News 7/22/10

Eligible ClearPractice clients can now qualify for a 2% e-prescribing reimbursement using ClearPractice’s e-prescribing solution, following authorization from CMS. CMS will also extend a 2% PQRI reimbursement for physicians reporting through ClearPractice’s EMR.

Quest Diagnostics blames a slowdown in physician office visits for its 1.4% decline in second quarter revenues to $1.87 billion. Profits were slightly ahead of estimates but analysts were looking for almost $1.93 billion in revenues.

From the Annals of Family Medicine comes the latest study in support of EMRs. Researchers from Brown University concluded that implementing an EMR can improve practice efficiency and time management without impairing patients’ strong sense of trust in the physician-patient relationship.

Heartland Surgical Associations (MO) implements iPads running Pulse Systems’ PulsePro.

Eugene Heslin, MD, who is with the six- physician Bridge Street Medical Group (NJ), will travel to Capitol Hill next week to talk HIT. Heslin is scheduled to meet with the House Committee on Ways and Means, Subcommittee on Health to tell why lawmakers why he believes HIT is essential to healthcare. Here’s a preview:

“I speak on behalf of my patients, representing their stake in health IT. Ultimately, my patients are why meaningful use of health IT is important. Federal incentives can help me persuade my colleagues that there is critical mass, that it is doable at the community level, and that they need to move now along the same pathway to benefit their patients and the community.”

It appears CCHIT will have plenty of competition as an EHR certification body. ONC reports that it has received six or seven completed applications out of the 30 sent to requesting organizations.  Multiple certification bodies means more price competition and quicker certification, which of course benefits vendors and ultimately end-users.

Marshfield Clinic (WI) hires Preferred Medical Marketing to provide contract monitoring services for its 700 physician practice.

Avisena is the latest HIT vendor to secure a patent for its software. The patent covers the proprietary technology and methodology of Avisena’s revenue cycle management software and services.

One hundred fifteen doctors and up to 25,000 patients are enrolled in the OpenNotes Study, which will track the sharing of chart notes between physicians and patients. Researchers will investigate whether patients given access to their chart notes through a portal, do indeed review their charts. They will also monitor what happens if patients find errors and what they do with their health information. Physicians will be tracked to see if they censor themselves or write more patient-friendly notes.

The AMA and other doctor groups send a letter to health insurers, criticizing the industry’s increased use of physician grading systems. The physician groups say the often unreliable and unfair ratings have lead some insurers to charge patients lower out-of-pocket costs for choosing a preferred physician. The latest healthcare reform legislation requires physician grading systems be implemented by 2013.

E-mail Inga.

News 7/20/10

The local paper highlights Austin, TX-based eMDs and its success selling PM and EMR to 1-10 physician practices. The 230-employee company is expecting $30 million in revenues this year and is experiencing record sales almost every month. I liked the comments from a physician who installed e-MDs eight years ago. He attributes his practice’s  high employee retention to the success of the EMR and believes it takes a few years of collecting patient data to achieve valuable clinical insights:

“You start seeing the beauty of it a few years down the road. The (patient) data starts talking back to you.”

MedWest Health Systems (NC) selects Allscripts EHR and PM for its 60 employed physicians. MedWest also plans to offer a hosted solution to 200 independent physicians in the region. Meanwhile, Erie County Medical Center (NY) chooses Allscripts EHR for 100 of its physicians. Erie will connect the Allscripts system to Meditech.

Vohra Wound Physicians contracts with athenahealth for its athenacollector services. Vorha is a network over over 100 physicians specializing in wound care needs of patients in nursing homes and rehabilitation centers.

Epocrates files for a $75 million IPO, just in time for its planned fall rollout of an EMR. Epocrates actually attempted an IPO in 2008, but pulled back because of poor economic conditions. The company posted $93.7 million in revenue for 2009, up 12% from the previous year, with profits of $7.7 million (up3%). However, the company had a small dip in its y/y revenues for Q1 and a $855,000 loss.

Buffalo Medical Group (NY) implements Midmark IQecg and IQstress into its diagnostic services. The practice reports that the solution, which interfaces with its Epic EMR, saved an estimated $50,000 in employee time in its first year.

A big welcome and thank you to Culbert Healthcare Solutions, our newest HIStalk Practice Platinum Sponsor. CHS is a professional services firm specializing in operations management, revenue cycle, clinical transformation, and IT for healthcare. IDX veteran Rob Culbert is the company’s founder and president and his management team has deep healthcare and HIT experience. CHS has particular expertise in applications from Allscripts, Epic, GE Centricity, NextGen, and eClinicalWorks. Many thanks to the Culbert folks for helping to  keep the lights on at HIStalk Practice. 

digiChart names Bob Allen its National Director of Sales and Stephen Faris VP of Technology. Most recently Allen was VP of sales in McKesson’s Physician Practice Solutions segment; Faris was CTO for Healthgate Data Corp. digiChart also announced plans to move its headquarters from Nashville to nearby Brentwood, TN.

The American Osteopathic Association installs Karen J. Nichols, DO as its first female president. Nichols, by the way, is a big advocate of spreading patient-centered medical homes.

Excellus BCBS finds the e-prescribing rate in upstate NY jumped from 12%  in 2009 to 17% in the first quarter of this year. Will other regions of the country report similar trends? Bet so.

Castle Connolly, the organization that compile the Top Doctors publications, says it will develop standards to recognize physicians who have decided to incorporate the Meaningful Use of HIT into their practices.

The use of EHR tools appears to increase screening of Native American victims of domestic and sexual violence. A federally-funded project has found screening rates have risen from 4% in 2002 to 48% today under a coordinated program that included the use of EHR to integrate routine domestic violence assessments and screening reminders.

I’m typically not a fan of marketing hype that is masked as “news.” That being said, I was intrigued by this article that features a Canadian doctor who seemingly likes his current EMR. The interesting twist is that he had been in practice in Louisiana but disliked the EMR so much that “it was part of the reason” he left the US. Wow — that must have been one really bad EMR! Anyway, the “American EMR system” used many point-and-click templates, unlike his current product that allows him to handwrite, dictate, voice-to-text, and type. I wonder if he tells his fellow Canucks that all American EMRs are as bad as the one he hated — and if his peers believe him.

Email Inga.

Intelligent Healthcare Information Integration 7/16/10

Musings on EHR Usings

By now, most of you know I’m a small-town pediatrician in private practice, with an IT department consisting of me. (Not to take anything away from the great job my wonderful EHR VAR support people do, but their 1,000-mile reach has its limitations.)

As the chief cook and bottle recycler, it sometimes amuses me just how challenging this EHR/EMR proposition is, especially when I think of others trying to pull this off who may not be so tech star-struck. I mean, really, how many doctors really care if they’re using pen and paper or mouse and keyboard? From what I see, most of my colleagues just want to provide healthcare help. All that charting stuff is more often seen as a way to get paid than as a real necessity for patient well-being and ongoing care.

I know: in bigger institutions and large practices where patients may see multiple providers, thereby necessitating better legibility and patient care communication, and when you consider data usefulness and sharing, I think most physicians understand that digitization is the way to go. However, I’ll bet that outside of CMIO and geekoids such as me/we, very few really want to be bothered with the technicalities of .NET or MUMPS or SQL or even CCD/CCR. They just want to be docs. And get paid reasonably. And get home sometimes.

We had a recent episode where our EHR kept slowing to a crawl just before freezing completely, again and again and again, over several days. A server reboot would fix it, but it would come back within hours, maybe minutes. My VAR support team finally figured out that a driver needed updating, but we really struggled for a couple of days there.

Then we had one of our touchscreen registration desk kiosks act up. Actually, it turned out to be the flexible, spill- and child-proof keyboard, but there wasn’t much my 1,000-mile VAR could help with on that one. It seems simple now, but the strange effects of the partially-working keyboard caused a diagnostic dilemma for weeks.

The other day I realized I had been using a poorly finished template for many months which necessitated my rewriting pieces of each note that should have been auto-populated. I wasted many seconds every time I had to do that, but during a busy day, who has time to stop and edit a template? Then, by the time the day has beat you into submission, you don’t even remember the little template nuisance when it is overshadowed by the many, much larger issues of the day. You just want to get home. Thus the template remains a constant reminder of the inadequate allotment of 24 hours within which to scramble.

As you can glean, the “Musings” title is befitting, as I’m really not too focused here on any particular issue. Within some of the other roles I juggle, be they doctor-y or HIT-ish, I have very little time for wistful reflection. Maybe that’s part of the point. Maybe that’s what I hope more of the vendor-programmer-developer folks out there will hear.

Being a physician these days isn’t about HIT. It’s still about being a doctor and it is harder than ever. When you sit inside your protected, usually air-conditioned HIT worlds and talk tech-ese with other technophiles, please remember — the people you’re trying to serve, for the most part, couldn’t care less about scripting, unless you’re talking prescripting. Keep it stupid simple … and easy to fix.

From the trenches…

“The most potent muse of all is our own inner child.” – Stephen Nachmonovitch

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 7/15/10

If you are in the ambulatory world and still not clear on all the just announced final ruling on Meaningful Use, here’s a quick and dirty summary:

• For Stage 1, eligible providers (EPs) must meet a total of 15 “core” requirements in order to qualify for Meaningful Use funds
• For Stage 1, EPs also have to to achieve an additional 5 objectives based on a list of 10 possible criteria

Here is the list (click to enlarge) of the core set of requirements (all 15 must be met):

Here is the menu set (click to enlarge) of requirements (must meet at least 5 objectives):

Also note that Stage 1 will not require practices (or hospitals) to submit claims electronically or verify insurance electronically. If you have been somewhat followed the discussions around Meaningful Use for the last few months, you are likely not surprised by any of the final requirements. Actually, the biggest surprise is that bar has been lowered a bit, giving providers a bit more flexibility  fewer Stage 1 requirements. Also, several of the measurement thresholds have been reduced, including the percentage of meds that must be entered electronically and e-prescribing requirements.  With these rules finalized, those providers who have been procrastinating on their EMR implementation are now just about of out of excuses.

If finding the right EMR is still an issue, you’ll want to check out a new website launched by AmericanEHR Partners. Multiple professional medical societies are participating in the organization, whose stated goal is to help practices evaluate EHRs, view user ratings, and compare functionalities. It doesn’t endorse any products, though 16 EHR vendors are currently part of the project (and prominently displayed on the site’s homepage.)

The 20-physician Northwest Georgia Oncology Centers joins US Oncology. The president of the NW Georgia groups says the arrangement will give his group the ability to expand its clinical informatics and research offerings.

Need an iPad? DrChrono.com is giving away free iPads when users sign up for its iPad EMR app. Don’t know how much it costs to sign up but the software apparently includes SOAP notes, e-prescribing, and billing.

New Jersey-based Physicians Resource Network )PRN) achieves “AdvancedBiller” status from AdvancedMD after adding 17 new providers over the last four months. PRN is a billing partner for AdvancedMD.

RCM solution provider Galen Advisors says its client base has grown over 50% in the last six months. Lest we forget amidst all this EMR buzz, practices need to control their collections more than ever.

Capella Healthcare (TN) selects athenaClinicals for its own physician network of over 130 providers. Capella’s physician network currently uses athenaCollector.

The Minnesota state Board of Medicine fails to discipline a physician at the University of Minnesota, despite a dozen privacy violations. The still-employed physician was estranged from his family and used his position at the university to peek into his wife and daughters’ medical records. Now the feds are investigating to determine if privacy laws were violated. Is it possible the good doctor received a bit of preferential treatment from his employer and local medical board?

ZocDoc completes $15 million in Series B funding round to expand its network of practitioners. ZocDoc uses online technology to help consumers and medical and dental offices book appointments.

HP introduces EHReady, a program aimed at helping hospitals work with affiliated doctors to deploy EHRs. HP says it will provide hospitals with marketing support services to educate physicians about getting EHR into their offices and extend financing options for physicians wanting HP products. Sounds like an underwhelming and late-in-the-game attempt to penetrate the small physician world. On the other hand, there are plenty of hospitals out their with strong HP ties so maybe health systems will be interested.

E-mail Inga.

Final Meaningful Use Regulations

The full text of the Meaningful Use final document is posted on HIStalk. We are updating the comments at the end of the article with interesting points we are finding in the revised document.

Rather than reposting here, we suggest that you start by reading our comments to the HIStalk posting, then take a crack at the 864-page document if you are so inclined. Feel free to add your comments to the posting – that will help everyone get a quick handle on what it means.