News 2/1/11

NCQA’s new patient-centered medical home standards reinforce federal Meaningful Use incentives for primary care practices to adopt HIT. The PCMH 2011 calls for medical practices to be more patient-centered and includes Meaningful Use language embedded into evaluation standards. NCQA believes that practices meeting PCMH 2011 requirements will be well prepared to qualify for Meaningful Use and vice versa. Download here.

The 170-physician Florida Woman Care adds athenaClinicals EHR and athenaCommunicator. The practice is already an athenaCollector client. I also see from athenahealth’s blog that Dr. Catherine F. Vanderloos of Shreveport, LA was among the early recipients of a $21,250 EHR incentive check.

Amazing Charts releases AC OnCall, an app that gives providers access to their Amazing Charts records from an iPhone, iTouch, or iPad. Users can download the app for free for three months or pay a one-time fee of $24.99.

Delta Radiology Medical Group (CA) signs a three-year billing services contract with Zotec Partners.

Doctors Urgent Care (WV) installs Benchmark Systems’ EMR and PM system for its three urgent and primary care practices.

Most doctors want to share patient information electronically with other providers, according to a new Markle survey. Almost half of doctors would also like to share records with patients electronically and 65% believe patients should be able to download their personal health information online. PHR adoption continues to be slow, with only 10% of the public claiming to maintain one. But, that’s up from 3% in 2008.

Michael Last Internal Medicine chooses the Waiting Room Solutions Internal Medicine EHR and PM product.

Holy Name Medical (NJ) selects Aprima’s EHR/PM software as a recommended and subsidized solution for its affiliated physicians.

AMA announces it is working with Covisint to help physicians receive reimbursements from CMS’s PQRI program. AMA members are eligible for discounts for the Covisint DocSite, a web application for submitting data for 2010 PQRI reporting.

Epocrates looks to raise $75 million in its IPO, which is scheduled for February 2. Epocrates is seeking listing on the NASDAQ exchange under the symbol EPOC.

AMA spent more on lobbying efforts last year than any other healthcare group. AMA shelled out almost $22 million, which was a nine percent increase over 2009. AHA was also a big spender, with almost $18 million in expenditures.

Men and the chronically ill are most likely to support remote monitoring and virtual visits. Nearly half of the 1,000 adults in this survey are receptive if it saves time and money; 23% said they would never consider a remote visit with a doctor.

Doctors report that one in 18 patients are considered difficult and more likely than others to stay sick. “Difficult” patients were defined as those more likely to have worse symptoms two weeks after their visit. Physician experience makes a difference: doctors with less than 10 years of experience report that 25% of visits are difficult, compared to just 2% of visits for physicians with more than 20 years experience.

The Florida Academy of Family Physicians recommends Ingenix CareTracker as a PM/EHR solution to its members. FAFP members are eligible for discounts on monthly subscription fees and implementation services for the product through the HIT distributor CareTracker Partners.

Providers can buy insurance to protect themselves from financial losses associated with data breaches. Agents see small group practices as good targets since most offices lack internal resources to manage security concerns. It’s pricey though: $5,000 a year will get you $1 million of protection for up to five physicians. Insurance covers fines, patient notification costs, credit monitoring, investigation, legal defense, and even PR-related costs to rebuild the practice’s reputation.

E-mail Inga.

News 1/27/11

From: Maybe Confused “Re: Certified EHRs. I understand that to qualify for Stage One Meaningful Use you only have to use five of 10 objectives on a menu set. Does that mean my EHR can be certified for just those five components? Or do all 10 objectives need to be certified? Confused.” I did a bit of digging and found a similar question on ONC’s FAQ section. Bottom line: you must possess EHR technology that meets ALL certification criteria, whether you use all of them or not. That could be a single EHR product with complete certification, or, multiple products with modular certification to cover all requirements. And, I agree; it’s quite confusing.

First we learn that EHRs may not improve care. Now researchers say that pay for performance programs have no effect on patient outcomes. A study out of the UK finds that paying doctors financial rewards to meet targets for improving patient care made no discernable difference to the health or treatment of people with high blood pressure. One researcher concludes that the government and private insurers “are likely wasting many billions on policies that assume that all you have to do is pay doctors to improve quality of medical care.”

Baptist Health South Florida selects IOS Health Systems’ Medios EHR for its Physician EHR Donation Program. I believe “Physician EHR Donation Program” is just a clever name for the hospital’s initiative to subsidy EHR for their affiliated physicians. Medios will also provide a connection to the hospital’s Siemens Net Access System.

Citing tight economic conditions, the ONC extends the amount of time it will cover most of the costs for RECs from two to four years. With the original four-year grant program, RECs would have been responsible for only 10% of costs during the first two years and ONC would pay 90%. In the final two years, that ratio would have switched. The ONC now plans to pay of 90% of costs for four years.

PrimeCare (FL) selects Doctors Administrative Solutions (DAS) as its EHR vendor of choice. PrimeCare will implement DAS’s personalized version of Aprima Medical Software EHR in 12 of its owned practices.

EMR vendor gloStream offers practices a full refund on software and services if physicians aren’t back up to their usual full patient load within 15 days of the implementation completion. As Mr. H mentioned in HIStalk yesterday, the offer sounds great but be sure to read the fine print.

Nuesoft Technologies updates its brand with a new set of logos and updated color schemes. They are looking for feedback here.

Healthcare Administrative Partners hires two new managers for its billing, coding, and medical practice management consulting business. Former Advisory Board product manager Yukki Lam will serve as a practice manager; former NextGen and Siemens Healthcare analyst Carol Smith will take over as Director of Data Analysis.

Office Ally says over 340,000 providers now use one or more of its products, following a 36% increase in users in 2010.

Need a free web-based patient appointment reminder tool? HealthCollaborate releases a free module to that sends automated appointment reminders via email or text messaging. In looking at their website I didn’t see any sort of “catch” for the service, but did note the company offers a number of other services for a fee.

The publisher of The Wall Street Journal files suit in US district court, seeking to overturn a thirty-two-year-old court order barring public access to a confidential Medicare database. Publisher Dow Jones & Co. says access to the database is essential to rooting out fraud and abuse in the Medicare program. The AMA has long argued to keep the records secret, saying that to disclose how much money individual doctors collect would violate their privacy. Health-care advocates, law-enforcement officials and others argue that access to the data would expose instances of fraud, ease evaluations of the quality and cost of care, and help ensure the government is doing everything it can to protect taxpayer funds. I say it’s public funds and taxpayers deserve to know how the money is being spent.

E-mail Inga.

Intelligent Healthcare Information Integration 1/26/11

Root Beer & Hope Floats … But Not All EHRs

This week, a colleague from Georgia wrote me about his parallel EHR search. His group had also ended up choosing Peak Practice after an exhaustive search, a search they have also again begun, looking for its replacement. But, after a few nice words about following along here on HIStalkPractice, yadda, yadda, his next three sentences were perhaps the most telling:

“Anyway, we’ve been busy doing our own demos. Initially, I wanted to be very thorough and consider almost all that’s available. My partners are not as patient and I’m getting tired of it, too.”

He then asked about a few specific products: two pediatric specialty-specific (Office Practicum and PCC) and two more broadly focused (Greenway and athenahealth). He mentioned several more that he had “no desire to even look at” and finished with another telling statement/question:

“I know nobody can predict the future of mergers, acquisitions, and decline of once solid-looking products (Encounter Pro, and Clinician/PeakPractice, etc.) but do you have any insider information or gossip from the health IT industry about the stability of and future direction of [EHR vendors]?”

Boy, oh, boy, Dr. Bu, are you feelin’ me, or what?!

To top it off, on that very same day, a market analyst at Software Advice, which provides software selection services for multiple industries, wrote me and I quote:

“In short, the EHR market has accelerated as a result of government subsidies. But vendors are having a tough time keeping up with the growth. As a result, we expect to see major consolidation in the market. Some will get acquired, others will just get left behind.”

Ain’t that the truth? The CEO at Software Advice, Don Fornes, had recently written a good piece on EHR Vendor Viability. In it, he notes that it’s not all about size, that execution and corporate management will be key. He further notes how tough it is for providers to assess the financial viability of EHR vendors and suggests that we could use a good A.M. Best for EHRs. Of course, he offers their Guide to Assessing Medical Software Vendor Viability, which, I promptly downloaded – also, “of course.” (Obviously they are trying to promote their software selection service, but at least it’s free to providers).

This line from the very first page started the old smoke drifting up from my ears again: “Or let’s say the vendor doesn’t go out of business, but they get acquired by another company. In this case the acquiring vendor informs you that they will ‘sunset’ the product and cease support within two years.” I couldn’t tell whether their guide was written before or after my birthday last year, the day I learned about the sunsetting of my EHR, but I sure wondered. It seemed as they had written it directly at/to me!

While I enjoyed reading what Don had written and what their Guide said, it still left me with same sour after-aroma that Dr. Bu and I now smell (i.e., having lived through three acquisitions of our chosen product, we can now only to watch it rot like a pumpkin in the sun after being sliced from the corporate vine). And Don’s article, while informative about the current state of the industry, only heightened my sense that rotting pumpkin aroma will be spreading from more EHR vines soon.

So, when it comes to concerns about the longevity potential of my next EHR and its vendor’s financial viability, unless I want to pay some consultant fees which I can’t afford, I’m left to a few choices:

1) Go with what my VAR (the original source of my current EHR) chooses and hope they’ve done good homework;

2) Go with one of the choices of my local REC and hope they’ve done good homework;

3) Try Software Advice’s “free FastStart Consultation” and hope they’ve done good homework;

4) Await the “A.M. Best for EHRs” (which may never come) and hope they do good homework; or,

5) Look for guidance from my Higher Power and hope I do good homework.

Best I have right now, Doc Bu. (I do recommend a good nose plug, just in case nobody does good homework. And naps. Naps are good. EHR hunting IS exhausting.)

From the trenches…

“Hope is the feeling that the feeling you have isn’t permanent.” – Jean Kerr

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 1/25/11

From Tina Goodman: “Re: Weno Healthcare. OpenEMR was removed because Carol Bean, at ONC said we could not share customers with e-community and testing/certification. Her verbal and written warning was that is was a significant issue and we must have ‘clean lines.’ Then they approved Surescripts and another company that did not have ‘clean lines.’ We have been denied a fair process and I have all the evidence to support our compliance.” Goodman is CEO for Weno Healthcare, which was recently denied approval as an ONC-ATCB. I noted last week that Weno’s OpenEMR product was no longer offered on the Weno Web site and Goodman provided this explanation. I have asked Carol Bean, ONC’s division director for certification and testing, for a comment on the subject, but haven’t heard back.

Cardiac Science Corporation completes certification for its HeartCentrix monitoring solution to run with Allscripts Professional EHR.

Louisiana Medicaid issues an EHR stimulus check payable to Winn Community Health Center, making it the first FQHC to receive funds. The clinic was initially established with the help of a $1.3 million ARRA grant. Winn Community runs SuccessEHS as its EHR.

Billing service Broadleaf Health (CA) selects Kareo’s medical billing software.

Billing and practice management service provider AdvantEdge Healthcare Solutions appoints J. Paul O’Haro as COO. He’s the former president and CEO of CompOne Services and also spent time at Per-Se.

Digital Assent secures $2 million in Series A equity financing. The company is the creator of  PatientPad, a self-service check-in and patient education tool that facilitates the collection of patient information, insurance verification, payment collections, and the signing of consent forms.

A new study out of Stanford University suggests that EHRs provide no clear improvement in care quality in the outpatient setting. Findings were based on over 250,000 outpatient visits between 2005 and 2007. Of 20 indices of care quality analyzed, only diet counseling for high-risk adults showed significantly better performance in EHR-related visits compared to conventional record keeping. Critics contend the findings may be irrelevant to today’s current EHR systems, which include more clinical decision support tools.

Cumberland Consulting Group promotes Matthew Good and Michael Worner from principals to partners. Good is a former consultant for Ernst & Young and is currently managing an EMR implementation for more than 550 physician practices. Worner is a former consultant with CSC and analyst with SAIC.

The new FAIR Health database, created under agreements with the New York attorney general’s office, is set to launch by late January. The database will be designed to show what is considered a "usual, customary and reasonable" payment rate for physician services and serve as a fair and transparent source for evaluating out-of-network reimbursement.

HIStalk Practice has just hit a new milestone with 1,000 confirmed e-mail update subscribers. When Mr. H suggested we start HIStalk Practice two years ago, I thought it was a terrific idea – until I realized he wanted me to run it. However, he persuaded me to give it a go and it’s all turned out better than I ever expected. Thankfully we’ve had supportive sponsors from the start, as well as a steady flow of new ones. Dr. Gregg Alexander has been a great addition with his regular from-the-trenches insights. Thanks, readers, for stopping by and for continuing to send new friends our way.

South Florida Health Technology REC selects Greenway’s PrimeSUITE 2011 as a pre-qualified EHR solution. PrimeSUITE has been selected as a preferred product with at least nine other RECs.

Speaking of Greenway, please join me in welcoming them as HIStalk Practice’s newest Platinum sponsor. A long-time HIStalk sponsor, Greenway decided to extend the love over to the Practice site. Greenway’s been in the EHR/PM business since its 1998 founding by W. Thomas Green Jr.  the company’s current chairman of the board. Its core product is PrimeSUITE, which is used by more than 23,000 healthcare providers in 31 specialties. PrimeSUITE just won two 2010 Best in KLAS awards in the ambulatory EMR and practice management categories and PrimeSUITE EHR has earned ONC-ATCB 2011/2012 Complete EHR certification. Other Greenway solutions include PrimeSpeech, PrimePatient, PrimeExchange, PrimeResearch, PrimeMobile, PrimeRCM, and PrimeEnterprise. Give their ad  a click to learn more. A big thank you to Greenway for supporting HIStalk Practice.

NextGen is offering a webinar demo of its Patient Portal, version 5.6 SP1 on Wednesday, January 26th. Details here.

New Jersey says it’s serious about accountable care organizations, approving legislation to enable the formation of five ACOs across the state. New Jersey lawmakers also agree to pay bonuses to participating providers based on the anticipated savings from reduced medical costs and improved patient health.

E-mail Inga.

HIStalk Practice Interviews Dan Nelson, Practice Administrator, Desert Ridge Family Physicians

Dan Nelson is practice administrator with Desert Ridge Family Physicians of Phoenix, AZ. He recently testified before the HIT Standards Committee’s Implementation Workgroup.

Give me some background on the practice.

The practice was started about 6½ years ago. When we opened, we started with NextGen in-house. We host all our own servers. That’s all internal. We retained control of all of that.

Because we started six years ago with NextGen, we really had a substantial head start on all of our infrastructure, and I guess in getting ready for Meaningful Use. I really had no idea that this was coming. Once it was all laid out, we found that we were really well situated for it.

You’re a six-physician family practice, correct?

That’s correct.

You’re using NextGen for the practice management application as well as the EHR?

That’s right. We also have NextGen’s Internet portal as well for patient communication.

Tell me about the experience of testifying for the HIT Standards Committee. How were you selected and what were some of the overriding messages you heard from other presenters?

I have no idea still how we were selected. We’ve been certainly involved with NextGen and a team of user groups. Because we’re a rich user, we talk with them to some extent. We’re very involved with our local Regional Extension Center, and because of how well-situated we are, we’ve done the best that we can to help them. We also had previous relationships with members within the REC, so that helped. Recently, just a couple of months back, when the ONC had come in town, they had brought back some members of the ONC to come and visit us. 

Which one of those was directly responsible or just added to us getting selected, I have no idea. When we got the call that we were invited to participate, it was really a shock to us. It was really interesting to participate in the panel.

I think the biggest thing that I took away was just how much they’ve actually accomplished in a very short amount of time. In my eyes, the program has been extremely successful — in less than in two short years, to bring electronic health records to the forefront like this program has. I think it’s a huge success.

When you watch the news, you see all the political divisions and people fighting, but I was really impressed with the committee. It was a big group of people all working for a common goal. Certainly there’s some different viewpoints and whatnot, but I was really impressed with the work ethic that everybody on the committee had.

In terms of the feedback that presenters gave the committee, were there any big issues or problems that were consistently mentioned or was it a variety of issues?

There was a whole host of issues. There were some commonality in viewpoints. Certainly I think there were a lot of little details that can use some fine-tuning, maybe some better communication coming from the ONC on interpretation of rules. But I certainly understand that each one of those interpretations was a single case, and so it’s going to be very difficult to make all those determinations. I certainly understand ONC having difficulty answering all of these questions.

On Day Two, there was even a little bit of pushback on electronic health records to begin with. That was fascinating to witness.

I read over the written testimony that you submitted. One of your comments was that the technical bar to meet Stage 1 of Meaningful Use is quite low for most of the vendors, but you think many of the vendors may have difficulty meeting Stage 2 and 3 requirements. If that’s the case, do you predict a shakeout of EHR vendors or do you see a lowering of that bar?

It’s difficult to say. I can only see a very low level from my position of a small practice administrator.

There’s something like 250 EHRs that have been certified by one body or another. That number astounds me. In looking through that list of the 250, I certainly see some EHRs that I don’t think should be on there. I don’t think they would be even be considered an EHR by some people.

I would caution any practice out there that’s in EHRs to not go with the cheapest one or the very basic one just as an attempt to get some Meaningful Use dollars. In my mind, that’s not what this program is for.

I’ve heard some practices made statements that the incentive won’t even cover the entire cost of the EHR. In my mind, I would be shocked if it did. I don’t think that it’s a program to make money off the government. I mean, for the program to improve your medical practices and help lessen the blow for that transition, but certainly it’s not a way to make extra money. I would caution any medical practice out there when making the choice, make the right choice for the long term and choose a quality EHR.

My biggest fear is that if these — I’ll call them under-qualified EHRs — are successful, and there’s a large market that they hold, then it will be very difficult to have serious Stage 2 or 3 criteria. I think that’s where we’re really going to start seeing the savings and the efficiencies and the quality improvements from sharing information on most medical practices. That’s what I’m really looking forward to in all of this. If at the end of the three stages all we have are a bunch of islands of electronic practices, I don’t think we’ve gotten our money’s worth. But if at the end we have an interconnected medical community, then I think that this will be a worthwhile program.

Tell me some of the challenges that you’ve experienced communicating with other providers. For example, establishing interfaces with the hospital and using external portals with insurance carriers and others.

I’m really not a fan of portals. We connect to probably 20 different portals on a daily basis for one reason or another. Most of those are health insurance companies. There are also labs, radiology, hospitals. For every single one of them, each user is supposed to have their own login name and password, but of course you don’t want to duplicate any of your login names or passwords across multiple portals. Just the management of those passwords is a nightmare. Besides that, it’s not part of their flow. When they’re seeing a patient and then they have to go and log on to some portal, it takes them out of what they’re doing.

Our goal is to have everything embedded within our EMR system. To do that means we need to be interfaced in one way or another. Up to this point, that’s been a rather difficult thing to do, but I think that has more to do with the state of information exchange than it does interfacing difficulties. The problem right now is in order to interface, it’s a single practice interfacing to a single carrier, and that carrier has to interface with every single practice. When you want to interface with a second carrier, that’s a whole other project, and they have to build a thousand interfaces.

So once we get to the point that exchanges are realistic, we should be able to connect to the exchange, and then by extension, we connect it to many different sources of information. But that’s what we’re looking forward to. In Arizona, our exchange is not ready for that yet.

How are you doing data exchange with your hospital?

With our hospital, we connect to them through a portal. I guess it just has all the same problems that portals do. We’re not proactively notified that we need to be logging into the portal. When we get to the portal, we don’t really have an expectation of what we’re going to find. We log in and then we find out what’s there. They are working always to get us interfaced into more of an exchange, but there’s just a lot of work to be done.

You had mentioned in your testimony the need for discrete data and that your hospital vendor was surprised that a huge data dump of information was not a sufficient solution. Is that still an issue for the practice?

Oh, absolutely. When talking about discrete data, my first worry is there’s going to be a bunch of EHRs that really aren’t capable of handling discrete data. They will just have big, huge text blobs of a bunch of information the physician then has to weed through. Or, it could be exchanging of large PDFs of information instead of, say, lab information, instead of having that lab as discrete data that could be properly imported.

My hope is that the EHRs are capable of using discrete data and then the exchanges can be capable of exchanging it that way. That remains to be seen. Certainly the technical complexity of discrete data is going to be far higher than just exchanging blobs and PDFs, but then the benefit of the discrete data will be the usability. If that information could be imported by our EHR and put into proper categories and spaces, then it’s very useful for our physicians. Otherwise, we get a whole bunch of documents that we have to read and it’s not usable in a full sense.

Is your hospital working to make the process better or are their hands tied due to the vendor?

I’d say it remains to be seen. I don’t know enough to know which way it will end up being. Actually, I think that’s a desire to make sure that their exchange is useful, but it’s difficult as well. I have hopes that they’ll do it the right way. But we really are a ways away from these types of things. I think they’re still all in the planning stages and they’re not rolling out an exchange yet.

Shifting gears a bit, why do you think it’s so much harder for smaller practices to adopt EHR?

We have — and I say “we” because I have many of the same problems, even though we’re a couple of steps ahead– but we still have all these same problems. We have too few people, we have a small practice environment, and you need to run a lean organization. We have too little time.  Especially in primary care, there never seems to be enough time, and certainly too little money.

I think the Meaningful Use program helps with that end. I think the Regional Extension Centers help with too few resources and too little time. They really can be a great asset in assisting practices and feeding them the right way and making sure we don’t need to learn everything ourselves. We have very useful guides. 

Another thing for our small practice is that there’s probably too little expertise. We’re getting into some very complex areas of IT and vendor selection and things of that sort, and that’s not always an expertise that a small practice has in-house. All those things add up. It’s difficult for the small practice environment to tackle a project this large.

Are you seeing in your area a lot of consolidation with practices?

Yes, we are. There’s absolutely a lot of acquisition going on in our area.

I trust that’s something that your practice is trying to avoid at this point?

I don’t think that I’d word it that way. It’s something that we’re not interested in. I don’t believe it’s the right move for healthcare. I don’t think that it will improve quality. I think that it increases complacency and I think that it’ll lessen innovation with all that acquisition.

You noted in the testimony that NextGen is a top-tier EHR. How do you respond to practices that say they simply can’t afford an EHR like NextGen, so they select one of the lower-end options?

I certainly don’t think that one size fits all. I wouldn’t try to necessarily talk a practice into going with NextGen or to spend a lot of money to get the very best. They have to do what’s right for them, what’s right for their technical abilities, what’s right for their flow.

I would show a practice what we’ve been able to accomplish with NextGen and try to make the case that by spending some extra money, you can get these efficiencies and these capabilities in return. That may or may not be worth it to them.

When we started off, we were a brand new practice with no patients and made the decision to with NextGen. We’ve never regretted it. We’ve been able to do some pretty amazing things with NextGen. That’s not to say that every practice could do what we’ve done or that any practice would want to do what we’ve done. They have to make a decision for what’s right for them.

I would just make sure that they are paying attention to the direction where healthcare is going. Practices being interconnected to each other and to exchanges. Make sure they have a system that won’t hinder their abilities to do so.

Any other thoughts on your testimony or EHR that you’d like to add?

Maybe only that I feel very fortunate that I’ve been able to participate with the committee hearings and that I’m really optimistic about the future seeing the great work that’s been done, how much they’ve accomplished, and how successful they’ve been at bringing a focus to electronic health records for the medical industry. I think it’s a huge jump start to where we want to take healthcare.