Intelligent Healthcare Information Integration 8/4/09

The Elegant Palm Pre Cereal Box Top EHR

Yep. Pretty happy with the new Palm Pre. Simple, nonetheless powerful. Stylish, yet practical. Hip, though perhaps not iHip. Zen, and so much so, that I quit maintaining my motorcycle.

But, regardless of the number of contemplatory eggs gracing Palm developer desks, it isn’t perfect. Battery life is abysmal unless you keep all the apps closed. This kind of diminishes the glamour of being able to keep a bunch of ‘em open and switch in and out at will. Of course, if you have a bunch of chargers scattered around, you can keep up and the new magnetic grab-n-go charger helps this. (Thank you, yet again, Mr. Tesla.) Still, I’m used to having my digital six-shooter on my hip and jumping about at will. Remembering to grab the little beauty when I run off to an emergency or bathroom break proves challenging.

Also, the Palm Data Transfer Assistant could use some work. You’ll find lotsa online tales of woe about Palm Desktop or Outlook data migration. (Thank you, Chapura PocketMirror.) Another noticeable weakness is Sprint’s cellular coverage, at least here in my little burg. Verizon had me covered and I could always hear you now. Sprint doesn’t want me getting calls in the surgery center or even sitting at my office desk. (I won’t bore you with why Sprint doesn’t want new business customers to have AIRAVEs to enhance their signal, but will freely give them to established customers – I have to endure crap coverage until them deem me worthy, I guess.)

Still, challenges and foibles aside, I realized the other day that I could pretty much do every common little computer thing I need from wherever I happen to be (within cell tower range.) This is phenomenal! The integrative nature of the Pre and the beyond-iPhone-friendliness of my new pocket-sized phone-calendar-contact database-camera-GPS locator-weather center-web browser-videocam-pager-planner-game system-younameit tool made me realize the future had hit. This was a, “Wow, I can actually do what I’ve always wanted to do,” light bulb moment.

Then, this morning, I was putting my Raisin Nut Bran cereal box away when I noticed the box top. Remember how cereal boxes always had that little semi-cut-out slit you had to punch open to stick the opposing flap’s tab into? Remember how it invariably would not be well cut and your attempt to pop it apart would, also invariably, lead to the little connector piece tearing such that the tab would never hold the flaps closed as intended? Well, some cardboard engineering whiz kid has figured how to cut the tab and its opposing flap indentation such that the punch is eliminated and my little box top stays untorn and closes right every time. Genius, though it took decades to discover.

So, a two-and-two flash strikes. That’s what I want from my EHR. I like my system well enough; it has lots of the gadgets and gizmos I need. The problem is it isn’t Pre slick yet. Close. Kind of like the difference between the Palm Treo and the Pre. Functional, but kludgy. Close, but still not quite brass ring worthy. Missing the box top simple solutions for functionality. I’m guessing many EHR users feel similarly. We know what we need, but no one has the truly elegant answer yet.

I would like to know if anyone out there knows the “Geniuses of the Box Top” and a couple of Palm Pre developers who might be interested in constructing the new Palm Pre Cereal Box Top EHR? To make the next generation EHRs, the ones we really need, it’ll take these types of Zen master geniuses, those who can make all the work underneath appear simple and elegant. Maybe I should ask Fred Astaire.

Where all think alike, no one thinks very much.   – Walter Lippmann

Postscript : Since submitting this piece, I came across a tremendous article, The EHR ‘killer app’, by Jeff Marion on EHRWatch.com. If you haven’t seen it, it is well worth a read.

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 8/4/09

Todd Park, co-founder and board member of athenahealth, is named CTO of HHS. He will resign from athenahealth’s board on August 10 and will divest his ATHN stock position to meet government service requirements. Park will report to Deputy HHS Secretary William Corr and will start on the job later this month. An athenahealth press release quoted him as saying, “My entire professional career has focused on developing technologies and services that can help our health care system work the way it should. I am extremely excited about the opportunity to help the Administration explore and catalyze new ways to improve the health status of the United States through the power of data, technology, and innovation.”

PracticeOne partners with the Connecticut State Medical Society-IPA to provide e-prescribing solutions to its members with no up-front costs.

Family practice physician Sterling Ransone testifies before the House Small Business Committee’s Subcommittee on Finance and Tax, asking them to consider legislation that would provide loan guarantees for physicians purchasing HIT systems. HR 3014 would guarantee 90% of loans up to $350,000 for individuals and $2 million for group practices, plus allow for a loan repayment deferral period of one to three years. Ransone, who was speaking on behalf of the AAFP, told committee members that without such a program, many family practice physicians would be unable to afford the upfront cost of EHRs.

Allscripts hosted its user conference last week in Orlando. The Allscripts Client Experience (ACE) brought in a  record 2,700 registrants for the event, which combined Allscripts clients and former Misys clients.

Speaking of Allscripts, Merge Healthcare announces that Allscripts has selected its Cedara WebAccess software application to “image enhance” Allscripts EHR solutions. The Cedara WebAccess portal will provide users a zero-footprint method of distributing medical images and reports.

Meanwhile, Merge Healthcare announces net income for $400,000 for the quarter ending June 30th. This compares to a $18.2 million loss during the same period last year. Second quarter 2009 revenues rose more than 15% to $15.4 million.

NextGen’s parent company QSI releases its earnings, which were below analysts’ expectations. The company reported a 21% increase in quarterly revenues compared to the same quarter last year, but net income declined 7%. Quarterly revenues were $66.6 million. Like other companies in this space, QSI says their sales have been impacted by delays in purchase decisions related to ARRA uncertainties.

I bet all these HIT companies are wishing they had some sort of cash for clunkers program that would spur providers to drop billions of dollars in less than a week.

Memphis Health Center and Church Health Center (TN) receive a $290,000 donation for telehealth equipment. The funds come from AmeriChoice, the TennCare branch of United Healthcare Services. Both clinics serve the under- and uninsured.

HHS Secretary Kathleen Sebelius announces that the Office of Civil Rights is now in charge of the enforcement and administration of HIPAA. Previously HIPAA oversight has been the duty of CMS, but Sebelius believes the change eliminates duplications and increases efficiencies in how privacy is protected.  Remains to be seen if the change will affect much of anything.

Officials from Medicare admit that Arizona senior citizens have been slow to enroll in a federal program that encourages them to store their medical histories on Google, Healthvault, or similar websites. Medicare and the Arizona Health-e connection say that adoption has been less than the estimated three to six percent of consumers nationwide using some type of PHR. Now officials are wondering whether or not to extend the $2.5 million project. One problem seems to be lack of EMR adoption by physicians: if the doctors aren’t using them, why should patients?

Larsen Billing Service, the country’s largest midwifery billing service, selects CollaborateMD to provide its hybrid SaaS practice management and billing software.

MD-IT cements its position as the largest company providing transcription services to physician offices with its acquisition of Transcription Prescription. MD-IT provides medical documentation services and software to 5,500 physicians nationwide.

The Boston Business Journal profiles the open business approach of eClinicalWorks founder and CEO Girish Navani. Long before social networking was hip, Navani encouraged an open and uncensored Internet site for users, which is now used by 5,000 doctors. My favorite quote, “You can go on our social network and write, ‘eClinicalWorks is terrible, the CEO is a moron’ and we say, ‘Thank you very much!’”  Gosh, I’m not nearly that tough, so please don’t post any comments like that on our sites. The article also notes Navani vowed six months ago to add 500 jobs over the next two years, although the company has only added 100 so far.

E-mail Inga.

Joel Diamond 7/31/09

More About Controlled Medical Vocabularies

I remain an advocate of structured data. I believe that it is the foundation for connected healthcare. As I have pointed out in previous posts, the art of medicine often rests on the nuances of communication. The patient’s chief complaint and the physician’s history of present illness can often tell a much richer story than drop-down lists and templates. We were taught in medical school to use the patient’s exact words whenever possible.

When I was in training, my fellow residents and I would often debate about the very best encountered chief complaint. Many of these involved malapropisms of medical terms used by patients in overcrowded emergency rooms.

It was not uncommon for women to complain of problems related to the “fireballs in my Eucharist” (fibroids of the uterus). Sometimes I think the gastrointestinal complaint of “die-a-rears” is more descriptive than the actual term (diarrhea), and certainly “sea roaches of the liver” seems more ominous that “cirrhosis”. One of my favorites, though, was a mother who was afraid her son might have a case of “smilin’ mighty Jesus”. It took me awhile to realize that she wanted me to rule out “spinal meningitis”.

The perennial winner chief complaint contest goes like this. An 85-year-old woman once presented to the clinic with “leaves growing out of my vagina”. Shockingly, physical exam confirmed this as true. Further history revealed that the poor lady had suffered from severe uterine prolapsed. For those less familiar with medical terminology, a pessary is a device that is inserted to hold up the cervix and uterus in order to keep it from “falling out”. This enterprising octogenarian decided to improvise and use a potato for this purpose. Potato… dark place… sprouts…. you get the rest.

My all time favorite (and true) encounter documentation would be completely lost of meaning (let alone humor) if it was documented with structured data.

Two seemingly unrelated traumas arrived within minutes of each other: a man with a severe laceration to his penis and a woman unconscious due to head trauma. The history of present illness is similar in both charts. The man and his girlfriend are “involved” on his kitchen table. Unfortunately for him, her poorly controlled epilepsy results in a grand mal seizure and unrelenting jaw-clamping. Frantic, he grabs a nearby cast iron skillet and whacks her on the head to make her stop. .. you get the rest.

Continuity of care and a patient-centered record are the holy grail of connected healthcare. Accurate and timely access to patient data is the foundation, but clinicians should not abandon essential storytelling just because of IT adoption. Documents, with appropriate free text, must be preserved, but … only when intelligently associated with overall workflow, can the art (and humor) of medicine endure.

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.

News 7/30/09

Emdeon announces plans for an initial stock offering of about 21.5 million shares priced at $13.50 to $15.50 a share. The claims clearinghouse and RCM vendor hopes to raise up to $332 million with the August 12th IPO.

Cardiovascular Consultants Medical Group (CA) adopts e-Medsys EHR from PracticeOne for its 13-doctor practice. The practice has utilized PracticeOne solution for over 30 years, having implemented a PM solution from one of PracticeOne’s predecessor companies in 1978.

If you have never checked out EHRtv, it’s worth a visit. The site includes an impressive collection of videos, news, and opinions on EHR and PRHs. CEO Dr. Eric Fishman and staff have produced a number of executive interviews, including one just posted with Allscripts’ Glen Tullman. The vendor demonstrations section lets you get a peak at a few products (and I suspect EHRtv plans to add even more vendors.) If you are looking to buy an EHR, check out Dr. Fishman’s “Vendor Selection 101” video, which offers advice on picking the right EHR for your practice.

MacPractice releases its iPhone Interface 2.0 which includes new tools for remote charge and planned treatment posting, staff and doctor reminders, practice management reports and doctor referral data. MacPractice is offering the interface for $800, plus $200 a year for support and updates.

Cardiothoracic surgeons may be in short supply by 2025 if current trends continue. Researchers estimate there could be a 46% increase in demand for surgeons, but a drop of at least 21% for available surgeons. Fewer residents are taking thoracic surgery fellowships, likely because those completing training have had difficulties finding employment. And the employment problem may tie back to the increased use of stents (handled by cardiologists) over heart bypass surgery (performed by cardiothoracic surgeons.)

A big welcome and thank you to our latest HIStalkPractice sponsor, eClinicalWorks. We’ve covered ECW over the past few years as it’s grown to become one of the leaders in the ambulatory EMR market. Mr. H has interviewed CEO and co-founder Girish Kumar Navani a couple of times and found him to be a sharp business leader who’s always ready to shake things up and try new business models (in case you are new to HIT, ECW has partnered with Sam’s Club to sell its EMR solution.)

If you’re interested in learning more about an HIStalkPractice or HIStalk sponsorships, drop us a note. We always appreciate the folks wanting to help us keep the lights on.

The FTC again pushes back the deadline to enforce the “red flags” rule. The FTC moved the deadline from August 1 to November 1 in order to provide additional resources and guidance to businesses. The “red flags” rule requires physicians and hospitals to adopt written plans to  identify, detect, and respond to the warning signs, or “red flags,” that could indicate identity theft.

As one of the millions who regular reads Wikipedia articles, I appreciated this story. The NIH is encouraging its scientists and writers to create and edit Wikipedia articles in their field, in an attempt to make information more reliable. Earlier this month the Wikimedia Foundation hosted a Wikipedia Academy training session to encourage contributions from about 100 NIH employees.

E-prescribing appears to be paying off at Henry Ford Medical Group. Health Alliance Plan estimates that the collective administrative savings for physicians is $560,000 annually. Another $540,00 a year is saved by reduced ER visits and hospital admissions resulting from prevented adverse reactions.

Thirty-two people, including doctors, are arrested Wednesday in a major healthcare fraud bust. Federal authorities made the arrests in NY, Louisiana, Boston, and Houston in the third such sweep since May. Authorities targeted such scams as “arthritis kits” and claim this raid represented $16 million in fraudulent Medicare claims.

A physician with Urology Associates of North Texas (UANT) recounts his practice’s move from an outdated EHR to a new one (Allscripts.) They survived the scary task of moving data from one system to another, a process that required taking discrete information from the older system, identifying and classifying it, then assigning to a new destination in the Allscripts system. He concludes, “With a sound, careful approach, an organization can manage the transition from one electronic medical record system to another without losing important clinical information and/or functionality of older data.”

St. Elizabeth Healthcare (KY) announces plans to roll out Epic throughout its entire system, which includes 31 primary care offices. Beginning in September, St. Elizabeth’s will  introduce EpicCare Ambulatory to its nearly 1,000 physicians.

E-mail Inga.

News 7/28/09

From Peds Guy: “Re: interview with Dr. Christoph Diasio. The piece got a lot of traffic on the AAP/SOAPM list this weekend. All the peds loved it.” Good to hear. Dr. Diasio shared how he is using technology in his pediatric practice and provided some spicy and informative commentary on CCHIT and the use of PM/EMR in general. Great read.

Starkville Orthopedics Clinic (MS) selects 7 Medical Systems to provide the 7 Ortho-on-Demand PACS for its four-provider practice.

An interactive computer questionnaire may give family doctors a better opportunity to identify and intervene with patients who are victims of domestic abuse. Researchers found that when patients were administered a multi-risk questionnaire using a touch screen computer in the waiting room, detection of domestic violence was doubled.

Blue Chip Surgical Center Partners raises $1.8 million through private equity. The company builds and manages physician-led ambulatory surgery centers in partnership with participating physicians.

I accompanied a family member to an urgent care center this weekend. The practice used EMR, so of course I was (almost) more interested in the computer than my family member’s health. The software was template driven with lots of drop-downs and nesting. Seemingly plenty of places to enter free-text as well. Observations: the medical assistant took all vitals, then manually typed everything in. It appeared the template prompted her to ask additional relevant questions about the patient’s condition. However, she only followed the template. By chance the patient mentioned this was not the first time he has had this particular ailment, which actually turned out to be a particularly vital piece of information. At the end of the visit, the patient was handed an electronically generated prescription plus an education sheet (handy). Obviously it would have been cooler if the prescription were electronically sent directly to the pharmacy but that was not the case. The biggest disappointment was that both the medical assistant and the PA who examined the patient had to turn their backs to the patient (and me) to enter data. Overall the product seemed pretty efficient, but I was left feeling as if the computer created this unnecessary barrier between the patient and provider and reduced eye contact.  And, I wished the MA had not followed the template so strictly, but instead started out with a simple open-ended question like, “Tell me what is going on.”  It’s clear that even the most comprehensive template does not necessarily reveal the whole story.

Interestingly, this physician seems to agree with me. An ophthalmologist shares details of his visit to an internist, who uses EMR. While the author and internist agree that the EMR provided constructive tools for monitoring physician productivity and patterns of care, the EMR also has drawbacks. At the top of the list: loss of rapport with patients because the internist was required to enter so much data. The author notes that two-thirds of the visit was devoted to data entry. The conclusion: an easy-to-read computer-generated medical record does not guarantee high quality personalized patient care.

RelayHealth signs a deal with VHA to supply its RevRunner financial clearance services.

Seems like just yesterday we were hearing projections that retail clinics would soon be available on nearly every street corner. Estimates were that 2,500 clinics would be operational by 2010; today there are only 1,100. The problem seems to be with the earlier business models, which relied on outside investors for financial support. Many investors underestimated the amount of time it would take to return a profit and were unable to sustain financial losses while clinics were coming up to speed. Companies like Wal-Mart are now looking to partner with local hospitals, which seem willing to shoulder the initial financial losses, believing the retail clinics serve as an entry point for new patients to become connected to hospital-affiliated physicians.

RealMed and TSI Healthcare (NC) partner to provide RealMed EDI Revenue Management Services to TSI clients.

No surprise here: obesity rates are rising rapidly and obesity accounts for over 9% of all medical spending. One in four Americans are obese and each one costs the system $1,492 per year more than normal weight individuals. Would putting Americans on a diet pay for healthcare reform?

The five-provider Beavercreek Family Medicine (OH) estimates it will save $100,000 annually in transcription costs with the implementation of Epic EHR. The five doctors at Samaritan North Family Physicians are already saving $50,000 annually. Both groups are part of Premier Health Partners, where MyChart was recently introduced and proving popular with patients. Overall the interviewed physicians claim the EMR is not saving time, but does improve patient care and redefine workflow.

E-mail Inga.