October 1, 2007

1. Voters Care Little About Healthcare IT Interoperability, Survey Says

Facts and Background

While 57% of Americans support the concept of a Nationwide Health Information Network, most of those polled in a recent HIMSS survey say a presidential candidate's position on it won't influence their votes.

Opinion

You can bet the poll overstates the voting public's interest in NHIN. Respondents invariably say they're in favor of something that sounds good even though they have no idea what it means, what it costs, or whether it would benefit them. Since HIMSS did the survey, I'd be surprised if price and privacy concerns got mentioned, both of which would likely cause great voter consternation and a much lower support figure.

Musings

• RHIO failures have probably killed what little chance NHIN had of seeing the light of day. Communities don't support RHIOs, which are relatively cheap, locally controlled, and personally beneficial, so why would they feel better about an expensive federal boondoggle that tries to do the same thing?
• Candidates claim that healthcare IT will make the system better and cheaper, but evidence supporting that reasonable assumption is scant, even in individual providers. If it did, those affluent hospitals that spend heavily on HIT should provide a shining financial and patient care beacon for the laggards.
• The average American isn't really worried about healthcare as much as they are about insurance premiums and coverage. People may occasionally gripe about some aspects of care delivery, but few seem willing to replace it with something new. Widespread dissatisfaction is necessary to create broad change, of which IT would be part.
   

2. New York State Health Department Offers $106 Million in Interoperability Grants

Facts and Background

New York's state health department announced this week that it would award $106 million in grants for IT collaboration projects that improve care and its cost. The state health commissioner cited interoperable electronic medical records, data collection, and quality-based healthcare reimbursement as goals.

Opinion

All the benefits sound wonderful -- and familiar, having come from the "Sure-Fire RHIO Failure Template." Maybe past history and likelihood of long-term viability will be considered when the checks are written, but the announcement sounds naive. The use of government grants to jump-start change in the free market doesn't usually work. But, given New York's startling and disproportionate healthcare costs, this is a drop in the bucket.

Musings

• The state awarded $53 million to six RHIOs in mid-2006 via the same program, Healthcare Efficiency and Affordability Law for New Yorkers.
• The grant application deadline is less than eight weeks from the press release. Expect some shoddily thought out projects prettied up by big-name government vendors and consulting firms to make them look worthy.
• When the grant money runs out, so will the consultants.
   

3. Nursing Adoption of HIT Poor, Vendor Reactions Differ

Facts and Background

A study by consulting firm KLAS showed poor adoption by nurses of healthcare information systems. The results were announced in late July, with the highest score 23 on a 40-point scale. A GE Healthcare response obtained this week by HIStalk apologizes on behalf of that company and the industry for inadequately supporting nurses with IT products, while other vendors issued press releases emphasizing their performance over that of competitors..

Opinion

Everybody knew it, but finally someone said it. Clinical systems, no matter how many are sold and at what price, often hinder rather than help nurses because of poor design, outdated assumptions, and lack of attention to usability. As a result, they aren't used consistently and have had little measurable impact on patient outcomes. 

Musings

• Interesting and opposite reactions: Cerner immediately posted a glowing press release for getting the highest score (the best D grade, in other words) while GE Healthcare said that "no vendor should be pleased with the results."
• Actions speak louder than words. Hospitals keep buying systems that nurses don't use, so shame alone probably won't motivate vendors to change.
• Many of today's systems were designed under a 1980s nursing system paradigm: nurses are a cost center for which the best use of computerization is charge capture, order routing, and labor management. If nurses all over the country don't use systems because they don't see any value added in patient care, it's a fair bet that there isn't any.
• CIOs and administrators often override the purchase of systems that nurses prefer because of strategic relationships, perceived integration challenges, or IT concerns. It's a stretch that nurses will voluntarily learn to love a system that was far down their preference list. Few nurses become CIOs or CMIOs, so their hospital IT influence is minimal.
• Lofty proclamations aside, if a hospital can't convince the average night shift, ED, and ICU nurse to willingly use IT systems, those systems will not deliver the expected benefits that nursing executives optimistically promise.
   

4. Physician Technology Use Varies by Specialty

Facts and Background

Results of a Center for Studying Health System Change report announced this week show a wide variation of IT systems by physician specialty and sub-specialty. For all basic clinical activities, oncologists reported the highest usage, while ophthalmology, psychiatry, and orthopedics were on the low end. Even for oncologists, only 18% used IT for guidelines, patient notes, prescription writing, exchanging information with other physicians, and exchanging information with hospitals.

Opinion

There's nothing counter-intuitive in these results, but they're a good reminder that not all physicians are created equal. Vendors know that physicians don't care what the general market wants, but rather what colleagues within their specialty are successfully using and benefitting from personally. Since so few physicians are fully using electronic medical records, pointing out which ones are the lowest on the low adoption curve probably doesn't mean much. Spend the time instead on increasing the percentage of the highest adopters to something better than one in five.

Musings

• For those who see CCHIT's certification as an influencer of physician EMR adoption (a small minority, in other words), its upcoming specialty EMR certification should be welcome.
• If the results were intended to be shocking or a call to action, don't count on it. Physicians don't use what they don't need or want. If a psychiatrist doesn't see the value in using a full-blown EHR system, then merely exposing that fact to the world probably won't change his or her mind.
   

5. Pecaitis Leaves Medsphere

Facts and Background

HIStalk confirms that former Medsphere VP Frank Pecaitis has left the company and joined GE Healthcare. CEO Ken Kizer had already announced his own departure, to take effect when a replacement is found to run the open source hospital software company whose product was derived from the VA's highly regarded VistA application.

Opinion

The high profile Kizer, fresh from notable successes with the VA, tangled with the founding Shreeve brothers almost immediately, resulting in their dismissal and their suing for $50 million in August 2006. Medsphere claimed a litany of transgressions, but outsiders were left with the impression that it was either Kizer's ungrateful ousting of the founders or a hypocritical company touting open source while disdaining the open source community. The departure of Pecaitis, the last of the original "star" executive hires, seems to confirm that the company has sustained significant damage while accomplishing modest results.

Musings

• The hiring of Kizer and Pecaitis gave Medsphere credibility. Losing them both damages it.
• Is Medsphere's product really open source, or just cloned from free taxpayer-purchased software? The difference is its contribution back to the community, which has been the source of contention among open source advocates.
• The ill-advised lawsuit has been the company's albatross, but Kizer won't drop it. Unless he knows of a secret $50 million stuffed away in the collective Shreeve mattresses, he's killing the company to make a point that's moot at best.
• What's taking the company so long to replace its lame duck CEO? They need to hire a strong leader, drop the lawsuit, and either embrace the open source community or break from it to become just another software vendor (except one whose competitive position ought to have been strengthened by an initial R&D cost of zero).
  
  

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