News 4/20/10

From Grizzled Veteran: “Re: EMR for neuro. Most vendors can easily handle the needs of a neurologist. It isn’t that complex.” I have to agree with Grizzled Veteran here. Unless you are planning to use extensive neurology-specific templates for charting at the point of care, a good number of vendors should be able to accommodate your needs. Obviously you’d want to avoid the niche vendors that focus on specific and unrelated specialties, e.g, pediatrics, oncology, urology.

Physicians working in hospital-owned outpatient facilities will be eligible for stimulus incentive payments, assuming they demonstrate meaningful use of EHRs. Congress passed a new bill which gives more physicians the ability to quality for funds, including an additional 13-17% of family physicians. Physicians working primarily in the ER and in inpatient settings are still excluded.

Congressmen Patrick Kennedy and Tim Murphy introduce legislation allowing behavioral, mental health, and substance abuse treatment provides to qualify for meaningful use of EHRs. If the intent of HITECH was to improve the quality of care through the use of HIT, why would you want to exclude the mental health providers?

mPay Gateway says more than 800 physicians signed up for its patient payment system during the first quarter of 2010.

eClinicalWorks makes the annual Boston Business Journal Pacesetters list of the 50 fastest growing private companies in Massachusetts. eCW ranked number nine, based on revenue growth.

In addition to revenue growth, eClinicalWorks has grown its staff and is in need of space to expand its headquarters. The company tentatively plans to stay in Westborough, MA with a move to another in-town site.

Microwize Technology earns honors as the best Value Added Reseller for Lytec in 2009.

EBM IPA (NY) selects MedAZ EHR, PM, and billing services for its 100 physician members. EBM IPA will also deploy the MedAZ PRH portal.

Managed care insurance provider AmeriHealth Mercy Family of Companies wants to help connect RECs with small physician practices. AmeriHealth, which covers Medicaid patients in several states, believes that providing these practices with extra support, including education on technology adoption, will ensure more practices remain in the AmeriHealth network.

Danville Polyclinic (IL) selects Sage Intergy EHR for its 40-provider practice. The clinic already employs Sage Practice Management and Practice Analytics.

Immediate Care at Stanford Medical Park, North Garrard Family Medical Center, and Ephraim McDowell Lancaster (KY) go live on the the Medical and Practice Management Suite by LSS Data Systems. The practices will share clinical data with Ephraim McDowell hospital, which runs MEDITECH.

ELLKAY takes advantage of what’s sure to become one of HIT’s fastest-growing segments: EMR conversions. ELLKAY announces a new conversion division focused on EMR-to-EMR data extraction and conversion services.

CMS takes steps to expand its current Medicare provider enrollment system and make it easier for physicians to register for meaningful use incentives. CMS awarded a $1.6 million contract to CGI Federal to make updates to the Provider Enrollment Chain Ownership System.

Here’s an interesting thought: could providers be liable if they fail to take into account information patients provide vis-à-vis a personal health record or an e-mail?  Is it too much to expect doctors to dissect every bit of of digital information coming their way, especially as we connect provider/lab/hospital in a community? One of the many questions pondered in this article about the future of medical data.

GE announces Q1 results, which included overall EPS of $.16 and first quarter revenue of $36.6 billion. Healthcare had a “strong quarter” with orders of $3.8 billion, up 5% from the previous year. US orders were flat.

The children of a deceased patient drop their lawsuit against an ER doctor they claim allowed their father to die in order to steal his Rolex watch. A jury also found the doctor not guilty of grand theft. The California Medical Board is still investigating the doctor, however, to determine if he illegally prescribed himself a stimulant two days before the watch incident.

A data security expert warns that practices need to address system security issues each time an employee leaves. Practices should not only block access for former employees, but also consider if the ex-employee shared passwords with remaining employees. Excellent point here:

"You wouldn’t let [departing employees] leave with the keys to the clinic. You shouldn’t let them leave with the keys to the data."

A New York plastic surgeon now holds the world-record for Donkey Kong. He sounds a wee bit obsessed with the game: he has a full-size arcade machine in his Manhattan apartment and spends hours playing each evening. To prove he won fair and square, he had to videotape the inside of the machine before the game, video the actual game, and video 29 other things. Incidentally, researchers have found a correlation between gaming and a proficiency in laparoscopic surgery. Regular gamers are apparently 27% faster than non-gamers and commit 37% fewer errors. Guess I am New York-bound for my next nip and tuck.

E-mail Inga.

Intelligent Healthcare Information Integration 4/17/10

AAs for EHRs

No, this isn’t an offering from Bill W, nor is it a Serenity Prayer for EHRs. (Though I could use one of those some days!) This is about the two main players acting upon providers when it comes to EMRs: aversion and attraction. It’s about what can draw doctors toward, and what will repel them from, digital healthcare data use and adoption.

Attraction:

· Ease of use

· Ease of use

· Ease of use

Think “apps.” There’s not one non-geekified physician out there who wants anything to do with learning about dropdown boxes, navigation panes, or data input modalities, no less any who care one whit about programming language limitations or whether it’s MySQL or yours.

Docs want to see patients. It’s that simple.

We never wanted to become data collection devices assisting insurance company profit margins nor defensive documenters dodging ambulance-chasing lawyers looking to capitalize upon the imperfections inherent in being human.

So, give us easier ways to practice medicine. Period. Do that and docs will literally flock, in mass migratory waves, to your door.

Aversion:

· Clicks

· Clocks

· Clacks

Clicks, also known as “clicky-clicks,” is shorthand for all the monstrously difficult ways we’ve thus far devised for interacting with computers. Compared with pen and paper, few information input methods can be called anything but regressive. (OK, voice recognition has gotten good, but it’s still tough to do in a noisy, busy office.)

Clocks are the continually ticking timepieces running doctors’ professional lives. Lower reimbursement leads to the need to see more patients, but more regulations require more data collection which takes more time per patient. More times more times more equals less: less time available, less fun, less happy providers, mathematically proven here: 

A clack is defined as both “thoughtless, prolonged talk” and “a simple valve allowing one-way flow.” Both definitions fit many of the tasks associated with EMR use and adoption. Think about it.

Minimize the clicks, enable slower clocks, cut out the clacks and, again, physician flocking will occur.

This isn’t about the incentive dollars which will be gone before we know it. If vendors and governments want docs to adopt, understand and address the AAs of EHRs and help us get flocked.

From the flocking trenches…

“A word to the wise ain’t necessary – it’s the stupid ones that need the advice.” – Bill Cosby

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 4/15/10

From John “Re: EMR for neurology. I am looking for a practice management solution, to include EMR/EHR for a neurology clinic … ideas please.” If you have suggestions, please forward them directly to me. I will compile comments into a single post.

Physicians from more than 860 practices in remote and underserved areas of California will soon be able to connect virtually with specialists in larger hospitals. The University of California, which is overseeing the initiative, just awarded AT&T a $27 million contract for the telecommunications infrastructure that will serve as the backbone for the California Telehealth Network.

Speaking of telehealth, American Well launches Online Care Team Edition, which brings live, on-demand specialist care consults into primary care physician exam rooms. Hawaii Medical Service Association will be the first health plan to deploy the technology.

Greenway Medical Technologies announces a meaningful use guarantee which has a slightly different twist from others we’ve seen to date. Greenway guarantees that its PrimeSuite EHR meets the reporting functionality and requirements necessary for providers to achieve meaningful use and qualify for stimulus funds. If providers fail to qualify for stimulus dollars, based on concerns with PrimeSuite’s certification or reporting standards capability, Greenway will fix the problem and in the interim pay customers an amount equal to any stimulus funds lost.  Different twist, but the onus is still on the physician to use the EMR in a meaningful way.

e-MDs announces it has increased its employee count by 36% over the last year. The company has also grown organic sales 36.5% since the beginning of the year.

Only 7% of US residents use personal health records, but that’s up from 2.7% last year. Younger individuals with more education and higher incomes are more likely to use PHRs. About 40% of PHR users are more likely to ask their their doctors new questions, and, about the same number say that PHRs made them feel closer to their doctor (the sweetness of that finding makes me smile.)

SourceMedical launches SourceTherapy Billing, a billing service specializing in outsourced revenue cycle and consulting services for physical therapy. The billing service is enabled by SourceMedical’s acquisition of Advanced Patient Financial Solutions.

Medical billing company HealthPac Computer Systems partners with AssistMed to integrate AssistMed’s data capture technology with HealthPac’s patient accounting and control system. The integration supports the use of a digital pen and custom forms and will automate charge capture and billing.

MDeverywhere releases a Web-based practice management offering for all its mobile hand-held devices, giving physicians the option to captures and view schedules via any smart phone or other Web-enabled hand-held device.

The Florida Medical Association selects Galen Advisors as its sole supplier of revenue cycle management services. Association members will be eligible for one month of free billing services for each 24 months of service.

Revenues from remote patient monitoring using mobile network will rise to $1.9 billion globally by 2014, with heart-related monitoring applications driving the initial growth in the sector. Also predicted to be big: healthcare smartphone apps that link to sensors worn on the body. Time to buy some stock, perhaps.

E-mail Inga.

Readers Write 4/14/10

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

From the “Other” Trenches
By Camus

I find the “In The Trenches” pieces intriguing. I only wish I had more time to author some counter thoughts to the good doctor. 

I had a physical exam with my GP last Monday. This physician is a member of a 30+ doctor group across the street from a MAJOR medical center in a major city.  He’s been my GP for seven years. Upon checking in I received a clip board with sheets of paper to complete. Each sheet starts with name, address, phone number, and SSN — the usual demographics the office has laying around on fifty other pieces of paper in my chart. (This was after I waited seven minutes on hold to schedule an appointment as they have no online appointment request and four minutes on hold while I verified my own insurance eligibility because they lack this ability themselves).

Physical exam is fine, usual blood work, history questions, and then an EKG. My reason for the visit was both a physical and concern over a near syncope event two days prior. Something’s not right in the EKG and there’s mild concern of an electrical block from the SA node. GP suggests making appointment with cardiologist in practice. Check out. Lab work promised later in week.

Walk down practice hallway to cardiologist office. Inform the receptionist I’d like to make an appointment as I’m a referral from my GP down the hall. There’s an open slot two days later at 1:00 pm and I grab it. Validate parking ($10 instead of $20) and depart.

Wednesday, two days later, arrive at cardiologist’s office 15 minutes early and check in. Receptionist hands me clipboard full of “new patient” forms. There’s five forms and each begins with the requisite name, address, phone number, DOB, SSN, etc. Filling this out is a waste of my time, so I do it once and write “see previous form.” One form seeks extensive personal and family history, which also resides in my chart some 75 feet away but that no one bothers to forward. One form seeks information on why I’m there, which would be obvious if they had an electronic system and the order from my GP who’s in their practice. No worries, I’m difficult to upset. 1:15, back to cardiologist’s exam room.

Dr. Cardiologist walks in, introduces himself, sits, and asks, “So, why are you here to see me?”

Somewhat bewildered, I answer “Because my GP in your practice suggested I do after a Right Bundle Branch Block readout on my EKG from my appointment Monday, two days ago.”

Dr. Cardiologist: “You have a doctor here?”

“Yes, I have for seven years.  He suggested I see you after the EKG.  I also have a very slow heart rate, with a resting pulse of 42-45. Normally my heart rate’s around 50. I went to see my GP for both a physical and because of a near syncope event last Saturday.”

Dr. C: “You had an EKG here?  Ok, we need to get that. Hold on a minute….”

Dr. C rotates in chair and presses buttons on wall mounted speaker phone. Four rings, voicemail. He hangs up, presses more buttons. Four rings, another voicemail.

Dr. C: “It would seem everyone’s out to lunch. Sit here while I go get your results.”

Question 1: Why aren’t the results in front of him?

Question 2: Why isn’t my paper chart in front of him?

Question 3: Why isn’t the order from my GP sitting in front of him with my GP’s comments surround the RBBB?

As he’s departing, I tell him,“You may wish to get a copy of the stress echo I had five years ago.”

Five minutes pass and Dr. C returns with chart notes, EKG, and stress echo results. A much better dialogue ensues and I joke with the good doctor I can make his life much easier and not have his office waste the patient’s time.

“Why don’t you have an EMR, Dr. C?”

“We’ve been looking a long time. It’s very complicated. Anything we get must communicate with the hospital and their system.”

And I dig further, “Yes Dr. it MUST communicate with the hospital. And there’s over 50 systems that will do that. I know my Dr. GP was on the committee to select a system three years ago. What happened?”

Dr. C: “We’ve seen so many systems, I don’t even remember how many. You should really speak with the hospital.”

Clearly Dr. C wasn’t in a hurry to solve the paper, process, workflow, lost revenue, lost charts, and patient inconvenience nightmare. That was fine as I was more interested in getting to the “heart” of the matter for my visit.

We’ll see how efficient this week’s visit is when I check in for my stress echo. I wonder if there’s a form waiting for me to write my name, address, phone, and SSN.

And, this happens every day, thousands of times around the country.

News 4/13/10

From Valley Gal: “Re: e-MDs. Why didn’t you mention e-MDs in the body of your discussion about the KLAS report? Only Greenway and athenahealth were mentioned. I have noticed that HIStalk Practice seems to avoid e-MDs. Why?”  The omission of e-MDs was definitely an oversight on my part, but they don’t make as much “noise” as some other vendors. They’ve issued five press releases since September. During the same time frame, Greenway had 14, athenahealth 32, and Allscripts 47. Press releases are the not the only way we get information on vendors, but there there is a definite correlation between vendor mentions and the output of their marketing team.

From Caymus: “Marketing and public companies. It’s fascinating to see the posturing among publicly traded companies as they influence the RECs and spend millions getting the message out, while behind the scenes, they’re settling lawsuits from previous partnerships mentioned in press releases. If we focus on improving healthcare first and market share second, both can result. I spent some time with (an unnamed vendor) and despite the rhetoric espoused by senior management, the customer isn’t first. When there are intense communication policies on ‘who’ is allowed to speak with anyone, and internal communications regarding appropriate ‘talk tracks’ for media, then the customer is not the focal point.”  I have worked for both private and public companies and I will agree that public companies tend to be much more focused on the financial metrics and driving market share. I definitely recall occasions when certain actions seemed more about making the numbers than doing the right thing by customers. That being said, I like the financial transparency you have with public companies. There’s value in knowing the financial strength (or weakness) of a company before investing thousands of dollars on its products. As for posturing with RECs, it’s the way to play the game right now, regardless of whether you are public or private.

CCHIT names Karen M. Bell, MD as its chair, replacing the retiring Mark Leavitt. Bell most recently served as SVP of HIT Services for Masspro. Her other roles include director of the Office of HIT Adoption and acting director of the ONC.

Hospitals, be good to your doctors. The average net annual income generated by physicians last year was over $1.5 million, with neurosurgeons bringing in almost $3 million revenue per doctor. With numbers like those, doctors have the upper hand when asking hospitals to subsidize their EHR purchases.

Good news: women are not ready to replace their physicians with the Internet. An online Harris Interactive survey finds most women feel more comfortable discussing private health concerns with their doctor than with an online community, spouse, friend, or family member. However, half of the women surveyed said the first place they research a health question is online.

Inadequate technology is blamed for poorly translated and potentially hazardous prescriptions, according to this study in Pediatrics. Half of Spanish-language prescription labels contain errors, causing confusion and possibly life-threatening situations if misinterpreted. Pharmacy leaders believe HIT needs to step up and improve the way pharmacy prescription software translates drug instructions. Debemos mejorar.

The administrator at the nine provider Cokingtin Eye Center (KS) claims their MedInformatix practice management software has helped reduce the practice’s A/R to 17 days and enabled them to collect 99% of collectible fees.

A Kalorama Information study suggests that relaxing meaningful use standards could lead to double-digit growth for the EMR industry. The requirement for 80% of orders to be completed via CPOE by 2011 was noted as one of the biggest concerns. The report suggests gradual adoption would be a more way to achieve widespread EMR adoption.

E-mail Inga.