Practice Wise 4/11/11

Be Your Own Consultant!

So you’re trying to convince your bosses that they need to purchase an EHR because Meaningful Use makes it so. It feels like Y2K all over again. You know, back in the day when we all used a PM system on dumb terminals (ah, but the UNIX platform was so stable!) and you had to convince your doctors that it was time everyone got a PC and Microsoft Office and the new PM software that could give you four-digit years and save the world.

Déjà vu! You’re in this terrifying role where you have to learn the lingo, understand all the bells and whistles of products that make your head spin. Then, convince a single owner or a board of partners that you understand everything you are presenting to them, and your recommendation is …

Who do you trust to educate you on all of this technology? And to help you not lose your job by making a colossal mistake and costing thousands of dollars and jobs and possibly the meltdown of your practice? I know it sounds like doom and gloom but admit it — this is the stuff that keeps you up at night.

I say trust yourself. You can hire a team of free experts, be one yourself, and thrive in this experience. Admit your terror and reach out to the other terrified individuals in your community. How? Start a user group!

1. Don’t wait. You don’t have to be users of anything to start a group. Don’t wait until you get your software and then decide to start or join one. Start a group of almost-EHR users who all know a little about a lot of things or a lot about some things. Share your knowledge.
2. Invite vendors to present to your group. This is easier than attracting dogs with top sirloin. Trust me, you will need to devise a method for a waiting list.
3. Be selective. Even as a group of users, you don’t have a lot of precious time to waste. Research your vendors and invite those who you think will give you the best bang for your buck. Which is zero, but don’t let that be the rate limiter.
4. Ask the non-EHR vendors. You know, that whole group of support consultants and third-party vendors that are like little seedlings in the spring of EHR adoption. They usually see most of the products as they interface. Better yet; they talk to the end users and hear the complaints and praise of everything. Boy, don’t we love to share our experiences with anyone who will listen?
5. Give them the lunch hour for presentation. Make sure they provide the lunch.
6. Invite real (EHR) users to your almost-users group. They will be your deepest resource (see above, don’t we love to share…). From them you will learn what not to do, who not to waste your time on etc. They’re like parents and you should learn from their experiences.
7. Have different members of the group host your meetings. If your office won’t accommodate the crowd, check out hospital conference rooms (can be reserved in advance), the local medical society (should willingly lend to their participating providers), or the presenting vendor (don’t think of this as giving up the upper hand – you get your needs met, they do their presentation, and nobody is worse for the wear).
8. Don’t limit your group to EHR discussions. This kind of change management doesn’t happen in a vacuum. Your entire practice operations are going through electro-shock therapy. Open up to the whole discussion and ways to help each other through this evolution.
9. Keep it free, short, and worthwhile. You will build an amazing panel of experts that are now part of your team. The president runs the superpower of the free world and even he doesn’t know it all. He has a cabinet of experts who advise him. You can, too.
   

Julie McGovern is CEO of Practice Wise, LLC.

News 4/7/11

Less than 14% of practices with EHRs believe they meet all 15 core criteria to receive incentive payments, according to MGMA’s 2011 EHR study. Other key findings:

• The main barrier for EMR adoption is expected productivity loss.
• 29% of the 4,588 respondents say they are selecting an EHR.
• Of practices that had adopted EHR, productivity reportedly increased for 27%, decreased for  31%, and stayed the same for 43%.

athenahealth is named a supported EHR vendor by HealthInfoNet, the organization that operates the Maine REC.

e-MDs is named an EHR vendor partner by the Medical Society of the State of New York. Five other EHR vendors were also selected, though I could not find details on the MSSNY Website.

Nuesoft introduces a nine-minute video that provides a high-level overview of Meaningful Use, including how to find certified products, how to apply for funds, and the role of RECs.

Practice Fusion closes $23 million in Series B financing, bringing the company’s total funding to $30 million. This round was led by Founders Fund, an initial investor in Facebook whose managing partner is PayPal founder Peter Thiel. CEO Ryan Howard says the cash infusion will help the company “reach every doctor and practice in the country in our market.”

EMR vendor GloStream will add up to 40 jobs this year and will invest $1.4 million in expanded operations.

AAFP publishes a resource to help physicians understand how they can earn an e-prescribing incentive from CMS and avoid penalties. The guide includes an explanation of the code G8553, denominator codes, qualified e-prescribing systems, and program exemptions.

Navicure and the American Academy of Professional Coders form a partnership to develop educational resources to help practices practices transition to the HIPAA 5010 standard and ICD-10 code set. Some of the initiatives include a dedicated Website (www.icd10hub.com), regional dinners around the country, and, a Webinar series.

In a random sample that included both clients and non-clients, Kareo finds that practices’ top concerns are reductions in Medicare payments and patient payment collections. The average days in A/R was less than 40 days for 39% of the respondents and only 17% reported a net collection rate of 92-96%.

Phreesia introduces an autism screening tool for its patient check-in technology. Using the PhreesiaPad, parents are able to complete an automated version of the M-CHAT screening tool for assessing the risk for autism spectrum disorder in toddlers.

Please join me in welcoming  Capario as HIStalk Practice’s newest Gold sponsor. Capario offers a revenue cycle portal that works with existing PM and billing systems and provides a validation engine that gets claims paid on the first payer submission 90% of the time. The company was named the highest rated indirect clearinghouse in KLAS’s 2010 ambulatory clearinghouse report and  processes almost one million transactions a day. The Santa Ana, CA-based Capario offers a dashboard view of the revenue cycle and provides a number of analytics tools to improve cash flow. Capario works directly with providers, as well as with a number of partner vendors. We ran an HIT Moment with CEO Jim Riley a few weeks ago, who offered practical information about RCM vendors, 5010, and ICD-10. Capario is also sponsoring HIStalk, so a double thank you to them!

Sutter Health (CA) announces its $50 million Sutter Community Connect program to provide Epic EMR to qualified independent physicians. Sutter will subsidize up to 85% of the EMR software and implementation costs for physicians in over 100 Northern California communities.

E-mail Inga.

News 4/5/11

Todd Rothenhaus, MD joins athenahealth as chief medical officer. He most recently served as SVP and CIO of Steward Health Care (formerly Caritas Christi Health Care).

Physician offices added 7,600 jobs in March, representing a 0.3% gain. Total physician office employment is 2.3 million.

Webahn announces that its Capzule EMR is available to solo practices free of monthly charges. Capzule EMR does not display advertisements and does not require revenue sharing, so what’s the catch? The Capzule Web site says the EMR is not (yet) ONC-ATCB certified and does not offer e-prescribing. Also, the EMR does not come pre-loaded with ICD-9 or CPT codes. The “free” option is limited to solo practices, includes only one additional non-physician license, and it includes limited templates and customization options. The standard package costs $150 per month per physician and $10 per month for non-physician users.

The newest generation of doctors want salaried jobs, fewer working hours, and specialties that are conducive to family life, according to a New York Times article. At the same time, doctors are not revered by their patients like days of old. In fact, patients today are more likely to see doctors as interchangeable.

The 80-physician Doctors Clinic (WA) goes live on Sage’s online patient portal.

The Child Guidance Center of Southern Connecticut implements CareLogic Enterprise EHR by Qualifacts’. The purchase was partly funded by a $100,000 private foundation challenge grant.

About 56% of practices have not scheduled testing of the 5010 transaction set, according to MGMA. Less than 4% said they had begun testing the transaction set with health plans. Most disturbing: 23% of survey respondents didn’t know what needed to be done to their software to implement 5010.

I noticed that AAFP opened its annual EHR satisfaction survey survey. AAFP members using commercial EHRs can participate here. It’s not the most scientific survey out there (results are based on physician self-reporting rather than a random sample). Still, the results are interesting and give certain vendors the chance to brag a bit.

AAFP also posts a special report EHRs, which includes a number of articles on EHR use in family practices, details on the EHR incentive plan, and more. I’m not sure there is much new, but the section includes a nice variety of information all in one place.

HIT consultants say practices often underestimate the amount of training required for EHR or reduce training to save money or time. When calculating the amount of time required for training, practices and vendors should keep in mind the amount of data being abstracted from previous systems; integration needs; introduction of new hardware, especially end-user devices; and existing computer skills.

And from a different group of consultants: if you have physicians resistant to structured data capture, find a hybrid approach that blends the ability to capture required structure data elements and provides the physicians the flexibility to document in their own personal manner. The result will be increased physician adoption and better data for reporting and exchanging with other providers. Evan Steele swears he didn’t write the article, but he could have.

There’s still a lot to process about the recently proposed ACO regulations, but one thing is clear: ACOs will need solid HIT infrastructure. The regulations call for ACOs to report on 65 quality measures, so systems will need to be in place to churn out those numbers. In addition, at least 50% of an ACO’s primary care providers be EHR Meaningful Users. Another takeaway: consultants are going to win big, as providers turn to them to determine their needs and assess the value of their potential ACO participation.

E-mail Inga.

DOCtalk by Dr. Gregg 4/1/11

First, a word from our sponsors. Oh wait, I don’t do sponsors. Well, then…first, a word about the title change.

You may notice that Intelligent Healthcare Information Integration has morphed into DOCtalk by Dr. Gregg. That is something I requested because:

1. The original title came from the blog I was just messing around with when Inga first saw it and asked me to join the HIStalk party. I had never intended it for use here, but out of lassitude, mainly, I left it how they originally posted it. (Actually, it was intended as a sarcastic statement on the state of HIT at the time.)
2. The new title seems to be more in thematic keeping with the whole HIStalk Empire. I’m honored to be allowed to use it.
3. Thus, going forward, this’ll be the new overarching tag for my prattle. Just in case anyone wondered.

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Baby Talk

I have been away from the hallowed wall-less halls of HIStalk Practice for a few weeks, but not because I haven’t been writing. Rather I’ve been pretty busy writing (and doing other assorted duties) for healthcare, for information, and for technology. So, though it is healthcare information technology of a sort, this project is really tangential to what most people think about when considering the realm of HIT. But, an intriguing corollary has become evident to me of late that I thought might be worth sharing.

The other project involves writing scripts for animation videos. These are short, about three minutes in length, and the first “Common Conditions” bundle of 14 videos covers a wide range of topics such as dehydration, diabetes, post-op infections, fractures, anesthesia, and even cancer.

Think about that for a minute. In a three-minute story, try to cover the important basics of, say, Type 1 Diabetes. You need to make it simple enough for a child to understand and engaging enough so that they’ll want to watch.

(In med school, I remember professors saying that if you understand diabetes, you’ll understand all there is to know about medicine. I’m not sure that’s really true, but the idea is valid: diabetes covers a whole heckuva lotta turf.)

So, pick about two minutes of diabetes material to try to get the most important points across for the first overview. (You’ll need a minute or so to get the engaging part, the gags, in there.) Make room to explain terms like “insulin” and “glucose” and try to make sure none of it sounds scary. (Hard to do when talking about shots and blood draws with kids.) Wrap it all together in some sort of “story” and, again, you have a hard ceiling of three minutes.

Challenging? Yes. But not undoable, not by a long shot. The tremendously positive responses we’ve received from test audiences verifies that we have been able to meet this challenge.

So, why do I mention this in the HIStalk Practice world? Because I see a very interesting parallel with what is missing in most HIT products, at least most that I’ve ever seen. That is, most providers don’t really want to be techies. They don’t want to talk — or even learn — the language of the geek. Just like most patients (kids or adults) don’t really want to spend their time learning the techno-babble of medicine.

I think exactly the same approach and process could dramatically advance the cause of most HIT vendors. In other words, spend some time really trying to humanize your tech. Not just the product, but also the training, the descriptors, the “Help” sections, your emails to clients or potential clients – everything that goes in front of the mostly non-geek providers. Talk to them in their language. Don’t try to make them learn yours.

I’ve noted a few vendors who seem to have this concept well in hand. For instance, SOAPware has a great online video education library which is easy to access and understand. From SRSsoft, Evan Steele’s EMR Straight Talk does just that. A few of the new iPad EHRs, like ClearPractice’s Nimble, Dr. Chrono, HealthFusion’s MediTouch, Mayo’s VitalHealth, and Quest’s Care360 seem to present in “people-friendly” formats.

And, the recently developed Thomson Reuters Pediatrics (just about to launch) addresses an old pediatric nemesis, weight-based dosing, which is something every provider who treats children needs. Most EHRs either ignore this or do it poorly. It’s something perfectly suited for the talents of a computer which then truly makes Rx’ing kids much simpler!

This isn’t about baby talk. Personally, I don’t do baby talk, not even with newborns. That’s an unnatural language (and somewhat condescending in my book.) This is about talking with people on a level consistent with their needs and experience and giving them useful tools that help them to take advantage of your special knowledge – without making them learn all that you know. It’s about translation. Making things easier to do and understand for people who don’t have the same expertise as you can go a very long way in facilitating adoption.

From the trenches…

“For success in training children the first condition is to become as a child oneself, but this means no assumed childishness, no condescending baby-talk that the child immediately sees through and deeply abhors.” – Ellen Key

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 3/31/11

Epocrates says its mobile and Web-based EHR is in beta at several solo and small physician groups. Epocrates also announces an agreement with Nuance Communication to leverage the Nuance Healthcare development platform to integrate Nuance’s cloud-based medical speech recognition component into that product.

Mission Surgical Clinic (CA), Coast Spine and Sports Medicine (CA), and the Rosen Anesthesia Group (CA) all select the ChartLogic EHR suite.

Physicians at Central Oregon Ear, Nose and Throat (OR) say that  Proxense’s proximity-based security with automatic logon/logoff saves them time and increases security. The system uses a combination of biometrics and RFID to authenticate EMR users. A fingerprint scan is required twice a day. Otherwise, RFID tags verify providers’ identities as they enter a room and shut systems down as they leave.

Mobile charge capture provider Ingenious Med Inc. receives $3.25 million in funding from Council Ventures to fund continued growth. The company has nearly doubled revenue, clients, and personnel each of the past two years.

AMA introduces its first-ever app to help physicians find appropriate E&M codes. AMA also announces the 2011 AMA App Challenge to find the next great medical app, open to physicians, residents, and medical students and offering $2500 in cash and prizes for two winners.

HIMSS and MGMA create a privacy and security toolkit for small provider organizations. It contains a roadmap for practices needing basic information on how to navigate privacy and security laws and to understand the security components of the EHR incentive program.

The Maine REC names athenahealth and e-MDs its supported EHR software vendors and Concordant as its supported implementation service provider.

A big welcome and thank you to Micky Tripathi, who made his HIStalk Practice debut Wednesday. Micky is president and CEO of the Massachusetts eHealth Collaborative and has agreed to regularly educate readers on technology decision-making in medical practices. You can find his debut Pretzel Logic column here.

Happy National Doctors’ Day. I am usually leery of some of these so-called observance days (how many of them does Hallmark invent?) However, Doctors’ Day has apparently been around since March 30th, 1933 when a physician’s wife decided to honor physicians by mailing greeting cards and placing flowers on the graves of deceased doctors. In 1990, President George Bush actually signed a law designating March 30th as National Doctors’ Day. So now you know.

The 50-physician Desert Radiologists extends its billing, PM, and RIS software contract with Zotec Partners.

At least one Washington insider doubts Congress will pass legislation to extend EHR stimulus benefits to mental health providers. Brian Darling, director of government studies at Heritage Foundation, thinks the chances of passage are “low,” especially if Congress does not find other programs to cut.

Less than 10% of Americans use online PHRs, but those that do are most likely to be white, older, and/or wealthier. In addition, of those who sign up, over half are categorized as "very low users" (logging in once at most in the prior two years), while a little over one-quarter were deemed "high users" (logging in 10 or more times). Though the authors of this Archives of Internal Medicine-published study explored the “digital divide” among those adopting PHRs, the bigger issue to explore should probably be why 95% of Americans show little interest in maintaining PHRs.

E-mail Inga.