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…

You would expect Children’s Hospital in San Diego to be very, very nervous about anything to do with porn. After all, this is the place where apparently a nurse and a tech roamed free taking pornographic pictures of children, molesting them, and spreading the pictures on kiddie porn sites.

Wayne Albert Bleyle, 54, who was arrested March 8, has pleaded not guilty to molesting five patients. He also pleaded not guilty to distributing pornographic pictures of patients on the Internet. Christopher Alan Irvin, 32, a nurse who was arrested April 15, has pleaded not guilty to charges of molesting a 4-year-old girl and distributing child pornography.

And speaking from experience I know about second-hand, people do very, very foolish things on their work computers. But it seems that the latest news from San Diego Children’s may be a little over the top. So far three doctors have been suspended because one of them, while logged on to the hospital’s system from home, visited a porn site

Hanscom said using the access code to look at pornography would violate hospital policy whether the images were of adults or children. The access appears to have been on a home computer. Improper use of the code was discovered as a result of more vigorous auditing adopted after the arrests of the two hospital employees.

Now the key issue we don’t know is what type of porn site—and there is a huge legal as well as ethical difference between the secret chat-rooms where paedophiles trade pictures, and the Playboy online type sites. And of course whoever was logged into the hospital’s Internet access was dumb, dumb, dumb not to log out and go off to their own local ISP before looking for smut online. But let’s get real. A huge proportion of Americans look at porn online, and doctors are no different.

Assuming that this is a case of legal behavior at home, that was inappropriately sourced through the wrong ISP, you have to think that handing this over to the “Internet Crimes Against Children Task Force, which includes local and federal agencies” and suspending three physicians and putting it in the newspaper, may be an over-reaction.

Did the hospital management not think to first have a quiet word with the physicians concerned to find out a) which one of the three was the guilty party and then b) have their IT staff and lawyers investigate what they saw, and discover whether their behavior was illegal or just stupid. And if was only the latter, then take some administrative action against them before ruining careers and getting law enforcement involved. Which if it was the former would clearly happen anyway.

Meanwhile, a reminder to all of you out there, make sure that you keep a private Internet connection, email server, et al away from your employer.

Here’s a piece I wrote for Health-IT World about portals and content management technology in health care. I learnt some interesting stuff talking to the folks at Vignette and CareFx and hope you will too by reading what I wrote!  Those of you who know more please comment here!

I’ll be dipping in and out of the CDHCC conference. Yesterday I popped in to remind Esther Dyson that we’d met 10 years ago, but now just know each other via email. (She emailed me during someone else’s talk to tell me to pay attention to it!) Esther didn’t really have a prepared talk—she’d been spending her time going weightless like one of those astronauts in training. She basically said that start-ups had to be realistic and very focused.

I asked her what VCs should be investing in. She suggested management of the chronically ill, such as compliance reminders, and products for women and family aimed at pregnant women and those with newborns.

Given that she’s spending a lot of time holding conferences on personal health records, Esther was asked about her vision for them….but more interesting was who was going to win. She said health plans were not trusted. We need something like banking system. She thinks that employers might be the driver of this. They’re well positioned to be the key. In the end its the consumer who has access, they’ll assign permission to providers and insurers to access that record. Each patient will have broad records, that will cut out lots of inefficiency, and pay up quicker. Then add data for researchers which will improve health care, even without changes in legislation.

Other interesting mentions; she’s getting involved in the open genome project. Genetic information is being put online. Esther will be one of the first to put her genes online. Esther realizes that this is a big political mess. (Perhaps we need an ICANN for health care). She said that we need to be clearer about how we ration things. But she didn’t really follow up on that.

Other talks—CEO of Healthline, the reborn Yourdoctor.com, and Intermap systems spent a while telling us how his search engine was better than everyone else’s. He might have noted that his site is only #7 when you do a Google search on the name, so perhaps the bug guys are scared of him! This is a third time restart for this technology and it’s pretty interesting, so maybe this will work out now. $42m in so far, though!

Ryan Phelan, ex Direct Medical Knowledge (which was basically PlaneTree online) had $5m investment in that and sold it to WebMD for $65m about 25 minutes later….instead of lying around on the beach drinking Krug (well maybe after a few years of that), she’s now started DNA Direct, which is aiming to be a consumer friendly hub for genetic testing. I thought that the presentation was succinct and that she may well have a real long term business model.

Today I’ll be dipping in some more. Pity Reggie is on before I get out of bed!

Ore. hospital loses 5,000 X-rays in hard-drive crash. Apparently 4 out of 5 hard drives failed, and the back-up wasn’t backed up. Still that’s nothing—I lost a whole year of downloaded soccer videos when I knocked over my external hard drive. And I still was too cheap to buy a back-up to the back-up.

Of course some of you might think that the radiology images are slightly more important than say Chelsea’s game with West Brom….

…they don’t, at least so says an HHS funded study by Avalere Health

While some states have progressed, the Avalere report highlights challenges in achieving national goals. None of the highlighted HIE projects — even those with deep political and physician support — have established a sustainable business or financial model. Some states are also struggling to gather providers and other commercial organizations’ agreement on technology standards and win over their long-term support.

At IFTF we (Jane Sarasohn Kahn and I) wrote a report on CHINs in 1994 which basically said we didn’t think they’d be much more than a sideshow—and it turned out we were over-optimistic!  Not that much has changed. Some things have, but there are few incentives to promote inter-operability. Don’t believe me, Brailer said as much when I saw him talk two years ago.

The incentives that prevent interoperability can be (and ought to be) changed—if we want to use that Medicare carrot/stick. But that would mean Congress taking on a litany of providers, payers and vendors…

It might be a little light round here today, although I’ve got a couple of whoppers in the works. So here’s some light reading for you

First you should go read Jane Sarasohn Kahn on Mixed Signals for Remote Monitoring

And then to remind yourself why pharma isn’t doing as well as it was in the 1990s, see this one from Derek at In the Pipeline on Why All the Gloom? (Hint: think lack of video chains….)

Score one for the little guy/gal — Work widow’s blog fuels revolt and EA settles for what appears to be a decent amount. $15m more than they wanted to pay anyway!

The original posting that started it all is here. Don’t underestimate the power of an anonymous blogger.