The other is that the four-year lag used in their analysis to look for long-term savings simply isn’t sufficient; savings will eventually appear, but only once the systems are in use for long enough for everyone to become proficient with them.

They favor the third possibility: the commercial medical marketplace is simply structured in a way that doesn’t favor optimal solutions. "Coding and other reimbursement-driven documentation might take precedence over efficiency and the encouragement of clinical parsimony," they suggest. "The largest computer success story has occurred at Veterans Administration hospitals where global budgets obviate the need for most billing and internal cost accounting, and minimize commercial pressures."

In other words, the current US healthcare economy is subverting any benefits that computerized healthcare might otherwise provide.

The American Journal of Medicine, 2009. DOI: 10.1016/j.amjmed.2009.09.004

Posted by Dana Blankenhorn @ 8:35 am

After 25 years following the technology industry for a living I have detected a pattern.

Niches are developed, then enveloped, then absorbed.

Computing enters new niches through specialty vendors, companies that “understand” the business at hand, and deliver “custom” solutions. (Picture from Mac512.com.)

New, expert companies are needed to do the incredibly hard and valuable work of adapting what is offered by the computing mainstream to the specific needs of real customers.

One of the first examples I remember is desktop publishing.

I held a party at my home back in 1984, where two young publishers were looking for a niche they could grow with. I suggested it to them, even suggested the name.

I deserve no credit. They did the hard work. They earned the rewards. But over time desktop publishing became mainstream computing. Some vendors moved up-market, turning magazines and newspapers into desktop publishers. My friends went on to other work, into other niches, like music and video.

This happens in industrial markets as well. I’ve seen it in warehousing, and banking, and legal work. Over time the vendors who begin in these niches either become giants themselves, like Adobe, or they are absorbed by giants.

Medical computing is incredibly complex. Sometimes this is accidental — an MRI file can be enormous. Sometimes this is deliberate — HIPAA is the law.

The companies that built HIMSS were specialists at this kind of thing. Some started in the mainstream and retreated into the medical niche. Others were launched specifically to serve that niche.

But to grow enough and become mainstream the health IT niche, like all niches before it, must be absorbed into mainstream IT.

Some of this is already happening. The HIMSS show I attended in Orlando, back in 2008, was a coming-out party of sorts for both Microsoft and Google. Many of the headlines concerned the two firms’ launch of personal health record systems — Healthvault and Google Health.

But Microsoft was also launching a hospital computing system that would soon be named Amalga at that show, and IBM had a large booth as well.

Still the industry was, and is, dominated by specialists like Cerner, McKesson, Siemens and GE. Some are big companies, but these are not the computing mainstream.

The computing mainstream is companies like Microsoft, like Hewlett-Packard, like IBM and Dell. The mainstream must envelope and absorb the niche in order for the niche to become mainstream.

All this is complicated by government mandates. But it is not made impossible by them. Absorbing the specialists into the mainstream is one way this can happen. That’s the trend to watch.

But the trend is set.

Patty Thierry, MBA, RHIA, CCS

Keeping an eye on health care trends has never been more important. We are accustomed to constant change but nothing compares to the changes predicted for the next few years. Already, there are new requirements for information technology (IT) and the sharing and management of data. In addition, clinical information systems have matured and new vendors are on the scene. Key standards will be regulated this year (transaction standards and code sets), and the Internet will pave the way for new health care delivery models.

Most of all, the transformation taking place in health care is creating the need to improve the quality of information systems. Exactly what kind of transformation is taking place?

• Under managed care, the lines are beginning to blur as payers are becoming actively involved in patient care and providers are developing managed care plans.
• Providers continue to consolidate at rapid speeds creating the need to tie information systems together at their disparate locations (creating integrated delivery networks [IDNs]).
• Consumers and competition are driving the need for information systems to share data with one another.
• Managed care and capitation are requiring providers to take on more financial risk and thereby changing their current business model and information management requirements.
• Y2K efforts have kept information system (IS) departments busy updating financial and billing systems. As a result, other purchases or upgrades were put on hold, creating a pent-up need to implement clinical information systems and other applications. Providers are investing in information systems to improve their business and provide a competitive edge, and to respond to the Balance Budget Act of 1997 (e.g., ambulatory payment classification-APC-implementation) and Health Insurance Portability and Accountability Act (HIPAA) (e.g., electronic transactions, security, privacy, identifiers, etc.).
• The Internet enables patients to be involved with their health care and facilitate communications between providers, patients and payers. The Internet reinvents the patient-provider relationship and empowers consumers to make choices about their health care.

New Doors for HIM Professionals
The focus on IT as a health care business enabler will open new doors for health information management (HIM) professionals who are comfortable marrying their HIM skills with technology initiatives. For example, as health care moves to the Web, HIM professionals can help their employers organize their content rich Web sites, implement security and confidentiality measures and develop policies and procedures to support personal health records. There are plenty of opportunities for HIM professionals in physician settings, IDNs and managed care organizations (MCOs). To help you think about the possibilities, let’s take a more specific look at some of the top health care trends and their technology solutions.

By Phillip Longman

he central contention of Barack Obama’s vision for health care reform is straightforward: that our health care system today is so wasteful and poorly organized that it is possible to lower costs, expand access, and raise quality all at the same time—and even have money left over at the end to help pay for other major programs, from bank bailouts to high-speed rail.

It might sound implausible, but the math adds up. America spends nearly twice as much per person as other developed countries for health outcomes that are no better. As White House budget director Peter Orszag has repeatedly pointed out, the cost of health care has become so gigantic that pushing down its growth rate by just 1.5 percentage points per year would free up more than $2 trillion over the next decade.

The White House also has a reasonably accurate fix on what drives these excessive costs: the American health care system is rife with overtreatment. Studies by Dartmouth’s Atlas of Health Care project show that as much as thirty cents of every dollar in health care spending goes to drugs and procedures whose efficacy is unproven, and the system contains few incentives for doctors to hew to treatments that have been proven to be effective. The system is also highly fragmented. Three-quarters of Medicare spending goes to patients with five or more chronic conditions who see an annual average of fourteen different physicians, most of whom seldom talk to each other. This fragmentation leads to uncoordinated care, and is one of the reasons why costly and often deadly medical errors occur so frequently.

Almost all experts agree that in order to begin to deal with these problems, the health care industry must step into the twenty-first century and become computerized. Astonishingly, twenty years after the digital revolution, only 1.5 percent of hospitals have integrated IT systems today—and half of those are government hospitals. Digitizing the nation’s medical system would not only improve patient safety through better-coordinated care, but would also allow health professionals to practice more scientifically driven medicine, as researchers acquire the ability to mine data from millions of computerized records about what actually works.

It would seem heartening, then, that the stimulus bill President Obama signed in February contains a whopping $20 billion to help hospitals buy and implement health IT systems. But the devil, as usual, is in the details. As anybody who’s lived through an IT upgrade at the office can attest, it’s difficult in the best of circumstances. If it’s done wrong, buggy and inadequate software can paralyze an institution.

Consider this tale of two hospitals that have made the digital transition. The first is Midland Memorial Hospital, a 371-bed, three-campus community hospital in southern Texas. Just a few years ago, Midland Memorial, like the overwhelming majority of American hospitals, was totally dependent on paper records. Nurses struggled to decipher doctors’ scribbled orders and hunt down patients’ charts, which were shuttled from floor to floor in pneumatic tubes and occasionally disappeared into the ether. The professionals involved in patient care had difficulty keeping up with new clinical guidelines and coordinating treatment. In the normal confusion of day-to-day practice, medical errors were a constant danger.

This all changed in 2007 when Midland completed the installation of a health IT system. For the first time, all the different doctors involved in a patient’s care could work from the same chart, using electronic medical records, which drew data together in one place, ensuring that the information was not lost or garbled. The new system had dramatic effects. For instance, it prompted doctors to follow guidelines for preventing infection when dressing wounds or inserting IVs, which in turn caused infection rates to fall by 88 percent. The number of medical errors and deaths also dropped. David Whiles, director of information services for Midland, reports that the new health IT system was so well designed and easy to use that it took less than two hours for most users to get the hang of it. "Today it’s just part of the culture," he says. "It would be impossible to remove it."

Things did not go so smoothly at Children’s Hospital of Pittsburgh, which installed a computerized health system in 2002. Rather than a godsend, the new system turned out to be a disaster, largely because it made it harder for the doctors and nurses to do their jobs in emergency situations. The computer interface, for example, forced doctors to click a mouse ten times to make a simple order. Even when everything worked, a process that once took seconds now took minutes—an enormous difference in an emergency-room environment. The slowdown meant that two doctors were needed to attend to a child in extremis, one to deliver care and the other to work the computer. Nurses also spent less time with patients and more time staring at computer screens. In an emergency, they couldn’t just grab a medication from a nearby dispensary as before—now they had to follow the cumbersome protocols demanded by the computer system. According to a study conducted by the hospital and published in the journal Pediatrics, mortality rates for one vulnerable patient population—those brought by emergency transport from other facilities—more than doubled, from 2.8 percent before the installation to almost 6.6 percent afterward.

Why did similar attempts to bring health care into the twenty-first century lead to triumph at Midland but tragedy at Children’s? While many factors were no doubt at work, among the most crucial was a difference in the software installed by the two institutions. The system that Midland adopted is based on software originally written by doctors for doctors at the Veterans Health Administration, and it is what’s called "open source," meaning the code can be read and modified by anyone and is freely available in the public domain rather than copyrighted by a corporation. For nearly thirty years, the VA software’s code has been continuously improved by a large and ever-growing community of collaborating, computer-minded health care professionals, at first within the VA and later at medical institutions around the world. Because the program is open source, many minds over the years have had the chance to spot bugs and make improvements. By the time Midland installed it, the core software had been road-tested at hundred of different hospitals, clinics, and nursing homes by hundreds of thousands of health care professionals.

The software Children’s Hospital installed, by contrast, was the product of a private company called Cerner Corporation. It was designed by software engineers using locked, proprietary code that medical professionals were barred from seeing, let alone modifying. Unless they could persuade the vendor to do the work, they could no more adjust it than a Microsoft Office user can fine-tune Microsoft Word. While a few large institutions have managed to make meaningful use of proprietary programs, these systems have just as often led to gigantic cost overruns and sometimes life-threatening failures. Among the most notorious examples is Cedars-Sinai Medical Center, in Los Angeles, which in 2003 tore out a "state-of-the-art" $34 million proprietary system after doctors rebelled and refused to use it. And because proprietary systems aren’t necessarily able to work with similar systems designed by other companies, the software has also slowed what should be one of the great benefits of digitized medicine: the development of a truly integrated digital infrastructure allowing doctors to coordinate patient care across institutions and supply researchers with vast pools of data, which they could use to study outcomes and develop better protocols.

Unfortunately, the way things are headed, our nation’s health care system will look a lot more like Children’s and Cedars-Sinai than Midland. In the haste of Obama’s first 100 days, the administration and Congress crafted the stimulus bill in a way that disadvantages open-source vendors, who are upstarts in the commercial market. At the same time, it favors the larger, more established proprietary vendors, who lobbied to get the $20 billion in the bill. As a result, the government’s investment in health IT is unlikely to deliver the quality and cost benefits the Obama administration hopes for, and is quite likely to infuriate the medical community. Frustrated doctors will give their patients an earful about how the crashing taxpayer-financed software they are forced to use wastes money, causes two-hour waits for eight-minute appointments, and constrains treatment options.

Done right, digitized health care could help save the nation from insolvency while improving and extending millions of lives at the same time. Done wrong, it could reconfirm Americans’ deepest suspicions of government and set back the cause of health care reform for yet another generation.

pen-source software has no universally recognized definition. But in general, the term means that the code is not secret, can be utilized or modified by anyone, and is usually developed collaboratively by the software’s users, not unlike the way Wikipedia entries are written and continuously edited by readers. Once the province of geeky software aficionados, open-source software is quickly becoming mainstream. Windows has an increasingly popular open-source competitor in the Linux operating system. A free program called Apache now dominates the market for Internet servers. The trend is so powerful that IBM has abandoned its propriety software business model entirely, and now gives its programs away for free while offering support, maintenance, and customization of open-source programs, increasingly including many with health care applications. Apple now shares enough of its code that we see an explosion of homemade "applets" for the iPhone—each of which makes the iPhone more useful to more people, increasing Apple’s base of potential customers.

If this is the future of computing as a whole, why should U.S. health IT be an exception? Indeed, given the scientific and ethical complexities of medicine, it is hard to think of any other realm where a commitment to transparency and collaboration in information technology is more appropriate. And, in fact, the largest and most successful example of digital medicine is an open-source program called VistA, the one Midland chose.

VistA was born in the 1970s out of an underground movement within the Veterans Health Administration known as the "Hard Hats." The group was made up of VA doctors, nurses, and administrators around the country who had become frustrated with the combination of heavy caseloads and poor record keeping at the institution. Some of them figured that then-new personal and mini computers could be the solution. The VA doctors pioneered the nation’s first functioning electronic medical record system, and began collaborating with computer programmers to develop other health IT applications, such as systems that gave doctors online advice in making diagnoses and settling on treatments.

The key advantages of this collaborative approach were both technical and personal. For one, it allowed medical professionals to innovate and learn from each other in tailoring programs to meet their own needs. And by involving medical professionals in the development and application of information technology, it achieved widespread buy-in of digitized medicine at the VA, which has often proven to be a big problem when propriety systems are imposed on doctors elsewhere.

This open approach allowed almost anyone with a good idea at the VA to innovate. In 1992, Sue Kinnick, a nurse at the Topeka, Kansas, VA hospital, was returning a rental car and saw the use of a bar-code scanner for the first time. An agent used a wand to scan her car and her rental agreement, and then quickly sent her on her way. A light went off in Kinnick’s head. "If they can do this with cars, we can do this with medicine," she later told an interviewer. With the help of other tech-savvy VA employees, Kinnick wrote software, using the Hard Hats’ public domain code, that put the new scanner technology to a new and vital use: preventing errors in dispensing medicine. Under Kinnick’s direction, patients and nurses were each given bar-coded wristbands, and all medications were bar-coded as well. Then nurses were given wands, which they used to scan themselves, the patient, and the medication bottle before dispensing drugs. This helped prevent four of the most common dispensing errors: wrong med, wrong dose, wrong time, and wrong patient. The system, which has been adopted by all veterans hospitals and clinics and continuously improved by users, has cut the number of dispensing errors in half at some facilities and saved thousands of lives.

At first, the efforts of enterprising open-source innovators like Kinnick brought specific benefits to the VA system, such as fewer medical errors and reduced patient wait times through better scheduling. It also allowed doctors to see more patients, since they were spending less time chasing down paper records. But eventually, the open-source technology changed the way VA doctors practiced medicine in bigger ways. By mining the VA’s huge resource of digitized medical records, researchers could look back at which drugs, devices, and procedures were working and which were not. This was a huge leap forward in a profession where there is still a stunning lack of research data about the effectiveness of even the most common medical procedures. Using VistA to examine 12,000 medical records, VA researchers were able to see how diabetics were treated by different VA doctors, and by different VA hospitals and clinics, and how they fared under the different circumstances. Those findings could in turn be communicated back to doctors in clinical guidelines delivered by the VistA system. In the 1990s, the VA began using the same information technology to see which surgical teams or hospital managers were underperforming, and which deserved rewards for exceeding benchmarks of quality and safety.

Thanks to all this effective use of information technology, the VA emerged in this decade as the bright star of the American health system in the eyes of most health-quality experts. True, one still reads stories in the papers about breakdowns in care at some VA hospitals. That is evidence that the VA is far from perfect—but also that its information system is good at spotting problems. Whatever its weaknesses, the VA has been shown in study after study to be providing the highest-quality medical care in America by such metrics as patient safety, patient satisfaction, and the observance of proven clinical protocols, even while reducing the cost per patient.

Following the organization’s success, a growing number of other government-run hospitals and clinics have started adapting VistA to their own uses. This includes public hospitals in Hawaii and West Virginia, as well as all the hospitals run by the Indian Health Service. The VA’s evolving code also has been adapted by providers in many other countries, including Germany, Finland, Malaysia, Brazil, India, and, most recently, Jordan. To date, more than eighty-five countries have sent delegations to study how the VA uses the program, with four to five more coming every week.

roprietary systems, by contrast, have gotten a cool reception. Although health IT companies have been trying to convince hospitals and clinics to buy their integrated patient-record software for more than fifteen years, only a tiny fraction have installed such systems. Part of the problem is our screwed-up insurance reimbursement system, which essentially rewards health care providers for performing more and more expensive procedures rather than improving patients’ welfare. This leaves few institutions that are not government run with much of a business case for investing in health IT; using digitized records to keep patients healthier over the long term doesn’t help the bottom line.

But another big part of the problem is that proprietary systems have earned a bad reputation in the medical community for the simple reason that they often don’t work very well. The programs are written by software developers who are far removed from the realities of practicing medicine. The result is systems which tend to create, rather than prevent, medical errors once they’re in the hands of harried health care professionals. The Joint Commission, which accredits hospitals for safety, recently issued an unprecedented warning that computer technology is now implicated in an incredible 25 percent of all reported medication errors. Perversely, license agreements usually bar users of proprietary health IT systems from reporting dangerous bugs to other health care facilities. In open-source systems, users learn from each other’s mistakes; in proprietary ones, they’re not even allowed to mention them.

If proprietary health IT systems are widely adopted, even more drawbacks will come sharply into focus. The greatest benefits of health IT—and ones the Obama administration is counting on—come from the opportunities that are created when different hospitals and clinics are able to share records and stores of data with each other. Hospitals within the digitized VA system are able to deliver more services for less mostly because their digital records allow doctors and clinics to better coordinate complex treatment regimens. Electronic medical records also produce a large collection of digitized data that can be easily mined by managers and researchers (without their having access to the patients’ identities, which are privacy protected) to discover what drugs, procedures, and devices work and which are ineffective or even dangerous. For example, the first red flags about Vioxx, an arthritis medication that is now known to cause heart attacks, were raised by the VA and large private HMOs, which unearthed the link by mining their electronic records. Similarly, the IT system at the Mayo Clinic (an open-source one, incidentally) allows doctors to personalize care by mining records of specific patient populations. A doctor treating a patient for cancer, for instance, can query the treatment outcomes of hundreds of other patients who had tumors in the same area and were of similar age and family backgrounds, increasing odds that they choose the most effective therapy.

But in order for data mining to work, the data has to offer a complete picture of the care patients have gotten from all the various specialists involved in their treatment over a period of time. Otherwise it’s difficult to identify meaningful patterns or sort out confounding factors. With proprietary systems, the data is locked away in what programmers call "black boxes," and cannot be shared across hospitals and clinics. (This is partly by design; it’s difficult for doctors to switch IT providers if they can’t extract patient data.) Unless patients get all their care in one facility or system, the result is a patchwork of digital records that are of little or no use to researchers. Significantly, since proprietary systems can’t speak to each other, they also offer few advantages over paper records when it comes to coordinating care across facilities. Patients might as well be schlepping around file folders full of handwritten charts.

Of course, not all proprietary systems are equally bad. A program offered by Epic Systems Corporation of Wisconsin rivals VistA in terms of features and functionality. When it comes to cost, however, open source wins hands down, thanks to no or low licensing costs. According to Dr. Scott Shreeve, who is involved in the VistA installations in West Virginia and elsewhere, installing a proprietary system like Epic costs ten times as much as VistA and takes at least three times as long—and that’s if everything goes smoothly, which is often not the case. In 2004, Sutter Health committed $154 million to implementing electronic medical records in all the twenty-seven hospitals it operated in Northern California using Epic software. The project was supposed to be finished by 2006, but things didn’t work out as planned. Sutter pulled the plug on the project in May of this year, having completed only one installation and facing remaining cost estimates of $1 billion for finishing the project. In a letter to employees, Sutter executives explained that they could no long afford to fund employee pensions and also continue with the Epic buildout.

nfortunately, billions of taxpayers’ dollars are about to be poured into expensive, inadequate proprietary software, thanks to a provision in the stimulus package. The bill offers medical facilities as much as $64,000 per physician if they make "meaningful use" of "certified" health IT in the next year and a half, and punishes them with cuts to their Medicare reimbursements if they don’t do so by 2015. Obviously, doctors and health administrators are under pressure to act soon. But what is the meaning of "meaningful use"? And who determines which products qualify? These questions are currently the subject of bitter political wrangling.

Vendors of proprietary health IT have a powerful lobby, headed by the Healthcare Information and Management Systems Society, a group with deep ties to the Obama administration. (The chairman of HIMSS, Blackford Middleton, is an adviser to Obama’s health care team and was instrumental in getting money for health IT into the stimulus bill.) The group is not openly against open source, but last year when Rep. Pete Stark of California introduced a bill to create a low-cost, open-source health IT system for all medical providers through the Department of Health and Human Services, HIMSS used its influence to smash the legislation. The group is now deploying its lobbying clout to persuade regulators to define "meaningful use" so that only software approved by an allied group, the Certification Commission for Healthcare Information Technology, qualifies. Not only are CCHIT’s standards notoriously lax, the group is also largely funded and staffed by the very industry whose products it is supposed to certify. Giving it the authority over the field of health IT is like letting a group controlled by Big Pharma determine which drugs are safe for the market.

Even if the proprietary health IT lobby loses the battle to make CCHIT the official standard, the promise of open-source health IT is still in jeopardy. One big reason is the far greater marketing power that the big, established proprietary venders can bring to bear compared to their open-source counterparts, who are smaller and newer on the scene. A group of proprietary industry heavyweights, including Microsoft, Intel, Cisco, and Allscripts, is sponsoring the Electronic Health Record Stimulus Tour, which sends teams of traveling sales representatives to tell local doctors how they can receive tens of thousands of dollars in stimulus money by buying their products—provided that they "act now." For those medical professionals who can’t make the show personally, helpful webcasts are available. The tour is a variation on a tried-and-true strategy: when physicians are presented with samples of pricey new name-brand substitutes for equally good generic drugs, time and again they start prescribing the more expensive medicine. And they are likely to be even more suggestible when it comes to software because most don’t know enough about computing to evaluate vendors’ claims skeptically.

What can be done to counter this marketing offensive and keep proprietary companies from locking up the health care IT market? The best and simplest answer is to take the stimulus money off the table, at least for the time being. Rather than shoveling $20 billion into software that doesn’t deliver on the promise of digital medicine, the government should put a hold on that money pending the results of a federal interagency study that will be looking into the potential of open-source health IT and will deliver its findings by October 2010.

As it happens, that study is also part of the stimulus bill. The language for it was inserted by West Virginia Senator Jay Rockefeller, who has also introduced legislation that would help put open-source health IT on equal footing with the likes of Allscripts and Microsoft. Building on the systems developed by the VA and Indian Health Services, Rockefeller’s bill would create an open-source government-sponsored "public utility" that would distribute VistA-like software, along with grants to pay for installation and maintenance. The agency would also be charged with developing quality standards for open-source health IT and guidelines for interoperability. This would give us the low-cost, high-quality, fully integrated and proven health IT infrastructure we need in order to have any hope of getting truly better health care.

Delaying the spending of that $20 billion would undoubtedly infuriate makers of proprietary health software. But it would be welcomed by health care providers who have long resisted—partly for good reason—buying that industry’s product. Pushing them to do so quickly via the stimulus bill amounts to a giant taxpayer bailout of health IT companies whose business model has never really worked. That wouldn’t just be a horrendous waste of public funds; it would also lock the health care industry into software that doesn’t do the job and would be even more expensive to get rid of later.

As the administration and Congress struggle to pass a health care reform bill, questions about which software is best may seem relatively unimportant—the kind of thing you let the "tech guys" figure out. But the truth is that this bit of fine print will determine the success or failure of the whole health care reform enterprise. So it’s worth taking the time to get the details right.

Phillip Longman is a senior fellow at the New America Foundation and the author of Best Care Anywhere: Why VA Health Care Is Better Than Yours as well as The Next Progressive Era: A Blueprint for Broad Prosperity.

SOURCE: http://www.washingtonmonthly.com/features/2009/0907.longman.html

By Kim Hart
Monday, July 13, 2009

Platinum Solutions, a Reston information technology firm that serves the government, needs to find new employees so fast that it hired four full-time recruiters. At any given time, the company has 20 to 40 job openings, and it recently opened an office in West Virginia that has 65 employees.

"We’re hiring as fast as we can," said chief executive Laila Rossi. "The past six months have been the peak for us."

She said the company used to have a new employee start every few weeks. Now it’s common to see nine or 10 begin work in a single day, week after week.

At a time when most industries are slashing costs and headcounts, IT firms in the Washington region are experiencing growth thanks to continued government contracts and an increased reliance on technology in nearly every sector of the economy. The demand for IT expertise has helped keep the local economy stronger compared with other regions of the country.

The federal government is expected to increase spending on technology services by 3.5 percent over the next five years, according to a report released last week by Input, a Reston market research firm. The estimate is lower than last year’s growth forecast of 4.1 percent, but "fairly optimistic considering the change in administration and the economic situation," said Deniece Peterson, manager of industry analysis.

"This is a spend-to-save administration," she said, meaning that the government is investing in IT systems now to create savings down the road in health care, energy costs and agency communication networks. She expects the stimulus package to contribute at least $15 billion to the industry over the next two to three years.

And President Obama’s push to increase the federal workforce and rely less on contractors will still create opportunities for local firms, she said.

"It will only add to the need for IT services," she said. "Even if there is a slight bump in federal employment, the government still has to supply the technological infrastructure for those workers. There’s still a gap to be filled by the contracting community."

So firms have boosted their recruitment efforts. CACI, the Arlington-based contractor, has 200 open positions at any given time, said Larry Clifton, CACI’s senior vice president of recruiting and workforce management. The company is looking particularly for candidates with expertise in cybersecurity, health IT and energy-saving technologies.

Clifton said the job market is also stable for recent college graduates, who understand social networking, cloud computing and other initiatives being pushed by the administration.

"There’s definitely a glut of kids out there — really sharp people — who are looking for jobs or waiting tables," he said, adding that the number of résumés he receives has doubled during each of the past three quarters.

Lockheed Martin, one of the largest systems integrators for the government, typically hires 16,000 people a year, and that number has held steady even during the recession. The Bethesda-based defense giant has beefed up its internship program by 30 percent to create opportunities for college students and recent graduates, especially those with an interest in cybersecurity and protecting databases, corporate staffing director Mike Byrne said.

Computer Sciences Corp. of Falls Church is also placing more emphasis on college recruiting, with plans to hire more than 300 new graduates this year, up from 250 last year. It still hires a larger number of midcareer professionals. The competition for skilled workers can be fierce, recruitment director Jim Gattuso said.

"As the market started to tighten up and opportunities started to shrink, we saw it as an opportunity to be more aggressive," he said. "We can be more choosy about students and other candidates."

Smaller firms are also finding the need to augment their staffs. MicroServe, an IT consulting and contracting firm in Gaithersburg, employs 12 people. By the end of the year, it plans to triple that number. Rick Albert, who founded the firm in 1991, says he is trying to be well-positioned for an economic recovery.

"This year will be a record year for us," he said. "Whether there’s a recovery or not, we help cut IT costs for commercial and government agencies" by consolidating servers in databases and reducing energy needs, he said.

"A lot of new projects are getting off the ground right now," said Barry Downs, branch manager for Robert Half Technology, a recruiting firm in the District.

The firm released a report citing increased interest in cybersecurity, Web-based and cloud-computing systems, and recovering information from devices. In interviews with 1,400 chief information officers, 20 percent of technology executives expect to add a mix of full-time and contract workers in the third quarter. Thirty percent cited the need for more customer support as a factor driving the hiring, and 27 percent cited rising workloads as a factor.

But with a larger number of candidates on the market, salaries are lower than a year or two ago, Downs said.

"A recent college graduate looking to make $50,000 may be competing with someone with five years of experience willing to work for the same amount," he said. "Clients can get more for a little less — getting more experience but at a lower salary is very appealing."

Kim Hart writes about Washington’s technology scene every Monday. Contact her at hartk@washpost.com.

As a former nurse working at Bozeman Deaconess Hospital who also earned a bachelor’s degree in health care informatics from Montana Tech, Misti Andersen keeps a foot in both worlds — medicine and technology — as she works to bridge the gap between them.

The health care informatics program graduates are the glue that can hold an information technology project at a hospital together, because they know both the technical and the clinical vocabularies, said Gary Mannix, the head of the Health Care Informatics Department at Montana Tech in Butte.

"Graduates from our program serve as translators between the technical staff and the clinical leadership," he said.

These translators, also known as "health informaticists," often have a background in the allied health professions, such as records or claims and have pursued additional training and education in health I.T. and project management through health care informatics degree programs such as the one offered at Montana Tech.

"I.T. staff manage the computer network and maintain the software, but it’s the health care informatics professionals who can truly analyze and understand the medical data; providing clinical staff with the information they need, when they need it," said Jim Aspevig, assistant professor in the Health Care Informatics Department at Montana Tech.

"Montana Tech’s informatics degree program is really taking off; we have more requests for our interns and graduates from hospitals and clinics than we can fill," said Mannix. "Montana Tech has already produced four graduating classes and we’re at virtually 100 percent employment within the industry."

Great Falls High School graduate Kaila Fowler, 26, was in the second class of graduates of Montana Tech’s informatics program. She’s now a research analyst at Benefis Health System.

She currently collecting and analyzing emergency room data.

"We work to bring technology into health care in ways that will lower costs and improve the efficiency of care," said Fowler. "This degree would prepare you to work as a consultant or for a software company as part of a team to provide input to create a better product."

Fowler is believed to be the first informatics graduate hired by Benefis, said Tammy Trovatten, data management manager at Benefis Health System.

"We do a lot of data mining for various vice presidents and managers to give them detailed, accurate information to base their decisions on," Trovatten. "This kind of degree is ideal because they learn the health care terminology as well as having the computer background. It helps them jump in a little quicker and have a smaller learning curve in terms of data mining."

American Medical Informatics Association chief executive Don Detmer estimates a demand for 70,000 health informaticians.

According to the association, midlevel jobs, like those for clinical analysts, generally pay around $70,000 a year.

Health informaticists often begin as specialists in technology, or started their career as health record administrators, medical technologists or nurses.

"Health care is recession-resistant, but many people find it difficult to enter the health care industry," said Charie Faught, assistant professor at Montana Tech. "This has also been true for informatics because most degree programs in the field are at the graduate level.

"Montana Tech’s bachelor’s and associate’s degree programs in health care informatics give undergraduates, especially students just coming out of high school, a clear path into this field, as well as providing a way into the health care system for ‘career-changers’ who want to start applying their knowledge to health I.T."

Changing from paper charts to electronic medical records sounds like a relatively easy sales pitch. It improves patient care, decreases the risk of error and adds enormous efficiency into the system.

But bringing state-of-the-art technology to health care is expensive, often running well into eight figures. Still, there are ways to keep the cost down and also provide excellent care. Forbes caught up with David Whiles, CIO of Midland Memorial Hospital in Midland, Texas, to look at ways to save huge amounts of money without sacrificing quality.

Forbes: What are you trying to accomplish with your electronic medical records?

David Whiles: First and foremost is patient safety. After that it’s efficiency. We started this project five or six years ago after receiving sunset notices on our major systems. That started us looking at replacing those systems and trying to figure out what the future would bring. We saw what was coming down the line. That was when Bush was putting his health IT plans into place and forming the Office of the National Coordinator for Health Information Technology. There were a number of reasons to move to electronic health records. We did not have any sort of electronic health records in place at the time.

What did you have before that?

We had a hospital information system, which is for the financial side of the business–patient accounting, general accounting, registration and basic order entry. It did not include physician order entry. We had automated our pharmacy department, too, but all of these were all separate systems with only a limited interface to the financial system. We had no clinical alert or bedside medication administration that notified the staff as to the appropriateness of the medication.

Did everything go smoothly from the start?

Well, we were somewhat shell-shocked from the sticker price. We were not in a financial situation to take advantage of the commercial systems that were being offered.

So what did you do?

We came across the VistA (Veterans Health Information Systems and Technology Architecture) system, which was developed by the Veterans Administration. That’s used by all the 160-plus VA hospitals in the United States, plus all of their outpatient ambulatory clinics. It’s been in use by the Veterans Administration for more than 20 years. It’s a very mature system. It’s won a number of accolades from the Institute of Medicine.

Is that available to non-VA hospitals?

Yes. It was released to the public through the Freedom of Information Act by the Veterans Administration. Today it’s publicly available. For a nominal fee, they’ll send you CDs of the software.

How much does it cost if you go to the commercial market.

Four or five years ago, the price was $18 million to $20 million for a hospital our size.

What does it cost to implement the VistA system?

The software is basically free, but it’s not free to install it. You need expertise to do that. It’s not a plug-and-play application. It’s a custom clinical system.

When you tallied all the costs, what was the final bill?

Our budget was $6.3 million, which was approved by our board of directors. That’s exactly what we spent. It included hardware–we have a full wireless system on both of our campuses–about 600 workstations, including 80 mobile workstations, and the bar code scanners and printers. The bulk of that money was for professional systems by Medsphere Systems Corp. They’re still our support vendor today. We rely on them for the technical expertise. They also have a lot of ex-VA employees who have experience with the Vista system.

Is it more upkeep on an open software system or less?

It’s probably about the same.

Is it fully implemented?

Yes. It was finished on Feb. 5, 2007. That’s the day we removed all legacy paper charts from our organization. At 5 a.m. that morning they pulled every paper chart. We’re not completely paperless, but we have no paper patient charts anymore.

Is it the same kind of complexity as an ERP system?

It’s probably far more complex. There are a lot of components to electronic health records, and the VistA system has the majority of those components. We use it for our lab system, pharmacy department, respiratory therapy and a number of departments around the hospital. That includes any nursing care, physician care and electronic documentation. When a patient is admitted, they get a wristband with a bar code. The nurses can scan that bar code to make sure it’s the right patient. The system matches the medication to the patient, makes sure it’s the right time for the medication, the right dosage and the right route of administration. When it matches up correctly, it gives them a green light.

Does it allow add-ins like portable devices?

Right now we’re evaluating portable devices. We have workstations on a stand right now for documentation or medication or administration. We don’t have any handheld portable devices yet.

What are your criteria for those?

It has to be light so people can carry it around but it also has to display the full application, so it won’t be cellphone size. We’re looking at tablet PCs. They also have to be waterproof. In the medical arena, you get stuff on devices. You have to be able to clean them and sanitize them. They also have to withstand shock if they’re dropped. And they need wireless connectivity for the barcode scanners.

But will those devices work with the overall VistA system?

Yes. That’s just a hardware issue. And there are plenty of good devices on the market these days.

How about security?

They will communicate through the wireless network. We’ve spent a lot of time on that network. They won’t be able to be tapped into.

Can they still access the Internet for information?

Yes. We have that already in our system.

What does the VA system run on?

The VA typically runs on Windows. We run on Linux. We’re using Hewlett-Packard servers, Red Hat Linux, the InterSystems Cache database management system, which is the only proprietary component in the stack. On top of that runs OpenVista.

Will there be changes to what you’ve installed over time?

Yes, it is a continuously evolving system. We are looking at adding in RFID technology for patient tracking and various other purposes.

Have you gotten a handle on what this has done for your legal liability?

It certainly improves patient safety in a number of areas. Medication is a big one. It’s certainly more foolproof than paper. Anything you do is kept permanently, and it has a lot of built-in protection from changing records. It’s a complete record of the patient care.

Is there a study that shows how much you’ve saved from an efficiency standpoint?

We’ve gone through a return on investment analysis. Our legacy systems went away. The money required for paper storage has gone down close to 100%. Electronic storage is a lot less expensive.

June 30, 2009 | Chip Means, Web Editor

David Blumenthal, MD

CAMBRIDGE, MA – Electronic technology will soon be considered as fundamental to medicine as the stethoscope, according to National Coordinator for Health Information Technology David Blumenthal, MD.

Federal incentives for the meaningful use of such technology will propel the nation, Blumenthal told a crowd of providers, technologists, vendors and advocates during a Tuesday morning speech at the Massachusetts Institute of Technology in Cambridge.

"I found that (information technology) changed me as a physician. I thought it was going to change practice. That was 10 years ago," Blumenthal said. "I think that reality will be realized within a few years."

Blumenthal’s opening keynote at the HIT Symposium at MIT focused on the transformational potential of stimulus funds marked for healthcare IT initiatives. He emphasized the sheer size of the funding, which is between $31 billion and $46 billion depending on certain factors such as adoption levels and provider qualifications.

"The American Congress doesn’t produce more than incremental change very often, but the HITECH provision is discontinuous – it’s a leapfrog over the current state of affairs," he said. He qualified this statement with a reminder that President Barack Obama considers the funding a "downpayment" on healthcare improvement.

Despite attendees’ enthusiasm for the Obama administration’s focus on healthcare IT, some expressed anxiety over the short timeline for adoption and incentives. "If you look at the calendar and think about the institutions we need to create by 2011, it is a truly daunting prospect," Blumenthal said. "And in some ways, if we started a year ago, we’d still be late."

Blumenthal acknowledged other challenges facing the ONC, such as addressing the needs of small providers, privacy and security concerns and the lack of attention the current legislation pays to providers of long-term care, home care and hospices. ONC hopes to include those providers later, he said.

"We need that connection, but very frankly we don’t have the resources or the authority in this legislation to do what we need to do in that sector," he said.

Blumenthal said he’s optimistic about ONC’s ambitious agenda. "We will not be successful unless we think of this as something with the purpose of changing individual health, population health and the efficiency of our healthcare system," he said. "That’s the brilliance of the meaningful use concept: To set goals that are about healthcare, and not about information technology."

ONC’s 2009 objectives include holding further policy and standards committee meetings, holding open meetings on certification processes, releasing a concept for infrastructure programs and issuing an initial rule on "meaningful use" by the end of the calendar year.

Regarding the final definition of "meaningful use," Blumenthal said the initial rule would hit the federal register in December. A 60-day commenting period will follow, and in early- to mid-2010 there will be a final rule for 2011.

"(Meaningful use) is going to be an evolving concept," he said, noting that by Congressional intent, the definition will change to demand more of the nation’s healthcare system.

http://www.healthcareitnews.com/news/blumenthal-meaningful-use-will-make-it-central-practicing-medicine