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Lou Agosta

Greetings and welcome to my blog focusing on reengineering healthcare using information technology. The commitment is to provide an engaging mixture of brainstorming, blue sky speculation and business intelligence vision with real world experiences – including those reported by you, the reader-participant – about what works and what doesn't in using healthcare information technology (HIT) to optimize consumer, provider and payer processes in healthcare. Keeping in mind that sometimes a scalpel, not a hammer, is the tool of choice, the approach is to be a stand for new possibilities in the face of entrenched mediocrity, to do so without tilting windmills and to follow the line of least resistance to getting the job done – a healthcare system that works for us all. So let me invite you to HIT me with your best shot at LAgosta@acm.org.

About the author >

Lou Agosta is an independent industry analyst, specializing in data warehousing, data mining and data quality. A former industry analyst at Giga Information Group, Agosta has published extensively on industry trends in data warehousing, business and information technology. He is currently focusing on the challenge of transforming America’s healthcare system using information technology (HIT). He can be reached at LAgosta@acm.org.

Editor's Note: More articles, resources, and events are available in Lou's BeyeNETWORK Expert Channel. Be sure to visit today!

September 2009 Archives

The announcement today that Dell will purchase Perot systems for $3.9 billion validates the suspicion that something was up with the recent marketing blitz by Dell offering an electronic medical record (EMR) system. Of course, as a hardware company, Dell does not have any such thing (as an EMR), nor will it in the foreseeable future. However, there is plenty of work to be had providing services in the healthcare sector installing, maintaining, customizing, and otherwise upgrading the EMR systems of hospital and provider infrastructure. I commented on this dynamic in my September 14th (2009) post last week, speculating on what might be up. I was thinking more in terms of software than services and wrote, "In any case, the software partners have not been named - perhaps since the paperwork has not yet been inked." Well, the paperwork has now been inked, and the acquisition announced today - but in services.

Perot Systems in already a powerful player in the healthcare IT market, reportedly earning about half its revenue in the healthcare vertical. This puts the earlier marketing blitz in context - which was otherwise as anomalous as it was incredible - and provides a positive roadmap for Dell to march up market along with the health information technology (HIT) transformation. Combing a computer hardware firm with a systems integration services enterprise makes for complementary strengths without too much overlap or internal friction. This positions Dell and Perot systems to compete with HP, IBM, and SAP, especially in the healthcare and public service verticals where Perot Systems is a force to be reckoned with. Obviously, Oracle and Microsoft are not missing a beat either and are definitely not starting from a standing position on this one. For example, Microsoft has acquired Amalga (formerly Axyxxi), a healthcare imaging integration platform developed at a research hospital in the pacific northwest geography. This is not yet a run-your-hospital information system; it is a specific module in one that can be built out. Oracle is now a hardware company with the acquisition of Sun and a force in cloud computing - remember, the network is the computer. Look to see Oracle Financials - the ERP modules - tweaked and sold aggressively into the revenue management side of the run-your-hospital business. For physician order entry (POE) and clinical decision support, providers will still need to talk to Cerner, Epic, GE Centricity, MedSphere, Siemens SMS, and the other covered in my HIT article - see (http://www.b-eye-network.com/channels/1568/view/11085/), which systems, by the way, still do not take advantage of a standard relational database. But that starts a new thread.


Posted September 21, 2009 7:06 PM
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If you are doing a double take on this headline, you are not the only one. Yes, Dell has developed and published a white paper on EMR developments. Several, actually. Yes, Dell smells a dollar. Yes, Dell would love to sell notebooks to physicians and servers to hospitals and large provider practices. But, no, Dell has not secretly developed an electronic medical records (EMR) system of its own, as the above-cited article reports, in its Round Rock, Texas software skunk-works. Does Dell even have a software laboratory? The reporting in the Healthcare IT News - http://www.healthcareitnews.com/news/doc-youre-getting-dell-emr - is simply not accurate. Dell definitely now has an EMR web site (Dell.com/EMR).Of course, Dell has computer hardware assembly lines.

A careful perusal of the available postings - as of Monday September 14, 2009 - indicates that Dell is partnering with hospitals that run an EMR systems so that a physician or practice can obtain (buy) a hosted EMR solution: "Tufts Medical Center in Boston and the Memorial Hermann Health Care system in Houston are early adopters [of the Dell Solution]." But what EMR system are these guys running? In any case, the software partners have not been named - perhaps since the paperwork has not yet been inked. Are the hospitals developing their own home-grown EMR? (It's possible, not probable.) One thing is for sure - the leading EMR system software providers such as Cerner, Epic, Eclipsys, Meditech, MedSphere, GE Centricity, etc., do not suddenly have a direct, new competitor (Dell). Still, it is an interesting development in the market, since hosting is often a substitute for buying and installing an EMR. And that will get the attention of the "big guys." Heck, Dell is a big guy.

Under any interpretation, Dell is advancing the conversation, educating the market, building the business case for the adoption and deployment of an EMR. Such software will require upgrades to infrastructure such as servers and notebooks, which hospitals and healthcare providers already buying notebooks from Dell will distribute to affiliated physicians and practices. Dell has Jamie Coffin, MD, as vice president of Dell's healthcare and life sciences division.

If you look at the white paper on Electronic Medical Record 101 (http://www.eweek.com/dellhealthcare/emrphysicians/), then you learn that Dell will refer physicians to an affiliated hospital:

"The Dell Affiliated Physician EMR Solution is hosted either at the hospital a physician is involved with or a service provider selected by the hospital. Because it is a hosted solution, physicians have little to maintain, update, and manage with its infrastructure. When physicians have their software systems tied directly to that of the affiliated hospital, all data transfers are handled by a secure HIE system that is managed."

Dell will probably also provide the physician or provider practice with Geek-Squad-class technical support to install and maintain the hardware, software, and connectivity. In general, a very good idea and opportunity. A hosted solution is a good choice for practices that are small to medium-sized or do not want to get into the business of operating an information technology function to support an EMR system. There is even a free one available on the market - provided you are willing to look at banner ads - www.practicefusion.com - which I have not used and about which, I hasten to add, all the usual disclaimers apply.

Pricing and availability is not discussed in the above-cited article. As noted above, Tufts Medical Center in Boston and the Memorial Hermann Health Care system in Houston are reportedly early adopters [of the Dell Solution]. The catch? Affiliating with the system will create "technology lock in" between the physician and the hospital, moving the pendulum back in the direction of hospitals who have sometimes been challenged to get affiliated physicians to admit patients only to their facilities exclusively. An obvious question that most doctors may not be trained to ask - Who owns the day if the physician wants to leave the network? This does not mean that doctors should "go it alone." However, be sure to read the fine print in any service level agreement or contract.

Even if the reporting is initially misleading, Dell gets credit for making a splash. As is often the case with inaccurate reporting, you can't buy publicity like it at any price. Expect all the big players such as HP, IBM, Microsoft, Oracle, SAP - to follow suit. Actually, they are all already doing so. It's just that Dell managed to spin the reporter at Healthcare IT News a bit off the ledge, getting the attention of the FUD buster machinery of this blog. After an exhausting inquiry to disentangle the facts - so this is really a criticism of the reporting rather than of Dell - I call this an unfavorable development in the signal to noise ratio in the HIT market. Unfortunately, that too is a near-term trend. Please send me your questions or observations - FUD busting is a growth industry these days!


Posted September 14, 2009 10:05 AM
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My number one myth is that having a detailed, useful, usable account of medical outcomes by procedure, demographics, and key biological parameters will change one's relationship with one's doctor - that is, require reduced physician flexibility or patient choice in treatment situations. The data cube for comparative effectiveness research - loosely overlapping with evidence based medicine - is a complex one. With as much data as we are currently collecting - and it is a lot - additional transformations, normalization of dimensions and individual tweaking will be required to address specific disease entities and treatments. Smart physicians and specialists are already looking at the available data - with data mining tool or spreadhsheet in hand - and using it to advise patients - some of whom are really sick - on the best approach for someone like the individual in question. The potential problem arises when government bureaucrats - some of whom may have M.D.s - obtain the data and use it to say that the only treatment that will be reimbursed is the one that is shown to work in the majority of cases. In medicine, every individual is unique, and while it is always important to consider what works most of the time, it is equally important to consult a long list of exceptions, independent variables, and individual medical history. Of course, such a matter of reimbursements is a matter of policy by government payers (Medicare) who set the standard for private payers (insurance companies).

It is a scandal that right now the vast store of data represented by the Medicare databases is not able to be the target of data mining for comparative effectiveness research. Someone out there, please tell me it isn't true, and that I have been misinformed. All the data is there - but it is off limits, because what the Wall Street Journal somewhat cynically calls "the world's greatest deliberative body" - the US Congress - says it is statutorily off limits. So it will literally require an act of Congress to transform this particular situation. The proposal is concise - the information should be posted on the Internet - this will not be a trivial job - minus patient identifying data of course - so that every citizen can see what historically works; and it should be off-limits to government bureaucrats for making reimbursement decisions. Right now we have got it exactly reversed. Upon further reflection I will have to qualify the opening thesis of this posr. Business intelligence will end up changing the patient-doctor relationship: the doctor will be better informed - and so will you.


Posted September 7, 2009 5:36 PM
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