Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
Bill Henderson, FACMPE, is administrator of Upstate Neurology Consultants, LLP.
We’re a neurology practice. We’re obviously a private practice. I’ve got an eight-provider practice that is seven MDs and a PA and we’re in Albany, New York.
What software are you using?
We use Sage Practice Management. We use Sage EHR. We’re running that on a Stratus server. We also run, within the practice, Xen servers for virtual machines. We run terminal services on a Windows 2008 server for remote access.
I run a bunch of other applications, Websense as well as standard kind of things that you would expect in this small network.
We also use Microsoft DPM for the purposes of data backup. Microsoft bought that product three or four years ago and it is a backup product. It kind of reminds you of the Symantec backup product that had continuous protection, only it’s significantly better in that it can do its “data backup pictures” much more often. It writes on the hard drive primarily and it’s far more robust and reliable. At least that’s my experience. I also have it on one of the servers running the practice analytics product that interfaces with the Intergy product — both the practice management side and the EHR side.
How long have you been using the Sage products and why did you pick them?
The practice management side we started in March of 2004. The EHR side we started and we went live on that toward the end of December of 2005.
I had done research for a couple years before we purchased the product. In the end, what finally convinced us to do this was a one-stop-shop, which it was an integrated solution that provided an EHR, a practice management product, and also a scanning interface. It also had the ability to do a lot of the connectivity things we wanted to see developed, such as electronic interfaces to labs and e-prescribing.
From the perspective of a small practice, it’s a lot easier to manage an integrated solution than it would be to manage two solutions — one for practice management, one for EHR. Maybe even another one for imaging, depending upon what’s out there. The product also benefited from the fact the interface could adjust to the work responsibilities of individuals, so that the clinical people using the EHR interface saw the things that are clinically focused; the office people saw the ‘base product,’ or the things that were relevant to the day-to-day billing operations and/or scheduling and/or tasks or communications with patients. So that was positive.
Plus the product also ran on PDAs and it ran on mobile phones. That capability would reduce the number of devices my doctors carried at one time from the three they carried at one down to one, which is obviously a very significant thing.
Tell me a little bit more about the analytical reports that you’re running and the software you’re using. What are the different reports for?
The product is Practice Analytics. It has two distinct features in version 5.5. One is the ability to run reports in what would be considered the standard financial analyses of a practice; such things as charges and collections and the analysis of procedures by provider. But the ability to be able to customize that is very important.
Examples of the kinds of reports we would run under that segment of the product are things related to pay-for-performance. We’re doing CMS stuff right now and e-prescribing for 2009. I’m able to run reports that look at specific procedure codes by a specific insurance carriers, by specific G codes by provider to be able to run tests throughout the year. I’ve been able to do that so far to see that we’re meeting the minimum requirements for reporting for each of those G codes.
So there’s just one example of what I consider to be fairly sophisticated reporting, even on the financial side. The product allows me not only to run reports, but to convert them to graphical charts if I want to do that; or also, to export the data to Excel. That’s fairly standard in a lot of the products that are out there. I’ve used Business Intelligence now for, oh my gosh, about 10 or 15 years. I’ve used Cognos and the like in the past. What I particularly like about this product is it actually allows me to get at each of my data buckets, if you will, so I’m not restricted about what I can necessarily pull out of the data that’s been collected. That’s just looking on the financial side of the product.
Looking at the clinical side, Intergy itself is built on a standardized database called MEDCIN. We had designed a unified template that all of our physicians use. It’s a multi-tabbed template because we obviously see general neurology and we cover a broad number of diagnostic categories. So we’re collecting clinical data on all the individuals that we see, which in turn means that I can run reports on a number of clinical factors, if you will.
I could give you examples of the kinds of things we do. Not too long ago we had a FDA recall on a particular drug and we needed to know who was on the drug; why they were on the drug; whether they would qualify for any humanitarian use, because the company would be allowed to continue it for that. I heard about the recall when the drug rep walked in. In fifteen minutes I had identified everybody in the practice who had that. We were able to contact them and do that because we had that clinical data recorded. In the old days, what that meant with paper charts was you’d have to remember who you had, you’d have to run a report of your diagnosis codes. Then you’d have to pull the charts and actually look. Now you don’t have to do any of that stuff because it’s all built into the data that you’re collecting. So that’s good.
For clinical research work, we can actually really drill down to find such things as the number of patients, by sex, who have a particular diagnosis who have never been on this particular drug and may have these other secondary conditions to see if they may be eligible or someone that should be spoken to at some point regarding the clinical trial. You actually have the ability to data mine clinically in a way that would benefit your patients.
Do you find your doctors are asking you for more and more reports now that they’ve seen the power of them?
Where the power of this product comes in is in the ‘dashboards’ that they’ve introduced in this new version. I use that actually with my doctors and bring into our meetings a laptop and LCD projector. We look at the data and let them see it graphically. You can click on one little button and it changes the look from a graph to a line chart and compare to the previous years. What makes it so exciting is that when you have a report doctors will spend some time analyzing it and then ask questions of the data. Before, if they need you to answer their questions, you would have to turn around and run another report, answer that question, print out more paper.
But now we actually can sit in the meeting look at a particular category of services that we provide; how is our E&M coding compared to last year; how are our neurological procedures compared to last year? We can change what are we seeing, how our population is changing by way of insurer, or where are we seeing people from different zip codes.
Before, you could run those reports — that’s not an unusual thing for an analytical product. The difference here is you can do it on the fly. You just make a couple little quick little changes. Click on what your options are while you’re there looking at the product and you could see how it changes. I could see if my referring doctor patterns changed in the last three months, and if so, how have they changed? Is this hospital providing enough work for us is another question; and, should we continue to work there or is it costing us too much money to see patients there? What you do again by just clicking on the place of service in the hospital and see how that hospital compares. Then you can look at that back over a couple years because now we have data that trails back now for us financially, back to ’04 and clinically to ’06.
Across the board, has the passage of the ARRA changed your focus at all in terms of technology adoption?
That’s an interesting question. I have been a long-spoken advocate within the American Academy of Neurology where I serve on a couple committees, to basically say that we need to have heavy investment in health IT. I felt that way for a long time. People come into my practice just to observe or to see it would say how much time it saves, how beneficial it is. And so for me and for our practice, we have invested heavily in IT all along the way. The new stimulus is nothing more — since we’ve already paid off all of our stuff and we’ve earned the money to do it — it’s nothing more than money coming into the practice. I would say however, that for practices that have not invested at this point, they need to play some serious catch-up to do and I think this bill really incentivizes them to be able to do that.
Why do you think EMR adoption, in particular, remains to be low?
I think pretty traditionally people tend to say the adoption rate for EMR is somewhere in the low 20%. The first thing you have to ask is what’s the average group size in the United States? Some numbers that have floated out there say 50%, at least, are three providers and less. When you’re in a group that’s that small, the costs for providing what I would consider significant IT and health IT is pretty great in comparison to what the revenue would be to a practice. You have to make a decision as to whether you’re going to make that investment or not and there hasn’t been a tipping point.
But the other side of the equation is, up until I had this level of data, the group that had more data than I had was the insurance company. So if I wanted to negotiate contracts, discuss reimbursement rates, I was dependent on the data they could show me about the work that I was doing. Now I’m in a position where I actually have more data than they have about their own patients because not only do I have the billing data, which we both all have — the insurer has it and we have it — but I also have the supporting clinical data and that’s something that they yet do not have.
I’m answering your question in a slightly different way, but having that level of data allows doctors to play on a more level field, if you will, with insurers in terms of the information that they have. And that’s just one example of why it’s hard for me to imagine why physicians have not adopted this. My guess is that the bottom line they look at is the cost. They don’t think their return on investment will be significant enough for them and they make the choice not to do it. I suspect that’s what most groups are doing, but that has not been our experience. So it’s a little bit harder for me to identify with that, although I have empathy with that.
What is your general impression of some of the major changes that may happen in the healthcare technology industry in the next couple of years?
I think one of the first things that’s going to occur is that meaningful use, whose definition has not been finalized yet, is clearly going to extend beyond CCHIT products. It’s going to probably look at what we would call less expensive ones. I think that will make a change because I think physicians will argue that if they can find a less expensive solution, that’s more beneficial to them. I think, however, in the long term, it’ll prove not to be beneficial because I’m not sure how many of these vendors will be in place so to speak, a decade from now.
I think one of the other big changes that will occur is that in exchange for providing money, the government is going to look for access to the clinical data. I don’t think we have actually, as a country, yet resolved the debate as to who owns that data. I think that is yet to occur. I see that as something that is coming down the road and may change.
I think that in the end of the day, a lot of these smaller private groups will merge into larger groups just for the sake of purchasing health IT or doctors may join hospitals or multiple specialty groups for the purposes of getting the benefits without the costs involved in it. Those are a couple things.