Wednesday, February 25, 2009

NextGen and Vendor/Doctor Dialog: Yet Another Patronizing EHR Company of Certified HIT Experts?

Note 6/9/09:

To those reading this post via a link in an email from CCHIT's Mark Leavitt, see this June 7th post "Open Letter to Mark Leavitt" first.

The link you are at now is several months old, one of many posts I've written over the years about the scarcity of leadership-level Medical Informatics-trained professionals in the health IT vendor world. I consider that issue contributory to EHR's often mission hostile user experience (my series on that topic is here), and ultimately deleterious to patient well-being. I also believe the HIT industry has put its own interests ahead of that of patients in its inattention to HIT safety and rejection of accountability.

Additional views on the recent CCHIT NJ Bill are at at "David Kibbe & Mark Leavitt:Openness vs. Opacity" and "Dossia, Microsoft HealthVault & Google Health: Illegal in NJ?". There are some now-familiar themes regarding CCHIT civility in those posts.

6/10: As a result of a link sent by a commenter, I am adding the post "The Kibbe/Leavitt Rumble in the High Tech Jungle!" to the list of interesting views in the note above.

-- SS

My early medical mentor, cardiothoracic surgery pioneer Victor P. Satinsky, MD, believed in public embarrassment (a.k.a. "sunlight") as a tool to fight bureaucracy and discrimination. I quote him on that. He wanted his NSF summer science training progam (SSTP) 10th grade students at Hahnemann Hospital to actually picket a clothing distributor, for example, when that distributor did not deliver our white coats nor a refund in a timely manner. He also was highly politically incorrect, for example having gay activists speak to our group of 200 high school students about bias and discrimination, at a time in the early 1970's when such talks were frowned upon. He took grief for that. Yet fairness and "critical thinking always, or your patient's dead" were his mantras.

Dr. Satinsky must be rolling in his grave at what has become of medicine due to the type of bureaucracy we cover here at Healthcare Renewal. He would probably be a healthcare blogger himself were he still alive.

At "A Vendor/Doctor Dialog On Healthcare IT?" I wrote that

In response to my recent post to the American Medical Informatics Association's clinical information systems (CIS-WG) and organizational issues (POI-WG) workgroups about my WSJ letter to the editor, Charles Jarvis, an AVP of Healthcare Industry and Government Relations at HIT vendor thoughtfully suggested I "come and listen to how the government, providers, insurers and yes- HIT providers- can work together for the common good before drawing such strong conclusions." (Soothing blue font original - ed.)

Dialog is a useful idea. I am always open to listening.

However, dialog must be among equals in an atmosphere of complete transparency. Otherwise it is not dialog, it is politics.

How can there be "dialog" in an environment where one side is able to squelch open discussion of the issues?

... p.s. in late 2003 after the collapse of Merck's pipeline, I wrote to your [NextGen's - ed.] CEO and HR department in Horsham about my availability to help in their EHR efforts. This was prior to the bulk of my writings on HIT difficulties. I did not so much as even get a response or inquiry, although I live thirty minutes away.

Perhaps you could explore why your company showed no interest in perhaps the only formally trained medical informaticist in this area, and former CMIO of a major hospital in the region (Christiana Care).

More on this below.

I found Mr. Jarvis' patronizing "why don't you come and listen" line, sent in a nice soothing blue font, disturbing, since it's vendors (immune from liability and from intra-organization scrutiny even when events such as this and these occur), not physicians and physician informaticists, who need to do the listening.

However, something else was at the back of my mind, and information saver that I am (I did run Merck Research Lab's science library and historical science archives department, after all), I checked my disk backups.

What I found reflects something I've noted numerous times in the past. Interactions with HIT vendors - both their products and their people - have most often been quite annoying.

Here is Mr. Jarvis' bio:

[Nov. 2011 editor's note - the bio disappeared from the original link; the link now points to]
Charles Jarvis, Assistant Vice President, Healthcare Industry Services & Government Relations

Charles W. Jarvis FACHE is Assistant Vice President for Healthcare Industry Services and Legislative Affairs – having been in this role since January 2005 [this date becomes relevant as below - ed.] Mr. Jarvis' responsibilities include community and partnership business development including overseeing the company grants and funding procurement program, government relations, new business planning, and educational efforts. Mr. Jarvis is active in the Electronic Health Record Vendor Association (EHRVA), currently holding the position of Chairman of the Government Affairs and Affiliated Organizations Workgroup.Prior to joining NextGen, Mr. Jarvis was in hospital and physician group practice management for 25 years in both the New Jersey and Massachusetts markets.

Mr. Jarvis holds a Masters Degree in Business with a concentration in Health Administration [i.e., he took a few courses in health admin - ed.] from Temple University and a Bachelors Degree in Economics from the Wharton School of the University of Pennsylvania. [Common to the HIT industry and to observations on HC Renewal about HC leadership in general, I note no clinical experience or credentials - ed.] He is also a Fellow in the American College of Health Care Executives and holds the American Medical Informatics Certification for Health Information Technology [what is that? More below - ed.]

Now, it was bad enough my earlier inquiries to the NextGen CEO were ignored. Far worse is the outcome of my application to NextGen for a position as Director of Industry Relations in late 2004:

NextGen Healthcare is currently looking for an individual to manage our Industry Relationships. We are a rapidly growing, publicly held company looking for an aggressive, self-motivated individual who is seeking a challenging position with a top tier healthcare IT company. As the Director of Industry Relations, you will be responsible for managing industry relations. This will include relationship management with the consultant marketplace, medical societies, health plans, and our Value Added Resellers. Qualified candidates will have preferably healthcare IT background either as a project manager, consultant, marketing manager, or sales representative . Applicant must also be career oriented, professional, and organized, possess excellent oral and written communication skills and be detail oriented. Working knowledge of MS Excel, Word and PowerPoint a must. Local and national travel required.

Here is the relevant email thread:

From NextGen:

In a message dated 12/27/2004 9:04:43 A.M. Eastern Standard Time, writes:

Hello Dr. Silverstein,

We would like to schedule an interview for you the week of January 3, 2005.
Would you please advise your schedule? I will be arranging an meeting with
the president and one of our vice presidents. Please let me know what day
and time are best.

Thank you.

Jennifer Wong
Business Development Coordinator
> NextGen Healthcare Information Systems, Inc.
795 Horsham Road
Horsham, PA 19044
215.657.7010 (p) 215.657.7011 (f)
Website -

My reply back:

From: []
Sent: Thursday, January 06, 2005 12:44 PM
Subject: Re: Interview

Hi Jennifer,

I have been away for the New Year. I'm following up on getting an interview schedule set.

I also left a voicemail.



NextGen gets back to me:

In a message dated 1/10/2005 11:47:51 A.M. Eastern Standard Time, writes:

Hi Dr. Silverstein,

I have forwarded your resume internally to the appropriate persons. Thank you - you should be hearing from someone shortly.

Thank you.

Jennifer Wong
Business Development Coordinator
NextGen Healthcare Information Systems, Inc.
795 Horsham Road
Horsham, PA 19044
215.657.7010 (p) 215.657.7011 (f)
Website -

My response after waiting, and waiting:

From: []
Sent: Thursday, January 20, 2005
Subject: Re: Interview

Dear Jennifer,

I still await contact from NextGen. Please advise if this opportunity is still available. I am in conversation with other organizations and want to finalize my schedules.



Then ... silence.

I never heard from the company again.

(Dialog? What dialog? There does not appear to have been even fundamental respect.)

In summary, an AVP who may very well have -- hypothetically speaking; I'd never heard of him before he responded to my recent workgroup posts -- made a decision about blowing me off as a Director in 2005 (he started in Jan. 2005) now tells me how I should "come and listen to how the government, providers, insurers and yes- HIT providers- can work together for the common good before drawing such strong conclusions."

I can also add that NextGen did indeed hire a medical informaticist straight away from the same program I trained in, Yale's, sometime after that person's completion of a postdoctoral fellowship in July 2006, as a "physician consultant." I had finished the fellowship in 1994 after a number of years of medical practice and by 2005 had quite a lot of applied and management experience under my belt.

(My current bio does not include my time as Medical Programs Manager for quasi-governmental agency SEPTA, with much interaction with SEPTA Industrial Relations, and with federal regulators DOT, FRA, NIDA and others on health matters in the transportation industry, but it did then.)

So, I was entirely blown off without so much as an explanation in 2005, but a new informatics trainee hired in 2006. This raises a number of questions. Hypothetically speaking, was this due to:

  • Lack of recognition of my background, which included extensive clinical, medical informatics and EHR experience and working in a critical role in a quasi-governmental organization with links to several federal agencies?
  • Age discrimination? I was in my late 40's at the time.
  • Perhaps it was felt I had too much experience for the organization?
  • Hiring the young and relatively inexperienced on the basis of "cheap?"
  • My patient-centric advocacy views on HIT, as in, "the patient must be protected from defective HIT?"

I am not making accusations in any way, only raising questions. Only the company knows the answers, of course, and it is their right to hire someone or not hire them or even have them in for interview. Even basic courtesy of followup with the professional community is optional.

However, I rest my case regarding the really annoying nature of health IT vendors beyond just their often poorly conceived products, and their inability or unwillingness to tap experienced healthcare informatics professionals as I've written about before on HC Renewal.

Finally, what is the "American Medical Informatics Certification for Health Information Technology?" claimed in Mr. Jarvis' biography?

I have never heard of it before and a Google search seems unrevealing. Could it be an overstated credential to impress stockholders and investors? (We in informatics strive for semantic clarity). AMIA does not "certify" anyone in informatics to my knowledge although they offer a short course in the 10x10 program that awards a "Certificate of Completion in the 10x10 Program." I'm not aware of an American certification board in HIT.

Is it like another Htraesian informatics "certification", CPHIMS, as I described here?

Is it a certificate like this, which students get after completing the intensive 3-course graduate program in an accredited university that I created? Perhaps something you get after completing one of these programs, created and funded by Don Lindberg and other informatics pioneers, that I spent two years of my life in?

Or perhaps it's more like this three day 10 course miracle certification and button? "Consists of 10 course, two and a half days curriculum and CPEHR Certification Examination" [is that like a 10 course meal? - ed.]

Oh, I forgot. In healthcare informatics, everyone's an expert.

Finally, I guess I won't be applying to NextGen again. They might blow me off.


-- SS


Anonymous said...

NextGen is very political and Director positions are usually given without merit to long time cronies. I've even seen nextdoor neighbors get positions without a lick of experience in healthcare or software. Charlie never impressed me, he usually stayed quite and followed the recommendations of others.

InformaticsMD said...

NextGen is very political and Director positions are usually given without merit to long time cronies

I don't know if that's true or not, but healthcare itself is highly political. That doesn't mean physicians go out of their way to put incompetent doctors in leadership roles.

I still want to know what an "American Medical Informatics Certification for Health Information Technology" is.

-- SS