July 14, 2008

1. Leapfrog's Leaps Not as Giant With One Foot in Mouth

Facts and Background

A Wednesday statement from the CEO of healthcare purchasing advocate The Leapfrog Group suggests that computerized physician order entry would have prevented anticoagulant overdoses in 17 neonates at CHRIST Spohn Hospital South in Corpus Christi, TX.  It urges prospective patients to ask hospitals if they have CPOE before seeking care.

Opinion

Remember Gerald Ford saying that Eastern Europe wasn't under Soviet domination in a TV debate? Or Dan Quayle arguing with a kid that "potato" ends with an "e"? This hastily rushed out comment will live with those in infamy as one of the most profoundly misinformed (and appalling self-serving) comments ever made voluntarily, and by press release at that. According to the hospital's analysis, the overdose occurred due to pharmacy preparation, not improper ordering, so CPOE would not have mattered a bit. None of the technologies that COULD have helped are on their list. Unless Leapfrog knows something that wasn't publicly announced, this is an uber-screwup, yet another ham-handed attempt to shame hospitals into buying CPOE, benefits be damned.

Musings

• A 2005 archive of Leapfrog's site showed over 170 employer members, including many healthcare IT vendors. It now shows fewer than 25, with zero healthcare IT vendors (including the CPOE ones). This comment surely won't help boost that number.
• CEO Leah Binder's education is in communications and government administration. Letting her make a comment on clinical information technology without apparent review by someone who understands it was a big mistake.
• The statement implies that the death of the baby by the time of the announcement was killed by a heparin overdose, but the physician who reviewed the death said it was due to natural causes. Either way, making a statement tied to the death is premature until autopsy results are in.
• "Overdosed" doesn't always mean "harmed."
• In fact, making any statement to rally the failing CPOE bandwagon around this incident is insensitive and ill-advised (not to mention looking like a desperate Leapfrog attempt to steal some sad limelight).
• The implication that CPOE hospitals don't make medication errors is just plain wrong. Binder was quoted as saying this: "Studies suggest that computerized physician order entry (CPOE) systems reduce medication errors by 50-100%." So she knows of a hospital that has eliminated medication errors COMPLETELY (100%) just by implementing CPOE? Can I have their name, please?
• The irony is that hospitals could afford technology that could have prevented this mistake (in-pharmacy automation) if Leapfrog hadn't sent them off chasing CPOE nirvana that has had questionable impact on patient care. 

2. Two Foreign Companies Increase US Unemployment Rate

Facts and Background

Sage Software Healthcare aid off 235 employees last week as Siemens announced plans to part ways with up to 17,000 workers.

Opinion

Sage is in an extremely tough market and has a product too expensive to compete on the low end, leaving them to compete with higher flyers like Allscripts and NextGen. Siemens still hasn't gotten over its worldwide corruption charges and, like all conglomerates, always has business lines that aren't producing.

Musings

• Layoffs happen all the time, but will become more common in tougher economic times.
• As devastating as employees are to affected employees (often the defining moment of their career), it is the obligation of corporations to do whatever is necessary to survive, including eliminating employee expense. Cold, but realistic.
• In this day and age, employees are more like contractors -- hired for specific skills, free to leave at any time, and subject to the market-driven need for whatever they do. Nobody gets a gold watch or pension these days, so it pays to have a backup plan (or to work for yourself).

3. Intel Inside ... Your Medicine Cabinet, That Is: Home Health System Gets FDA Approval

Facts and Background

Intel announced Thursday that it had received FDA market clearance for its Intel Health Guide, a care management tool that electronically links providers and patients.

Opinion

Intel has quite a few people in its Digital Health Group working on healthcare projects and this one looks good.

Musings

• The press release says the product provides vital sign collection, patient reminders, education, videoconferencing, and e-mail, sending collected information to a secure server for provider review.
• This is an interesting approach, with the device not only gathering information, but providing a communication channel between patients and doctors.
• The eight-pound device runs WinXP.
• It appears to be a brilliant product, but now the question is how Intel plans to market and support it. They're good at design, but creating provider demand will be a challenge (marketing to patients won't help if there's nobody on the other end to receive and use the information in their care).

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