Intelligent Healthcare Information Integration 12/19/09

Feeding Those Who’ve Already Supped

From Healthcare IT News, Diana Manos, December 2, 2009:

Health and Human Services Secretary Kathleen Sebelius and David Blumenthal, MD, the National Coordinator for Health Information Technology, have announced $235 million in grants supporting non-profit organizations and local governments that can exemplify the positive impact of healthcare IT on population health.

From Grants.gov, Recovery Act – Beacon Community Cooperative Agreement Program :

Selected communities must already be national leaders in the advancement of health IT, workflow redesign and care coordination, or quality monitoring and feedback. In addition, successful communities must have advanced rates of electronic health record (EHR) adoption and health information exchange (HIE), and the readiness to incorporate health IT to advance community-level care coordination and quality monitoring and feedback.

Seriously? The way to advance healthcare for communities, to help “communities to build and strengthen their health information technology (health IT) infrastructure and exchange capabilities to demonstrate the vision of the future where hospitals, clinicians and patients are meaningful users of health IT…,” is to give more money to those folks who already have money and support? They’re saying the answer lies in encouraging those things that have trudgingly brought us to our current quagmire of NHIN limbo?

This then implies that those 2,000 or so small communities across the U.S. with their associated small community hospitals where 60-70% of American’s receive their healthcare, most of whom have little to no HIT and little to no HIT funding support, are again left standing beside the table, starving, watching those who already have been tossing down giblets and gravy get fed yet again. All the while, there they stand, hunger pangs piercing their bellies, as they watch another course of fat and feast go to those who’ve already eaten while the hungry wonder where they might catch a cast off crumb or two.

No consideration for a new way to advance community healthcare integration? No promotion of novel thinking and innovation for community HIT? No “let’s encourage some disruptive shake-up for this semi-stagnant industry” to encourage new adopters and new connectors?

Maybe in my little foxhole here on the frontlines I’ve missed something, but darned if it makes any sense to me to take ARRA monies and consistently push all of them out to the “already haves.” If they already “had it” sufficiently, wouldn’t we already be seeing the integrative fruits of their labors? With so few really grand success stories in the world of CHINs and RHIOs and HIEs, what is the logic that says throwing more free (i.e., taxpayer) money at them will provide them their long sought spark?

Kathleen, David, I hereby offer my two-cent suggestion: There are lots of small communities who could use that money and I know of several disruptively innovative, out-of-the-container thinkers who might really send HIT integration to new levels for all us little guys if somebody would provide them a seat at the banquet. (They eat very little and would even help with the dishes.) How about a helping hand for the “have nots”?

From the (hungry) trenches…

“I’ll be more enthusiastic about encouraging thinking outside the box when there’s evidence of any thinking going on inside it.”  – Terry Pratchett

PS – Thanks, Shabbir.

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 throughhttp://madisonpediatric.com or doc@madisonpediatric.com.

News 12/17/09

From Much Ado: “Re: free Cerner EMR. I got Cerner EMR ‘almost’ for free from my hospital. Less than a year into it, I realized that I couldn’t afford the inefficiencies of ‘free’ and ended up buying another system. Best decision I’ve ever made. I wish the winner good luck.” On HIStalk, Mr. H compares the giveaway to “free kittens” that no one wants.

KLAS announces the best healthcare IT software vendors. Epic is the big winner in multiple categories, including EMR and PM in the 100+ physician market. Other winners in the ambulatory world include eClinicalWorks and Greenway for EMR; and McKesson, Greenway and athenahealth for practice management. In addition to eCW, Greenway, and McKesson, a number of other HIStalk and HIStalkPractice sponsors made the list including Eclipsys, Wellsoft, Nuance, CareTech Solutions, and Hayes Management Consulting. Congrats to all.

A trio of healthcare IT companies announce new applications for mobile devices. 3M Health Information Systems releases 3M Mobile Dictation software for its Mobile Documentation System, giving physicians access to patient data on their smartphones. Amcom Software’s Mobile Connect application allows clinicians and staff to use BlackBerry devices for messages and critical codes. And, Halfpenny Technologies introduces ITF-Mobile, which allows physicians to securely access test results.

SynaMed announces a free HIPAA-compliant patient-to-doctor messaging system that works with its free EMR and PM systems. Reading the fine print on the website, it looks like in addition to the “free” stuff, SynaMed also offers upgraded packages that include software hosting (for $358 a month per provider plus $20 per staff member, you can get EMR/PM and hosting). Unlimited e-mail support is $1,500 a year and support “training” is $85 an hour. When you add it all up, it sounds a bit like getting four free tires, but needing to buy a car if you want more than a tree swing.

ONC accelerates its timetable for rolling out health IT regional extension centers (HITRECs), planning to announce 30 grants on January 21 and another 40 or so in March. Sounds like a good move, given the amount of work that needs to be done in short order.

The computer scientist who wrote the iPhone application iStethoscope says he did it as, “a bit of fun,” and has been astonished by its success. The app, which allows heart sounds to be recorded and e-mailed to other doctors, sells for $.99 and many cardiologists consider it superior to $3,000 digital stethoscopes. That being said, on the iTunes app store, users give iStethoscope an average of two stars out for five.

Culbert Health is conducting a series of EHR workshops on behalf of BCBS Massachusetts. Keith MacDonald, Culbert’s director of strategic services, is leading the sessions that are specifically designed for the needs of smaller practices and cover everything from funding and practice readiness to vendor selection and physician adoption. More details here.

Cerner says it will offer Certify Data Systems’ HealthDock appliance to facilitate bi-directional clinical information sharing between providers, labs, hospitals, and other care settings.

Next time a Pfizer sales rep is in your office, check out the company-issued tablet PCs. Reps will use the devices when requesting drug samples for doctors, choosing the doctor on the screen, which then displays a list of appropriate products for sampling. Pfizer has a mighty big meaningful use incentive: the company paid a $2.3 billion fine for illegally marketing its drugs to doctors, so Uncle Sam wants to keep an electronic eye on them.

Most physicians believe that HIEs would improve quality of care, reduce costs, and save time. Despite the benefits, this survey of 1,000 physicians didn’t find a single doctor willing to pay $150 a month to connect to an HIE. Half of the doctors believe access should be free.

A study of mental health professionals finds most believe electronic records were clearer and more complete than paper records, though not necessarily more factual. A whopping 83% said that if they were a patient, they wouldn’t want other healthcare providers to routinely access their mental health records.

Speaking of mental health, here’s a shocker: teens are more likely to talk to a computer than people. Adolescent patients using a hand-held device to input medical information were 24%  more likely to have a follow up medical visit and six times more likely to get care for behavioral problems like substance use or depression.

Daniel J. Kohl resigns as CEO of the struggling Spheris, a medical transcription service company. The company reported a 15% drop in revenue the first half of the year and ended its registration with the SEC in November. Likely adding fuel to the fire was the company’s poor showing in last week’s KLAS report on medical transcription service vendors. Amid customer complaints that Spheris was unable to resolve quality and technology issues, the company was ranked last in a field of 15.

Hanukkah Wishes.

News 12/15/09

From: D. M. Bennett “Re: Seeker of Truths Comments. Review of ARRA funds status will demonstrate that dollars are being dispensed by the Regional Health Centers, as widely publicized by Sebelius and Biden – the dollars seem to be going to pay for assistance in ‘selection’ and ‘infrastructure.’” And thus not exactly being handed over to providers to purchase EHRs, despite what a few unscrupulous vendors may be suggesting. Speaking of the RHCs, no one should underestimate the potential power these organizations will wield over the next couple of years. If I were an EMR vendor, especially one catering to primary care, I would want to become BFF with every one of them. Those vendors overlooked by (or out of favor with) the RHCs may find themselves struggling for survival.

From: Scrooge “Re: AMA concerns. I suggest you may be too ‘willing to believe’ in the ‘heart’ of the Physician – just wait until the Reform Bill kicks in with its full complement of ‘panels’ and some bureaucrat’s definition of P4P gets pushed down – there won’t be any time for that ‘heart.’”

Here’s an option for providers wanting an EHR but don’t want to pay for it. CDW Healthcare and Cerner are launching the Tech Rx Transformation Contest, offering physician practices the chance to win a $50,000 EHR solution, including implementation and support services. To enter, practices may submit a description about why their practices needs an EHR or PM system. Deadline is January 22nd.

Greenway, NextGen and Pulse all receive CCHIT 2011 Ambulatory EHR certification.

Business journalist and blogger Dana Blankenhorn predicts 2010 will be a year of serious buying for EHRs, lots of implementations, sector job growth and some big mergers. The experts (or optimists) have been saying that for years, but, this time I think it’s a pretty safe bet.

That being said, a new study concludes that EHR systems often fail to achieve expected gains in healthcare efficiency. A Milbank Quarterly report looked at EHR projects around the world and determined: EHRs do often increase auditing and billing efficiencies, but decrease efficiency in clinical work; full interoperability may never occur; paper records are more flexible for clinical work; and, small, local EHR systems tend to be more effective and efficient, compared with larger systems.

UCSF Professor Dr. Robert Wachter evaluates the health IT industry and gives it an overall C+ rating. Quality Systems (NextGen) and eClinicalworks were the highest-rated ambulatory-specific vendors, earning at least a B.  GE, Cerner and McKesson received the highest marks.

‘Tis the season to do good works, and the team at Hayes Management Consulting is doing its part. Hayes has opted to forgo traditional holiday cards and instead donate to the Toys for Tots Foundation and Susan G. Komen for the Cure. Far better than a card.

Meanwhile, CollaborateMD and its founder/CEO Douglas Kegler have led his company and employees to make donations to dozens of organizations this year. At the beginning of Q4, Kegler committed to make a donation on behalf of every single employee to the charity of the employee’s choice. In addition, CollaborateMD offered 100% matching gifts for all employee contributions. Well done.

The Healthcare Authority for Baptist Health (AL) purchases McKesson Practice Complete to handle physician billing and claims management for its employed physicians. Physicians will also use the McKesson-hosted Horizon Practice Plus PM system.

meridianEMR and LABORIE MEDICAL announce the integration of LABORIE’s urodynamic test results directly into meridianEMR’s urology-specific EMR.

The Justice Department says that healthcare fraud remains a key target of the federal False Claim Act, and the government is stepping up enforcement. A healthcare attorney warns physicians that going forward they may have to do more due diligence in their billing and business activities. For example, physicians now face false claims liability for failing to disclose or return overpayments promptly to the government. A reminder that despite all the buzz about EHRs, a strong practice management system remain essential.

E-mail Inga.

Intelligent Healthcare Information Integration 12/12/09

WOG – World Of Giants

I seriously doubt very many of you will be in any way familiar with a short-lived T.V. series from 1959 called “WOG – World Of Giants.” It was about Mel Hunter, “a ’special’ special agent”, who had been miniaturized to “the size of a six-inch ruler” behind the Iron Curtain. (Exposure to some unknown rocket fuel ingredient was blamed).

I barely remember it, but it etched upon my toddler brain images of the black and white view from mini-Mel’s perspective of the sole of a giant shoe about to flatten him and the freakishly large fangs of a tabby cat about to devour our mini-spy hero. The show was often recorded with the view of the microman, giving young, formative brains a fear of all things gigant-esque.

This week I was reminded of the aforementioned show by three separate events. One dealt with IT, the other two with physicians. Each reminded me that poor little Mel Hunter was not the only hapless soul who has to live in a World Of Giants. The only difference is his giants were measured in physical stature. In the worlds of healthcare and IT, we measure our giants in terms of gargantuan egos.

My recent encounter with the IT WOG (IWOG) came in the form of an exquisitely arrogant and condescending “support” person with a television service provider I won’t DIRECTly name. When I expressed unhappiness that our bedroom’s brand new HD “box” had stopped working less than 30 minutes after the installer had left, he said, and I quote, “Well, it isn’t like you don’t have reception. You have several other receivers that are working which you can watch, now don’t you?” Gosh, really? I didn’t know that. OK, now I feel better that it’ll take two weeks to get another tech out to repair my brand new box.

The physicians’ WOG (PWOG) is literally littered with episodes of WOGiness. Many docs still feel they should “control” their patients and their patients’ healthcare. Many feel offended that anyone might condone examining their track record and comparing them to so-called “best practices” or “evidence-based” standards. “They don’t know my patients or what’s right for them!” Many docs never volunteer to help their local hospitals (or communities,) yet bitch and moan when the hospital administration doesn’t kowtow to their fancies.

Seriously, where else can you bring ten people into a room and get ten completely different opinions (sometimes more!) which are argued with circuitous logic, backed up by conflicting stats ad nauseam, and filtered through gray matter which often refuses to even consider divergent points of view? All of this typically happens with a completely condescending cadence and vocal intonations of downright disdain for anyone who might disagree. Doctors are notorious for their god complexes. But, I swear, IT people are often not too far behind in personal estimation of the value of their knowledge base bank accounts. Hells bells, Helen, even the local computer repair shop guy will often evidence this IT ego elevation.

(Why would anyone ever want to venture into the dual-WOG world of healthcare IT?)

OK, yes, I fully realize I AM a physician and at least a pseudo-IT guy. Maybe it’s my own ego that refuses to see that I am as full of myself as I probably am, but I further swear that most of the time I feel a whole lot like poor old Mel Hunter, constantly watching out for giant falling pencils and carelessly discarded super-sized cigarette butts cast off by the WOG people all about. And I just don’t see the point.

Medicine is, at best, an artistic science. We know far more about how to name medical conditions than we often do about the conditions themselves. People often get better, or not, despite what we pull from our little black bag of medical magic. IT, for all its definitive ones and zeroes with its quantifiable bits and bytes, still often stymies even the most experienced vets. Bill Gates once said he, too, was often frustrated with glitches and ghosts in his machines. So, what’s with all the “ego-tude”?

Truly, there’s not a one of us who couldn’t learn a thing or thirty about a better way to do our jobs or understand our respective fields, is there? So, I suggest we just give up on the pretense that we actually know so very much and abandon our need to make sure that others around us know it. Doesn’t seem all that hard, really … unless … unless there’s a whole lot of IT and medical folks out there who actually feel more like little Mel Hunter than they let on. Maybe all this self-inflation is just an effort to guard against perceived colossal cats and enormous falling filter tips by a whole bunch of folks who, on the inside, feel just like Mel and me.

From the trenches…

“When they discover the center of the universe, a lot of people will be disappointed to discover they are not it.” – Bernard Bailey

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 throughhttp://madisonpediatric.com or doc@madisonpediatric.com.

News 12/10/09

Physicians are more likely to report information about adverse events through an EHR system rather than a paper-based system, according to this Pfizer-sponsored survey. Participants included 300 primary care physicians, two-thirds of whom use some form of an EHR. Most of the doctors agreed that adverse event reporting through and EHR would improve patient care.

DrScore.com launches its “i Need a Doctor” iPhone application, which provides rating information on about 800,000 doctors. The idea is that the information handy if you find yourself sick and away from home. I’ll be curious to see if anyone really thinks its worth its $4.99 price tag.

Here’s an iPhone application much more likely to be a hit. Nuance introduces a Dragon Dictation application that lets users speak e-mail and text messages, as well as notes to oneself. For now, it is free. Here’s the drawback: apparently the app uploads and stores all your contacts.

President Obama announces plans for the HRSA to administer $600 million to support construction and HIT projects in community health centers. Eighty-eight million dollars is earmarked to upgrade EMRs and other technologies. Great time to be selling to that market.

At its Executive Summit in Las Vegas, Allscripts announces its Professional EHR 9.0 release, as well as Allscripts Remote for BlackBerrys. The 9.0 release includes an enhanced user-interface and expanded disease management capabilities.

Speaking of Allscripts, Community Memorial Health Systems (CA) selects Allscripts’ EHR, PM, and RCM products. Community Memorial Health System will host applications for 70 contracted physicians and a pilot group of 12 community physicians. The health system will also use technology from dbMotion to allow physicians access to a virtual patient record that includes aggregated clinical information from all the heath system’s computers.

David Blumenthal writes on his Health IT Buzz blog that meaningful use criteria will be announced “in a matter of weeks.” Blumenthal also says that proposed plans for a new certification program will be published in early 2010. Is it nit-picking to point out we were promised these details by the end of the year? Hard to believe it’s been 10 months since ARRA was passed.

Former Sage Healthcare executive Maureen Peszk joins Pittsburgh Life Sciences Greenhouse.

The Centers for Medicare and Medicaid takes a look at today’s primary care physicians and concludes most have too few patients to reliably measure significant differences in quality and cost performance measures. The results suggest that today’s typical P4P and quality reporting initiatives may be flawed.

Aprima Medical Software adds HDI Technologies as a reseller to implement and support Aprima’s EHR and PM solutions.

KLAS takes a look at the medical transcription market and pronounces it fiercely competitive.  Most providers have switched providers at least once and vendors must maintain high performance levels to retain clients. Acceptance of off-shore transcription is growing, with 43% of providers willing to risk reduced quality in favor of saving some money.

The North Carolina Medical Society informs members of a security breach involving MedSolutions, the vendor that administers pre-authorizations for certain Medicaid services. For an undetermined period of time, the MedSolutions website allowed anyone accessing the site to see demographic information, including Social Security numbers, of an unknown number of North Carolina physicians. The warning is prominently displayed on the NCMS home page, though I couldn’t find any details on MedSolutions’ website.

The 5,500-member Texas Academy of Family Physicians contracts with RemitDATA to aggregate members’ reimbursement data to provide real-time benchmarking. The organization will use the data to identify and resolve payment trends.

OmniMD partners with 361°md to offer OmniMD’s EMR and practice management products to its client base.

A “team” of researchers from the University of Illinois assesses the safety of walking across a street and talk on the cell phone. The conclusion is that talking on a cell phone is far more dangerous than listening to music on an iPod and the public should be aware and act accordingly. Brilliant work. Did I mention that the University of Illinois is a publicly funded school?

Drop Inga a note.