News 7/21/09

Half of all physician practices, medical billers, and billing offices are unable to estimate the amount due at the time of service. And, doctors collect only about half of the balance due from patients, with the balance going to bad debt. In other words, each year doctors are not collecting $14 to $30 billion of the money they are due. A few companies now offer tools to calculate the patient responsible portion at the time of service. As consumers pick up a bigger portion of their health care costs, look for increased adoption of these type technologies.

Google Health now supports document scanning, allowing patients to upload paper medical records. Google is also partnering with Caring Connections to allow users to download free advance directive forms.

Mednax pays cash for Mid-Tennessee Neonatology Associates, a 24-provider group serving NICUs in the Nashville area.

I happened upon this blog written by an ophthalmologist who also apparently runs a practice management and consulting firm. Dr. Peter Polack offers some sound advice on ways to ensure medical records remain legally sound, once doctors transition from paper charts to EMR.  The key is ensuring EMRs are not altered, which requires automated audit features to track who accesses a patient record and when. I find it curious that Dr. Polack used the phrase “remain legally sound,” which somewhat suggests a paper chart cannot be altered. I’m pretty sure I’ve never seen an automated tracking system for paper charts, either.

Providers in Minnesota are now required by law to submit all insurance claims electronically, including those for private and governmental carriers. The state hopes to save about $60 million in administrative costs once all 60,000 providers have made the switch from paper. I’d actually like to see that math. I’m sure most larger clinics have already been submitting claims electronically for years. Is the $60 million a “real” number or just one that Minnesota legislators hope will impress their constituents?

EMR does not necessarily kill the use of pen and paper. So concludes a researcher from Roudebush VA Medical Center (IN). Clinicians often use sticky notes, index  cards, and notebooks to improve workflow efficiency, as well as for memory aids. Don’t dump that Bic stock just yet.

A Phoenix-area OB/Gyn practice bans e-mail on Fridays to encourage more interpersonal communications. The 16-doctor, 130-employee group now have “Conversation Fridays” to promote more personal interaction among employees.

A Kaiser pediatrician shares his thoughts on EHR in an LA Times opinion piece. He admits that EHR doesn’t save time or money, though it does allow him to work remotely from home after the kids go to bed. He’s also enthusiastic about the efficiency of e-mail consults, which can reduce errors and boost care. He concludes, “Ultimately, getting away from a pen and paper is better for my patients.”  Ahhh…so EHR isn’t just about stimulus money.

ENT and Allergy Associates (NY/NJ) announces they’ve expanded the use of their NextGen EMR system to 10 of its 30 practice sites. The practice includes about 90 physicians.

Fairfield County Community Health (OH) makes plans to purchase a PM/EMR solution after being awarded a $250,000 federal grant.

Parents claim that when their children’s care is coordinated through a medical home, their children have fewer hospitalizations and fewer school absences. Parents also worry less about their children’s health. The findings are based on a three-year New Hampshire survey that examined the effectiveness of using medical homes to coordinate pediatric care.

Disturbing: the Congressional Budget Office estimates that HR 3200 (America’s Affordable Health Choices Act 2009) would grow the deficit by a net $239 billion between 2010 and 2019.

The family of an elderly patient sues his dentist for allegedly dropping tools down the patient’s throat on two separate occasions. The  suit claims the dentist dropped an implant screwdriver tool in 2006 and a mini-wrench in 2007. The 90-year patient had several medical procedures to remove the tools but never recovered.

E-mail Inga

Intelligent Healthcare Information Integration 7/20/09

The Six Degrees of Integration

Tipping points and network theory. Malcolm Gladwell and Kevin Bacon. If short books and the Science Channel have taught me anything, it’s this: while I may not have all the answers, it is only a hop, skip, and a jump to where the answers lie and simple things may have the biggest impact (TV and the Web reaffirm this daily).

Have you noticed that no matter where you look, someone is promising the grand digitization of healthcare in the oh-so-near future. I’m starting to chafe from the tipping point upon which we’re supposedly perched. However, a look at the percentages of full-blown HIT users, either provider-side or consumer, doesn’t seem to tilt the impression that mass adoption is all that imminent.

Still, with Facebook at nearly a quarter of a billion users and Twitter plotting its plan to become the first Internet site to reach a billion users, it is apparent that providing people with a tool they: a) understand; b) find simple to use, and: c) find real, immediate use for has major power to quickly topple a tool over into mass adoption. If healthcare IT could get off its high horse and learn a lesson or three from these more “common” contrivances, maybe we could actually reach the Promised Land of Healthcare Information Integration.

Enter Kevin Bacon. HIT struggles virtually non-stop to understand how to integrate all the data we derive daily, be it patient care info, new medical knowledge, or business numbers management. And, from Kalamazoo to Cocoa Beach, everyone is trying to figure it out almost independently. Well, Kevin says we are all only separated by some six degrees or less. What if we take a part of Mr. Bacon’s recipe, sprinkle in some of Facebook’s Gladwellian success spices, stir it all up within the HIT pot, and then dump the whole stew out upside down?

Instead of Six Degrees of Separation, what if healthcare information integration chose to focus upon the reverse view that we are all within “Six Degrees of Integration”? We are not separated so much anymore as we are integrated. A quick breeze about the HIT blogs brings up some pretty interesting observations along these lines from both the more notorious as well as some lesser-known HIT brainstormers.

Many of them are now bandying about notions related to direct-to-consumer healthcare information integration management beyond PHRs and EHRs. After all, every person on the planet has health which needs care at some point or another, just as most everyone has social networks with whom they want to keep connected. If simple social networking tools are able to empower such rapid adoption and end user deployment, then haven’t they demonstrated the fast, focused force available for integration of healthcare info if we only harness similar motivating energies?

To promote this reverse view of the Six Degrees for HIT, I propose a new organization: Pursuers of Integration’s Six Degrees, to be more affectionately known as PISD. If you don’t want to wait for the trickle down of big, siloed systems, consider becoming a PISD member. Help all of America, even all of the world, become PISD so we can get beyond the abrasive point upon which we tip.

The unwitting modern day Moses, Kevin Bacon, has shown us the Promised Land past the HIT Tipping Point. Now, if we could just pass over.

“If you’re not scared or angry at the thought of a human brain being controlled remotely, then it could be this prototype of mine is finally starting to work.” – John Alejandro King

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 07/16/09

iMedica changes its name to Aprima Medical  Software to avoid confusion with several other similarly-titled healthcare companies. The company also rolled out a new website, aprimaehr.com.

The HIMSS Electronic Health Records Association (EHRA) sends a letter to the ONC recommending, among other things, that CCHIT be “the single certifying entity to avoid duplication of effort, unnecessary expense and confusion in the market.” In case you need a refresher course on how these various entities are intertwined, here’s some background. CCHIT was spawned from HIMSS. The EHRA is comprised of EHR vendors, most of whom are CCHIT-certified. CCHIT’s operations are largely funded from the monies vendors must pay to apply for CCHIT certification. Certification fees are $28,000. So, it makes perfect sense that the EHRA members want to preserve their investment by supporting CCHIT. It certainly helps keep the riff-raff out of the game.

One vendor definitely not in favor of mandatory CCHIT certification is SRSsoft, who just announced Northern California Medical Associates as its latest client. The 21-location, 50-provider group displaced two CCHIT-certified EMRs in place of the SRS EMR product.

Doctors at Gaston Medical Group (NC) contact police claiming more than $333,000 has been embezzled from the practice. The six-doctor group claim the money was stolen using counterfeit payroll checks.

DocSite announces that six state medical associations are now offering its PQRI product to facilitate PQRI reporting. Medical societies in Colorado, Tennessee, Idaho, Nebraska, Iowa and New Hampshire are now offering the product to members.

e-MDs releases its 6.3.0 Solution SeriesTM solution, which incorporates such enhancements as a First DataBank’s drug database solution, upgrades to the Surescripts e-rx application, abd support for continuity of care documents.

It’s hard not to be sucked into the Michael Jackson medical drama since the media is constantly providing “breaking news!” with the latest scandalous details. Today’s headlines include word that at least nine doctors are under investigation for their role in providing Jackson prescription drugs.

Allscripts announces it is working with the AMA to offer an AMA-branded e-prescribing tool. The tool will be available at no cost to subscribers of a new online solution being developed by the AMA, with help from Covisint.

TetriDyn Solutions is now a certified VAR for McKesson’s Practice Partner EHR solution. TetriDyn also offers its own small-practice EHR solution, AeroMD, and is a Medisoft PM reseller.

XM Satellite Radio fans now have a new source for advice on improving physician practice management. Practice Success is a practice management radio show featured on ReachMD’s channel 160. Karen Zupko of KarenZupko & Associates is hosting the program, which will offer practical practice management advice for physicians and their staff.

The consumer price index for physician services rose 3.3% for the 12 months ending in June, which is a tad more than the 2.8% increase the previous year. Physician office prices rose .2% in June, compared to a .1% decline in May.

A Washington state oncologist files suit against Olympic Medical Center, charging the hospital’s hiring of employed physicians constitutes a monopoly. Dr. Robert Witham claims that the medical center’s direct hiring of doctors violates the law by creating unfair competition with private physicians. The case could be interesting to follow, especially with more and more practices selling themselves to hospital systems.

The HHS announces plans to develop an electronic family history tool that will help doctors identify women at risk for having preterm labor or delivering a child with a birth defect. The web-enabled My Family Health Portrait program will allow patients to enter data via computerized tablets, which would then be analyzed electronically.

Lori Heim, AAFP’s president-elect, tells Congress that healthcare reform will not succeed without an adequate supply of primary care physicians. The AAFP is calling for measures that would boost the number of primary care physicians to at least 45% of the healthcare workforce, and include an immediate increase in primary care physician payment.

E-mail Inga.

News 7/14/09

Louisiana continues its efforts to advance the use of electronic medical records. Governor Bobby Jindal signs a new law establishing an EHR loan program that gives the state government authority to apply for and administer $25 million in federal stimulus funds and $5 million in state monies.

Cook Children’s Health Care System (TX) collaborates with athenahealth and Microsoft to provide athenaClinicals and athenaCollector for its 350 providers. Cook Children’s will also implement the Amalga Unified Intelligence System (UIS) 2009 to create a community-wide patient record. In addition, the purchasing organization of Cook Childrens, PedsPal, will offer preferred pricing for the athenahealth solutions to its 1,100 affiliated physicians.

Ophthalmologists may want to consider delaying a decision on buying an EMR, according to AAO’s medical director for health policy. The words of caution from Dr. William L. Rich stem from the fact that no ophthalmology-specific EMRs are currently CCHIT-certified. Rich believes that without certification, eye care providers will be unable to qualify for any stimulus money. The AAO is also urging Congress to delay the incentive programs until CCHIT-certified eye care EMRs become available. Obviously Rich and the AAO are convinced CCHIT-certification will be a requirement for stimulus funds, even though the ONC has yet to clarify that point.

Three Wichita, KS health clinics will benefit from over $2 million in federal stimulus money, a portion of which will be used to fund EHR projects. The clinics serve low-income and underinsured patients.

A Kaiser Permanente paper concludes specialty care physicians can improve the health of high-risk patients by reviewing EHRs and pro-actively providing e-consults and treatment plan recommendations with primary care physicians. A reader had asked Mr. H for his impressions, to which he shared: “I truly believe that once the pain of getting EMRs running as data collection appliances is over (meaning we’ve got data collection clerks known as doctors and nurses in place, which is the ‘pain’ part), the benefit will be incredible.” More insight here.

About 45,000 US physicians could each receive up to $63,750 in Medicaid incentive payments if they demonstrate meaningful use of an EHR and at least 30% of their patients are Medicaid recipients. This according to a study by The George Washington University. Total dollars from taxpayers: about 2.8 billion.

After a mere two-year partnership, Sermo and the AMA are in the midst of a nasty divorce. Sermo published the results of a survey in which its members expressed declining support for the AMA. Seventy-five percent of the doctors said they are not AMA members and 89% claim the AMA does not speak for them. The AMA critics charge that the organization has not advocated for them on a number of policy issues. The Sermo folks also dislike the fact that the AMA makes millions of dollars licensing CPT codes. Someone smarter than me will have to explain why the world is not big enough for both organizations.

Epocrates announces a new OTC drug module that can be loaded on mobile computing devices.

In what would be a boon for EHR vendors, CMS  considers expanding PQRI to include data on quality measures submitted from EHRs, rather than simply claims data. CMS is determining if it is feasible to include the EHR-based reporting mechanism in the 2010 PRQI program.

Arizona Governor Jan Brewer signs a bill making it harder to successfully sue emergency medical providers for malpractice. The new law raises the legal burden of proof required to win legal claims of negligent care.

In an article highlighting the leadership of Massachusetts in digitizing healthcare, ECW’s Girish Navani says his company is hiring twice as fast as it would have without the economic stimulus and will add 200 new employees this year. John Halamka, CIO at CareGroup Healthcare System, is quoted as saying his state has an EMR adoption rate between 30 and 50%, which is significantly higher than the national average.

President Obama names Dr. Regina Benjamin US surgeon general. Benjamin is a family physician from Alabama who established a rural health clinic in an underserved shrimping community. The clinic was destroyed in Hurricane Katrina, rebuilt, and then burned down right before it was to re-open. She’s also served as president of her state’s medical society and last September won a $500,000 “genius award” from the John D. and Catherine T. MacArthur Foundation.

E-mail Inga.

Intelligent Healthcare Information Integration 7/13/09

You Have To Let It All Go, Neo

Just for fun, let’s say you have 19 billion dollars and a tremendously philanthropic heart. Let’s say you decide to devote your vast fortune to solving the healthcare crisis in America. As you also have a geeky soul, you settle upon healthcare information technology enhancement as the vehicle you deem most likely to have give you that big bang for your many, many bucks.

You look around the HIT realm and see many, many players providing many, many digital solutions, but realize that the vast majority of them are siloed, they don’t work and play well with others. There are some really wonderful systems, many of which have the potential to provide the electronic underpinning to your truly national health care project; however, very few, if any, have all of the tools with all of the interoperability you seek. Virtually none have the diversity of user interface that end users’ widely divergent personal preferences demand. (People do want their own style.)

It appears to you that no current system can provide the be-all-end-all tool that works for everyone, no system yet has the easy and highly individualized personal customization required to entice everyone into adoption with a tool that works for their unique needs and their unique eyes. Thus, you begin to ponder, “I wonder what kind of a broadly attractive system I could build from scratch for my 19 billion dollars?”

Pursuing this thought train, you muse:

• How many top notch developers could I hire? (2,000 X $150K = $300 million)
• How many designers could I employ to make user interfaces that are easy with thousands of skins so everyone can look at whatever suits their eyes? (2,000 X $150K = $300 million)
• How many educators could I deploy throughout the country to make sure “no child is left behind” – or any adult? (10,000 X $150K = $1.5 billion)
• How much of my money pile could I afford to give to individual smaller communities across the nation to help them step across the digital healthcare divide? (Micropolitan areas: 577 X $3M = $1.73 billion)
• How much could I give to schools to help educate the young so that, going forward, this digital healthcare stuff becomes second nature? (94,000 X $100K = $9.4 billion)
• How many really great support personnel could I hire and deploy to every corner of the land in an effort to insure uptime? (10,000 X $250K = $2.5 billion)
• How large a chunk would be left over for various loose nuts and bolts, including quality CEOs, COOs, CIOs, and all the little “o”s? ($3.27 billion)

2,000 developers; 2,000 designers; 10,000 support personnel; 10,000 educators; big, no huge, chunks of money to help small communities join the party and teach our children how to be digital healthcare thinkers using existing Web and cell phone technologies which already reach every knook and most every cranny? “Hmmmmmm…,” you further muse, “I bet this money could really do some good.”

“You have to let it all go, Neo…fear, doubt, and disbelief. Free your mind.” – Morpheus

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.