News 7/1/10

CMS wants to integrate their PQRI program with the EHR Meaningful Use incentives. Assuming the effort would reduce duplicate reporting requirements, it sounds like a win for providers. Look for the final ruling in July.

Physicians at Tufts Medical Center are using the Web to conduct live medical consultations to patients in Haiti. Students from Tufts University School of Medicine are in Haiti and providing the on-site medical services, while faculty physicians are providing real-time consults using American Wells’ Online Care technology. And the medical world gets a little flatter.

Arizona Integrated Physicians (AIP) selects eClinicalWorks EMR/PM system for its 600 physicians. AIP member physicians will be eligible for preferred pricing and receive the eCW software via a SaaS model. Post-implementation support services will be handled by AIP.

Fifty thousand participants are now receiving weekly text messages from Text4baby. The free Text4Baby service provides both English and Spanish updates to women from early pregnancy through the babies’ first year.

According to MGMA members, the top three challenges of running a group practice are dealing with rising operating costs, managing finances with uncertain Medicare rates, and, selecting and implementing a new EHR. Interesting to note that compared to previous years, implementing a patient-centered medical home model is a much bigger concern. Surveyed members ranked medical homes as their 12th biggest challenge, compared to 22 last year.

RCM provider Capario enters a preferred partnership with software billing developer Healthpac Computer systems.

Greenway Medical Technologies is awarded a patent for its custom clinical template builder. Over the last few months a number HIT vendors have announced patent awards, making me wonder if companies seek patents because they want to product truly unique technology, or, because it’s a good marketing tool. I am hoping someone smarter than me will advise.

NeuroCenter Medical Clinic (CA) selects Acentec to provide IT services, including MedInformatix software and integrated Dragon voice recognition.

Enforcement of Red Flags rules for physicians may be delayed yet again as the FTC works through several lawsuits with medical associations and societies. FTC chair John Leibowitz says that members of the AMA, American Osteopathic Association, and state medical societies will be not be required to follow the rules until 90 days after a decision is handed down through the federal court. In case you are counting, the FTC has delayed physician enforcement five times already.

HIStalk Practice had a big month in June with over 10,000 views. In the last six months readership has jumped a whopping 35%, which makes both Mr.  H and me very happy. We appreciate readers stopping by, and, are very grateful to our terrific sponsors for keeping the keyboards clicking.

Happy Independence Day to all!

E-mail Inga.

News 6/29/10

Healthcare providers participating in the health alliance Better Health Greater Cleveland believe the use of EMRs has helped improve the quality of care for patients with chronic conditions. The organization reports that patients who received care at sites with EMRs tended to improve at a faster rate than those using paper records. One physician exec says:

Electronic health record systems provide tools for physicians to increase the likelihood that their patients receive the right care at the right time. In addition, clinical practice leaders can use these tools to identify changes they can make in their medical offices to do a better job.

St. Cloud Medical Group (MN) contracts with Greenway Medical Technology for EHR and practice management. The 55-provider group will implement Greenway’s PrimeSuite software, as well as online portal PrimePatient and remote clinic PrimeMobile.

Physicians’ Alliance of America selects iMedicor’s secure messaging as its recommended communications systems for members. The 20,000 network members will be eligible for a 25% discount off the regular $20/month subscription rate.

Score one for doing things the old-fashioned way. A physician with Robert Wood Johnson University Medical Group finds that patient no-show rates were lower if an actual person made an appointment reminder call, versus an automated machine reminder. However, no show rates were even higher when no phone calls were made, suggesting an automated call is better than no call at all.

Bayer Healthcare Pharmaceuticals launches a free mobile app for hemophilia A that helps patients track and record hemophilia factor VIII infusions. Another cool smart phone app: MIT Media Lab develops a smart-phone based eye exam tool designed to make exams more affordable in developing countries.

The incident of real-time claims adjudication and processing could improve with wider adoption of EMR. If physicians are able to enter clinical data at the point of care using an EMR, data could be immediately forwarded to insurance companies. One Harvard economics professor believes that administrative costs could be reduced $125 to $150 billion within five years with real-time adjudication. Sounds good. Unfortunately, too few practices find point of care charting a viable option.

RealMed introduces two new RCM products, REALCLEAN and REALASSURE. REALCLEAN (love the name) provides claims editing tools and REALSSURE helps manage the patient collection process.

Beginning July 1st, Indiana providers leaving health records illegally unsecured will be subject to fines. Additionally, state’s attorney general’s office will have the right to obtain and secure the abandoned records.

gloStream introduces a new sales promotion that targets the EMR replacement market. gloStream will give practices a $7,500 in practice management software for “free” if they upgrade from a competing EMR. I couldn’t say if that’s a great deal or not, but, it does point to the fact that the EMR replacement market is growing.

The AMA advocates for insurance payment for all non-face-to-face electronic visits. The AMA House of Delegates says that insurers need to recognize that telemedicine “is going to be a true form of health care delivery, not just a convenience.”

Medical billing service ECCO Health selects Kareo as its billing software solution.

Pulse Systems unveils a number of new products at its recent Knowledge Forum, including a patient web portal, Mobile MD for iPhone, a self-service kiosk solution, and solutions for use with iPads.

Primary care providers saw a 3% increase in their 2009 compensation, though OB/Gyns experienced a 1% decline, according to an MGMA survey.  Dermatologists earned the largest compensation increase, bringing in an additional 12% over the previous year.

E-mail Inga.

News 6/24/10

Privately held AdvancedMD announces Q1 revenue of $8 million, a 29% increase over last year. The company closed on the purchase of PracticeOne EHR in December, so I assume some of the revenue growth can be attributed to that acquisition. The company also claims 26th consecutive quarters of revenue growth. Reading the financial highlights, I am reminded of one of the biggest advantages of being privately held: you can be much more creative in how you spin your results. AdvancedMD mentions big gains in revenues and clients, but I’m left wondering why there’s nothing said about profitability (or lack of it).

Speaking of spin, Practice Fusion reports a 72% jump in its EMR users so far in 2010, adding 200 medical professionals each day. Practice Fusion’s software is free and can be downloaded over the Internet (presumably only if you are a licensed provider). So just how many of those 200 new professionals a day are downloading the software and just taking it for a test drive? How many of the 43,000 users really “use” the system?

I don’t mean to pick on AdvancedMD and Practice Fusion because I know they aren’t the only companies, in HIT or elsewhere, that use their creative licenses to paint things especially rosy. I guess I’m just having one of those days when I’m weary of wading through the fluff.

Sounds like this West Virginia practice might have benefitted from a bit more fluff-filtering before they outsourced its IT services. The physician office is suing its former IT company, claiming backups were improperly performed and were withheld from them. Reps claimed the company had experience supporting eClinicalWorks software. The practice says they were lying and wants compensatory and punitive damages.

Electronic clearinghouse provider Health-e-Web expands its operations with the purchase of a competitor, Electronic Translations and Transmittals Corporation (ET&T).

Patients using a wireless electronic pill bottle to remind them to take medication have 27% higher medication adherence rates, according to findings from the Center for Connected Health. The study focused on patients with high blood pressure and utilized Vitality’s wireless GlowCap product.

United Healthcare and Centura Health launch Connected Care to provide rural medical facilities access to services using telehealth technology. Patients at four facilities in remote areas of Colorado will soon be able to connect with physicians in Denver, Littleton, and Pueblo for routine and specialty care.

Five new practices contract with PatientPoint for its patient kiosk solutions.

EMRs, better follow-up care, and more collaboration with patients and families would help pediatricians avoid errors in diagnosing illnesses, according to research from the Baylor College of Medicine and VA. Surveyed physicians admit to making diagnostic errors at least once or twice a month. These same doctors believe errors could be reduced with EMRs because they provide better care coordination and make clinical data more readily available.

E-mail Inga.

Joel Diamond 6/23/10

Random Thoughts on e-Prescribing

A few years ago, I admitted a 35-year-old man to the hospital with severe dehydration and electrolyte disturbance due uncontrolled diarrhea. The poor guy started out with fairly mild symptoms. After using his neighbor’s bathroom, he looked in the medicine cabinet and saw a drug labeled colchicine. The instructions read “Take every 1 hour– gout relief or diarrhea”.

For those of you unfamiliar with this old but effective treatment, you literally take it every hour until painful gout resolves, or stop taking it when you get the side effects of diarrhea. I will not comment on this gentleman’s intelligence or judgment, but somehow he misinterpreted the instructions as a treatment FOR diarrhea. Worse than that, as his symptoms got worse, he diligently followed the instructions and continued taking more, and more, and more… every one hour for the next 24 hours.

Sort of reminds me of the old lady who was prescribed a rectal suppository for symptoms of nausea. She called saying the medicine didn’t work. “And while I’m at it, how did you expect me to take that giant pill? And if you must know, it tasted awful!” I guess it’s not as bad as the elderly woman who didn’t enjoy the taste of the “Kentucky Jelly” on her toast in the morning. (K-Y Jelly is usually used for other purposes).

Clearly, the Sig (i.e. instructions) portion of a prescription is extremely important. Practitioners claim that the unstructured format in handwritten prescriptions offers more flexibility. For instance, writing complex dosing for a tapering course of medication can be difficult in an EMR.  This is commonly cited as an obstacle to widespread adoption of electronic prescribing. But in the end (pardon the pun), I suppose that the above suppository story could have been averted if the instructions had read “carefully place the huge waxy tablet firmly up your ass.”

Speaking of which, a colleague of mine told me of the time he once prescribed drops for a baby with an earache. The instructions were: “Put two drops in right ear every four hours” with right abbreviated as an R with a circle around it. The mother returned when the child did not get better. She showed the doctor the baby’s wet rectum as evidence of complying with the prescribed treatment. It turns out the pharmacy printed the instructions as “Put two drops in R ear every 4 hours”.

I’m a huge advocate of electronic prescribing. Elimination of handwriting errors, dose range checking, and monitoring drug-drug interactions are but a few of its virtues. My patients definitely appreciate having prescriptions waiting for them at the pharmacy.

As an aside, several years ago when I started e-prescribing, a pharmacist I knew told me that the drug store pharmacies were worried that this convenience would cause them to lose revenue. It seems that waiting around is precisely why they put the pharmacy there in the first place — to make you shop for other stuff during the 30 minutes it takes to put 30 tablets in a bottle.

Progress can oftentimes be thwarted by outdated legal issues. I still can’t figure out why I can call in prescriptions for Vicodin and Xanax over the phone (or worse, fax them), but I am not allowed to e-prescribe these controlled substances and significantly decrease illegal prescription diversion.

Speaking of old fashioned, one of my old mentors told me that he had an agreement with the local pharmacist back in the day. Whenever he had a hypochondriac in the office, he prescribed Obecalp for whatever ailed them. The pharmacist would fill the script with the biggest vitamin capsule he had in stock. (Obecalp is placebo spelled backwards). I often wish for that drug to appear in my EMR’s drop-down list. Talk about “Primum non nocere” –First do no harm (The Hippocratic Oath).

Frequently,  I just miss what might be the last bastion of the lost art of medicine … pulling a leather-bound prescription pad out of my pocket and writing Latin instructions with a fountain pen as closure to a satisfying doctor-patient encounter.

And then getting a call from the pharmacist telling me the drug isn’t on formulary!

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 6/22/10

CMS launches its official website for the Medicare/Medicaid EHR Incentive Programs. Maybe technically it is a “new website” but it looks to me that CMS simply consolidated all the Incentive Program information into one area and there’s not much, if any, new data. CMS opted to save taxpayers’ money by not incorporating any graphics. None-the-less, it’s now easier to find the specific EHR incentive data you need, regardless of whether you are a hospital, physician, or vendor.

ONC releases long-awaited details on its temporary EHR certification program. Starting July 1, organizations can pay $75,000 to apply to become an Authorized Testing and Certification Body (ATCB) for EHRs. Programs previously certified by CCHIT will not be grandfathered and will be required to go through additional certification. In addition, CCHIT, like other interested testing bodies, will be required to apply to become an ATCB. The Drummond Group, another entity planning to apply to be an ATCB, provides a succinct overview of the final rule here.

NaviNet announces plans to introduce an integrated patient information system to supplement its current healthcare communications network. NaviNet is seeking technology partners to integrate their PM and EMR systems with NaviNet’s existing claims processing and HIE solutions.

PatientPoint names Raj Toleti CEO. PatientPort provides self-service applications for healthcare providers, including a patient-facing kiosk system.

Navicure hires James McDevitt as CFO. McDevitt previously worked with Geac Computer Corporation and Bausch & Lomb.

A researcher from CSC predicts that private insurers will follow the government’s lead and impose financial penalties for contracted physicians not meeting EMR meaningful use standards. Insurers did it with electronic claims, so why not with EMRs?

Looking for some User Group meeting activities in the coming months? Here are details on a few:

• NextGen Healthcare opens registration for its 2010 user group meeting, to be held November 7-10  in Orlando.
• Allscripts Client Experience (ACE) is August 5-7 at the Mandalay Bay Resort in Las Vegas.
• eClinicalWorks  heads to Orlando’s Gaylord Palms Resort & Convention Center October 30th – November 2nd.
• e-MDs hosts their users July 22-24th in Austin, TX.
• SRS users head to Woodcliff Lake, NJ (outside of NYC) September 15-17th.
• Atlanta is the place to go August 29 – September 1 if you are a client of Greenway Medical.

Deja vu or quelque chose de nouveau? Practice management firms are buying up practices, though a few things have changed since a similar buying spree in the mid-1990’s. First, most of the buyers today are are experienced in the industry and they know how to operate practices. Purchase prices are more modest and cash is king. Finally, rather than primary care practices, today’s buyers are focused on hospital-based physicians. It almost sounds like my love/hate relationship with skinny jeans: I want them as much as I did in 1995, but with my expanded view of the world I am not willing to pay as much, and, mais bien sûr, I only pay cash.

E-mail Inga.