Intelligent Healthcare Information Integration 11/30/10

Time for the Cheese, Please

“Thought provoking EMR comment. Don’t be sparing us the details of the cool features you’ve seen and which companies are providing the cool features you’ve found … show me the good stuff!”

That’s a compilation of a couple of quotes from John over at EMR and HIPAA after a recent post here where I mentioned I was starting to find some pretty cool pieces and parts amidst the waterfall of EMR/EHR demos I’ve been drenching myself within of late. I promised I would “stop the tease and show the cheese.” (John requested sharp, but it may be more along a Muenster.)

Four upfront caveats:

1. I am in no way receiving any remuneration from any of the vendors I will be mentioning.
2. I have really enjoyed many, if not most, of the people who have taken their time to show me their solutions. Part of me wishes I didn’t have to end up choosing but one answer / company for our office’s needs.
3. While I am certainly keeping self-interest at the fore, I try to consider the needs of my heretofore undigitized colleagues and what my understanding of their needs might include.
4. There’s only one of me and I have a day job (well, often a day and night job,) so I wouldn’t even begin to imply I’ve seen all there is to see – but I’m trying!

OK, here we go, and in no particular order of coolness…

Ultimate Usability

Unfortunately, there’s not a system in existence today that has this feature – yet — but the hands-down winner in my book goes to Medicomp’s CliniTalk and its yet-to-be-named Type / Write / Click cousin. Using their medical knowledge engine of “260,000 coded clinical concepts mapped to CPT®, DSM, ICD, LOINC®, RxNorm, SnomedCT®, and other billing codes and clinical reference terminologies,” this middleware allows truly smart data capture, integration, manipulation, and utilization. It’s coming very soon to some pretty good systems which it will help to make great.

I’m so enamored with this functionality that I’m doubtful I’ll be able to choose a new system that doesn’t have it incorporated – or at least one with plans to do so. Seriously, it does for clinical data what I’d always thought a computer should: it adds an intelligence and an level of association-making that a busy clinician really needs while helping to minimize the “Wow, I went to med school to become a data entry clerk for insurance companies” feeling. Unconfirmed, but I hear Sage Intergy will be one of the first to engage this hyper-enhancement.

Eye-Friendliness

This is one of my personal “gotta be there” criteria. It was a huge factor in my love at first site with Bond Clinician, the now life-support-plug-pulled Peak Practice. If my “blink” upon first view of an EMR isn’t one of “OK, that’s kind of pretty,” then I know the demo from there on out will likely only yield ideas for features or functions I might want to see in the other system I do eventually choose.

Prettiest faces in this category are all iPad-ian: Quest’s Care360 and ClearPractice’s Nimble. Right up there, too, is Dr. Chrono, but I admit to enjoying the warm feel of faux leather, even if only digital, which Care360 and Nimble use. This familiar view might even assuage some of the anxiety of docs who are still pen-and-paper bound. (I especially like the slightly askew desktop look-and-feel of Care360, perhaps because my desk is usually pretty askew, too.)

Desktop systems could learn a thing or three from these iPad implementations. I mean, really, isn’t there a whole science about HCI (Human-Computer Interaction) and how to make visual content appealing, productive, and efficient? My take: Many EMR vendors could use a few less chief marketing officers and a few more humanistic computer interface designers.

That said, I have seen a couple of desktop systems worth noting. SOAPware’s EMR has come miles from when I first remember its rather basic layout. athenahealth’s athenaClinicals also has evolved nicely since I joined Inga and John Smalling in a group demo about a year ago in an ill-fated jaunt into product demo reviews. (I liked it then; its look and feel is even better now.)

As this is a long, ongoing, often sleep-inducing process, I guess it’ll have to be a “to be continued.” But, before I go, here’s a few I’ll be discussing next time:

• We “get” the “App Me, Baby” idea: SRSsoft’s Hybrid EMR and Medicity’s iNexx.
• EHR vendor team who seems to have the most creative fun: Nuesoft.
• Most exciting new non-EMR EMR: Mitochon Systems mEMR.
• Best digital office preparation tool: Welch Allyn’s EHR Prep-Select.
• The value of views: DIS.
• Using exo-EMR stuff, mostly iPad apps, as really useful patient education and engagement tools: Blausen Medical’s Human Atlas, Pampers’ Hello Baby – Pregnancy Calendar, CHADIS, and Text4baby. (Pseudo exception to caveat #1 above: I also like start-up Health Nuts Media for whom I am the unpaid CMO). Heavy prejudice toward pediatrics, I know, but remember the source here.
• Vendor web sites: what attracts and what repels.
• “The Good, The Bad, and The Ugly” of demos and vendor/client connections.

So, while not meaning to continue the tease as I’m really trying to dole out the requested cheese, I’ll close here with the promise to grate some more fresh Parmesan soon.

From the trenches…

“The early bird may get the worm, but it’s the second mouse that gets the cheese.” – Jeremy Paxman

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 11/30/10

From Telepathic: “Re: Your post. Your readers are thankful for you! Your post made this dry overcooked piece of turkey feel better knowing she isn’t the only one ‘done’ after burning out in sales in this exhausting and unrelenting (and oddly unfulfilling) world of HIT. Funny how the universe works!” Thanks to Telepathic and others who took the time to send equally affirming notes. Heck, I’m just thankful to anyone who took the time to read HIStalk Practice over the extended weekend.

University Radiology Group (NJ) says its MedInfomatix RIS, along with ZirMed’s RCM solutions, have allowed the practice to reduce its A/R staff from five employees to three. The practice can perform insurance eligibility searches in 15 seconds using ZirMed’s online tools.

Hartford Healthcare (CT) is negotiating a $28 million purchase of the 30-physician Constitution Eye Center. Practice co-founder Kris Mineau says the deal will give Constitution Eye access to a deeper resource pool for new technology, including electronic medical records.

The Burlington, VT newspaper highlights the charity works of John Canning, the president of Physicians Computer Company. Canning and the practice management software company donate $30,000 to $50,000 a year to charitable causes, most of which support musicians and the arts in Vermont. I’d bet he’s not your typical HIT leader. The reporter notes that he was wearing sandals during the interview despite sleet outside. I also noticed an older posting on the company’s web site where Canning mentioned he just completed a class in conversational Japanese. I’m thinking this industry could use a few more non-traditional leaders.

The House approves a one month delay for the planned 23% Medicare pay cut. The Senate approved the postponement a couple of weeks ago, so the legislation goes to the President for signature. It’s anyone’s guess as to how long it will take Congress figure out a permanent fix.

Indiana Hand to Shoulder Center selects SRS Unifed Desktop for its 35 providers.

A few housekeeping items: despite my never-empty inbox, I love getting e-mail, so send any rumors, story ideas, interview suggestions, or haikus my way. Our terrific sponsors allow us to keep HIStalk Practice rolling, so please visit their sites and check out their offerings. You can also friend me or like HIStalk on Facebook, or, follow me on Twitter. If you aren’t getting an e-mail notification for new HIStalk Practice posts, it will take just two seconds to sign up at the top right-hand corner of the page. And, thanks to everyone for reading.

Policies that require insurance pre-authorization before treatment can negatively impact patient care, according to a new AMA survey. Physicians complain that pre-authorizations take too long to obtain and that approval is often difficult for many of the required tests, procedures, or drugs. The AMA says such oversight programs are costly and can delay patient access to medically necessary care.

Black Book releases the results of its Top EMR Vendor survey, which includes the top 20 EMR vendors in 10 different categories. The results are based on responses from over 4,000 users and each ranked vendor had to have at least 10 unique clients in order to be ranked. Black Box allows you to see the top 20 vendors in each category for no charge, but if you want details (including rankings), you must purchase the report (for about $3,000). That seems a bit pricey, especially since KLAS will give providers similar data at no charge.

eClinicalWorks takes silver honors in the Team Massachusetts Economic Impact Awards, given to businesses for their outstanding contributions to the state’s economy.

ProHealth Physicians (CT) selects CoActiv EXAM-PACS for the management of medical images across its 250-provider, 75-location practice.

The National Labor Relations Board files suit against an ambulance company that fired an employee for criticizing her supervisor on Facebook. The action prompts labor attorneys to remind physician practices of the need for social media policies that are not too broad. Practices have the right to establish social media policies, but guidelines should include specifics, including the requirement that employees not post anything that would harm the practice’s reputation, violate HIPAA regulations , or disclose patient information.

E-mail Inga.

Overcooked Turkey and Thankfulness

I am thankful that I was laid off. No, not from HIStalk, but from the last job I had before I begged Mr. H to hire me.

I spent several years in the HIT vendor world. Most of the time I was in sales, spending many hours a week in physician offices trying to convince providers and their staff that my offering would help them achieve the doctor’s office version of nirvana.

I loved sales. My co-workers were my closest friends. I generally enjoyed office managers and administrators, most of whom I found to be smart and dedicated. I loved most of the physicians (particularly those in primary care), though I thought some of them were … well, jerks.

Despite all the good stuff over the years, towards the end, I was more than done, kind of like the Thanksgiving turkey I once cooked about two hours too long. I had known for weeks that my position might be eliminated during company-wide efforts to trim costs. In the end, I was just another crossed-through line item on a bloated spreadsheet.

Happily, my parting gift included a healthy severance package, It gave me time to figure out what I did and did not want to do with the rest of my life.

Rather than immediately securing a job, I had the freedom to tell headhunters that I wasn’t interested in interviewing for another high-stress job with 70% travel. Instead, I invested time and a few dollars with a career coach, who encouraged me to think beyond the world of HIT vendors. All the while, I had a chance to work out daily, go to the grocery store in the middle of the day, read a pile of books, and catch up on lost sleep.

Of course I kept up with the HIT world, reading various online publications. HIStalk really was my favorite since it kept me up to speed with all the highs and lows over at my former company. One day Mr. H made a tiny mention that he needed “some help” and wanted to hire someone “who might work a few hours a week to handle routine stuff.”

It took me about 10 seconds to ponder the comment. I sent over an e-mail … and the rest is HIStalk history.

Of course, I am leaving out a lot of details, like the fact that I never meant for this to be a long-term gig. However, I got lucky: HIStalk has grown tremendously, we’ve added HIStalk Practice and HIStalk Mobile, companies keep sponsoring, and readers keep stopping by. And you couldn’t ask for a better boss than Mr. H, who has become a combination coach, mentor, and friend. He’s the only one I can always count on to laugh at my one-liner e-mails.

So, I’m thankful that I’ve been lucky. What if I had missed Mr. H’s tiny mention that day? What if Mr. H had been a jerk? What if, what if, what if …

In addition, I’m thankful that some companies write stupid press releases so Mr. H and I can make fun of them.

I’m thankful that I have over 1,000 Twitter followers, because it makes me feel important in a most pathetic sort of way.

I’m thankful that readers send me links to good online shopping sites. And, how can any real shoe lover not be thankful for Zappos.com?

For these things and so much more, I am thankful.

HIStalk is far more than the original “few hours a week” that Mr. H and I thought it would be. I’m thankful that I was freed from my previous career, because it allowed me to toss that overcooked turkey part of life and replace it with a big ole slice of homemade pecan pie.

E-mail Inga.

News 11/23/10

IBM, ActiveHealth Management, and Medens Corporation collaborate to accelerate EMR adoption in Puerto Rico. Medens will promote its Medens Cloud offering, which includes the IBM and ActiveHealth Management solution for collaborative care and SOAPware EMR and PM.

North Sunflower Medical Center (MS) plans to deploy McKesson Practice Partner EHR and RelayHealth claims and eligibility solutions for its 44 providers. The 25-bed hospital will also implement McKesson’s Paragon HIS.

The South Florida REC selects 10 EHR vendors to promote and facilitate EHR adoption.

The Bureau of Medical Economics, a non-profit billing company associated with Santa Clara County Medical Association and the Monterey County Medical Society (CA), picks gloStream as its exclusive medical practice software partner.

I inadvertently left GE Healthcare out of our recent HIT vendor executive discussion on helping doctors qualify for Meaningful Use. A special thank you to Vishal Wanchoo, president and CEO of GE Healthcare IT, for sending over an overview of what GE is doing to help physicians get their organizations ready.

American Medical News publishes a comprehensive overview of the current state of telemedicine, including details on how and where physicians are participating and why the industry will continue to grow. One reason telemedicine will likely expand: CMS is working to make it easier for providers to participate. For example, CMS will in January expand Medicaid coverage for remote services, including disease management for training patients with diabetes or kidney disease.

Speaking of telemedicine, American Telehealth Corporation launches myRealMD.com, an online medical consultation service that uses telehealth technology to connect to “real” doctors. The service, which offers plans starting at $10 per month, uses video chat, phone, or secure e-mail to connect patients and “real” doctors. Am I the only person who wonders if something is really “real” when the realness is overemphasized?

A small survey finds that only 16% of providers use an electronic process to send patient records for referrals. Most practices either use the telephone or provide patients with the details when referral to another provider.

A local paper profiles family practice doctor Bret Rosenblum, who says his paperless setup gives him more time interact more with patients, saves him money and storage space, and affords him the time and portability to provide house calls if needed. He’s using an Allscripts system, for which he is paying $700 a month for the next five years, to handle both billing and EHR. He has no other staff. There’s a certain irony in the fact that a digital system has allowed this physician to practice medicine in such a throwback fashion. Maybe things will change as he builds up his practice (he just opened the doors last month), but it’s a great story for now.

Elsevier offers a new iPhone app that provides First Consult users ready access to its clinical decision support resource tools.

Over the last 10 months, practices owned by hospitals and health systems have increased their EMR adoption by 11%. Adoption has grown fastest in midsize practices with six to 10 physicians; solo practices have seen the slowest growth. Research firm SK&A also finds that practices with more physicians, exam rooms, and patient volumes have the highest EMR adoption rates.

SuccessEHS introduces Mobile EHR for the iPhone, which allows physicians to view summary patient information, appointment data, and pending documentation. Providers can also use their iPhones to dictate directly into the SuccessEHS EHR.

Atlas Medical Software launches Atlas Mobile, an add-on module for the Atlas LabWorks order entry system. Atlas Mobile runs on the iPad and gives physicians mobile CPOE capabilities. Atlas also announces the launch of ION, a service to connect ambulatory EMRs with hospital and commercial labs. Atlas, which already connects to over 125 national and regional labs, says the ION network eliminates the needs for custom point-to-point interfaces.

Speaking of the iPad, the MedPlus Care360 EHR now comes with a native app for the iPad.

A new AHRQ report finds that most practices experience problems that potentially compromise patient safety. The study looked at 470 medical practices, over half of which had some type of an EMR. Overall, a whopping 86% say they’ve used the wrong chart for a patient at least once or twice in the last year and 70% said medical information had been filed, scanned, or entered into the wrong patient’s chart at least once or twice.

E-mail Inga.

Joel Diamond 11/19/10

Shut Up and Get Your EMR Already!

I don’t mean to sound so superior, but it’s enough with the whining already. Forget the early adopter thing. It’s been 10 years since I put an EMR into practice. 10 YEARS!!! Way before Meaningful Use and widespread broadband, we showed a return on investment, improved efficiencies, and better patient outcomes due to this technology. Yet I still must endure colleagues constant complaining about how difficult it is to adopt computers in their professional lives. 

So pardon my attitude today, but come on … my 80-year-old mother has a Facebook page and regularly communicates with her seven-year-old grandson using Skype. Did you ever see the TV ads for the motorized wheelchair, Hoveround (“you can go, go, go in your Hoveround”)? I hear the new versions will have GPS and WiFi. Please tell me that doctors “just aren’t ready for technology in their lives”.

And also don’t continue the old line that EMRs are “disruptive technology”. I’ll buy an argument that they are just not cool or dangerous enough. The “disruptive” argument doesn’t apply to things like … lasers. Think about it, like Dr. Evil in Austin Powers (“I didn’t go to six years of Evil Medical School to be called ‘Mr.’ thank you very much”) most doctors want “frickin’ lasers” everywhere.

Its true — there are papers written on how to reduce a one-inch carpal tunnel incision to ¾ inch using laparoscopic technique. In fact, I’ll bet you’d get a standing ovation at Grand Rounds for demonstrating how you lanced an ass pimple with a laser, compared to the yawns resulting from a presentation on how Information Technology saves lives.

I guess I shouldn’t be too harsh. After all, I am sure that it must be difficult for docs to employ this obtrusive technology while downloading the latest Angry Birds and iFart apps on their phones.

Speaking of iPhones, here’s one of my favorite lame excuses: I’m waiting for an EMR that will work exclusively on my smart phone. Yeah right. I’m sure your patients will be convinced that you are actually comparing trends in their complex laboratory values while your Flo Rida “Who Dat Girl” ring-tone is blasting in the background.

Here are some of my other favorite excuses (it’s best to read out loud with a nasal-whining voice):

• I’m concerned about hackers. This from a group of people that routinely purchase with credit cards over the Internet, trade stocks online, download music and (um)… movies… from untrusted sites.
• It’s too many clicks. Remember, people used to make this same argument about newfangled “word processors” compared to the good old-fashioned typewriter. Just stop sometime time and count the number of steps involved in manual routine tasks that we accept as normal.
• I’m not sure my patients would like me staring at a screen. No doubt. I’m sure that your patients feel the same about their banker’s preference of a computer over a handwritten ledger, and I’m so sorry that your only two choices are paper charts or an incredibly bad bedside manner.
• And (drum roll, please), my all-time favorite excuse: Patients will die! This is doctors’ trump card when talking to administrators and IT professionals. I heard this multiple times when our hospital turned off paper lab feeds in favor of electronic versions. That, too was many years ago. No one has expired as a result yet.

Come on… please… it’s enough already.

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.