Lab Soft News

Brochure for the 12th Annual APIII Informatics Conference Now Available

The brochure for the 12 Annual APIII Informatics Conference is now available. The conference is subtitled Anatomic Pathology Informatics and Imaging Support for Translational Medicine. It will be held on September 9-12, 2007, at the Marriott City Center Hotel in Pittsburgh, Pennsylvania. This is one of the preeminent pathology informatics conferences of the year. Be sure to review the brochure and attend if you are able.

The WSJ Health Blog and Reactions to Justen Deal

This one is too good to pass up. Mr. HIStalk published the following recently. It contains first his reaction to a Wall Street Journal Health Blog note about Justen Deal followed by a comment by a reader of the WSJ note:

(Comment from Mr. HIStalk) WSJ has what they call a blog (doesn't look like one to me) that's got reader responses to their Justen Deal article. Their piece also got mentioned in Metafilter (which I'd heard of, but never looked at) with a link to my interview with Justen Deal, which sent lots of their readers HIStalk's way. Here's one of several strong reader comments to WSJ's so-called blog:

(Comment from a WSJ reader) "As a former IT person who was a major player in the implementation of the exact same EMR system Justin is referring to, I can tell you he is 100% correct. The system is a nightmare to implement, the company who sells the EMR is a joke, the CIO’s, CEO’s, etc; of these healthcare organizations are job hopping from organization to organization selling the idea they need to implement this system, it makes you wonder who’s pockets are getting lined." 

(Comment from Mr. HIStalk) Thanks, Neal.

I have the following reactions to both Mr. HIStalk's piece and also the WSJ health blog:

• I agree that one needs to take both very negative and positive anonymous comments in blogs about LISs and EMRs with a grain of salt. As Mr. HIStalk's response indicates, they may be generated by a business competitor engaging in cheap tricks.
• It's worth scanning all of the WSJ comments to the piece on Justen Deal in the WSJ Health Blog if you can (access is limited to subscribers). Some of them are right on target but many of the others are written by stuffed-shirts moaning about corporate whistle-blowers such as Justen, even those that are right on target.
• The WSJ comments that got to me the most, however, are those complaining about Justen's lack of formal degrees and his relatively young age. Some of the most talented and productive people I have encountered in my 25 years in healthcare IT are "formal education drop-outs" who have gotten fed-up with the standard academic curricula because of sheer boredom. Many of them now fill critical roles in healthcare and keep our LISs and EMRs running on a daily basis.
• Do me a favor and run this little experiment. Have lunch with one of your local well-placed healthcare IT execs who you believe may be a little sketchy but who has a nice title and perhaps multiple degrees. Ask him/her to describe what they consider to be the crowning achievement of their entire career. Then ask him/her to describe their specific role in that process. After this, corner one of the IT "formal education drop-outs" working in your hospital. Ask what achievements he or she is most proud of during the last month.

Nighthawk Radiology Acquires Radlinx

I have closely followed NighHawk Radiology in recent months and posted a number of notes about the company. My interest stems from the fact that anatomic pathology is still is its digital infancy whereas digital imaging is so prevalent in the world of radiology that the specialty has spawned a successful company built on a pure play in teleradiology. Nighthawk can thus serve as an important model for pathology and lab medicine. A recent article (See: NightHawk says buys Radlinx Group) discusses the consolidation that is now occurring in this business sector (boldface emphasis mine):

NightHawk Radiology Holdings ...said it acquired Radlinx Group, a Texas-based provider of teleradiology services, for $53 million, increasing its customer base to cover 24 percent of all U.S. hospitals.The provider of off-hours radiology services said it expects the deal to add about 5 cents a share to earnings in 2007, excluding non-cash stock compensation and amortization of intangibles, tax effected. The Coeur d'Alene, Idaho-based company expects the acquisition of Radlinx Group and its 303 hospitals to contribute $17 million to $19 million in revenue for the remainder of 2007.

I find it quite remarkable that the NightHawk reach now extends into 24% of all U.S. Hospitals. In a recent note, I discussed how NightHawk has expanded its product offering from interpretation of images off-hours to the licensing of the software that it developed to support its primary business model to other radiology groups (see: NighHawk Radiology Services Enters Software Arena). Look for them to now expand into medical imaging in other specialty areas.

It's interesting to ponder whether U.S. radiologists, by helping Nighthawk Radiology establish an efficient infrastructure for managing and interpreting digital images on a global basis at night and on the weekends, are paving the way for total support of medical imaging off-shore by the company at some later time. If this happens, it probably won't be NightHawk leading the charge. To do so, they would risk alienating those U.S. hospitals and radiologists with whom they currently have a congenial relationship and thus disrupt their successful business model. However, Nighthawk Radiology could be purchased by a company with another agenda in mind.

Introducing Clusty, an Innovative Search Engine

An occasional visitor to Lab Soft News has been referred to Lab Soft News recently by Clusty, a search engine that was previously unfamiliar to me. I decided to investigate, thinking that a new search engine may have some value for the readers of this blog (boldface emphasis mine):

Clusty got its start in Pittsburgh, PA in 2004 when the search software company Vivísimo decided to take its award-winning search technology to the web. Vivísimo was founded in 2000 by three Carnegie Mellon University scientists who decided to tackle the problem of information overload in web search. Rather than focusing just on search engine result ranking, we realized that grouping results into topics, or "clustering," made for better search and discovery. As search became a necessity for web users, Vivísimo developed a service robust enough to handle the variety of information the everyday web user was after. The result was Clusty: an innovative way to get more out of every search.

As an example of how this type of "cluster" search works, I launched a search using the term clinical pathology. The top 172 results of "at least 795,800" were displayed on the right hand side of the screen.  There are three icons adjacent to each retrieved result that perform the following tasks when clicked: (1) display the result in a new window; (2) show a preview of the result's home page; and (3) retrieve a "cluster" of additional items closely linked to the result. While all of this is going on, there is also a list on the left hand side of the screen showing all of the possible clusters related to your search term. Those cluster names are expandable by clicking the "+" icon next to them. If you click on the "cluster retrieval icon" beside an item on the right, the specific clusters associated with the item are highlighted in yellow in the list on the left.

One unique feature of this search engine is that different advertising messages are displayed at both the top and the bottom of the search engine retrieval page (SERP). I am surprised that Google and the others have not yet tumbled to this interesting advertisement positioning strategy.

Like all great web sites, Clusty is clean in its design and intuitive about how it works. It is, of course, free, supported by its advertisers. Give it a try. The advantage of a "test drive" of a new web search engine is that one knows right away whether it is useful by the quality of the items retrieved for a favorite search term.

Justen Deal Resurfaces as Front Page News

I previously posted a set of notes about Justen Deal, the now famous healthcare IT whistle- blower at the Kaiser Health System. You may recall that he generated an enterprise-wide email at Kaiser criticizing various aspects of the deployment of the their new EMR called HealthConnect.  A classic David vs. Goliath epic with all of the cyber-nuts rooting like crazy for young Justen. The Wall Street Journal has just published an article about him with emphasis on his persistent nature and also the story of how a minor functionary in a huge health system rattled the windows of the C-level executive suite (see: How an Email Rant Jolted a Big HMO). Most of this story is well-known to readers of this blog or even those with only passing knowledge of the healthcare IT industry. However, the article did make several points about which I was unaware. Below is an excerpt from it:

On a Friday morning last November, Justen Deal, a 22-year-old Kaiser Permanente employee here, blasted an email throughout the giant health maintenance organization. His message charged that HealthConnect -- the company's ambitious $4 billion project to convert paper files into electronic medical records -- was a mess....In a blistering 2,000-word treatise, Mr. Deal wrote: "We're spending recklessly, to the tune of over $1.5 billion in waste every year, primarily on HealthConnect, but also on other inefficient and ineffective information technology projects.... Mr. Deal, meanwhile, quickly became a cause celebre in the blogosphere and beyond. HIStalk, a popular health-care IT site, featured "an exclusive interview," with Mr. Deal....Mr. Deal wasn't satisfied. That's when he decided to send the email. But it wasn't as easy as pushing a button. He didn't have access to a company-wide "send all" address, so he improvised. He says he bought a cheap software tool that helped him gradually build a list on his own computer....Kaiser fired him on Jan. 11. A company spokeswoman says he wasn't dismissed over the email flap, but "rather because he violated numerous company policies, including making an unauthorized order for three Apple laptops that he converted to his own use." ...In February, he was named "IT Industry Figure of the Year" by HIStalk, based on an online reader poll conducted by the site.

This article clears up a few issues about which I comment below:

• We now know the basis for Justen being fired. It had nothing to do with sending an enterprise-wide email and putting Kaiser in a bad light for the perceived problems with the roll-out of its expensive EMR. It had nothing to do with causing a bunch of highly paid healthcare execs to flail around looking for answers. His unpardonable mistake was placing an unauthorized order for three Apple laptops.
• I was wondering all along how a twenty-something had access to the "send all" button for the entire Kaiser email system. Justen continues to be one of my heroes. He kloojed together an email master list using some unnamed software tool. Notice the WSJ does not name the specific software tool. The reporter is certainly not going to be complicit in the support of copy-cat whistle blowers in the future.
• Finally, note the use of the quotation marks in the reference above to the "exclusive interview" of Justen by Mr. HIStalk. This is a technique used by traditional journalists to look down their noses at bloggers and the blogosphere. What right do these pajama bloggers have to claim an exclusive right to anything? In retrospect, it is apparent that Mr. HIStalk has the last laugh and that the WSJ is a little late in providing prominent coverage for this important story.

FDA Provides Web Access to Information on Post-Approval Device Studies

With a nod to the need for transparency and information access in this digital era, the FDA now provides a web page displaying information about the status of post-approval device studies (see: FDA Provides Web Access to Information on Post-Approval Device Studies). This new web page can be viewed here. Below is an excerpt from the article discussing this new FDA service (boldface emphasis mine):

The U.S. Food and Drug Administration (FDA) has unveiled a new Web page that will keep the public informed about the status of post-approval patient studies for certain recently approved medical devices...."Electronic access will give the public an opportunity to see progress being made on a company's post-market commitments," [according to an FDA spokesperson]. Modern devices provide significant health benefits, but experience has shown that the full magnitude of some potential risks doesn't always emerge during the mandatory clinical trials that are required for approval. FDA sometimes orders post-approval studies to address remaining issues such as the product's performance once it becomes more widely available or is used over a longer period of time. Generally, companies must submit interim post-approval study status reports every six months for the first two years of the study and annually thereafter until the final report has been submitted.

A total of 44 records are displayed on this web page. Many of them are exactly the type of medical devices that one would expect to appear in such a list including including carotid artery stents, breast implants, a Birmingham hip resurfacing system, and the Monoprep Pap Test from MonoGen. Copied directly from the web site table, here is the post-approval study description that is now underway for the Monoprep Pap Test:

1) The completion within 24 months of a post-approval clinical study of the direct to vial performance of Monoprep pap test for the detection of HSIL+ [high-grade squamous intraepithelial lesion] in comparison to the conventional pap smear. This data must be supported by comparative data from histological examination (colposcopy and if appropriate, biopsy) of cases with cytologic diagnosis of HSIL+ from both Monoprep pap test and conventional pap smear cohorts. Analysis data should be presented separately for HSIL and cancer diagnostic categories. The data will also include detection rates for all other Bethesda system 2001 abnormal categories.
2) The completion within 18 months of a post-approval study with data and analysis of existing clinical data establishing, both for Monoprep pap test and concentional pap smear methods, the frequencies of slides that are unsatisfactory based on results form the study laboratories. These slides need only be reviewed by the independent pathologist.

This web site quickly and efficiently provides a viewing window for FDA post-approval device studies and also access to information about the remaining unanswered questions about such devices. Although only one small step, it's a sign of increased transparency in the FDA regulatory and communication processes.

 

Texas Web Site Lets Healthcare Consumers Shop Around

I have written a previous note about Health 2.0 (see: Introduction to Health 2.0). It's  a complex topic but generally encompasses the concepts of empowerment of healthcare consumers, price transparency, and the integration of the decentralized islands of healthcare clinical information stored in multiple healthcare delivery venues. Dr. Scott Shreeve, one of the most prominent promoters of Health 2.0, has written a note about some of the  change agents or enablers of Health 2.0 (Health 2.0: Change Agents of the New Paradigm). Simply put, these are largely web-based resources that support healthcare consumers in various ways, often by providing the information necessary to assist them in making informed choices about their health. A recent article (see: Web site lets hospital patients shop around) discussed a web site called Texas PricePoint that enables healthcare consumers to shop intelligently for services by price (boldface emphasis mine):

A new Web site launched by the Texas Hospital Association in Austin will allow health care consumers to view and compare prices on inpatient hospital services at Texas hospitals. The Web site, Texas PricePoint, includes charge data on the most common inpatient services, links to data and general information on all Texas hospitals....Through basic and advanced queries, users can request information on a single hospital or look at multiple hospitals to compare information. Users also have the option of clicking on a link to the hospital's own Web site if one exists. The site uses hospital-supplied data, updated quarterly, from a variety of sources including the Texas Health Care Information Collection and the Centers for Medicare & Medicaid Services. It's operated under contract with WHA Information Center, a subsidiary of the Wisconsin Hospital Association

Web sites such as Texas PricePoint are all about the transparency of the pricing of healthcare services. In a previous note (see: Bargaining Down the Cost of Your CT Scan), the discussion focused on the importance of knowing the discounted rate that was obtained for a service such as a CT scan by commercial insurance carriers or Medicare. Armed with this knowledge, the consumer is then well positioned to request a similar discount. Such a strategy is particularly relevant when the consumer has a high-deductible health plan coupled to a health savings account. For the uninsured, negotiating a discount can be an absolute necessity. Another option would be to consider medical tourism whereby one would travel to a high-quality overseas hospital for an elective or semi-elective surgical procedure.

Texas PricePoint offers the following advice on its web site to uninsured consumers, and actually forces them to read this material before proceeding:

• For patients who do not have insurance, hospitals typically offer discounts. Some discounts may be based on the patient’s income level and family size.
• You should contact the hospital’s business office for information on the hospital’s policies and how to request a discount. In some cases, you may be asked to verify income or other assets to determine whether or not you qualify for full or partial financial assistance.
• Access on-line information provided by the Texas Department of Insurance to help you shop for health care coverage at www.texashealthoptions.com.

Here's some information from another web site (see: How to Cut Your Health-Care Costs) about negotiating strategies when the need arises to go out of your network:

...[T]here may be times when you need to go out-of-network. What can you do? Negotiate. Ask your doctor to lower his or her fee. You'll be surprised to see how much wiggle room there can be....The key to negotiating successfully is knowledge. Call your insurer and ask a customer-service representative how much the company will cover for the type of service you need. Then pass that information along to your doctor. If your doctor isn't willing to come down in price, you may want to find a physician who will. Certain insurers will even help you shop around. Cigna, for example, offers a cost-comparison tool on its Web site.

Additional Discussion About the Quest Purchase of AmeriPath

In a recent note (see: Quest Diagnostics to Buy AmeriPath), I discussed the breaking news about the proposed purchase of AmeriPath by Quest Diagnostics. Three separate businesses will be acquired by Quest: (1) Specialty Laboratories, the provider of esoteric reference lab services; (2) AmeriPath Dermatopathology; and (3) the remaining anatomic pathology assets of AmeriPath. At the end of this note, I speculated as to whether this purchase would draw the scrutiny of the FTC:

One wonders whether the acquisition of Specialty by Quest as part of this Ameripath deal will run afoul of the FTC anti-trust regulations because of the continuing consolidation in the reference lab industry. This same issue was raised previously in connection with the LabOne purchase.

I have now had a chance to talk to some knowledgeable individuals in the industry about this acquisition and here are some of the issues that they have raised, keeping in mind that much of this is speculative at this early point in time:

• This acquisition is being described by some as a highly significant event that may well mark the beginning of the national consolidation of the anatomic pathology (AP) business sector, a phenomenon which has generally run its course on the clinical pathology (CP) side.
• It may not be the CP component of this proposed deal that will draw the interest of the federal regulators but rather the AP part. The national clinical reference labs have been quite successful in the past in making the point that the total CP market in the U.S. is so large that the acquisition of even a large esoteric lab like Specialty does not rise to the level of a monopolistic threat. However, such a possibility has never been discussed in detail on the AP side.
• In the AP sector, there is a paucity of reliable information about the total size of the national market. It is therefore in the best interests of the Quest executives to perhaps overstate the size of this market during interviews and news releases in order to cast the AmeriPath purchase in a more favorable light. One way to estimate the size AP market in the U.S. might be to look at Medicare Part B billing for such services and then apply some appropriate multiplier to estimate its total size.
• Finally, we come to the question about exactly which organization would file a complaint with the FTC challenging the Quest acquisition of AmeriPath. There are few major players in the AP provider market. One possibility would be a large private anatomic pathology group that feels threatened. Another would be one of the pathology professional societies. It's not clear, however, whether any of them will have the interest, resources, or political will to launch such an effort.

Poppy Seed Strudel and Drug Testing

I was browsing one of my favorite blogs called Dumneazu that focuses on "ethnomusicological eating east of everywhere" when I happened on a note describing the type of foods that appear in the markets and restaurants in Budapest at Easter time (see:  Easter: An Extremely Porky Week in Budapest). Below is an excerpt that discusses strudel with poppy seed filling:

Some of the best looking strudel I've seen in a while. The white fillings are cheese, the black fillings are poppy seed. There is enough poppy seed inside these babies to keep you failing your drug testing pee-tests well into the next century. It's sad, but in the US it is legal to deny work to a prospective employee who fails a drug test because opiates show up in the seeds of legally available poppy seed bagels. And Switzerland forbids importation or even mere possession of poppy seeds. Now as any culinary scientist knows, the active ingredient in opium is absent from the seeds, but the tests are designed to detect the traces of any part of the poppy plant.

What? Is this some sort of urban myth? You eat one poppy seed bagel and fail your pre-employment drug test? My frenzied research about this topic on the web took me to to another article in a Q and A format (see: Will poppy-seed bagels cause you to fail a drug test?) that I quote from below:

Q: You mean I could get high eating poppy seed rolls?
A: No, goofball, I said they might make you flunk a drug test. The amount of morphine and codeine in poppy seeds varies enormously. One study found that Dutch, Czech, and Turkish poppy seed contained minimal opiates, Australian seed was up there, and Spanish seed sounded like it should be sold by creepy-looking guys on street corners. But, while test volunteers who ate poppy seed products sometimes flunked urine tests, nobody really got what you could call stoned.... You're limited by the fact that the poppy seeds are usually contained in food--you get full long before you get high.

Here's more discussion about this same topic (see: More Frequently-Asked Drug Testing Questions);

It's true that poppy-seed ingestion can cause false positives for opiates a few hours later in urine tests. But labs claim that hair analysis can distinguish between opiate abuse and poppy-seed ingestion. Additionally, the Feds are familiar with urine-adulteration tricks. Consequently, the Feds upped  the ng/ml detection level beyond that of "normal" poppy-seed ingestion, but still within the range of abuse. Normal ingestion is considered to be like two poppy-seed muffins in a day, tops.

And here is yet more information to satisfy your curiosity (see: Poppy Seeds & Drug Tests):

Poppy seeds contain both Morphine and Codeine and can cause false positives for Opiates in urine tests. Most Opiate urine tests have a cut off level of 300 ng/ml. Ingestion of a single poppy seed bagel can produce an opiate level somewhere around 250 ng/ml three hours later. 3 teaspoons of store bought poppy seeds can result in 1200 ng/ml 6 hours later. We have read an estimate that 70% of DOT opiate positives are from poppy seeds. The U.S. Military uses cut off levels of 3000 ng/ml in order to minimize false positives.

I come away with the distinct impression that eating one large Hungarian strudel stuffed with poppy seeds and then reporting for a drug test, Hungarian or otherwise, is not a wise move. Take a nap. The urge to get a job will surely pass.

Revolution Health Launches New Health Portal

The New York Times recently provided extensive coverage of a new health portal launched by Steve Case as a venture by his Revolution Health company (see: AOL Founder Hopes to Build New Giant Among a Bevy of Health Care Web Sites). Below is an excerpt from the article (boldface emphasis mine):

This week [Steve Case] plans to unveil his new company’s Web site for consumers, RevolutionHealth.com, which has built a growing audience since a test version went online in January....Revolution Health’s other medical ventures include a stake in the growing RediClinic chain of retail health clinics operating in some Wal-Marts, Walgreen’s and other stores around the country....It is such a potentially big opportunity, in fact, that one of RevolutionHealth.com’s main challenges could be making itself visible in a market increasingly crowded with competitors elbowing for the consumer-patient’s attention. The biggest in the pack by far is WebMD Health, a stock market favorite of late, which has more than 40 million unique users a month visiting its network of consumer sites, including the flagship, WebMD.com. Other leaders, as measured by Web traffic, include NIH.gov, from the National Institutes of Health; Yahoo Health; Mayoclinic.com; and About.com Health, which is owned by The New York Times Company.

Included in the article is the following list of the top 15 fifteen health information web sites ranked by the number of visitors, which I list below for your interest and review:

• WebMD Health
• NIH.gov
• Yahoo Health
• Everyday Health
• About.com Health
• Mayoclinic.com
• AOL Health
• Weight Watchers International
• Kidshealth.org
• Drugs.com
• Aetna.com
• iVillage Total Health
• The HealthCentral Network
• Lifescript.com

The following reference in the same NYT article about personal health records (PHRs) caught my attention:

Like WebMD.com and many insurers, including Aetna, RevolutionHealth.com will also promote personal health records, giving consumers a place to assemble their medical information, prescription records and insurance payment claims, for example.“One of the most hyped terms in the country is the personal health record,” [a Gartner analyst said]. “Only a tiny fraction, less than 1 percent, of those who have access to their information in all of the health plans together actually look at it.” The complications, he said, include the technology issues involved in linking such records to the doctors, hospitals and other health care providers that might be in a position to use them to improve a patient’s treatment. And consumers may have trouble compiling the data from various health care providers into a single record, he said.“The real issue is that the providers don’t want to give up that data,” [according to the analyst].

I have written a number of previous notes about PHRs. Such applications will most certainly be web-based but, as noted above, but most of them available in the market today lack the single most critical element for success -- the ability to interface electronically with, and transfer clinical data from, the EMRs of providers such as health systems and physician offices. Also, as noted above, the providers/holders of such information view it as proprietary to them and don't want to share it. Happily [for them], they have the "technically unfeasible" excuse to fall back upon rather than risk offending healthcare consumers with the real explanation for the lack of opportunities for the frictionless exchange of clinical information.