Intelligent Healthcare Information Integration 10/11/10

About a week ago, I asked the wonderful Mr. H and the wonderful and lovely Inga to post a piece I wrote about the impending death knell of my chosen EHR, Peak Practice. While they are sensitive to their sponsors (though vendor neutral) and almost fanatically conscientious about their reporting reliability before posting such a “rumor,” typically seeking firm confirmation before such stories go live, they decided to run the story based upon our longstanding good relations and my assurance that my sources were impeccable. (Plus, I begged like a bratty three year old because this was my “Right EHR,” as I mentioned, and I was mad as heck to lose such a technologically-sharp and future-friendly tool!)

Thus, they ran the piece at my bequest. (Thanks, again, guys.) The official Peak sunset announcement was reportedly going to come out that same day, but, as you may have noticed, there’s been a Mormon Tabernacle-sized choir of crickets chirping since that post.

True, the vendor has not denied it. Also, true, I’ve had the story confirmed from multiple reliable sources since then. True, I’ve been told this was “the blog heard round the world” – or at least around the Peak Practice-related portion thereof. Third-hand true, I’ve heard that there have been lots of phones ringing off lots of hooks and lots and lots of lawyers making lots of unexpected overtime and lots of VARs wondering what they’ll do next for lots of clients who also happen to love – or at least, want to keep – Peak Practice. (I really feel for you lucky former MediNotes “e” clients who were migrated to Peak and who now get to go through yet another conversion – hoo boy.)

I’ve heard that I’ll get “upgraded” to one of the vendor’s other products. Don’t care what you say, guys: practically speaking, from a real world, workflow adjustment, staff frustration, conversion blues, and just, plain, personal preference perspective, none of what you’re offering looks like anything but a step down. One option runs dual databases, which provides no attraction. The closest would be the MyWay product, but the original vendor of that product seems to have done a better job advancing its technology, so if I were to go that way, why wouldn’t I go with them?

As I mentioned last time, it isn’t just the tool; the people, the corporate philosophy, the general “here’s how we deal with people” gestalt makes a huge difference to us small guys. Big companies sometimes seem to forget that talking corporation-to-corporation is a completely different language and doesn’t translate very favorably into the native trench grunt tongue.

I’ve been with this product for a long time and I’m pretty sure I’ve helped lots of people make lots of sales (and money) from my advocacy. I now know that some people appreciate that fact as I’ve had a slew of reach outs from multiple other EHR companies since last week’s piece. That makes an impression.

I have a distinctly different impression about the folks who now own my “Right EHR.”

Question: Is a new customer more important than keeping a current customer?

One of the wisest HIT people I know recently wrote me that “it is too bad that they won’t sell the product to someone else. They didn’t buy Eclipsys to bury a feared competitive product, but the result will be the same.”

The announcement is coming. The die is apparently cast. So, while the crickets seem to be chirping quite loudly right now, morning is coming, the crickets will fade, and the sun is about to rise on a new day – one which will no longer have a Peak.

From the soon to be Peak-free trenches…

“No quote today…I’m not feeling Peaked enough.” – Gregg Alexander

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 hisblog, practice web site or directly from doc@madisonpediatric.com.

News 10/7/10

Patients are concerned with the ability to communicate with their healthcare providers, according to a new poll. They say their experiences would be more satisfying if they could spend more time discussing health issues and would prefer having a single provider overseeing their care.

Carolina Family Practice and Sports Medicine apparently already understood the need for better provider-patient communication, having recently implemented Intuit Health’s patient portal.The portal allows patients to securely communicate online with their doctors, as well as pre-register, request appoints, and pay bills.

If you are looking for a great online resource for EHRs, I happened across this section on from the Maryland Health Care Commission (MHCC) Web site. MHCC developed the Physician EHR Portfolio as a tool for physicians evaluating and comparing EHRs. It includes product and pricing information (both ASP and client/server options) for about 30 products. Most vendors include screen shots and user references. MHCC also created pricing comparison tables that aggregate the per-year projected costs by vendor. FYI, the five-year cost for a four-doctor practice utilizing an ASP model ranges from $13,000 (total) for RxNT to $192,906 for EHS’s CareRevolution.

Fletcher-Flora Health Care Systems and Praxis Electronic Medical Records announce a partnership to interface Praxis EMR with the FFLex eLink IMR instrument management system. The integration will allow providers to import patient results from clinical lab instruments into the Praxis program.

MedInformatix combines its EMR and practice management platform with PhoneTree’s Patient Messaging, giving users the ability to issue automatic reminders and announcements based on data in the MedInformatix database. The integration is bi-directional and message tasks can be executed from both the MedInformatix and PhoneTree applications.

The e-MDs folks point out that both winners of the 2010 HIMSS Davies Ambulatory Care Award of Excellence are e-MD clients. The Diabetes Center (MS) and Miramont Family Medicine (CO) were individually recognized for leveraging their use of HIT to provide excellence in care. The Diabetes Center, by the way, was the first nurse practitioner-owned practice to be considered for a Davies award.

Yet another health system buys a large private practice. St. Joseph Mercy Health Systems (MI) purchases the 150-physician Integrated Healthcare Associates (MI). St. Joseph’s CEO says the healthcare reform bill played a role in prompting the merger, since care is being driven away from hospitals and back into doctors’ offices and outpatient centers. Personally, I think that is code for, “Accountable Care Organizations are on the way and we’re proactively lining up our team.”

We try to minimize the overlap between HIStalk and HIStalk Practice, but I wanted to point out some particularly insightful comments Mr. H made about hospitals buying up  primary care practices.  Mr. H points out that back in the 1990s, hospitals went on similar buying sprees, paying big money for practices — only to have doctors buy themselves back out a few years later. See here why Mr. H predicts history will repeat itself.

In addition to worrying about Meaningful Use and Accountable Care Organizations, industry consultants say physician offices should be prepping for the ICD-10 transition. The deadline is October 1, 2013, which means practices have less than three years to assess their needs, implement a transition plan, and make the switch. AHIMA says 59% of their members haven’t started to address the transition, which is estimated to cost more than $83,000 for a 1-10 physician practice. A couple of organizations estimate that the complete ICD-10 conversion process will take providers 966 days to complete, which means the planning process should have started January 8, 2010, in order to meet the October 1, 2013 deadline. In summary: there’s a new storm a brewing.

I’m sorry I couldn’t attend last week’s Xconomy Xchange in Boston featuring athenahealth’s Jonathan Bush and eClinicalWorks’ Girish Navani. Pediatrician Andrew Baumel, MD provided an overview on HIStalk Practice earlier this week, noting both leaders were forthcoming about their views and company strategies. He also mentioned a lack of fireworks (which of course would have been entertaining.) Xconomy filed its own summary, also noting frank talk “without (too much ) verbal bloodshed.” There’s such honor in HIT.

E-mail Inga.

News 10/5/10

From ToldYa: “Re: Peak Practice. Look for an announcement soon that Allscripts will discontinue the Peak Practice product (originally developed by Bond Technologies.)” Dr. Gregg Alexander shares his thoughts on the announcement here.

CCHIT extends ONC-ATCB complete certification to 17 ambulatory EHR products, plus modular certification for eight other ambulatory EHR products. The Drummond Group also certifies one complete ambulatory EHR solution and two ambulatory modular products.

The whole “complete EHR” versus “EHR module” is a bit confusing, but my take is that a complete EHR means the technology meets, at a minimum, all the applicable certification criteria. EHR Module applies to any service, component, or combination that can meet the requirements of at least one certification criterion. An eligible provider (or hospital) can have a certified EHR technology that includes a combination of certified EHR modules covering all the required functionality, rather than a single, complete EHR.

Even as more physicians in solo or small group practices move to larger groups or hospital-owned practices, plenty of doctors are sticking with solo practice. The Pittsburgh newspaper profiles a few solo practitioners who have shunned the big groups in favor of lower overhead, fewer patients, and more independence. To keep staffing and paper work at a minimum, most rely on technology:

“One trait these streamlined, independent doctors often share is an embrace of technology, in some cases setting up their own electronic medical record systems to reduce paper work.”

A local paper profiles startup Practice Velocity, a developer of practice management and EHR solutions for urgent care centers. Founded by two physicians five years ago, the company now has 58 employees and serves over 600 centers. The founders are optimistic about the company’s growth, predicting they could double in size over the next year. There’s no mention of profitability, but I can’t help wonder where these guys will be in a couple of years considering the flurry of mergers and acquisitions over the last few months.

Similarly, I’d like to peek into my crystal ball to see what happens with ClearPractice, a 10-year-old company just featured in The New York Times. Last week ClearPractice, which has fewer than 500 physician clients, introduced its latest EMR product, Nimble, designed to run on an iPad. The full EMR/PM solution is $499 and targets the 1-10 physician space. When checking out their website, I noticed that former Coker Group SVP Jeffery Daigrepont is now ClearPractice’s chief strategy officer. I interviewed him a few months ago and he shared a number of observations and predictions, a couple of which are particularly interesting in light of his new gig: the market will continue to compress through vendor consolidation and the REC business model will hurt the smaller, innovative EMR companies.

Sage’s healthcare division teams up with Agfa Healthcare to offer PACS for radiology and orthopedic practices. As part of the agreement, Agfa will recommend Sage to its ambulatory clients. In addition, the integrated Sage EHR/Agfa solution will allow users to view images from within the Sage EHR application.

Catholic Health Initiatives selects the Allscripts EHR as the exclusively endorsed EHR for its 7,200 affiliated physicians. It’s already installed at all 1,050 of CHI’s employed physicians and the Allscripts PM solution will be added. CHI is also implementing Sunrise EPSi  in 73 hospitals.

More bad news about pending physician shortages. The Association of American Medical Colleges (AAMC) predicts that by 2015, the country will be short 63,000 doctors, including over 33,000 in specialties such as cardiology, oncology, and emergency medicine. AAMC claims that recent healthcare reform and the aging population will exacerbate physician shortages over the next few years.

In addition to providing wait time details for its hospitals, Centegra Health Systems (IL) now provides real-time wait information for its physician offices. Patients can access details via a smart phone or computer. I love the idea of this, but in reading the fine print, it looks like the office staff must manually update the status. Not a great solution for a super busy practice.

The AMGA continues to help members ramp up for accountable care organizations, convening 22 medical groups and IPAs for the AMGA ACO Development Collaborative. It’s a year-long project aimed at helping member organizations establish the capabilities necessary to become a successful ACO.

Population care tools that extract information from EMRs can help primary care physicians improve the care and management of all their patients, according to two new Kaiser Permanente studies. The studies analyzed patient care changes when providers used Kaiser’s Panel Support Tool (PST), which compares the care patients receive to the care recommended by national guidelines.

E-mail Inga.

Intelligent Healthcare Information Integration 10/5/10

Thanks for Nothing, Glen

Even though I hear that he read it, I now know why Mr. Tullman didn’t bother to respond to a recent blog comment I blurted out a few weeks ago. He and the Allscripts brain trust who now own my favorite EHR have decided that they don’t share my enthusiasm.

After buying up Eclipsys (which, remember, bought up MediNotes which, remember again, bought up Bond Technologies) Allscripts has declared that what I really need is their MyWay product. It is, as they proclaim in their market messaging, The Right EHR.

Thus they are killing off my chosen EHR, Peak Practice, originally known as Bond’s Clinician.

I spent a long time looking for my Right EHR. I had no delusions that I’d found the perfect EHR, but I had found a whole lot of what I value: great people, great interface, great foundation, and a great, technologically future-friendly, architecture. I’d found my Right EHR when I decided to buy Clinician back in 2004-2005.

Since then, despite a horrible name change (Peak Practice – yuk!) it was strong enough to survive two major corporate acquisitions. In fact, it was one of the major reasons for those acquisitions, so I’ve been told. It was apparently not, however, strong enough to survive a third.

Today, I just finished helping pull off a great experience called the Pediatric Office of the Future, an educational exhibit for the 2010 American Academy of Pediatrics National Conference and Exhibition. We showcased all kinds of technology for improving pediatric healthcare delivery. It felt good that we seemed to have conducted a well-received show.

While riding this high, I got blessed with the news of the death sentence for Peak Practice. Talk about a showstopper!

Oh, well. As we used to say back in my rock and roll sound engineering days, “The show? It’s only business.”

Who cares that all that money I spent on my EHR (which I worked very hard to make by actually caring about and for other people) will now be but an ill-remembered poor investment? That I’ll have to retrain a staff who took years to move from almost complete techno-illiteracy to Peak Practice competency? Who cares what some whiny, so-called “grunt in the trenches,” solo doc from nowhere, Ohio, thinks?

I’m just glad that you get to make yourself and your investors more money by killing my EHR.

I’m just glad you’re not silly enough to let go of this great technology to open source or some other company that might care to advance it even further because that might compete against The Right EHR.

I’m just glad I get to tell the lucky winner of the Peak Practice EHR, part of the Office of the Future’s prize drawing today, that their “Woo hoo, I just won a $10,000 prize!” moment was actually just a big “You got punk’d!”

Oh, and, I’m really glad I get to start looking for a company and an EHR that I can believe in again. (that was so much fun the first time…)

So let’s see…

Mr. Bush, do you honestly care as much as you sound like you do? How do you feel about trench grunts? You’re not planning on selling any time soon, are you?

From the sometimes depressingly muddy trenches…

“To build may have to be the slow and laborious task of years. To destroy can be the thoughtless act of a single day.” – Sir Winston Churchill

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.

Report: Bush vs. Navani on Healthcare IT, Boston

Jonathan Bush (president, CEO, and chairman of athenahealth) and Girish Kumar Navani (CEO of eClinicalWorks) met at Xconomy Xchange: Jonathan Bush and Girish Navani Face Off on the Future of Health IT in Boston on September 29. Andrew Baumel, MD, a pediatrician with Framingham Pediatrics and HIStalk Practice reader, attended the event and provided this overview.

Today at the offices of WilmerHale, Girish Kumar Navani, CEO of eClinicalWorks, and Jonathan Bush, CEO of athenahealth discussed their views of the healthcare IT environment and how their own companies are navigating the changing waters. The discussion was in front of a packed room of over 200 people. It was moderated by Pamela McNamara, president of Cambridge Consultants.

The CEOs first discussed heathcare reform and ARRA. They agreed that both companies were on high trajectories prior to the stimulus and will both have smaller market shares over the next five years as older, less nimble companies are able to survive with this temporary injection of stimulus funds. Girish mentioned that one of their new strategies to come out of the stimulus will be in five years when practices decide to replace the systems they rushed to buy to take advantage of ARRA.

When asked to compare and contrast their strategies, Bush highlighted the fact that every user was on the same iteration of the same application, which allows athena to gather valuable data that they can use to improve payment remittance and work out bugs quickly. He also highlighted the cloud nature of his software. 

Girish highlighted the very large (nearly 100,000,000 patients) penetration of eClinicalWorks and the fact that users can customize the product on their own without IT specialist and that many customers demand different customizations or versions that athena, on one application, cannot provide.

Bush then highlighted athena’s Community software which attempts to move patient PHI seamlessly between providers and institutions, cutting down on cost of registering patients, and his view of a Facebook-like interface in which clinical information could be shared between providers if they "friend" each other and that Athena would collect a modest $5-$8 fee per transaction.

Girish spoke about a project at Children’s National Medical Center in which they determined the basal metabolic rates of children, entered the data into eClinicalWorks, and then were able to give custom medication to their patient based on the metabolic data in each electronic chart. He used this story to illustrate one of the many ways clients can innovate with eCW to help them improve patient care.

In the Q&A period, one questioner challenged both CEOs, implying that their products were weaker than Epic’s and Cerner’s as those products can aggregate data from 12 clinical departments in a large hospital. Girish took on the questioner and stated in these hospital systems, one would likely find the outpatient doctors using eClinicalWorks and that his company cares just as much about the solo practitioner as the large health care systems.

Another questioner who was starting a company supplying EHRs to mental health providers asked the leaders for their advice on size of sales force. Bush stated that he had 100 sales people and Girish said he always put more employees in post-sales positions and let satisfied customers be his sales force.

For their final words, Bush stated that he wants to be a backbone of HIT. Girish said that eCW will not be distracted by the stimulus funds and will focus on the long term to be able to change with the times.

Both leaders were very forthcoming with their views and strategies for the future of their companies. Those hoping for fireworks would have been disappointed, as the two CEOs displayed much cordiality towards each other, saving their barbs for their mutual competitors. While Girish was unwilling to name names, Jonathan showed no hesitation in calling out Allscripts, GE/IDX, and a few others as ones that would remain relegated to prehistory when the story of HIT is written.

Unlike politicians in a debate, both CEOs answered the questions that were posed by the moderator and did so in the time allotted. Both exuded confidence in their business plans (private vs. public funding) and the ability of their products to thrive in what both agreed would be a rapid and unpredictably changing playing field.