News 3/23/10

Tallahassee Memorial HealthCare (FL) chooses Allscripts PM/EHR for its 106 providers and 33 family medicine residents

A recent AMA provides a few tips for physicians wanting to offer online consultations – and get paid for them:

• e-mail exchanges must address specific problems not associated with a prior visit, either on-line or in the office, within the previous seven days
• practices are typically charging about the same as a patient copay for online consults; other practices offer unlimited email options for an established fee
• not every managed care plan allow practices to offer email consults, so check your plans
• have patients sign a consent form describing what services can be rendered through online consults and how they will be billed
• specify an established turnaround time for emails
• make sure the email exchange becomes part of the patient’s permanent medical record.

Dr. Brian Yeaman of Norman Physician Hospital Organization (NPHO) shares details of the EHR database his organizes uses to facilitate record sharing with Norman Regional Health System (OK.) The organizations went live on a connected network in December and is currently installed in 100 practitioner offices. The health system, including the ED is also tied in. Yearman calls the setup “powerful.”

Here’s a smartphone app that sounds cooler than it actually is (at least after my five minute assessment.) The American Society of Health Informatics Managers, Inc. (ASHIM) releases a free application that “enables Health IT Consultants to help physicians select” an EHR. The application, called EHRBook, produces names of products based on a keyword search. It appears you can only put in a single keyword, e.g., e-prescribing, and not something more specific  like e-prescribing, family practice, and CCHIT.  The result is merely a list of vendors and hardly enough data to help anyone actually select an EHR. Perhaps the next version will offer more meat.

A North Carolina doctor sues Secure Telemedicine, a telemedicine company that the doctor says convinced him it was legal to offer medical consultations and write prescriptions by telephone. The doctor claims Secure Telemedicine solicited him to provide consults and provided him with legal opinions that claimed the medical services provided were legal. Eventually the NC Medical Board and four other states suspended his license for prescribing controlled substances without physical exams or any prior physician-patient relationships. The doctor is suing for Secure Telemedicine for unfair and deceptive trade practices and is seeking payment for the damages made to professional reputation, plus treble damages for legal costs.

Zotec Partners announces that four radiology groups have signed five year renewals for Zotec’s billing and practice management tools.

University Physicians & Surgeons, the 200+ member faculty practice of Marshall University’s Joan C. Edwards School of Medicine, selects McKesson’s billing and PM services.

WEBeDoctor releases WEBeVision, a web-based EMR solution for eye care professionals.

athenahealth launches athenaCommunicator, a patient communication service that integrates with athenahealth’s PM and EHRs. The tool includes a web portal, automated messaging services, and a live operator option.

Consulting firm Concordant introduces EHRopt, a Web portal support tool to help physician practices implement EHRs.

Humedica and AMGA subsidiary Anceta launch Humedia MinedShared Ambulatory, as well as Anceta Collaborative Data Warehouse. The tools will provide clinical, operational and financial benchmarking tools and comparative analytics for medical groups.

E-mail Inga.

Intelligent Healthcare Information Integration 3/20/10

EMR: Smaller Office, Longer Road

What’s the absolutely, positively worst thing about converting to an electronic medical record? A few guesses:

• Workflow disruption, redesign, and the general suckiness of changing all you know?
• Template building and its inherent drudgery?
• Loss of income from the reduction of patients seen as you relearn all your tasks?

Nope, nope, and nope.

The absolutely most dreadful part of adopting an EMR or EHR, even if it is a great one with tons of bells and whistles (and, perhaps, more so if it has tons of bells and whistles) is the ever-present knowledge that you aren’t even scratching the surface of this high tech tool’s multiplicitous talents.

Sure, I hate all that other yucky stuff mentioned above. Change is hard, templates and vast amounts of “clicky-clicks” aren’t fun, and, especially as one of medicine’s bottom feeders, income-wise, any pediatrician will tell you there just isn’t much room to tolerate revenue reduction.

Despite the gazillion and one well-documented difficulties with EMR adoption and despite the many, many times I’ve almost yanked the server up from its alternating current roots and sent it flying from one of our second story windows, I continue to be amazed, almost daily, by the tremendous tools I now have within my digital arsenal. But, therein you’ll find the source of my digital dismay.

In a small office (now with two, count ‘em, two, docs and six full or part-time staff) with no IT department (except me) and no education/training division, by far and away the most difficult part of transitioning to an EMR has been, and continues to be, finding the time to learn all about the tricks behind the tools we now possess.

It is sooooooo frustrating knowing we have the abilities to do so much more with what we have. I know we’ll eventually get around to many, hopefully most, of them. But, after a long day deciding how to keep asthmatic kids breathing in smoke-filled homes, deciphering the cryptic histories we often receive, deducing which weird rash we now face, and defending against the latest delay tactic of (fill in the blank) insurance company in preventing payments for services rendered, it’s really, really hard to justify more time away from home and hearth to decode another piece of our enormous EMR puzzle.

Yes, the training manuals are available online, and yes, my support peeps are really good and really friendly, but I want to be able to do this stuff NOW and my daggone limited brain and that stupid only-24-hours-in-a-day limitation are putting up roadblocks to my EHR happiness! (Delayed gratification, be damned!)

Alright, reality bites and I know we’ll get to all that good stuff just percolating away on my servers, waiting for our impending moments of discovery. I just wish my resources — time, brains, personnel — weren’t so “small office confined.” I suppose this is just one of the prices I pay trying to bring big city medicine to my small town and our small practice. Being a small business has its perks, but it sure has its pains, too.

From the (frustrating) trenches…

“Those are my principles, and if you don’t like them… well, I have others.” – Groucho Marx

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

News 3/18/10

RCM provider Emdeon reports that Q4 revenues grew 9.5% over 2008 numbers and net income jumped 12%. For the full year, revenue increased 7.6% to $918 million; income grew 18% to $14 million.

Providers with Jordan Physician Associates (MA) implement MedAptus Inpatient Edition to capture and submit charges while on service at Jordan Hospital.

Score one for e-prescribing. In an AHRQ-funded, researchers find that primary care practices using e-prescribing systems reduced prescribing errors almost seven-fold over one year. The study compared prescribing error rates between six practices using e-prescribing and six using paper. While the paper-based error rates remained relatively constant (about 37%), the e-prescribing error rates fell from 42.5% to 6.6%. All the e-prescribing practices used the same e-prescribing tool (MedAllies.)

Physicians at Dreyer Medical Clinic (IL) sign an agreement with OPTIMIZERx to implement its SampleMD solution. I’ve never heard of SampleMD before but am intrigued by their offering. The system facilitates electronic searches for sample vouchers and prescription co-pay offerings, plus electronically dispense drug samples through a national pharmacy network. It also eliminates the need to manage and store physical drug samples in physician offices.

The FTC releases its plans for expanding broadband Internet connectivity and boosting HIT connectivity. Healthcare-specific plans include allocating $29 million a year for Indian Health services for broadband services and increasing federal funds and reimbursements for telemedicine and underserved areas.

Wayne State University Physician Group (MI) contracts with NextGen Healthcare to deploy NextGen Practice Solutions. The 540-physician group already uses NextGen EHR.

Speaking of NextGen, we welcome them to HIStalk Practice as our latest Platinum sponsor. NextGen Healthcare Information Systems has long been one of the ambulatory HIT industry’s most respected vendors, offering a suite of practice management, electronic health records, and HIE products. Last month NextGen announced the acquisition of Opus Healthcare Solutions and Sphere Health Systems, increasing their presence in the hospital IT space. Almost three years ago they became one of HIStalk’s first non-hospital specific sponsors and we appreciate their expanded support of our efforts.

The AMA launches a new managed care contracting resource to help physicians analyze and negotiate contracts with insurers. The National Managed Care Contract (NMCC) and database includes a searchable database and provides model contract language

McKesson adds a number of new practices using its Practice Partner EHR, including Consultants in Gastroenterology (RI), Virginia Nephrology, and Paradigm Medical Group (CO.)

A local Indiana paper examines one practice’s transition to EMR, including possible effects on patient satisfaction and the doctor-patient relationship. One of the practice’s doctor, who still handwrites and dictates his notes, believes that EMR will ultimately save time, but worries he might alienate patients as he concentrates on the computer screen. Others acknowledge the transition will be difficult, but will save patients time and money, reduce redundant tests, and increase safety when prescribing medications. Says like concerns raised by every doctor when transitioning from the paper world to an EMR, regardless of the practice or EMR.

E-mail Inga.

Intelligent Healthcare Information Integration 3/16/10

“HOST YOUR EMR LOCALLY!” the Web Yelled Today

Here I sit, typing away between patients, grateful that we haven’t had to yank the old pens and papers from their dusty shelves. We’re still seeing patients, still point-and-clicking away, capturing data and making appointments with ease, but not because we’re just so darned connected. Actually, we’re not.

I just got off the phone with our high speed DSL provider, a company with whom I’ve been well-pleased these past four years. After the expected interminable on-hold time, I was told by the very first rep with whom I was connected that she had just received word of a large area problem affecting our service. We had been issued a “Level 4” status (as if I’m supposed to know what that signifies) and the repair worker bees were busy getting to the problem. “They have three days to correct the problem,” she told me.

Not knowing just exactly who had granted them those three days and uncertain as to what little old me could do if the problem persisted beyond the allotted period, I gratefully thanked this pleasant rep, realizing she was just another worker bee who had no more she could offer. (She was likely on her way to many more calls about the very same issue and I didn’t envy her at all.)

Four more patients seen and digitally scribed since that last paragraph, four more who won’t need to have their info re-entered at a later time nor scanned in and, thus, essentially worthless, digitally speaking. Seven patients scheduled for follow-up or for a new appointment, work which won’t need duplicated once we rejoin the Web. In the meantime, the ISP home page which I had opened twenty minutes ago is about two-thirds loaded. (Dialup was never so slow.)

My EHR is Web-based. We could have gone the ASP route. Personally, I love the “cloud” concept and see real value for many “softwares” as a service. But, perhaps it is the geek in me who wanted his own servers, perhaps I’m more of a control freak than I care to admit, or perhaps I just knew I’d be happier with locally hosted speed and reliability. Any which way, I chose to host at home and, especially right now, I’m really happy with that decision.

Full disclosure here: Yes, we’ve had problems with our servers. Yes, we’ve had down time from RAID failure. The difference, and why I’m still a fan of local hosting for our purposes, is that when those occurred, I had some control. I could call for help, boots on the ground, and see what needed to be done, swapped, or replaced. Today, I just sit and wait while the worker bees are hopefully buzzing their way to the honeycomb cell which is the source of our hive’s disruption. I have no clue if three days will pass without being hotwired to the Web. Hector’s pup, I can’t even get my daily news jolt! That’s almost as bad as a lack of coffee. (Maybe I want to restart my daily newspaper subscription?)

Interestingly, Google searches still work like a charm, fast as ever. Score one for the cloud. Still, I’m listening to the Web yell, “Keep your hosting local!” while I handwrite another prescription that I am unable, today, to e-prescribe.

From the trenches (wondering when, or if, this will get through to the Web)…

Who cares about the clouds when we’re together? Just sing a song and bring the sunny weather. – Dale Evans Rogers

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

News 3/16/10

CCHIT files its comments on the Interim Final Rules and warns that the currently proposed standards might slow the pace of EHR adoption. Dr. Mark Leavitt points to the omission of standards for receiving lab results and for exchanging clinical standards, even though widely support standards already exist. CCHIT also says that some of the proposed functions are too microscopically defined, while others are still undefined.

Meanwhile, CCHIT says it is suspending any initial or incremental modular testing until it has an accredited Stage 1 ARRA test script to use. A note on their website also indicates that CCHIT is “confident” about its prospects for becoming accredited.

And, Drummond Group re-affirms its desire to be certified as a authorized testing and certification body. The company is making internal preparations and plans to be ready for EHR testing later this year.

The Senate passes legislation that would allow certain hospital-based physicians to qualify for incentive payments under ARRA. The amendment excludes ER physicians or those furnishing substantially all their services in an inpatient room. However, the legislation would make eligible physicians working in ambulatory facilities owned by hospitals. The provision was part of a jobs bill that now moves to the House for further consideration. If you recall, the House had included similar wording in a bill a couple weeks ago, but it was stripped at the last minute. Don’t spend those stimulus pennies yet.

After delaying the release its numbers, athenahealth posts a decline in profits and jump in revenue for Q4 and 2009. athenahealth restated its financials going back to 2005 as a result of an internal accounting policy review, initiated by the company, and related to the timing of amortization for deferred implementation revenue. For Q4, revenue grew 33% over 2008’s numbers, to $54.4 million; for the year, revenue jumped 38% to $188.5 million. Reported GAAP net income, however, fell 84% to $4.3 million in Q4, compared to $26.8 million a year ago; annual net income fell from $31.5 million to $9.3 million. The $.17/share earnings were in line with analyst expectations.

Vitalize Consulting appoints Tim McMullen its executive VP of sales. McMullen most recently served as a VP at maxIT Healthcare and was a national VP and partner with First Consulting before that.

Sales types be warned: physicians report that their offices are visited by up to 20 sales reps each week from the pharma or medical device industry. No wonder doctors have no time to hear about your best-thing-since-sliced-bread EMR. Half the physicians say they require or prefer reps to schedule one-on-one appointments.

Edge EHR Corp. announces plans to acquire Goal Software, a provider of practice management software for the eyecare industry. Edge is hoping some of Goal’s 700 providers add its EdgeEHR application.

One hundred percent of primary care doctors in Denmark use EMRs and almost all medical communication between providers, specialists and hospitals is electronic. The government made EMR use mandatory in 2004, and in 2009 doctors were required to use email to communicate with patients. To spur adoption, the government used financial incentives to physicians, including faster re-imbursement and payment for patient-doctor email consults.

Marquette General Health System plans to deploy McKesson’s Practice Partner EHR to its 140 employed clinicians across 30 owned physician practices. In addition, the hospital expects dozens of independent affiliated practices to adopt Practice Partner as well. The hospital will integrate the EHR with its Paragon HIS.

BCBS of Western NY and Blue Shield of NE-NY are the latest carriers to agree to cover telehealth services for patients connecting to providers via the American Well Online Care platform.

AdvancedMD hires William H. Stone as its VP and GM of Billing Services. Stone joins AdvancedMD after 11 years at MED3OOO where he served as corporate VP of Business Development.

A Gerson Lehrman Group report suggests that EHR adoption is growing faster than once predicted. Physicians have finally begun to realize that they will have little choice but to go electronic in order to maintain a viable professional existence. Physicians are now concluding that if they must do it, they might as well get as much from the federal government as possible. The report suggests we will soon see a “tipping point” toward widespread adoption of EMR. Perhaps, although it seems the “experts” have been saying we’ve been on the verge of a tipping point for the last 10 years.

CapSite sent over a copy of their very juicy 2010 U.S. Ambulatory EHR Study, which looks at the market’s response to the HITECH component of ARRA. The company sees an opportunity of more than $1 billion in net new business in the 1-10 provider space and $2 billion across the whole ambulatory EHR space. In other words, when we hit that tipping point, it’s going to be mighty big. The report is a good read, if you want to get a handle on today’s market.

E-mail Inga.