Here are the results from a recent web poll that asked: “What is your favorite scripting tool:“

• Boston Workstation: 546,465,355,300,154
• Summit Healthcare: 546,465,355,221,355

Let me know if you get it.

I was just reading at Mr. HISTalk’s blog how much he enjoyed the entertainment portion of the opening keynote. I thought I could count on him for sarcasm and a jaded point of view? Personally I thought the entertainment portion was very cheesy. Being from Wisconsin I know 8-year old cheddar when I see it. I didn’t come to HIMSS to be semi-entertained.

Brailer’s speech was the first opening keynote that I ever fully attended. I sat in the front-most section. Clearly the message was that Brailer and the president only want to “prime” the capitalism pump. They are going to let the free markets lead us forward to an interoperable EHR. One of the ways that this would be done is through “standards harmonization.” Which sounds like new standards on top of standards. Cool, I was hoping for more complexity.

Meet The Bloggers turned out to be as big of a nerdfest as I expected. It was great to meet the folks that share my interests. They were genuinely nice people that really wanted to discuss healthcare IT at a meaningful level. But if a fight broke out I didn’t have anyone I could hide behind. Thanks guys, I had a great time.

I have vowed not to mention the weather when calling back home. Too cliche.

Everything is going smoothly in my travels, unlike those on the East coast. It sounds like many MEDITECHers won’t arrive until Tuesday due to the weather.

When I travel my goal is to keep my expenses so minimal that it isn’t worth submitting them for reimbursement (other than lodging and airfare). Ground transportation is an expense that can really add up. The great thing about San Diego is that you can take the city bus from the airport to downtown for 2.25. I had about a half mile walk to the Hyatt from there.

Speaking of the Hyatt…I made my lodging reservations way too late. The hotel problems for this conference are well known. Luckily CHIME books a block of hotels for member CIOs. That saved my bacon.

I worked at the University of California – San Diego Medical Center in my consulting days. During that gig I remember waking up every morning and saying “this is the most beautiful day God ever made.” That is still the case. It is a beautiful day. I went for a run along the harbor and I loved every minute (except the running part).

Now I am getting ready to head over to the HIMSS welcoming reception (I will be fashionably late). My big decision is clothing. I am torn between business attire and a shorts/Hawaiian shirt combo. Maybe I will compromise.

Then it is off to the Meet The Bloggers event. It will be great to see my friends in the blogosphere.

The best kept secret in Healthcare IT may be St. Clare’s hospital in Weston, WI. St. Clare’s opened in October 2005 without a single file room. It is Wisconsin’s first digital hospital. Some hospitals have received tons of recognition, including the one in Birmingham that probably will never open. St. Clare’s, however, has flown under the radar despite being a state-of-the-art facility with everything from e-learning to full CPOE.

The entire project is the vision of Steve Pelton, the CIO for Ministry Health Care’s central region (Ministry and Affinity are sister organizations). The project enjoyed comprehensive project management support from the Ministry PMO. As a result, there are some good numbers regarding the total overall effort. St. Clare’s is a new hospital, so there weren’t any conversions or worries regarding existing paper records.

In total, the IT effort for this digital hospital has been just over 100,000 hours (including intense post-opening support). I calculate that to be just under 50 man-years. If you are going to take on the effort alone you will want to get an early start.

I found a fun new web site at http://www.netdisaster.com. It allows you to virtually deface someone’s web site. It is a great way to take out some vendor and competitor frustrations.

Likewise, a vendor may use this site as a way to take out their frustrations with me.

I had toyed with the idea of using my competitor’s web site with for this demonstration, but I was afraid the press would mis-interpret that as being something other than healthy competitive spirit.

Also, I don’t have any vendors that currently deserve such treatment.

Updated with event details…

I really enjoy being part of this emerging Healthcare IT blogosphere. Better than the exposure that I have gotten is the fact that I am exposed to a lot of ideas.

Several of us bloggers have decided that HIMSS will be a great chance to meet the faces of those ideas. Please consider joining us to share your insights and reactions to the hot topics.

If you are looking for free food and drink then this is the wrong place. This is an unsponsored event to preserve the independent spirit of blogging. This is the place to come if you thirst for knowledge (poetic, eh?).

The event will be on Sunday, Feb. 12 at 8:30 p.m. at Hennessey’s Gaslamp, 708 4th Ave., San Diego. That’s walking distance from the convention center and most of the HIMSS hotels. Click here for a map. So far we have 36 attendess. A manageable number.

If you think you might be able to join us, visit the HIMSS 2006 Blogger and Reader Meetup Registration site. Your e-mail addresses and private comments are not shown to the public.

I couldn’t seem to get my hands on good numbers regarding Computerized Physician Order Entry (CPOE). So, I have decided to do my own research. These numbers are based upon the Leapfrog Group survey reported on their web site.

You may ask “but Will, what if there are hospitals that have implemented CPOE but have not reported it to the Leapfrog Group?” I cannot imagine that someone would go through the effort of a CPOE implementation and not report their success to the Leapfrog Group. At many hospitals “Leapfrog” is the reason to do CPOE.

Is it possible that a lot of hospitals have gone live on CPOE since that last survey submission deadline? After all, each large HIS vendor claims they have hundreds of hospitals implementing CPOE. Well, it is possible that some new CPOE installations have recently gone live but, according to the Leapfrog site, only 58 hospitals claimed they were within 12 months of bringing their CPOE system live.

The other cautionary note is that all of the Leapfrog Group surveys are self-reported. I am going to write a separate post on why I am skeptical about many of these self-reported surveys.
So, how many hospitals claim they have implemented CPOE, as defined by Leapfrog?

68 hospitals operated by 43 different health systems claim to have fully met the CPOE leap. This represents 1.7% of all hospitals in the US according to my database.

Here is a breakdown by Type:

• Academic Medical Center: 30
• Community Hospitals: 26
• Government Owned Facilities: 6
• Children’s Hospitals: 5
• Heart Hospital: 1

This means that only .08% of American community hospitals have implemented CPOE (according to my database). But, I would be the first to admit that the definition of a “community hospital” is open to interpretation. I think this is a more important number, because Academic Medical Cetners can rely on residents to enter orders online without much regard to their desires. Community hospitals risk losing their top admitters to the competition.

I also think it is interesting to look at these hospitals by bed size (staffed beds):

• 101 – 249 beds: 14
• 251 – 400 beds: 14
• >400 beds: 34

The fact that most of the hospitals are big is no surprise. The real eye opener is the 6 that are under 100 beds. Again, I will write about this in a future post (we will have some fun with that).

I also plan to run the numbers by software vendor in a future post.

I hope this is helpful. I think the numbers can help set some expectations.

I am pleasantly surprised that my blog receives 30 – 60 unique visitors a day. I have to admit that I have become a bit addicted at looking at the logs to see what I can learn about the visitors and how they arrived here.

I had to laugh out loud when I saw one person arrived here by searching “i hate meditech” on MSN’s search engine. I can only wonder what caused such an action. BTW, I am ranked 6th on that search even though that exact phrase (or any such connotation) does not appear on my blog.

Speaking of MEDITECH, they are frequent visitors here. I am sure my account exec is keeping an eye on me (Hi Priscilla). But, it appears other MEDITECHers are visiting too. Maybe even Howard Messing, who I have never met.

Some of my other vendors that have stopped by include Valco, McKesson, Quadramed, and Wellogic.

I have also received some visits from organizations that may have been less than thrilled with the attention that I gave them. Even though the Leapfrog Group and Avaya have been here, they did not respond to my posts.

I also get emails from people that discovered me through my blog and want to sell me something. I am slightly more open to listening to somebody that took the time to learn about me, than someone mis-pronouncing my last name off of a call list. Still, that isn’t very interested.

But, it appears that most visitors are like-minded healthcare IT professionals looking for an exchange of ideas and some fresh thinking on tricky topics. A few visitors are from my own organization. Some visitors are with competing organizations (Aurora, not ThedaCare yet). But most from hospitals and health systems in other parts of the country and the world.

Traffic really began to become noticeable when I became a part of the healthcare IT blogoshpere. Other, more established sites linked to me and referenced my posts. I appreciate the attention they have brought my posts. If you want to be exposed to other healthcare IT bloggers the best starting point is Shahid Shah’s HITSphere.

I hate software demonstrations. They are nearly useless. Here are my primary gripes…

Suspension of disbelief
I cried when I saw ET. That is the magic of movies. Somehow a perfectly rational person can believe that a lost alien has been rescued by children. I think that same aspect of human nature betrays us when we watch software demonstrations. People want to believe. I have seen people swear that they saw something in a demonstration that I know was impossible. Somehow, people see what they want. Perhaps people are too optimistic.

“Cannit”
I know I am trapped in a bad demonstration when a volley begins between participants and demonstrators. Each question begins with “Can it…” Of course each response is “Yes.” Or my favorite “Yes, with customization,” which is vendorspeak for NO.

There are so many problems with this approach I don’t know where to begin. Actually I do. The vendor is lying through his/her teeth until proven otherwise. Any simple question that someone asks can be interpreted in a way to illicit a positive response. Usually the questions are too poorly thought out to really capture the intent. Furthermore, if the vendor is not demonstrating, but just volleying back positive responses is anyone really learning anything?

Watching TV
I guess Americans would rather watch TV than read a good book. That is the true when it comes to the software selection process too. Everyone would rather crowd into a room to see a fraction of the functionality demonstrated than read through the documentation to really learn how the system works. See my earlier post about reading documentation.

Why are we here?
When we do have software demonstrations (which is as seldom as possible) I always make sure we start the meeting by telling everyone why we are gathered. There are two reasons for demonstrations: education and acquisition. Everyone assumes that a software demonstration will lead to a purchase decision, so it is important to strongly emphasize to all parties if you are just window shopping.

It is OK to have software demonstrations just to spark ideas and expand your understanding of what is possible. When that is the case it is critical that the participants and vendors know this and that the message is clear that there is NO commitment beyond today. These demonstrations should have a very limited internal audience.

If the demonstration is part of a selection process at my organization that will be self evident. The demonstrations will be tightly scripted. Everyone participating will have assignments, including:

• completion of evaluations that are tied back to the features/functions required to achieve the project goals;
• documentation feature/functions that need to be pursued; and
• identification of possible gaps.

Bottom Line
If there is no written documentation that is attached to the contract than this whole exercise has limited value. There is no obligation on the vendor’s behalf to provide the client with anything discussed during a demonstration.

In my previous post I emphasized how important it was to have a vision for an electronic health record before you head into a selection process. One should not buy their requirements from a consultant, they should develop them based upon a clear business purpose.

So, I present to you the most recent draft of Affinity’s Electronic Health Record (EHR) Manifesto:

Preface: For the first time in the 100+ year history of Affinity, and it’s predecessors, we are fundamentally changing the way that we practice medicine. This new model is based upon the Affinity Health Management Vision.

How we practice medicine will be hard-wired into the patient encounter: Good care will no longer be dependent upon the physician’s ability to remember the guidelines that vary by patient’s age, gender and existing conditions. Instead, the guidelines will be pushed to the physician via the exam room computer. These will not be generic guidelines, they will be specific to each patient. Consequently, the patient and the physician will know every patient is being treated by the most current and up to date evidence-based guidelines every time without anything being missed due to memory lapse or a lack of guideline awareness. This zero-defect approach will make good doctors great and great doctors even better.

Information systems will support efficient, thorough care: Valuable physician time will not be wasted searching the abyss of today’s electronic medical record. Instead, a new generation of electronic health records will assemble the most relevant test results and vital signs in a way that facilitates the practice of medicine using the guidelines. This presentation of the patient’s electronic health record will be the centerpiece of the exam room visit.

The management of the patient’s health will no longer be limited to the clinic setting: Population management tools will be used to monitor patient compliance with their guidelines and to intervene before care is overdue. These efforts will be coordinated across the system (AMG, NHP disease and case management, Occupational Health, Nurse Direct, etc.) to ensure the most efficient use of resources. As a result, AMG patients will receive all of the appropriate primary care and screening exams, improving their health.

Furthermore, our interactions with the patient will extend to their homes through WISDOM mailings and AffinityConnect, the patient portal.

How patients perceive Affinity will be greatly improved because patients will see us proactively reaching out to them, not just waiting for them.

The patient experience will be more open and personalized: Our WISDOM initiatives will provide patients access to the same personalized health information as the physician. They will more fully understand their plan for care and patients will be more engaged in the physician/patient partnership. AffinityConnect will provide access to their information when they want to review it. Constant feedback will engage the patient and enrich the physician/patient partnership.

Our interactions with the patient will be personalized using the data and new electronic tools. Ironically, the result of this high tech approach will be perceived by patients as more human and caring.