HIT Blawg - New Layout!

In addition to new features and HIT business insights, HITBlawg now features a new, cleaner, easier to read format and layout.  Please pass on your thoughts and comments.

Study Finds Electronic Medication Administration Reduces Errors

A study in the May 6 issue of the New England Journal of Medicine finds bar code technology used with an electronic medication administration record (eMAR) system significantly reduces transcription and medication administration errors.

Brigham and Women’s Hospital in Boston conducted the study, funded through a grant from the Agency for Healthcare Research and Quality. Researchers compared 6,723 medication administrations on hospital units before bar-coded eMAR was introduced with 7,318 administrations using the technology.

Observers noted 776 non-timing errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate) — a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it.


Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Data showed that the bar-code eMAR is an important intervention to improve medication safety. 

NewCardio to Unveil New CardioBip Technology

NewCardio, Inc., (NWCI) a cardiac diagnostic technology provider, will unveil its patented CardioBip technology for remote wireless 12-lead detection and monitoring of atrial fibrillation, ischemia and other cardiovascular events at the Heart Rhythm Society 31st Annual Scientific Sessions, May 12-15, 2010, in Denver, Colorado.

InVentiv Health Acquired by Private Equity Firm

Pharmaceutical services provider InVentiv Health Inc (VTIV) said it agreed to be acquired by private equity firm Thomas H. Lee Partners for about $1.1 billion.

THL Partners will pay $26 per share, a premium of 7 percent to InVentiv’s closing price Wednesday on Nasdaq. However, InVentiv shares had already risen 42 percent since March 26, when the company confirmed that it had been approached by investors.

Mistaken Computer Entry Sends Dow into Crash

According to CNBC, a trade involving Procter & Gamble was mis-entered, as someone meaning to sell several million shares mistyped an order with Citigroup for several billion-with-a-b shares instead, sending the Dow Jones Industrial Average down nearly 1,000 points.

Earlier reports had blamed the government of Greece, which voted to adopt severe budget-reduction programs in order to qualify for emergency bailout loands to solve the company’s enormous debt, on which hundreds of billions of dollars in payments are about to come due.

Medsphere Systems Announces Successful Pilot Project with UCSD

Medsphere Systems Corporation, a provider of open-source health IT solutions, today announced that students at the University of California, San Diego Extension Health Information Technology Program had successfully completed a capstone project focused on implementing an electronic health record system in a sample community clinic system. With an eye toward the burgeoning health IT jobs market, Medsphere made the company's OpenVista system available to UCSD Extension at no charge so students could apply their training by working with a currently live health IT system.


OpenVista is an open-source EHR solution derived from the U.S. Department of Veterans Affairs' award-winning VistA system. The VA has invested decades and billions in developing VistA, which has been proven to help reduce healthcare costs and improve safety and quality. Medsphere markets OpenVista as the foundation for a portfolio of clinical transformation services that enable hospitals and integrated delivery networks to dramatically improve patient care and qualify for federal stimulus funding.

echoBase and Dassault Systems Partner for EHR -- With iPhone Access

Dassault Systèmes (Paris:DSY)(Euronext Paris: #13065, DSY.PA), a maker of 3D and Product Lifecycle Management solutions, announced today a partnership with application developer echoBase, Inc.  This marks DSY's entry into the electronic health records market. echoBase's Resonate iPhone application for doctors, hospitals, pharmacies and other healthcare providers will leverage Dassault Systèmes' ENOVIA V6 online collaboration and data management solution.


"The adoption of the iPhone and other mobile devices in the healthcare industry is just the latest example of how technology is creating greater transparency and an improved experience for consumers when dealing with service providers of all kinds. As a result, we see this as a natural use of ENOVIA V6's data management and federation capabilities," said Michel Tellier, CEO, ENOVIA, Dassault Systèmes. "Based on its experience in industries like aerospace and defense, ENOVIA has a strong track record of developing solutions that provide portability, security, and availability for classified data in Department of Defense programs. Dassault Systèmes and echoBase's Resonate are now leveraging these same IP security and online collaboration strengths to address the need for greater portability while maintaining security regarding electronic healthcare data management."

Eclipsys to Provide EHR to Malaysian System

Eclipsys Corp. (ECLP) is set to provide health IT for Pantai Holdings Berhad.  Pantai is to replace legacy solutions and paper-based processes with Eclipsys's Sunrise Enterprise 5.5 integrated EHR.

Pantai Holdings Berhad is a healthcare conglomerate which has a network of ten hospitals throughout Malaysia.

Surgical Robot Examined in Injuries - WSJ.com

A da Vinci surgical robot has been reported in a series of surgeries with bad outcomes.

At Wentworth-Douglass Hospital, located in Dover, New Hampshire, the da Vinci has been used in several surgeries where injuries occurred. One patient was badly injured and required four subsequent procedures to correct the problems.

The robot is made by Intuitive Surgical, Inc. (ISRG). The Wall Street Journal reports:

One of the machines was featured on the cover of U.S. News & World Report's Best Hospitals issue last summer, while another appeared on the TV show Grey's Anatomy. It also became a symbol of health reform when President Barack Obama was photographed trying his hand at one during his visit to the Cleveland Clinic.

View Full Image

Intuitive Surgical

More than 800 U.S. hospitals have acquired at least one of the da Vinci machines in the past decade.

However, some surgeons have questioned the way the robot has been marketed. Intuitive Surgical has marketed the da Vinci to hospitals as a way for them to increase their revenues and gain market share.

A 14-minute video on the company's website features testimonials from surgeons and hospital administrators. A key message: The robot has been good for business. One cardiac surgeon in the video says at least 70 of his 250 annual cases are new patients who wouldn't have been referred to him if not for the robot.

Small hospitals have been receptive to the pitch. The 853 hospitals with da Vincis include 131 hospitals with 200 or fewer beds.

Wentworth-Douglass began leasing its da Vinci in 2006. The 178-bed nonprofit facility competes for patients with six other hospitals located within a 30-mile radius in eastern New Hampshire and southern Maine. None of those hospitals had the robot, so Wentworth-Douglass saw an opportunity to gain a technological edge.

Some of the hospital's surgeons opposed getting the robot because they felt Wentworth-Douglass didn't perform enough surgeries to overcome the machine's long learning curve, several current and former members of the medical staff say.

Some surgeons with extensive robotic experience say it takes at least 200 surgeries to become proficient at the da Vinci and reduce the risks of surgical complications. That's difficult for surgeons at smaller hospitals to achieve.

Jim Hu, a surgeon at Brigham and Women's Hospital in Boston who has done more than 1,000 surgeries with the robot, says it takes a urologist anywhere from 250 to 700 cases to master it. Dr. Hu considers the da Vinci a clear benefit for experienced surgeons, saying, "You can do a better job." But he cautions it can do more harm than good when used without adequate training.

Aleks Cukic, Intuitive Surgical's vice president of strategy, says the robot's learning curve "varies from procedure to procedure and from surgeon to surgeon." He adds: "There's no number" of surgeries required to master the device.

One of Wentworth-Douglass's surgeons, Paul Butler, expressed his opposition to buying the robot in a letter to the hospital's board of trustees.

Another surgeon, Robert Lambert, says he told one of the trustees of the staff's opposition while the robot was being shown to the board. Both said the robot wasn't needed at a hospital the size of Wentworth-Douglass.

Ms. Biehl says the hospital "took into account the opinions of all surgeons" before leasing the robot: "A majority were in favor and some were not in favor."

Soon after leasing the machine in early 2006, Wentworth-Douglass began marketing it in advertisements on radio, television and in the local newspaper.

The hospital also began pressuring its surgeons to use it, the current and former members of the medical staff say. Dr. Lambert, who left to become an assistant professor of surgery at Upstate Medical University in Syracuse, N.Y., says the pressure contributed to his departure.

Ms. Biehl denies any such pressure. Wentworth-Douglass says Dr. Lambert left mainly because he couldn't convince the hospital to start a bariatric surgery program.

Some current and former members of the medical staff say the training Wentworth-Douglass offered on the robot was insufficient. It included two days of operating on pig and human cadavers at a hospital in New Jersey.

Upon their return, the trainees started operating on live patients. Surgeons from other specialties supervised the first few da Vinci surgeries of newly trained doctors. A urologist supervised some of the hospital's gynecologists in their first robot surgeries.

Ms. Biehl confirms the training regimen but says the urologist, who was on the staff of another hospital, had considerable experience with the robot.

Intuitive Surgical says the New Jersey hospital, Hackensack University Medical Center, is one of 20 hospitals that train surgeons on the robot. When new hospital clients buy the robot, the package includes the two-day course for two surgeons at one of the training centers, which the company pays for.

Intuitive Surgical's Mr. Cukic says it's up to hospitals to create guidelines for when their surgeons can do surgeries with the robot unsupervised. "That's not for us to say," he says.

At Wentworth-Douglass, surgeons begin doing da Vinci surgeries unsupervised after four cases.

Dr. Hu of Brigham and Women's, who did a one-year fellowship and assisted on 400 robot surgeries before he began operating solo, says that's much too soon. "None of us would go and get surgery if we knew the guy had done it just a couple times before," he says.

Wentworth-Douglass's four urologists resisted using the robot without more training, people familiar with the matter say. Three of the four ended up leaving the hospital.

Unlike the urologists, the hospital's gynecologists started using the robot. Several complications occurred. The bladders of two female patients were lacerated during routine gynecological surgeries performed with the robot, a person with direct knowledge of those cases says.

One of the patients had to be sent to the Lahey Clinic in Burlington, Mass., for another surgery to repair the damage, the person says. The patients survived. A spokesman for the Lahey Clinic declined to comment.

Ms. Biehl says bladder injuries "are a known risk of this type of surgery" whether or not a robot is used. She declined to discuss the cases or identify the patients, citing patient privacy laws.

Mr. Cukic of Intuitive Surgical says it's hard to draw any conclusion from the cases without knowing Wentworth's overall rate of complications.

In June 2007, one of general surgeon David Coppola's first da Vinci patients was an elderly man with a stomach condition. Under the supervision of a proctor, Dr. Coppola operated on the man for several hours with the robot, people with knowledge of the case say. But Dr. Coppola eventually gave up on using the robot and switched to open surgery. The patient died after his esophagus was perforated.

It's unclear whether the esophagus was injured during the robotic part of the surgery or after Dr. Coppola opened the man's abdomen and reverted to traditional surgery. Dr. Coppola didn't return calls seeking comment.

Ms. Biehl declined to discuss the case, citing patient privacy laws, but she says the hospital has had "no deaths of patients related to robotic surgery injuries." Mr. Cukic declined to comment about the case.

One of the surgeons featured in the hospital's robot advertisements was gynecologist Elizabeth Chase. In one newspaper ad in which she posed with a smiling patient, Dr. Chase was quoted as saying that the robot enabled her "to perform intricate surgery more safely."

On March 2, 2009, Dr. Chase proctored another Wentworth gynecologist new to the robot, Rebecca Ann Banaski, during a routine hysterectomy. During the surgery, Dr. Banaski accidentally cut both of the patient's ureters with the robot, people familiar with the operation say.

The ureters are the tubes that connect the kidneys to the bladder. Cutting both ureters is considered a rare and serious surgical complication because it can cause the kidneys to shut down. The patient, a woman in her 40s, had to undergo four more procedures over the following eight months to repair the damage, the people with knowledge of the matter say.

After the incident, Wentworth-Douglass made Drs. Chase and Banaski undergo remedial training on the robot, the people familiar with the matter say. Dr. Chase was also temporarily barred from proctoring others and placed under the oversight of another surgeon when she resumed using the robot, they say.

The Joint Commission, an independent body responsible for hospital accreditations, investigated robotic injuries at Wentworth-Douglass in October.

Ms. Biehl says the commission came away satisfied with the quality of the hospital's robotic program and required no improvements. A spokeswoman for the Joint Commission confirmed it issued no requirement for improvement but declined to otherwise discuss the inquiry.

Dr. Chase and Dr. Banaski didn't return calls seeking comment.

Ms. Biehl calls Dr. Chase "an excellent surgeon" and says she is currently cleared to operate with the robot on her own. Ms. Biehl adds that no medical malpractice lawsuits have been filed against Wentworth-Douglass "related to robotic surgery."

How to Win Angel Investor Funding - WSJ.com

If you're looking for a cash infusion for your high-growth company, angel financing might be for you.

Susan Preston, author of Angel Financing for Entrepreneurs and an angel herself, explains what an angel wants to see before making an investment. Here's her list:

• A solid potential for return. Angels want to know how your company will make money, when it will turn profitable, and when they can expect a return on their investment. You'll need to back up those promises of profitability with financial documents that include an income statement (also referred to as a profit/loss statement), a balance sheet and cash flow statements.

• A good plan for the cash. Investors want to make sure their money will be spent wisely. And emphasize your thriftiness: angels don't want to see the money being used for big salaries or fancy office space.

• A winning attitude. Get fired up. Angels want to see passion; they want to see you're committed to your concept and company and that you'll stay the course when obstacles arise. Aside from enthusiasm, you must be able to clearly articulate your company's mission—and how you'll make that dream a reality.

• A seasoned team. Angels want to see a strong management team that's capable, experienced in their industry and, more important, open to suggestions and opinions. "If I don't think that a CEO or founder is coachable, I won't invest," Preston says. "Someone who comes in and says 'I know all the answers' is the kind of person who is doomed to failure."

• A competitive edge. How are customers responding to your product or service? An angel will want to know that you can capture market share quickly and beat out competitors as you ramp up. If your product or service is fairly unique, an angel will want to see you've secured the patents, copyrights or trademarks to protect your intellectual property.

• A well-defined exit strategy. Investors will want to know exactly how you plan to make them money—and just saying "IPO" or "acquisition" might not be enough. Research how other companies in your industry have returned profits to investors. Identify potential suitors for your business. "It's a homework point that they need to have done," Preston says.

Discovery - Spoliation of Evidence Charged Against Hospital for Loss of Records

On April 16, 2010, in Howard Regional Health System d/b/a Howard Community Hospital, et al. v. Jacob Z. Gordon b/n/f Lisa Gordon , the Indiana Court of Appeals issued an opinion holding Howard Community Hospital ("Howard Community") liable for losing medical records and thereby making it impossible for a patient to pursue a medical malpractice case against an obstetrician.  Jacob Gordon suffers from various medical complications that could have been caused by breaches in the standard of care when he was born.  Following his birth and after having an attorney review the case, Jacob's mother filed a medical malpractice claim against Howard Community, the Community Family Health Center, and the obstetrician who delivered Jacob.  After she filed suit, Jacob's mother requested certain medical records from Howard Community.  Howard Community responded that it had lost some of the records from Jacob's birth.  A trial court entered partial summary judgment in favor of Jacob's mother, finding that Howard Community had a duty to preserve the medical records, that it breached the duty, and that the breach made it impossible for Jacob's mother to pursue the medical malpractice case against the obstetrician.  The Indiana Court of Appeals affirmed the trial court's decision.

This case concludes that a patient can have an independent third party "spoliation" claim against a health care provider for losing medical records.  Significantly, the claim is outside the Indiana Medical Malpractice Act and does not need to be reviewed by a medical review panel prior to being heard in state court.  In this case, the Court found that a hospital is required by Indiana statute to maintain medical records and if the hospital violates that statute, it commits negligence per se, making an independent spoliation claim available to the patient. 

The Court found that summary judgment was appropriate because Gordon's mother had established that the record loss was the proximate cause of making it impossible for her to pursue the case against the obstetrician.  Counsel for the hospital has indicated that a transfer petition to the Indiana Supreme Court will likely be filed.  

Infosys Pessimistic on Fallout from Greek Crisis

Infosys Technologies Ltd. warned of a possible decline in the volume of outsourcing work from Europe if the current debt crisis in Greece spreads across the continent.


The current situation in Europe "is a concern and we are watching it closely," Chief Financial Officer V. Balakrishnan told Dow Jones Newswires in an emailed statement late Monday.

Infosys (INFY) shares were down 1.98 Tuesday amid 1.9 M in trading.

McKesson

McKesson (MCK) rose by 4% to $67.50 at closing. The San Francisco-based company said it expects earnings of $4.72 to $4.92 per share in 2011.  FactSet Research estimate for earnings was $4.70 a share.

For the fourth-quarter, McKesson's net income was $348 million, or $1.26 a share, up from $281 million or $1.03 a share from a year ago. Revenue was $26.6 billion, compared with the $26.2 billion. Analysts had expected McKesson to earn of $1.29 a share on sales of $27.4 billion for the quarter.

In Technology Solutions, revenues were up 2% for the quarter and for the full year. Services revenues grew 2% in the fourth quarter and 4% for the full year, reflecting the steady nature of our offering. Software and software systems revenues increased 5% for the quarter. Software and software systems revenues were flat for the full year resulting from a bookings shortfall in Fiscal 2009 due to the uncertain economic climate and delays in purchasing due to regulatory uncertainty that slowed down implementations.


Technology Solutions operating profit was $85 million for the fourth quarter and $385 million for the full year. The operating profit margin was 10.37% for the quarter and 12.32% for the year. Operating profit margin for the fourth quarter and the full year were impacted by a higher software revenue deferral rate, a change in revenue mix, and continued cost controls.

NEW! Health IT Business Deals

The HIT Blawg now covers health information technology business deals and transactions.  This new source of information will focus on business dealings among electronic health record (EHR) vendors, personal health record (PHR) vendors, consultants, and related industries.

Please view the latest news on HIT business deals in the sidebar.  Additional information will be posted for review as it becomes available.