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No such thing as a free lunch

SAN DIEGO—The gathering of chief medical information officers and other technologically inclined clinicians here for the just-concluded Association of Medical Directors of Information Systems meeting was abuzz this morning over yesterday’s New York Times story headlined, “U.S. Will Offer Doctors Free Electronic Records System.”

The story talked about the soon-to-be-released VistA Office EHR, a “lite” version of sorts of the Veterans Health Information Systems and Technology Architecture long in use by the Department of Veterans Affairs.

According to the Times, “Medicare, which says the lack of electronic records is one of the biggest impediments to improving health care, has decided to step in. In an unprecedented move, it said it planned to announce that it would give doctors — free of charge — software to computerize their medical practices. An office with five doctors could save more than $100,000 by choosing the Medicare software rather than buying software from a private company, officials say.”

News outlets all over the country took this to mean that doctors could get free EHRs. One blog I saw, a self-described former IT consultant going by the screen name of “drsaddam,” called this news “VERY EXCITING!” (emphasis in original). “I should call the doc next week and see if he’s interested in taking advantage of this government offer. I’d like to help him set it up,” this blogger wrote last night.

The AMDIS folks, of course, know better. Yes, as something developed by the federal government, VistA Office EHR will be in the public domain — as the full-blown VistA has been for 20 years — and thus free of vendor licensing fees. However, the enterprise-class VistA is notorious for being difficult to implement in the private sector. If large health systems with their own IT departments haven’t taken advantage of free software, what makes anyone think that every physician in a small practice will simply be able to download a copy and instantly leave the paper world behind?

(Actually, I’m not sure if anyone will be able to download the software, nor is the program completely free. Some HHS folks told me that practices will have to pay a shipping fee.)

Perhaps “drsaddam” has the skills to get his physician up and running on VistA. Even so, it remains to be seen if the physician will find the system user-friendly. And what of the tens or even hundreds of thousands of other physicians out there without a “drsaddam” volunteering to set them up? Consultants don’t come cheap.

One thing that also is certain is that even if “drsaddam” calls his doc next week, he won’t be able to get VistA Office EHR right away, since the software won’t be available until at least Aug. 1.

Remember, there is no such thing as a free lunch, unless, of course, you work in journalism. A lot of reporters seem to have been sloppy eaters this week. Note the egg all over their faces.

July 22, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

NYT discovers VistA , forgets what ‘VA’ means

SAN DIEGO—Today’s New York Times includes a feature story on the Veterans Health Information Systems and Technology Architecture (VistA) of the Department of Veterans Affairs.

Specifically, the Times is looking at how the forthcoming release of the VistA Office EHR, a scaled-down version of the VA’s comprehensive clinical records system that is more appropriate for small physician practices.

About two-thirds the way through the article, the Times refers to the VA as the “Veterans Administration.”

Memo to NYT Executive Editor Bill Keller: There has not been a Veterans Administration since 1989, when the VA became a Cabinet-level department.

July 21, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

‘Human super glue’

SAN DIEGO—I’m at the Physician Computer Connection, the annual conference of the Association of Medical Directors of Information Systems. It’s a gathering of about 150 of the best and brightest in medical informatics, mostly chief medical information officers and other high-level, technologically savvy clinicians.

It’s a good bet I’m the dumbest person in the room. With this crowd, I don’t feel so bad about it.

Speakers include Dick Gibson, M.D., of Providence Health System in Portland, Ore.; Clinicomp CEO Richard Kremsdorf, M.D.; and Kaiser-Permanente IT pros Howard Landa, M.D., and Dean Sittig. David Brailer, M.D., will be here Friday morning, not so much to speak as to have an open discussion with the AMDIS folks.

Gartner’s Vi Shaffer described the CMIO as the “human super glue” of healthcare IT, the person who holds everything together. Gartner is conducting a survey with AMDIS to shed some light on what makes a CMIO, what they do, how they think, what they earn and how they lead.

Shaffer discussed some interim results, but those, alas, were not for publication by people like me. Look for some surprises when a report comes out in August.

Also in the pipeline is a full mea culpa from Cedars-Sinai Health System on the infamous 2003 failure of the Los Angeles hospital’s CPOE system. Cedars had a “lessons learned” poster at last year’s international MedInfo conference, but now some of the key players are working on a more comprehensive report that will be submitted to JAMA or some other widely read journal.

(Click here to read what I wrote about the MedInfo poster.)

Showing the forward-thinking nature of this crowd, Diane Gilbert Bradley of Eclipsys said that electronic clinical notes are only as good as the system they are part of. She talked about how hospitals must shoot for the “next level” of point-of-care documentation, namely interdisciplinary documentation, so, for example, a rehabilitation specialists know a radiologist found.

Online patient-physician communication guru Eric Liederman, M.D., of UC-Davis in Sacramento, Calif., talked about how to safeguard patient privacy without compromising care. He included a message for the many healthcare executives and lawyers who still are confused about HIPAA.

“Privacy is what we apply to the people who are already inside the castle,” Liederman said. “Security is about keeping the bad guys out.” For example, a user ID is a privacy tool; a password is for security.

It sounds simple enough in this company, but the masses continue to scratch their heads.

July 20, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Syndicate this site

I’ve made a few changes to the site recently, most notably the Google ads that appear at the top of new posts. I doubt I’ll make much money off the ads, but it’s worth a shot.

Another change is the addition of the logo at the top of the right-hand column. Click this button to syndicate this blog to a newsreader such as NewsGator, My Yahoo or other aggregator program. You will receive automatic notification whenever I update this blog.

Also, stay tuned for an upcoming experiment in podcasting.

July 18, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

That Walgreens pharmacist strike

Here in the Chicago area, about 1,200 pharmacists at Walgreens drug stores went on strike about two weeks ago to protest what they call a staffing shortage and unsafe workloads.

The National Pharmacists Association, which represents pharmacists in northern Illinois and northwest Indiana, says that the workload at many Walgreens pharmacies routinely exceeds the “safe” threshold of 20 prescriptions filled per pharmacist per hour. The company disputes the claims and says that about one-third of the original strikers have returned to work.

Regardless of who is right, the debate clearly is missing something. Raise your hand if you think that the so-called “safe” level could at least double without endangering patient safety if every prescription came in electronically, with potential interactions, insurance coverage and formulary compliance already verified.

July 17, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

You say tomato …

About three months ago, I threw out for discussion whether an informatics professional should be called an “informaticist” or an “informatician.” Three people posted short comments directly on the blog, but I received several other opinions via e-mail.

While I personally prefer informaticist, my unscientific poll showed that the issue is far from settled.

One of those who commented on the blog—a techie whom I actually know—suggested “the plain and simple ‘guru of everything.’”

An e-mail from an EMR vendor joked that the debate was akin to “physicist” vs. “physician.” (Most physicians I know would want to make sure everyone is perfectly clear on that distinction.) This individual went with informatician “because mostly these folks apply the principles of IT rather than being purely in the computer science of information.”

Another vendor executive — a physician — went with informaticist, only because it’s easier to say.

One of the more thoughtful comments said that informatician has lost popularity as the field of informatics has evolved:

Some other thoughts:

  • I think the -ian suffix implies a practitioner of informatics, whereas the -ist ending seems to imply a more academic pursuit. This is in keeping with the progression of informatics — it is increasingly moving out of academia and moving into the field.
  • I much prefer “informaticist”, because it sounds like informatics, does not appear too contrived or stuffy, and has a much greater chance of getting into common usage (I don’t even know where the accent falls in “informatician”). If the real world is going to start hiring informaticists (e.g., as CMIOs), they’d better have a convenient way to say it!
  • Regarding “informatician” vs. “informaticist,” I tend to prefer informatician. That said, whatever we call ourselves, I think that we have much bigger identity problems. In fact, there are no well-defined core competencies that an informatician/icist must possess, especially when our esteemed leaders profess the nice-sounding but ultimately impractical (at least for the next 100 years) dogma that bio-informatics and clinical informatics are one discipline. Everybody knows what an anesthesiologist/anesthetist does, but an informatician might be a change management specialist, an ontology wonk, an NLP geek, or a CPOE “expert.” Or a protein folding or genetic sequence analysis guy. Perhaps this is one reason why I hear so many of my friends in formal informatics training programs complain that there are no jobs out there for informaticians, despite the supposed “shortage.”

My favorite comment suggested that informatician might be more popular on the East Coast, while informaticist holds sway with the West Coast and Midwest, though the terms might as well be synonymous. “However, I prefer ‘informatician,’” this individual added. “Sounds like what we do — info-morticians: dealing with dead, legacy data.”

July 14, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Updated conference listings

Here’s just a quick note as I plunge head-first into a big stack of stuff that piled up before the July 4 holiday: I have updated the listings of upcoming conferences related to health IT and patient safety. Scroll down in the right-hand column for some fresh links.

July 5, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.