I often hear CIOs describe their Leapfrog and IHI initiatives and as “compliance projects.”

I am not sure if those CIOs realize that these are private organizations with no ability to legislate healthcare operations. It sure doesn’t seem that they realize that these are supposed to be patient safety initiatives with measurable and significant improvements in patient safety. If you are only working on CPOE because of Leapfrog, you should stop. Then again, if you are really looking at improving patient safety, you are probably working on something with more proven results than CPOE.

By the way, I am declaring Leapfrog dead. Let’s move on.

True story…I personally know of an instance where a CEO had his assistant email the CIO to ask why he thought doctors don’t want to use CPOE. Do you understand the irony?

I know that conventional wisdom is that an Electronic Health Record will be good for trees. But, I am finding the two to be incompatible. At our Affinity clinics we have an authentication system on our exam room PCs that uses the physician/nurse fingerprint to log them in. It also uses an ultrasonic detector to lock the PC when they walk away. It is a pretty cool system.

One of our doctors planted several trees on Arbor Day weekend. When he returned to work on Monday the system would no longer recognize his fingerprints. Apparently he had roughed up his hands too badly. We put him on a prescription of liberal doses of hand cream. That seemed to fix things after a day or two.

There are two ways to improve quality measures. The most important way is to improve quality (duh). But your good quality can be diluted if you don’t manage the denominator.

Most physician practices don’t manage their panels. Panel management is the key to top P4P results. If your panel includes patients that are no longer seeing your physicians, then ultimately they will be non-compliant with you health management targets (e.g., diabetic eye exams, annual physicals, chlamydia screenings, etc.).

My experience is that a physician practice takes no action when a patient leaves their panel (moves, switches insurances, dies). In fact, they often don’t know. But these people will pull down your P4P results. Physician practices need to introduce new processes to actively track down patients that they have not seen and flag when they have left their panel. Their IT systems also need to be able to flag them as out of the panel. So they can be excluded from the P4P denominator.

Ideally the system will allow the practice to document why and when the patient left as well. This information could come in handy if we get to the point that these results start getting audited.

At HIMSS this year I spoke in the Dictaphone booth regarding our experience with their EXSPEECH voice recognition system. It was a good project that had a solid ROI (less than a year). We implemented the system while their then parent company, Learnout & Hauspie, was going through bankruptcy in 2001. This turned out to be a good move since we got a great deal of support. Like your financial portfolio, your IT portfolio should have some agressive, high risk investments.

This year there was a sense of deja vu in the Dictaphone booth as they were being acquired by Nuance. Nuance holds much of the same assets held by Learnout & Hauspie (e.g., Dragon Naturally Speaking) when they acquired Dictaphone in the 1990s. The primary difference in the 21st century is that Dictaphone sold out for 1/3 the price.

A couple of years ago I had dinner with Rob Shwagger, the president of Dictaphone. Rob was on a low-carb diet. As he ate a cheese platter for dessert he told me a great story about the Learnout & Hauspie acquisition that really captured the spirit of the Internet boom. This is the story as I remember it:

Apparently Rob and another Dictaphone exec were meeting with the L&H principles in a Belgium outdoor cafe. The L&H dudes wanted to know the selling price for Dictaphone. Rob threw out an amount he considered to be outrageous, just to test the waters: $1B, as I remember it.

The L&H executives excused themselves and walked into a nearby farmer’s field. After a few minutes they returned to tell the Dictaphone executives that they accepted their offer.

I am starting to study IT infrastructure frameworks such as ITIL. The idea is that you have a standard way of handling most aspects of IT service management such as change management, continuity, capacity management, incident management, etc.

In my research I found the IT Service Management Forum whose mission is to “enable member organizations to achieve measurable operational excellence by introducing, developing and promoting IT Service Management Best Practices. ” However, I wasn’t able to order any publications from them because their online ordering page is down. How ironic is that?

Still, the notion of IT frameworks is more appealing to me as Ministry Health Care begins to consolidate its IT services into a single service organization. Ideally, we will develop a framework that addresses these elements of infrastructure management from an enterpise perspective. Otherwise, they will only be as good as each person assigned to manage a specific technology. For example, we can set some standards for managing availability. Those standards will be a guide for the rollout of services at the enterprise level. When we consolidate email, the email guru will have some guidelines for addressing availability. S/he will be given direction on assessing availability requirements; develop an availability plan; monitor availability; etc.

I don’t think this apporach makes sense for most community hospitals. But for larger networks that have 10,000 plus employees there is value in this level of discipline. Especially as more mission critical applications are brought online.

Well, I guess I am on a Microsoft bashing streak (the folks at the Leapfrog Group will appreciate the repreive). I read Dr. Bill Crouse’s blog with regularity and generally find it to be quite good. But this post makes me crazy.

Dr. Crouse is employed by Microsoft. In this post he blogs about a a Micorsoft partner, HealthUnity, that has developed something called a RHIO In A Box. The name alone makes me crazy. Anyone that has tried to exchange data between healthcare providers knows this is a huge challenge that cannot be solved with software or technology alone. All of the problems in creating a RHIO are outside the box. Posts like this only serve to make CEOs think that creating a RHIO is as easy as buying software.

I picked up this marketing gem from the vendor’s web site:

“A hospital that wants to tap into the HealthUnity™ network can do so using our low-cost, plug and play solution. Once deployed, this solution will enable your physicians to collaborate with internal as well as external parties over secure and HIPAA compliant mechanisms. We provide all the services required to maintain smooth operation of the system. This keeps your IT investments minimal while increasing the returns on your investment.”

When I got to “plug and play” I began to involuntarily heave.

Neither the HealthUnity web site, nor Dr. Crouse’s post, address the complexities of patient matching. For example, how does the RHIO know that John Smith with Medical Record Number 123 is also Jack Smith in another provider’s database with another medical record number?

Then we have the fact that most physician offices don’t collect allergies in a codified manner. In fact, many don’t even have the free form text online. The solution to that problem is not going to be in a box.

Dr. Crouse points out that the product has the ability to exclude parts of a patient’s chart from automated access, yet make it available for case by case requests (e.g. an AIDS test result). Driven by patient privacy and state laws. How does the RHIO In A Box know which of the lab tests are for AIDS tests? While there are some emerging standards for univerally coding lab tests (i.e., LOINC) less than 5% of health care providers use them. How does the box know what my hosipital lab system calls an AIDS test?

My mission in writing this blog is to add some realism into the healthcare IT debate. Healthcare IT has over-promsied and under-delivered. We have been selling unrealistic dreams. These are complex topics. To pretend they are not is the worse thing we can do to forward the IT cause in healthcare.

One of the great things about being in the same industry for 20 years is that there are some people that I have known for a long time.

It is great to see them at HIMSS. I was going through some pictures and found some that reminded me just how much things have changed. I guess these pictures are a metaphor the maturation of the entire healthcare IT field. Here are some examples:

Me and William Greskovich (left) in 1987 when we were FCG
consultants working on a gig at St. Mary’s – Evansville.
William is now the Vice President of Oerations and
Chief Information Officer for St. Agnes Hospital in Baltimore.

Mary Pat Fralick is currently the co-president

I haven’t seen Bobbi Coluni in 15 years. But I believe she is still the
Director of Product Development at Thomson Medstat. This is us circa 1985.
I have no idea what we were doing here, but it wasn’t as intimate as it appears.

I have identified the single greatest contribution that Microsoft can make to healthcare.

They need to remove the Auto Correct option in the office applications that turns “EHR” into “HER”. I am so tired of correcting Microsoft’s correction. I realize that this can be turned off through options. But, I use many computers (including Citrix). And everytime I get a new one I have to make this change.

I also know that this could probably be fixed globally with some good desktop management tools and a registry change (let me know if you know where this resides). However, my desktop management fokls have not figured this out yet.

It seems like Bill Crounse would have enough pull to have Microsft make this fix globally.