From Tom Foremski at Silicon Valley Watcher, Net neutrality has already left the building. You can subtley divert lots of content and commerce if you own the ISP and the pipes…

The conventional wisdom among the three of us who care is that physician clinical IT use is climbing among docs in big groups (really taking off 2003 onwards), but at a slower rate amongst other docs. A new survey from HSC that looks at physician IT use in another way seems to confirm that. But frankly it’s written in a way that makes it a little confusing, and I suspect that the key question about “Accessing patient notes, medication lists or problem lists” means that physicians can be doing that in a hospital, which is why it’s at 50%, but they probably aren’t using a computer to generate notes or orders.

The availability of ePrescribing is at 20%….given that these numbers are about “availability in the practice” not about actual use, it’s fair to assume that the 15% number I’ve been using for eRx is still about right.

But the conclusion makes sense.

On an annual basis, the proportion of physicians with IT for the various clinical activities examined increased an average of between 1 and 4 percentage points a year. The fairly slow average year-to-year growth and the significant proportion of physicians that continue to have only limited access to clinical IT suggest that physicians as a group have not yet reached a tipping point in the adoption of IT for most clinical activities.

I have an article up at Health-IT World which is about the evolution of PACS — largely based on a long interview I did recently with Oran Muduroglu, a founder of Stentor which Philips bought last year. I found it pretty tough to squeeze this one into the few words allotted, as it’s largely about a market and tech evolution that’s pretty messy! Again feel free to come back here and comment.

If you really have nothing better to do over the holiday weekend, take a quick look at where Cerner claim that they’re going to make their money in the future. I’ll be back Tuesday to comment.

I’m up at Health-IT World talking about interoperability. I interviewed the Sun guys and TeraMedica for this brief article, and will have something else on the topic out later this week. I hope that I made it understandable….it’s the kind of buzzword-full topic that makes your head spin. Please let come back and let me know what you think after you’ve read it.

Also at the TEPR Conference, Phil Sissions, who recently left working for the UK’s NHS’ National Program for Information Technology (NPfIT), gave a pretty critical account of the progress to date for the single largest program in health care IT. The only real successes were getting broadband into the various hospitals and practices, and getting some PACS systems up. Getting doctors their own email address was somewhat mocking called the biggest achievement. Sessions said that many of the other programs, including the Choose and Book appointment system are barely being used, and that GPs have revolted when being told that they had to change out their practice management systems. So far the project has spent hardly any of the money allocated to it (approx. 650m GBP each year) because most of the contracted software hasn’t been delivered. Meanwhile, local hospitals and physician authorities have little money for process change, and have stopped much IT development progress waiting for the central program to provide for them. Sissions didn’t give the attendees much cause for optimism, and indicated that there was a heightening level of hostility between the vendors and NPfIT head Richard Granger.

More later….

I’m at TEPR, the electronic patient record conference, in lovely Baltimore Maryland. The line for the $4 latte at Starbucks is way too long, but across the street at Edie’s Deli, two eggs, home fries, scrapple, toast with jam, and a large coffee is $4.95!

I gave a fascinating talk to a packed room at 8am on Sunday about the Prescribing infrastructure and eRx. Thanks to the few brave soles who showed up!

Some other things I’m hearing…

Steve Pelton, CIO, Central Region Ministry Health care in Wisconsin (built a new 112 bed hospital) “CPOE is tough. Trying to change physician practice at the points of order entry is the biggest challenge I’ve faced in 29 years in health care IT”

David Muntz, CIO Texas Health Resources (merger of Harris Methodist in Ft Worth, Presbyterian in Dallas, Arlington Health System in 1997) Have won tons of  awards, including non-health care IT awards & their CEO talks about “1 Hospital at 13 locations, but we’re not there yet!” — “When they came together they had 400 applications and only 3 were the same. Now down to 157 of which 50 are the same” “63% of docs use their portal caregate—and we don’t demand CME, so they find it useful”

Saw a very packed talk in the “small practices” track, from Pamela Moore, a rather jovial editor at Physician’s Practice magazine. She thinks that small practices are taking off in their EMR use (somewhere between 15 and 30% now—Manhattan apparently say their 2006 general use number is 27%)…She then said that in 3 years no one would be talking about this any more “it would be like talking about having telephones” I started chortling and so did the guy next to me….I then noticed on his badge that he was a Research Director in Healthcare research at Gartner.

What does this mean? Most of the people asking questions of the hospital CIOs in the RHIO session are from the Social Security Administration!

More later, so long as I can keep stealing Ekahau’s network (weird because their competition PCTS is running a wi-fi location tracking exercise…perhaps they’re working together?)  The Conference Center has Wifi, but it’s $15 a day! I prefer free…