Intelligent Healthcare Information Integration 5/23/10

A History of the Future of EHRs

Amid the carved skulls at the great Mayan monument of Tzompantli, a recently discovered hidden chamber revealed an amazing revision to the well known Mayan Calendar which describes the end of the world in 2012. Apparently cast aside for its heretical proclamations, this new Calendar is most impressive for both the time extension it allows humankind as well as the incredible glyphs just now decoded which appear to describe the tumultuous rise of electronic health records and the NHIN, known in Mayan as the MHIN.

For the first time, the heterodox Mayan timeline for the history of the future of EHRs is revealed:

2011 — Vast turmoil as great masses of people are running willy-nilly under the misplaced perception that EHR adoption is a “do or die” decision.

2012 — Multiple EHR vendors collapse or are subsumed by larger corporations as scrambling to meet federal guidelines has created near panic in the EHR streets. Many end users struggle with poorly researched EHR purchases and inadequate staff workflow change preparation. In conjunction with insufficient “boots on the ground” support, both in numbers and in abilities, massive installation failures ensue. (Some are disappointed that December 21st, the predicted End of Days, passes without event.)

2014 — Numerous HIT-RECs failing as greed, misappropriations, and planning failures waste billions of dollars. The unexpected bailout of the global oil giants diverts most of the remaining funds intended for Meaningful Use success, leading to massive global flooding from the tears of the disappointed.

2015 — The loss of funding leads to great innovation and a torrent of development of healthcare informational tool “apps.” The new ease of use and miniscule learning curves seem to assuage the fears and disappointments of discouraged end users. Massive installation failures abate.

2017 — The rise of the “Age of Minority Report.” Freeing end users from mice, pens, and smudgy monitor screens, MR-style, floating in air, graphical displays along with air guitar-esque user input methods allow everyone to adopt digital health record technology. Seamless integration into healthcare provision workflows without loss of revenue stream or diminished patient care capacities lead to true “paper-less” healthcare. (The Mayan symbol for this Age looks uncannily like Tom Cruise.)

2019 — Rejuvenated HIE efforts build upon the foundations of the only three surviving HIT-RECs remaining from 2010. The seeming HITECH debacle seems to have bottomed out and the refocus appears to be gaining momentum.

2020 — Patients, providers, hospitals, and all sorts of associated players begin to reap amazing benefits from the integration of personalized medicine, advances in genomics, and (finally) a tremendous push toward patient-centric medical care and community-empowered health management.

2021 — The NHIN (MHIN) reaches true “total integration.”

2022 — December 21, 2012, brings about the recalculated end of the current b’ak’tun cycle and the true End of Days.

Well, heck, at least we get an extra decade and are granted enough time to see this frustrating HIT thing through to its eventual success!

From the modified Mesoamerican Long Count trenches…

“It’s not denial. I’m just selective about the reality I accept.” – Bill Watterson

 

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 5/20/10

digiChart partners with PeriGen to integrate the digiChart OB-Gyn EHR with PeriGen’s clinical decision support system, PeriBirth.

About half of all parents would like to be able to communicate with their children’s doctors online, according to a poll by C.S. Mott Children’s Hospital. Even though many parents think online tools would be great for requesting records or refills, less than one in six say they currently have the ability to electronically connect with their kids’ providers.

Hill Physicians Medical Group (CA) says that more than 1,000 of its doctors are using EHRs, and requests for new installations is at an all time high. The IPA also reports 2009 net income of $4.7 million and revenue of $419 million. That compares to 2008 revenues of $420.6 million and a net loss of $4.4 million. In 2009,  Hill spent $4.7 million on EHR installation and support, and paid out $32 million in bonuses to member physicians who met clinical quality and patient satisfaction criteria.

The US Patent and Trademark Office issues athenahealth a patent related to its self-service implementation capability that allows practices to virtually implement athenahealth services.

National Medical Billing Services, a billing company focused on ambulatory surgery centers, names Nader Samii CEO. Samii founded Ajuba International, an RCM outsource company.

NightHawk Radiology issues its “Rules of Engagement” for servicing hospitals directly or indirectly through a non-radiologist-owned entity. The commitments are meant to demonstrate NightHawk’s alignment with radiologists and reduce concerns that NightHawk is attempting to undermine radiology practices. Among other promises, NightHawk vows it will only consider providing services if the hospital does not have an existing radiology group offering services, or, if the invite comes from a radiology group already providing that hospital services.

Quality Systems, the parent company for NextGen, is named a finalist in 10 different categories in the 2010 American Business Awards competition.

More than half of all doctors delay the adoption of medical innovations because they fear possible litigation, according to a Jackson Healthcare survey. Surgery subspecialists and OB-Gyns are the most likely to delay adopting new pharmaceuticals, procedures, and medical devices.

AMA membership dipped over 3% in 2009, but operating profit surged 560% to $16.5 million. The profit figures are actually less than numbers posted in the last few years ($30 million in 2006 and $24 million in 2007.) About 16% of the AMA’s revenues come from membership dues, so the decline in membership has to hurting the bottom line. Since 2007, membership has fallen from 241,000 to 228,000.

Good news if you are a physician concerned about online reviews from your patients: a study of posted comments finds that most reviews are overwhelmingly positive. Furthermore, patients really aren’t all that interested in rating sites for physicians. Turns out that restaurant reviews are far more popular. And who doesn’t want to know if the new Japanese place down the street has great sushi, before plopping down a few Andrew Jacksons?

E-mail Inga.

News 5/18/10

Ulrich Medical Concepts, an EMR/PM vendor, earns a patent from the US Patent and Trademark Office. I must admit I had never heard of this company before, which was founded by Dr. Dennis Ulrich and is apparently installed in 12 states. In looking over the website and the press release, I can’t identify particularly unique about the product that warrants going the expense and hassle of getting a trademark, but what do I know.

I also have never heard of MTBC, a HIT company that just launched a “100% free medical billing software.”  Since I’m convinced there aren’t too many free things worth having that are free (except the HIStalk blogs) I had to dig deeper. Turns out that providers must actually pay 4% of collections for the PM tools and 5% if they also want integration with a third-party EMR.  That’s just silliness.

CMS selects Northrop Grumman to develop a National Level Repository to process HITECH payments to providers meeting Meaningful Use objectives. The order is valued at $34 million over one year with five and one –half year option periods.

Greenway Medical Technologies announces the availability of its PrimeMobile application for the iPhone, iPad, and iPod Touch. PrimeMobile works with Greenway’s PrimeSuite EHR.

Thanks to the reader who tipped me off about Vermont Information Technology Leaders (VITL) EHR demo week. VITL is a regional extension center, tasked with helping physicians adopt EHRs and earn meaningful use stimulus dollars. This week the organization is hosting one hour web-demos from athenahealth, Greenway, PRISM Regional, and Allscripts MyWay. At least three of those vendors are offering discounted pricing through VITL. The site offers a “selection process overview,” which seems pretty basic, though probably helpful to a truly novice buyer. I did notice that VITL says products “must” be certified, and that “for now, CCHIT is the certification body.” And, of course, that’s not true since CCHIT, nor any other agency, has been named a certifying body. I’m looking forward to hearing more details on what other RECs have cooking.

If you are a provider wanting to learn more about REC options and offerings, here’s a good overview. Keep in mind that each of the 60 RECs will have its own business model and pricing.

I must have missed this news from a couple months back. PBFOnline, who acquired the financially struggling MedcomSoft a year ago, merges under the single name of MedcomSoft. MedcomSoft also recently added a new director of sales and a director of operations.

Aprima Medical Software says its first quarter was strong and that the number of providers selecting Aprima has increased at a compound growth rate of more than 84% since 2004.

Adventist Healthcare (MD) chooses eClinicalWork’s EMR/PM system as an option for its employed and affiliated physicians. Adventist will also use eCW’s electronic healtheXchange for community records. I believe that Adventist also promotes Allscripts’ EHR.

Centegra Health System (IL) is partnering with Dell to launch a Centegra Physician Network, an HIE that provides EHR and PM systems. I think it’s safe to assume Dell will be supplying some hardware. Not so clear: which EMR vendors will be promoted.

If you can’t beat ‘em, join ‘em, perhaps? Medical transcription company MxSecure releases MxChart, a web-based EMR. Frankly I am surprised that more medical transcription company don’t offer EMRs to supplement (and preserve) their core business.

Kramer Healthcare Technologies deploys RQI Practice Management, a front-end verification tool for physician practices. Kramer already supports a similar inpatient product, RQi Registration Quality Improvement.

MGMA sends a letter to Secretary Sebelius, asking HHS to trim EDI costs and consider the administrative costs associated with processing claims when calculating medical loss ratios. More MGMA insights:

Health insurance administrative processes should be standardized to reflect the provisions included in the recently passed healthcare reform legislation and to free up needed resources for patient care. By including these onerous administrative costs in the calculation of health plan costs, plans would be pressured to more quickly standardize, simplify, and automate many of these interactions between plans and medical providers.

A former security guard in Texas pleads guilty to trying to shut down a Dallas medical clinic’s computer system, a day before he was suppose to quit. Supposedly the security guard (known as “Ghost Exodus”) was the leader of a hacker group called Electronic Tribulation Army and bragged about his exploits on the Internet before getting caught.

On a much more uplifting note, a pair of Orlando-area physicians leave their private practices to form Grace Medical Home, a facility serving working poor families and providing $20 office visits. Private donors, foundations, hospitals, and churches have all chipped in to help get the clinic operational. In addition, pharmaceutical companies are helping with the cost of expensive medications and local companies have donated lab equipment, painting services, cabinetry – and an EMR.  Good stuff.

E-mail Inga.

Intelligent Healthcare Information Integration 5/16/10

The Complexities of Stupid Simple

Trying to follow, no less actually wrap your brain around, what’s happening in US healthcare these days is somewhat akin to trying to follow the rope through the Gordian Knot. Just think about some of the currently running debates, most hotly contested and all fueled by the NOS of the Internet:

• Privacy versus data sharing
• HIT best-of-breed versus enterprise systems
• Payers versus players
• Institutions versus individuals
• McDonald’s medicine versus medical homes
• Evidence-based versus medical art
• Security versus usability
• Etc., etc., etc.

Goodness golly, Nurse Molly, if you have half a handle on even one of these momentous mental jigsaw-like messes, you’ve got more moxie than most. This stuff is just massive…and that doesn’t even touch upon the multitude of subtopics and permutations thereof!

The fact of the matter is, for most of us, whether big brain pan or small, such giant complexities are only conceivable via analogy, simile, allegory, metaphor, or imagery. Trying to follow and make useful sense of all the threads and nuances and twisty-turns will lead to mental meltdowns and the turning on of American Idol.

The difficulty arises when trying to take the pictures within one person’s head and make them similarly visible within another’s. Vulcan Mind Probes may one day yield such seamless data transfer, but until then we’re stuck with words and numbers, pictures and symbols, ones and zeroes. We typically gain and share knowledge linearly, but our minds process it conceptually.

We humans have processed images and concepts long before “communication” via symbols, and even pictograms, came about. A single “picture paints a thousand words” because it transfers information in an easier to process format for our brains, a format for which our brains have been wired for millennia.

Accepting our limitations is by no means accepting defeat. We just need to work within the constraints of our current design criteria. Malcolm Gladwell’s “Blink” is a wonderful explanation of the power within our conceptual capacities belied by our limited communication facilities and meager attempts at linear thought processing.

Thus, I am a firm believer in the power of Stupid Simple.

Stupid Simple is not a simplistic or light-minded concept. Rather, it is the acceptance of the reality of our actual mental processing powers. Stupid Simple is what brings “light bulb” moments. It says, “We are smarter than our communicational clarity capabilities. We can understand far more deeply than the extent of our dictionaries.” Thinking clearly, communicating clearly, is typically an outcome of Stupid Simple.

Look for the Stupid Simple solution and, more often than not, you’ll find answers. Whether it’s how to portray medical info on a computer screen so that it is at its most useful or how to pay for healthcare: the higher the complexity of the explanation, more often, the less the value. Our problems may be deeply intertwined and complex; our best answers most often come from Stupid Simple address.

According to legend, Alexander of Macedonian was confronted by the classic such knotted mess at Gordium in Phyrigia, then a province of Persia. The legend contends that when incapable of finding the Knot’s ends in order to untie it, he sliced through with a stroke of his sword. Historical debate argues he may have pulled the Knot from the pole pin to which it was tied, exposing the ends, thus enabling an actual untying of the knotty problem. Regardless of the exact method of solution, Alexander got one thing right: Stupid Simple rules.

From my stupid simple trench…

“I am dying from the treatment of too many physicians.” – Alexander the Great

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 5/13/10

California Forensic Medical Group, a healthcare provider for correctional facilities, selects eClinicalWorks for EMR.

Alaska’s largest orthopedic clinic contracts with SRS for its hybrid EMR solution. Anchorage Fracture & Orthopedic Clinic includes 12 physicians.

Ophthalmic Imaging Systems reports Q1 earnings: revenue up 72% from last year to $4.1 million; net loss of $857,000 compared to the previous year’s loss of $1.1 million.

GEMMS selects Medfusion’s patient portal solution to interface with the GEMMS practice management system.

Speaking of Medfusion, Intuit announces plans to purchase the company for $91 million in cash. Intuit is the maker of Quickbooks, TurboTax, and Quicken Health. Inuit says it will use Mefusion’s technology to enable patients to communicate with providers, review health information and track healthcare expenses. Allscripts happens to be a reseller for Medfusion’s portal and Quicken Health, so they’ll likely be happy to see further integration between the product. Medfusion founder/CEO Stephen Malik with become an Inuit SVP and GM.

Aunt Martha’s Youth Service Center (IL) selects NextGen’s EHR and PM solution, plus QSI’s electronic dental records program. I was curious who this  “Aunt Martha” was so I checked out the website. Turns out Aunt Martha is really just a “concept,” or the embodiment of a caring relative a youth can turn to for help. Cool. The organization includes 17 community health centers.

Hunterdon Healthcare System (NJ) is using InterSystems Ensemble to connect its 15 affiliated physician groups running NextGen EHR/PM to the medical center’s QuadraMed Affinity HIS.

The 780-physician Marshfield Clinic (WI) joins Premier healthcare alliance, giving it access to Premier’s clinical, financial, and outcome data, as well as its purchasing network.

The Health IT Policy Committee endorses a permanent certification plan that includes provisions to monitor EHRs after they are purchased to ensure providers are installing the proper technology. The committee also wants EHRs to be checked regularly to see if they are labeled with the same meaningful use stage that they have been certified. In addition, they recommend giving the ONC authority to de-certify EHRs in “egregious situations.”  While all that sounds great in theory, wouldn’t it be pricey to oversee, not to mention complicated for providers (will they understand what year certification they need and/or will they needlessly shy away from products that are pending certification for future years?)

In case you missed it, we released the results of our HIStalk Practice reader survey. My favorite stat: 85% of readers say HIStalk Practice helps them perform their job better. And, my favorite recommendation: talk about men’s shoes once in a while.

The Boston Globe publishes an editorial in support of EMRs and chastising providers who “feel little or no responsibility for symptoms that get misdiagnosed because of inadequate information about a patient’s past medical care, let alone the tests that get repeated because no one has a record of the previous results.”  As proof that the providers are wrong to avoid technology, The Globe cites the oft-referenced IOM study that suggests thousands of deaths a year could be prevented with computerized records. As a final dig at providers, the editors suggest doctors and hospitals are “putting their own habits ahead of the clearly demonstrated needs of patients.” Interestingly, readers seem to be agree with The Globe at about a  2:1 ratio. Even more interesting, to me anyway, is that the only ones getting blamed for the situation are the providers. Hmm.

South Miami Criticare selects McKesson to provide ED billing, coding, and reporting services. Here’s something I didn’t know: McKesson’s Revenue Management Solutions group has 4,000 employees and does billing for over 1,000 physician clients. I am sure it’s a relatively small segment for McKesson (they employ 32,000 and have $106 billion in annual revenue,) but they clearly have a good chunk of the physician medical office billing market.

An Institute for e-Health Policy panel says that healthcare reimbursement needs to be changed in order to spur more physicians usage of mobile health and tele-health technology. Currently CMS pays just $2 million of its $400 billion Medicare spending on tele-health reimbursement.

E-mail Inga.