News 5/28/09

If Massachusetts lawmakers have their way, “sorry” will no longer be the hardest word for doctors to say. The state is considering a bill that would let doctors say “I’m sorry” without admitting they made a medical mistake. Expressions of condolences or compassion would be inadmissible as evidence should a medical malpractice lawsuit be filed.

Southwest General Health Center (OH) selects Allscripts Professional EHR for its 30 employed physicians. The practice will deploy the EHR via the Software as a Service model and integrate the Allscripts application with its existing MicroMd practice management system.

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Retail clinics in grocery stores and retail chain stores seem to be following the money, with most setting up in regions with higher median incomes and lower poverty rates. No surprise that Wal-Mart, CVS, and others prefer areas that offer better odds of getting paid.

We’ve recently mentioned incidents involving paper medical records showing up in dumpsters and recycling centers. Now a Michigan doctor is being made to pay $350,000 to settle a lawsuit with the Michigan Department of Health, which charged the doctor of improperly disposing medical records from a now-defunct hospital. The doctor burned the charts at his farm, which frankly sounds like a far better solution than the dumpster and recycling options. I suppose in all these cases people are trying to save a few bucks by not hiring a professional contractor to get rid of the charts. Hasn’t anyone ever heard of a paper shredder?

EMR/PM vendor gloStream secures $7.5 million in series B financing to bolster its development, marketing, and sales efforts. gloStream plans to hire additional staff across the company to further develop and promotes its Microsoft Office-embedded EMR and PM solutions.

The Richmond Academy of Medicine (VA) aligns with NextGen reseller TSI Healthcare to offer Academy members preferred pricing on EHR and billing services. The Academy is an alliance of 1,700 doctors in the greater Richmond area.

Medical billing companies PracticeMax and MedaPhase merge to form one of the largest regional billing service companies in the southwest. The new entity, PracticeMax, will focus primarily on revenue cycle management needs of ER and urgent care physicians, along with certain other specialties.

The gloves come off in the continuing debate of the role of HIMSS and CCHIT in HITECH payments. The Washington Post ran two semi-critical articles suggesting that HIMSS used its lobbying influence to convince the Obama administration to spend billions on healthcare IT, then pushed CCHIT (which it was involved in creating) as the certifying agency for EHR products. In an apparently unplanned third article, the Post ran some heated comments from CCHIT head Mark Leavitt in response to these comments from Dr. David Kibbe: “One has to question whether or not a vendor-founded, -funded and -driven organization should have the exclusive right to determine what software will be bought by federal taxpayer dollars…It’s important that the people who determine how this money is spent are disinterested and unbiased…Even the appearance of a conflict of interest could poison the whole process.” Leavitt’s response: “For months, I’ve been ‘turning the other cheek’ to Dr. David Kibbe … his repeated use of falsehoods and innuendo to attack CCHIT have found an audience in the national media, reaching a level that can no longer be ignored. By implication, he demeans the integrity of everyone who has contributed to that work – and I must rise to their defense.” More of Leavitt’s comments are in the graphic above.

Allscripts CEO Glen Tullman earns a “Best of Illinois” award from the Juvenile Diabetes Research Foundation Illinois chapter. Tullman, whose son and niece have Type 1 diabetes, was recognized for his service on the Illinois Board of Directors, on the International Board, and for his support of the organization’s efforts in developing an artificial pancreas. Glenn’s brother Howard wrote about the event and took the picture above, which I found on his site.

Memorial Health University Physicians (GA) selects McKesson’s Revenue Management Solutions for billing and practice management. The group will deploy McKesson Practice Complete, which includes the Horizon Practice Plus financial application and RelayHealth Ambulatory Claims Manager.

About 150 Alabama physicians are pilot testing a new e-prescribing tool made available from the state’s Medicaid agency. The e-Rx technology is part of QTool, a web-based EHR and clinical support tool developed by ACS to support Alabama Medicaid’s statewide EHR system.

Here is an interesting article, geared to the average consumer, that explains some of the key benefits of EHR. The stuff mentioned sounds great: fewer trips to the doctor’s office because EHRs allow you to converse with your doctor online; personal access to your medical records online, regardless of where you are in the world; and no more dragging X-rays (or another diagnostic test results) from doctor to doctor because everyone can see them online. Maybe the average consumer wants to believe all that, especially since their tax dollars are going to subsidize the purchase of EHRs. The rest of us are left wondering how long will it take to achieve nirvana.

Properly implemented HIT, including EMRs and electronic prescribing, is a requirement for changing the model for primary care that is in place today. So concludes a New England Healthcare Institute report that claims HIT improvements would increase physician time during visits, provide timely access to information, and aid in the overall coordination of care. The study calls for a number of additional innovations to improve the quality of primary care, including patient-centered medical homes and better pay-for-performance initiatives.

E-mail Inga.

Intelligent Healthcare Information Integration 5/27/09

Life in a Little Trench, or Supply Side HIT
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A “grunt in the trenches.” That’s a term I’ve used to describe who, what, and where I and thousands of healthcare providers like me are, occupationally speaking. It is probably a different perspective than many you’ll see on these pages. Please allow me a moment to offer a few descriptive moments to sketch out that picture a bit more.

• I’m a solo pediatrician in a small town (pop. ~9,500) in the rural flatlands of central Ohio.
• I’m on call for neonatal emergencies and C-sections 24/7/365.
• I love living in and serving my small community. I’m the medical director for the county health department, a member of the town planning commission, a local United Way board member, a Rotarian, a member of the local hospital Foundation Board, and have a spot on our town’s Bicentennial planning group.
• In the last three years, my true “vacations” have totaled 3 days.
• Our busy little practice serves a rural populace: about 65% of our families are Medicaid.
• I locally host our EHR on two servers. For IT for our office, I’m it.
• My three wonderful employees started off almost fully computer-illiterate. (OK, one knew how to turn a computer on, one didn’t, and one called the mouse a “duck.” Seriously.)
• I spent hours upon hours researching more than 200 EHRs, demoed scores of systems, and went into deep detail on the finalists before deciding upon an EHR for our office
• Life in my trench includes traffic “jams” of six cars and friends who know me before I’ve ever seen them. It allows for a trip to the post office, a bank deposit, picking up a prescription from the pharmacy, grabbing a forgotten paper from my home, and being back to the office, literally, in less than twenty minutes. There are Scout meetings, sports, school functions, and homework. I insist upon family time and some (admittedly brief) down time.
• I don’t miss big city life in the least.

I’m not offering this description to glorify myself nor anything I do. Rather, I am a very run-of-the-mill, small community, primary care physician. There are thousands more like me out there, working hard to care for our communities and families. We have wonderful, fulfilling lives and enjoy our labors.

There is, however, something missing from our great little lives. We need inclusion in this great big HIT discussion going on. With very few exceptions, nobody’s talking about us – even though we serve the majority of US healthcare needs. Systems and plans are almost completely focused upon the Mayos, the Clinics, the HIEs centered around giant centers, etc. Doesn’t anyone care about all us little grunts out in the frontline trenches?

It seems most everyone’s focused on the big guys and their bigger pools of money. Even the purported Keynesian liberals in political power now seem to be counting on the “Trickle Down Effect” (or its precursor, the “Horse and Sparrow Theory” from the 1890s) to spread HIT from the big centers to all us little guys. Last time it was the conservatives telling us grunts how well we’d all be served by supplying the big boys’ side and letting us little fellows feed off the crumbs that fell.

OK, so that was finance, not healthcare IT. I suppose it’ll work better this time.

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.

News 5/26/09

A California eye surgeon uses Twitter to provide patients’ friends and families with surgery updates. His staff has set up a Mac notebook in the waiting room and he Twitters his patients’ status to a private Twitter account at the conclusion of a procedure. The 42-year-old doctor says that using Twitter is “just a different way to do outreach.”

A Florida ophthalmologist hopes the economic stimulus package will boosts the growth of his sideline EMR business. Dr. James Croley designed Quickview Medical Records, which is targeted for use by ophthalmologists and optometrists. Currently the product is being marketed across 20 states and costs about $14,000 for a typical office.

The Arkansas physician injured in a February 4th bombing hopes to return to his family practice in July. Dr. Trent Pierce, who is also chair of the state medical board, lost his left eye and hearing in his left ear after an explosive device went off in his driveway. No one has been charged with the incident, though officials say they have a person of interest.

AAFP subsidiary TransforMED signs a strategic partnership with EthosPartners to provide a customized analytics tool to integrate and track operational and financial performance in primary care practices. TransforMED’s client base will have the opportunity to use Ethos’ VitalStats to track RCM, physician productivity, and other practice measures.

Transcription service provider MxSecure plans to incorporate M*Modal’s Conversational Documentation Services and speech recognition into its MxTranscribe EHR document management software.

Physicians for uninsured African-American and uninsured/Medicaid Latino patients are less likely to use and EHR than physicians primarily treating privately insured white patients. In general, physicians in urban areas and in group practices utilize EHRs more than doctors in rural areas and solo practices. This article does not theorize why, but likely the cost of technology is the primary factor.

The sluggish economy is making physicians less likely to leave an existing practice, based on findings from an AMGA survey. Last year physician turnover was 6.1%, compared to 6.7% in 2006. In addition, 62% of physicians are delaying retirement due to economic conditions. In other words, physicians have found their 401Ks shrinking, just like the rest of us.

Montana physician Dr. Ron Bearss gives up his private practice for three months to care for soldiers in the Middle East. We thank you for your service.

E-mail Inga.

News 5/21/09

McKesson announces the availability of its Medisoft v15 version and its new Medisoft Clinical product, which includes the new version plus McKesson’s Practice Partner Patient Records. Medisoft Clinicals will be targeted to current Lytech and Medisoft clients and primarily sold through resellers.

A three-doctor family practice clinic in San Diego claims its automation tools are performing the work of one to two full time employees. Specifically, Del Mar Family Practice is using ReminderPro for automated appointment reminders and LabRetriever to deliver tests results. Both products are offered by Inphonite.

The Dartmouth-Hitchcock Clinic (NH) plans to roll out the MedAptus Professional application to 150 specialty providers. The clinic will deploy the MedAptus Practice Plus Edition to facilitate charge capture.

CCHIT approves its final 2009-2010 criteria, but says it will put the new certification process on hold until it can review the forthcoming ONC stimulus package requirements. The ONC has until August 26th to provide the requirements for ARRA reimbursement, including the government’s definition of a “certified” EHR.

When it comes to healthcare and medical records, what do patients want? A Beth Israel Deaconess Medical Center study suggests that patients are looking for full access to all of their medical records, are willing to make some privacy concessions in the interest of making their medical records completely transparent, and going forward, fully expect computers to play a major role in their medical care, even substituting for face-to-face doctor visits. Patients say they not only want computers to bring them customized medical information, they anticipate in the future to rely on electronic technology for many routine medical issues.

HEALTHeLINK negotiates special EHR pricing on behalf of its physician members. The Buffalo-area HIE says the agreements are with six EHR vendors.

E-nagging apparently works. That is, people receiving regular e-mail messages suggesting modest lifestyle improvements do increase their activity level and make healthier food choices, according to a Kaiser Permanente study. If physicians adopt this tool, how long will it be before someone wants to begin billing for it?

I like to think I am fairly technologically savvy, so I was frustrated that I had no idea what this athenahealth press release was all about. The company announced that “it has completed a Statement on Auditing Standards No. 70, as amended, (SAS 70) Type II examination, which was performed by Deloitte & Touche LLP (‘Deloitte’) over its service operations. Under the SAS 70 Type II examination, Deloitte examined athenahealth’s design of controls and tested the operating effectiveness of such controls related to the Company’s revenue cycle management service operations and its centrally-hosted software platform.” The translation from athenahealth spokesperson John R. Hallock is that the company is demonstrating that their RCM operations adhere to the same level of security and privacy standards that are required of commercial banks and other fiduciaries. Ahh … like a CCHIT certification for RCM providers. Which now leads me to wonder if any/all/no RCM vendors have received similar seals of approval?  Should they?

e-MDs promotes Christine Homer from VP of Client Services to COO. In addition, e-MDs hires Mike Maldonado as the new director of support and Jeff Falwell as director of training and implementation.

Citizens Memorial Healthcare (MO) claims its 15 outpatient clinics increased new patient revenues 23% as a result of implementing the Medical and Practice Management (MPM) practice management and EHR suite. The EHR provided improved documentation, which enabled code levels and helped contribute to a strong ROI.

An AAFP survey confirms the negative impact the recession is having on American’s access to healthcare. Fifty-eight percent of AAFP members have seen an increase in appointment cancelations and 60% have observed increases in health problems because patients are forgoing preventative care. Overall, physicians report seeing fewer patients today than in January 2008, but most claim the number of uninsured patients has jumped.

Patients with high deductible insurance plans can now refer to an iPhone application to estimate their costs for medical procedures. The Mobile CDH application estimates the patient’s costs based on public programs as well as some commercial carriers. Canopy Financial, which traditionally provides banking technology for health insurers, is the creator of the $4.99 application. Sounds like something a small physician office might want to check out as well.

E-mail Inga.

Joel Diamond 5/20/09

What’s Wrong with ICD

I suppose only geeky doctors amuse themselves like this: my medical partner and I used our EMR messaging to send ICD-9 related insults to each other throughout the day.

For instance, I pointed out that his E828.9 (accident involving animal being ridden) was undoubtedly due to his 302.1 (zoophilia arotica). This was after he accused me of frequent CPT 54450 (foreskin manipulation). Clearly this was one of the most flagrant examples of religiously-inaccurate coding, by the way. Besides, I told him that he should be so lucky with his 752.65 (hidden penis). All this led to a serious E960.0 (unarmed brawl).

Why is ICD-9 so rich in its expression of seemingly silly/worthless diagnoses, but falls so short in reflecting the realities and nuances of day-to-day medical care? No doubt, that it has been widely used as a tool for billing. I suppose that someone finds the need to accurately code for E928.4 (accident due to constriction by hair), and am fascinated by the ability to drill down to great detail, such as E910.2 (water activity injury without diving board). Much has already been written about the need to document E845.9 (spacecraft injuring another person).

What about the heralded switch to ICD-10? I’m not sure how the 318 codes for diabetes mellitus are going to be helpful, but I an so glad to know that there will be V32.22  (Occupant of three-wheeled motor vehicle injured in collision with two- or three-wheeled motor vehicle, person on outside of vehicle, nontraffic accident, while working for income).

Like many physicians, I didn’t worry too much about this before EMR adoption. I admit that I would scribble a single diagnosis on my superbill and let my billing staff “do the rest”. When I first used an EMR, I was shocked to find out that I needed to specify an ICD-9 code in order to complete my documentation. One of my earliest frustrations with adoption was the difficulty in finding the code that I needed. Fibromyalgia could only be documented as “myalgia and myositis unspecified” (729.1). I had to search for a long time to find a code for hemochromatosis—finally deciding it was 275.0, (disease of iron metabolism).

Despite the “geekiness”, controlled medical vocabularies and semantics will have to be tailored to the needs of “real” doctors as we move forward with HIT adoption.

In the meantime, I hope that you don’t get E905.4 today (bitten by a venomous centipede) or know anybody with the misfortune of a 929.0 or 937.0 (look them up yourself!)

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.