DOCtalk by Dr. Gregg 7/30/11

Stage General

Knowing how much Mr. H enjoys his tunes, I found myself thinking of him and the whole HIStalk world last night when I was attending a benefit concert for our local Madison County Health Partners Free Clinic. (I know…sad, right? Thinking of HIT during some rare time out for a charity benefit … sigh.)

First off, the setting: the First Presbyterian Church here in little London, Ohio. Packed to the gills and then some. On stage: a homegrown, 18-year-old, multi-instrumental phenom named Chase Potter, along with a cornucopia of very talented musicians and singers from 18 to well past 18 who enter and leave through a nonstop revolving door process orchestrated seamlessly by Chase.

The music: another cornucopia, with lots of jazz, swing, gypsy swing, blues, gospel, big band, rock, French impressionist, and more, including some rather complex and moving original tunes penned by Chase himself.

To say that this guitar-bass-violin-alto sax-drum-playing young man is talented is sort of like saying Mr. H knows a thing or two about HIT. Truly, when I used “phenom” to describe him, I chose that word very specifically. As I mentioned, he had assembled a group of talent for this night which included some very fine artists: some younger and skilled, some quite well experienced with histories of playing on the world’s bigger musical stages.

All were very good. Chase, however, was the sun around which all these satellites revolved.

Now, from my past life as a rock-n-roll sound man, I know that almost everywhere you go, there are musical talents galore. Every city, town, village, and burg seems to have a group of amazing musicians that, but for fate or circumstance, could all be gracing the cover of Rolling Stone or kicking it at Carnegie Hall. But, some cream just seems to be destined to rise higher. This kid is that highest-rising of creams.

Technically, he’s good. But, he adds that Stevie Ray Vaughn quality when embracing an instrument; he sort of becomes a part of the instrument, melding himself into it so that the music which flows out is more of a collaboration than a performance. It makes the music more of an experience than a listen.

OK. He’s hugely talented, right? Sure, but, what captured the HIT side of my brain, though, was that this kid had this natural “stage general” capability that was flawless. With almost every song, he exchanged one set of musicians with another, rotating them in, out, and back in again with lighthearted verbal dexterity and an effortless, suave stage presence that most veteran performers would envy.

Bringing up singers, pickers, piano men, and this horn or that, he made the show flow seamlessly. Despite all of the ins and outs and “who’s on whats” that were constantly occurring, he was the consummate conductor and more. This stage general was directing the musician “troops,” staging the musical “attacks,” and commanding the attention of all.

Exactly what the world of HIT needs.

No, I’m not speaking of Mostashari and ONC. I’m speaking more in terms of medical IT tools that work in concert allowing a central conductor to orchestrate their harmonies. We need systems that don’t need to be the one-man band trying to do it all as much as we need good “stage generals” who know when to bring certain pieces into play, when to send others back to their seats, and what to say to the “audience” during the down time between “songs.”

Just as no one-man band can ever outdo a full orchestra, no single HIT performer is ever going to outshine the combined power of a coordinated set of “hot” players.

Perhaps this thought was also motivated by the recent Innovator Showcase on HIStalk. The product promo’ed there by Aventura certainly seems to be focused upon playing a specific role in the HIT ensemble, but also has some of the generalship which I saw in Chase. They aren’t the overall stage general, though they appear to have some conductor in them. They seem to understand that their role is to facilitate the bigger picture, to make the whole orchestra better.

Powerful, joltingly good HIT parts and pieces are out there, but they can’t get onto the same stage. Just like a mess of musicians milling about tuning up before the show, it’s an asynchronous cacophony. If they could be allowed to perform together, with a good stage general/conductor, what a symphony we might have.

I know it’s wish list stuff, but thinking of it in an HIT tangential, I hope we see more development of HIT stage generals who allow lots of other players on stage, bringing in their supporting talents, knowing when to bring ‘em up and sit ‘em down, and who can also, just like Chase, make me smile between songs …er, I mean patients.

From the trenches …

“The principal task of a conductor is not to put himself in evidence but to disappear behind his functions as much as possible.” – Franz Liszt

PS – In case you were wondering, Melissa Canney, the Free Clinic’s director and one of the best people walking the planet, told me this afternoon that Chase et al generated some $4,000 in donations. Quite a bit better than the standard bake sale!

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 7/28/11

Michigan Eye Institute chooses SRS ERH for its eight provider, five-location practice.

MGMA calls on HHS to withdraw its proposed HIPAA accounting of disclosures rule, which would require practices that maintain an EMR to have the capability to produce a detailed report of every instance a patient’s information is accessed by any staff member for any reason, including claims submittal.  MGMA notes that because over 90% of surveyed members believe the proposed rule would be “very” or “extremely” burdensome, an unintended consequence could be that practices avoid implementing EMRs.

Ampla Health chooses MED3OOO’s InteGreat EHR for its eleven FQHC and community health centers.

Telemedicine and telehealth technologies may address an increased need for quality healthcare in rural locations, according to a report by the UnitedHealth Center for Health Reform & Modernization. The report calls for the expansion of broadband connectivity to facilitate telemedicine adoption, a reduction of regulatory barriers for using telemedicine technologies, and improving and aligning reimbursement to encourage greater telemedicine use across rural settings.

Five providers from Aquidneck Medical Associates (RI) are among the first in the state to receive an $18,000 check for their Meaningful Use of eClinicalWorks’ EHR.

Kremer Eye Center (PA) selects NexTech’s EMR/PM and marketing software for its 11 surgeons and eight optometrists.

DrFirst introduces EPCS Gold version 2.0, which support electronic prescribing of controlled substances, based on individual state laws and the ability of the receiving pharmacy to meet DEA’s requirements to process the prescriptions.

HITEC-LA, the REC for Los Angeles, adds Greenway Medical to its list of preferred EHR vendors.

Epocrates announces first phase availability of its Epocrates EHR mobile and Web-based EHR, which is designed for primary care practices with 10 or fewer physicians. Epocrates will also offer a license to a native Apple iPhone app that supports remote patient look-patient look-up, schedule access, and e-prescribing capabilities.

Physician offices added 5,000 new jobs in June; the healthcare sector as a whole added 13,500 jobs.

Almost half of physicians who use digital tools to access prescription drug information would like to view the information on their smartphones or iPads, according to a Manhattan Research report.

Please join me in welcoming Preceptor Consulting as HIStalk Practice’s newest Platinum sponsor. Preceptor provides HIT training and support services and over the last five years has provided system design, building, testing, and go-live support for over 500 facilities. Preceptor specializes in EMR support and resources for multiple systems, including Epic, Cerner, McKesson, Allscripts, Napochi, and NextGen. Mr. H and I are very thankful for Preceptor’s support of both HIStalk Practice and HIStalk.

The AMA and 91 other medical associations send a letter to Dr. Donald Berwick expressing concern that healthcare providers will not have enough time to react to CMS’s newly proposed changes to the e-prescribing program.  Specifically, the medical associations contend that providers won’t have time to apply for exemptions and are concerned that CMS has not provided an additional reporting period in 2012 for physicians who don’t comply with the 2011 e-prescribing requirements. The medical groups assert there should be no penalties applied until 2013 against a physician facing a 2012 e-prescribing penalty.

E-mail Inga.

News 7/26/11

The local press highlights Western Wisconsin Medical Group and its success implementing Cerner Ambulatory EMR. The paper notes the 55-physician practice is the “first medical group in Wisconsin – and perhaps the entire United States – to have all its doctors using electronic medical records.”  I am sure plenty of practices across the country would beg to differ.

Speaking of Cerner, I notice that Saint Barnabas Health Care Systems (NJ) is promoting its Physician Community Connect Program, which extends discounted pricing  for Cerner EMR. Saint Barnabas is subsidizing the purchase of Cerner EHR by the lower of 85% of implementation-related fees or $5,000 per physician.

e-MDs joins eClinicalWorks, Greenway, NextGen and Sages as Preferred EHR Partners for the New York eHealth Collaborative (NYeC) REC. The preferred partners offer special pricing and contract terms for REC participants. NYeC  also recognizes another dozen EMR vendors who have completed a vetting process and are designated as  “Meaningful Use Partners.”

The American Academy of Ophthalmology (AAO) develops a list of EHR requirements for ophthalmologists seeking to achieve Meaningful Use incentives. The recommendations address how EHRs should accommodate certain areas of ophthalmic practice, including supporting documentation between the office and operating room; capturing and displaying vital signs of the eye; and incorporating hand-drawn sketches or annotations into records.

The AAFP partners with Avatar International to launch an online patient survey portal for gathering and analyzing patient feedback. The survey gathers information required for medical home recognition, including data on patient satisfaction, timeliness of providers, and provider accessibility and communication. Aggregated data is shared with AAFP. Price tag: $150/year for AAFP members.

The 50-physician St. Joseph’s Clinic (AR) adds MedQuist’s clinical technology and transcription services

The Tampa Bay Business Journal names Doctors Administrative Solutions, an ambulatory EMR implementation firm, to the region’s list of 50 fastest growing private companies.

UT Physicians, the 900-provider faculty practice for The University of Texas Health Science Center at Houston, expands its agreement with McKesson’s Revenue Management Solutions to include coding for the anesthesia and radiology departments.

The median compensation for practice managers remained relatively flat from 2009-2010, according to MGMA. Administrators in practices with six or fewer FTE physicians earned median compensation of $86,459, a slight decrease from 2009. Median compensation for administrators in seven- to 25-physician groups earned an average of  $115,000, which is 0.28% increase from 2009.  Large group administrators earned an average of $150,756.

E-mail Inga.

News 7/21/11

Beacon Partners announces the expansion of its Allscripts service lines to include consulting for Allscripts MyWay, Professional EHR, Enterprise EHR, and Practice Management.

The Reading Hospital (PA) selects PivotHealth to provide physician practice management services for its affiliated physicians. The hospital also names Gregory Lutz executive director of The Reading Hospital Medical Group. Interestingly, Lutz was most recently was a SVP with PivotHealth.

Cardio Pulmonary Diagnostic (NJ) and Hudson County Cardiovascular Care (NJ) contract for McKesson’s Practice Complete EHR and PM system.

AdvancedMD announces the release of its ONC ATCB-certified EHR 2011 solution that includes an enhanced patient portal, new Meaningful Use reporting tools, and utilities for submitting immunization and health surveillance data.

The seven provider Premier Medical Clinic (FL) chooses MedicsDocAssistant EHR from Advanced Data Systems.

For practices implementing EHRs, perhaps it’s mildly comforting to know the process is not any easier for physicians in Canada. The Canadian Medical Associates Journal (CMAJ) highlights some of the more common complaints from physicians adopting EMRs (most sound mighty familiar):

• Vendors give hard sales pitches and will try to sell items that aren’t necessarily required
• Software often comes with glitches
• Training is not always up to standard
• Practice administrators do not sufficiently involve physicians when selecting an EMR
• Government certification programs for EMRs don’t  address software usability or clinical needs
• Clinical data is not easily shared between systems.

The 13-physician Kootenai Imaging (ID) chooses McKesson Revenue Management Solutions, including preparation for ICD-10 coding changes and PQRI tracking.

DrChrono.com incorporates M*Modal’s Speech Understanding technology into its EHR application, making it the first medical speech-to-text functionality for the iPad. Check it out above.

Findings from an MGMA survey indicate that almost 70% of practices are in the process of becoming a patient-centered medical home and 20% are already accredited. The top challenges for PCMHs include establishing care coordination and modifying or adopting an EHR to support PCMH functions.

Surescripts recognizes Allscripts as one of seven Gold Solution Providers for e-Prescribing. Surescripts also awards e-MDs its White Coat of Quality.

The AMA introduces AMA Coding Online, a website that offers coding, billing, and compliance resources. Pricing for the tools range from $185 to $800 for a one-user, one-year subscription.

E-mail Inga.

Joel Diamond 7/19/11

Technology Reflections of the Past Decade

Ahhh, the dog days of summer. Hot afternoons followed by soothing evening breezes, with care-free children chasing fireflies.

The recent summer solstice sadly reminds me that 2011 is halfway gone, and I reflect on the past decade. So much has changed. The fear of Y2K was quickly overshadowed by 9/11. Technology seems to be no longer an accessory, but an intrinsic part of our day-to-day (rather, second-to-second) frenzied lives, deeply woven into our culture.

So with the first half of the first year of the second decade of the second millennium nearly over, let us look back on the incredible changes that have taken place in the past ten years—as well as the amazing transformation of physicians’ attitude towards information technology.

• Over the past decade, heart disease deaths have decreased dramatically by 40%. The routine use of cardiac stents and statin drugs have much to do with this.
• 10 years ago, cardiologist actually wrote illegible progress notes on paper. A decade later, the quality of ink in pens has markedly improved, making these records appear more vibrant and “easier to read.”

• The rise in information technology has shown a fascinating trend over the past 10 years. Some estimate that the use of CPOE has approached the remarkable 10% level.
• A decade ago, most physicians obtained pornography by looking in magazines or renting VCRs. This has vastly disappeared today, as doctor compliance with Internet pornography approaches 98%.

• Speaking of VCRs, the last 10 years has resulted in their eradication, much like dracunculiasis (also known as the Guinea worm.) Even the DVD has largely been replaced by newer technologies. The soon-starting medical student class of 2016 is completely unfamiliar with the phrase, “Programming my VCR is so difficult that only a brain surgeon could do it,”
• Despite loss of financial incentives and eventual penalties looming in 2016, the majority of neurosurgeons do not have current plans to adopt EMR technology. However, most report greater job satisfaction in 2011 despite long work hours since they seldom miss their favorite shows now that they can “TiVo them.”

• In 2011, a fascinated audience watched a computer named Watson successfully compete on the game show Jeopardy, reflecting a new era of Natural Language Processing and the prospect of vital data mining from spoken and written word. In parallel, health care analytics attained new heights as more discrete EMR data became available.
• While other industries have moved from a quaint vision of subservient secretaries “taking dictation,” doctors in 2011 have maintained this charming tradition with an unrelenting grip on their olde worlde “Dictaphone.” Some icons are worth holding onto in this gadget-crazed world of ours.

• In the year 2000, the Human Genome Project finalized the mapping of our entire DNA, leading to exciting advances in targeted gene therapy and personalized medicine.
• Today, 90% of doctors use Google Maps. Advances in Global Positioning Satellite technology have allowed many of these practitioners to use these digital maps to guide them through the complicated route from home to hospital. Interestingly, less than 1% of these clinicians report the similar use of handheld devices to routinely access vital patient data. By contrast, gene technology is beginning to see clinical benefits in 2011, although the wearing of jean shorts (or as couture designers refer to them, “jorts”) has been largely confined to clinicians in rural Kentucky.

As summer fades and days get shorter, don’t forget to raise a frosty mug to the next decade. Let’s hope that our industry, which is ranked lower in productivity than the US Post Office, will change its perspective and just try a little harder to keep pace with the rest of the world.

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.