Here is a quick video of a doctor unlocking his workstation using a fingerprint reader imbedded in the keyboard. These keyboards are from Cherry. The single signon software is from Healthcast. Affinity uses this setup in physician offices and exam rooms.

Whenever someone is discussing a RHIO I can’t help but daydream about Duran Duran videos. Anyone else?

It is very common for a new software selection to be determined by a scoring system. I am sure most of you have seen this. The selection team identifies the various considerations and assigns them a weight. Then, usually through demonstrations, the team assingns a ranking to each of the considerations It might look something like this:

This was actually an RFI scoring matrix we used to whittle down vendors. An actual PACS scoring matrix should be much more complex. But, you get the idea. Yes, we did choose Amicas and we are very happy with the decision.

The best thing about this approach is that it makes the selection more objective. Approving bodies like executive teams and boards love that.

But, I often find that this kind of scoring system can fail a selection team. I frequently see these scores end up to be within a couple of percent of each other. Because the process of weighting is based upon gut, they really present subjective results in an objective looking way.

In my mind the ideal selection chooses the least expensive option that meets all of the critical capabilities. That is, I think price should be balanced against the feature function scores.

It is common in ERP selections to see vendors chosen based upon bells and whistles that will never be implemented. Remember, we use less than half of the features of the software that we buy. Be sure not to make your purchase decision based upon those unused features. Especially if you are paying good money.

I bet all of you got emails from non-IT people this week letting you know that H.R. 4157 was passed by Congress. Did you politely thank them, or, did you say “hey, I am on the same email lists as you”?

Anyway, I think the most substantial impact of this bill would be the fact that hospitals would be able to provide physicians with EHRs without being in violation of Stark. This will clearly benefit the largest providers and those with the most advanced technology. If you are a free-standing community hospital the pressure is getting greater to align with a larger system (as if it weren’t already unbearable).

I received two emails before H.R. 4157 went to the floor. One from CHIME encouraging me to let my congressman know we needed him to support the bill. The other was from AHIP (I am also the CIO for our HMO) encouraging me to tell my congressman to vote against the bill. I may have too many lobbying groups working on my behalf.

I think AHIP got it right. This bill originally called for interoperability standards. Theoretically it wouldn’t matter if a doctor used a particular hospital’s EHR because the interoperability standards would allow them to practice at the competing hospital and still have access to those patient’s information. As passed, HR 4157 gives large health systems ways to lock in physicians. If you are a doctor and all of your patient’s information was in one system, it would be too inconvenient to admit them where you don’t have easy access to that patient data.

AHIP is also concerned about the deadlines for the ICD-10 coding systems. That will be a lot of work.

For those of you with a fiscal year that starts 1/1 you are probably ramping up your planning and budgeting efforts. When trying to determine which IT projects you will add to next year’s plan there are two constraints that one must consider: staff time and money.

Of the two of these, I find the human constraint to be the most limiting. You could double our capital budget, and we still couldn’t accomplish significantly more.

Even though we are acutely aware of this contraint, we still manage to commit to more projects than we can complete.

At the planning stage it is extremely difficult to estimate how much staff time a project will require. There isn’t enough time before budgets are due to develop detailed project plans. Universally people always underestimate the amount of effort a project will take. Even seasoned veterans make this mistake over and over. I guess we always assume that things will go to plan. the fact is, that they never do.

Vendors are little help. The time estimates they provide for projects are not based in reality in any way. One of our HIS vendors states that their eMAR and medication scanning product can be implemented in 3 – 4 months. Our experience is more like 15 months., and we have our A-team working on that project. You can’t even get your medications unit-dosed and bar-coded in 4 months.

I was discussing this tendency to underestimate effort with one of my colleagues. He suggested that we should start multiplying our best guesses by 3. I was thinking 4. We are both probably underestimating.

MEDITECH has a terrific customer web site. They were one of my first vendors to log all of the service issues using a web tool that was shared by the customer and the vendor. They do a great job of documenting everything related to an issue, even the phone calls. It is great to be able to read the complete history of a problem.

Because of this system, I can tell you that Affinity has 204 open issues. While that may seem like a lot, it really isn’t when you consider the breadth of applications and the size of the organization. I can tell you that none of them are significant (you don’t have to turn off your mobile phone, Priscilla).

It amazes me the number of vendors that still don’t have an online system for tracking service issues (Amicas comes to mind). Some use Excel spreadsheets to track issues. When you are going through a major implementation and issues are by the minute, it doesn’t work to have a tool that only one person can update. We use our own tools (QuickBase or SharePoint) when our vendor doesn’t have one.

Update: Amicas now has a great web-based service tracking tool.

Some issue tracking systems could be better. Our health plan uses products from QCSI to manage that line of business. They have an online issue tracking system. But it could be better. In our service agreement we went through painstaking efforts to define levels of issues and acceptable response times to each level. However, their issue tracking tool does not allow us, or them, to specify which level issue is being reported. Consequently, they have no basis to provide us the promised support and we have no basis for knowing if we are getting the promised level of support.

In our selection processes we always ask new vendors how they manage service issues. This is an important consideration to me.

Back to the MEDITECH customer web site – I am not going to let them totally off the hook. They have had a greyed out link to a “CIO Portal” for a number of months with a little icon claiming that is is coming soon. I guess “soon” is a relative term.

Look for my next post soon.

For my friends that visit here I thought you would get a kick out of this story that appeared in the Guardian. Maybe I don’t understand British humor, but it seems like they had a laugh at my expense.

In the past I have written about my frustration with constant requests for surveys. But it is cold calls that are the bane of my existence.

Frankly, I only listen to voicemail about once a month. 90% of the voicemails that I get are cold calls and I have created a a game to see if I can delete them in the first second of the message. There are some key phrases that let me know when the voicemail is a cold call. Anything that starts with “Hello Mr. Weider” is a goner. Nobody that I know calls me Mr. Weider (except my daughters’ friends). People that call me “Bill” are also immediately deleted.

I love people that ask me to call them back without any reference to the subject. That is a technique that does not work with me.

I suppose that there are some worthwhile products and services in some of those cold calls. But, they are needles in a haystack and I don’t have time to search for them. Most of the voicemails are just plain bad. This voicemail is from someone purporting to be from IBM offering to connect me with a business partner that has a turnkey solution that will allow me to archive and access the information on my databases. Huh? Finally, I will be able to access all that information that I have been storing in my databases. I thought the day would never come. It seemed silly to be storing data for all these years without a way to access it.

I think bad cold calls could be a regular feature on my blog.

My heart sinks when I pick-up an incoming call, thinking it is someone that I am expecting, and it turns out to be a cold call. I feel obligated to let them finish their lengthy intro, before politely telling them that I don’t have time to take their call. I guess I am Midwestern nice.

Happy Father’s Day.

I have been averaging about 200 visitors a week to this blog over the last couple of months. It should be interesting to see if that spikes since a link to this blog was posted on HISTalk, a wildly popular blog healthcare IT blog.

That blogger referenced a comment I made about a patient safety incident where the hospital took responsibility, but seemed to focus their communications on the nurse mistake, not the processes and systems that enabled the mistake. I pointed out that this seems counter to a basic tenet of patient safety: eliminating the culture of blame. Of course those things are probably being evaluated, but the marketing folks handling the press may not understand that.

In classic Mr. HISTalk fashion, he took it a little further than that. It certainly makes for good reading. But, I do have to clarify that the comments in his June 15 post are his, not mine.

Last week the census reached 330 at St. Joseph’s Hospital in Marshfield, WI. It is the second largest hospital in WI. That is amazing given Marshfield has a population of less than 20,000 and it is in the middle of nowhere (sorry Marshfield). There isn’t even a a highway within 30 miles of the city.

But, Marshfield is the home of the Marshfield Clinic, a highly regarded multi-specialty clinic with 750 physicians. If you need tertiary care in Northern Wisconsin you make the track to Marshfield.

Marshfield is also the home of a remarkable healthcare IT story. The Marshfield Clinic has been developing its own clinical IT systems since 1984 (or so). In 1995 they had an electronic medical record that rivals the most advanced systems you would find anywhere today.

Other large clinics have tried to write their own clinical applications. There have been some spectacular failures. John Deere Clinics wrote-off tens of millions of dollars in their attempt. Kaiser Permanente wrote-off hundreds of millions of dollars when they abandoned their internally developed EMR. But somehow the Marshfield clinic has succeeded where others have failed. Carl Christensen is the CIO there. He leads a team of 280 IT professionals.