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.

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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.

News 7/9/09

RealMed earned the top spot in a recent KLAS survey of ambulatory electronic claims clearinghouses. Navicure and ZirMed tied for second place in the study that compared 15 industry solutions. Getting paid correctly the first time was an important factor in overall satisfaction, though customer service was also a crtical variable. Interestingly, price had little correlation to customer satisfaction.

For $.99, you can purchase a new mobile iPhone application that screens for depression. The physician-created Sad Scale ranks symptoms and emotions, comes up with a score, and gives the patient the option to forward results to his primary care physician. I am pretty much convinced I could develop a hot-selling new application called Do You Need to Get a Life? Sample questions: do you spend more time Twittering than talking? Do you have 1000 Facebook friends but still unable to find anyone to go out with on a Friday night? Do you hyperventilate if you can’t check your texts or e-mails for more than an hour? Feel free to send additional questions my way (though I may not share any of the royalties.)

Considering a remotely-hosted EHR solution? Information Management magazine presents a comprehensive overview of the pros and cons of using an application service provider versus an in-house server solution. In terms of cost, their take is that the ASP service is less money up-front, but likely costs about the same as the local server option over the long haul.

SRSsoft bags another customer willing to drop their CCHIT-certified EMR in favor of the SRS hybrid EMR. Southeastern Orthopedic Center thought they were good to go with regard to HITECH, but says, “The CCHIT EMR we had purchased would have placed overwhelming demands on our physicians and resulted in a significant loss of productivity, even if we had overcome the initial implementation hurdles.”

A study in the Annals of Internal Medicine finds that time pressures, chaotic environments, low work control, and an unfavorable organizational culture were strongly associated with low physician satisfaction, high stress, burnout, and intent to leave. Really? Would anyone be content working in such an environment? The report also found some correlation between work conditions and quality of care and errors, though stress and burnout were not found to affect care.

Physicians using Allscripts Clinical Quality Solution (CQS) earned more than $4.5 million in pay-for-performance bonuses last year. The CQS solution is powered by TeamPraxis, a Hawaii-based MSO that developed the clinical data extraction tool. Currently 24 medical organizations across 16 states have implemented the CQS product.

St. Rita’s Medical Center (OH) selects Retasure’s retinal risk assessment solution for its 75 primary care physicians. Digital Healthcare, the developers of Retasure, say deployment of their product is up 50% over last year.

Eclipsys names Chris E. Perkins executive VP and CFO. Perkins previously served in similar roles at Per-Se and Emageon. Perkins takes over from interim CFO David Morgan, who stepped in after the January resignation of Robert Colletti. Colletti left the company after Eclipsys announced it would miss its Q4 earnings projections.

Advanced Data Systems (ADS) announces a partnership with Medflow, allowing them to offer Medflow’s ophthalmology-specific EHR. ADS is a provider of the MedicsPremier PM solution, as well as MedicsElite EHR.

The CDC launches an environmental public-health tracking network to explore potential links between environmental contaminants and chronic diseases. The new network brings together data on air quality, drinking water, and other environmental information and will allow the public and researchers to compare it against disease data.

E-mail Inga.

Intelligent Healthcare Information Integration 7/8/09

KISS, Please

Simplicity. As complex as healthcare is, if we try to add the density of technology to it, perhaps it is counter-intuitive to think of ‘simplicity’ as a key operating principle of the NHIN construct. However, I believe this is the must have nuclear core for the successful initiation of the broad masses of both consumers and providers to the adoption of healthcare information technology. It is also key to their subsequent and sustainable utilization of these tools.

Everyone who has been listening to the widely broadcast cachet attributed to HIT has at least some appreciation for the extensive list of advantages we all envision for our future digitally-enabled healthcare provision. Seeing what tech has done for shopping, banking, communications, social networking, political campaigns, and general information sharing, it is virtually impossible to imagine that such benefits would not also transcribe well into the realm of healthcare. Indeed, it is the very complexity of healthcare that makes it seem such a likely candidate for technology enhancement.

Therein lies the rub: We know what technology can achieve, yet we are seemingly overwhelmed by its application to so complex an arena as healthcare. We want all the benefits which we know it can provide, yet we are stymied by the vastness of healthcare as well as the currently available information technology solutions, most of which have trouble working and playing together.

I propose we let the big players continue to duke it out over who shares what with whom and how they’re going to solve their big center issues. I mean, while they have helped to push HIT along the past quarter century or so, they’re also the ones who have enabled the ‘silo-ization’ with which we are now hamstrung. They have oodles of money and should be the ones to fix the dilemmas they’ve enabled.

In the mean time, for the rest of us (consumers, small providers, ancillary healthcare delivery providers,) let’s do simple. Already familiar tools. Real, immediate value. Attractive, intuitive user interfaces. Internet as the backbone, no silos. Easy-to-use cell and smart phone push-pull data collection and dissemination apps. Work with the individual end user in mind, both consumer and provider – together, not separate. Important pieces first, add complexities as mastery grows. Small sips to start; avoid the overwhelming drink-from-a fire-hose phenomenon.

As John Gaule said, “A complex system that works is invariably found to have evolved from a simple system that works.” Couldn’t agree more.

Keep it simple, stupid? No…Keep it stupid simple.

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 7/7/09

From: Handy Man “Re: Should CCHIT-certification be required for EMRs? Perhaps the analogy ought to be that when I hire a contractor to build a house, I don’t mandate what tools they use…. Do I really care whether they use Craftsman hammers or 10 oz or 16 oz hammers? Or, do I care that the house stands up straight and level? I.E, let’s focus on goals of medical care, not just having technology to say we have technology.”

Executive Solutions for Healthcare, a developer and manager of ambulatory surgery centers, selects ProVation MD and EHR solutions for two of its facilities. Trinity Plaza Surgery Center and The Endoscopy Center of Lodi (CA) will utilize the ProVation solutions from Wolters Kluwer Health.

JL Software announces the release of The Handbook of High-Risk Obstetrics for use on Phones and iPod Touches. The $49.99 application covers all aspects of perinatal practice.

The Tennessee Medical Association sues a collection agency, alleging the company is fraudulently trying to take back reimbursements paid to doctors. Health Research Insights is demanding repayment from physicians, on behalf of its insurance company clients. The collection agency is demanding repayment for claims that in some case date back several years. The company accuses the physicians of coding visits at too high a level, a charge based on claims data and not actual medical records.

Metropolitan Health Networks (FL) selects eClinicalWorks for its nine internal medicine clinics.

A New Hampshire nurse files a class-action lawsuit against three Obama administration officials, claiming that the health IT provisions in the ARRA violate patients’ rights to privacy and violates HIPAA privacy rules. The suit seeks an injunction to prevent the distribution of the $22 billion earmarked for HIT.

The 12 providers at North Oaks Obstetrics and Gynecology (LA) select Sevocity EHR.

David Brailer says that the government’s lack of specificity about how stimulus money will be paid out to providers is hurting EMR adoption as potential customers wait and see. He also predicts that meaningful use criteria will be loose even if that dilutes the whole point of having them. “They’ll go for the big tent as opposed to a narrow solution. That’s not good policy, but that’s the politics of the matter.” The CNN article mentions EMR licensing expense and the potential use of VistA, quoting Medsphere CEO Mike Doyle in comparing the $9 million the State of West Virginia paid it for eight hospitals vs. the $90 million West Virginia University (which he incorrectly called the University of West Virginia) paid Epic. “If Obama is serious about this, he won’t be able to do it $90 million at a time.”

The AMA offers some strategies for practices wanting to reduce their carbon footprint. For example, turning off computers when not in use, offering follow-up consults via phone to reduce driving, and replacing film x-rays with digital.

Omega Medical Solutions (SC), a medical billing and consulting agency, selects Allscripts Practice Management and Payerpath solutions for its physician practice clients.

A St. Louis-area practice launches a program aimed at helping the uninsured and stimulating the local economy. The seven employees of Baker Medical Group were given $300 work of $2 bills they could spend on anything. Employees can also give a $2 bill to an uninsured or unemployed patient, who can then redeem it for a free office visit. By the end of June, 20 patients had taken advantage of the program.

E-mail Inga.