Intelligent Healthcare Information Integration 8/16/10

Help for an Amazing Pioneer

Like most of you, I try to accomplish a few things during my time here on this earthly coil. Every now and again, I start getting a little full of myself and start getting a Steve Martin The Jerk-esque “I’m somebody now” sort of feeling. You know, a “look at me, look at me” moment just like every little kid shouts to their mom or pop at some point to achieve a little validation of their worth.

Through some of what I do in the realm of HIT, and especially through some of my writing here on HIStalk Practice (thank you, again, Mr. H and Inga), I have made some pretty wonderful contacts and some even more wonderful friends. These folks come from across the gamut of healthcare, from all over the US and even from around the world. When I start thinking about how fortunate I am to have such a breadth of colleagues and acquaintances and start to consider how I’ve maybe been able to have some impact upon the growth of this fledgling industry, I can sometimes actually feel my cranium getting fuller as it begins to swell. Until…

Until I remember Sid.

Dr. Sidney Nesbitt, to be precise. Sid is a pediatrician in Nairobi, Kenya. He is one of the “blessings” I have been granted through my time in the HIT realm. He runs the Muthaiga Pediatrics Clinic located on the grounds of the Gertrude’s Children’s Hospital, a charitable trust founded over 70 years ago to help the children of East and Central Africa.

Sid’s working very hard to develop and employ advanced office design, practice management, and especially healthcare information technology techniques and tools at Muthaiga Pediatrics. His goal is to set a standard, an example that he can share with physicians all around East/Central Africa. He even engaged the interest of MIT Sloan’s Global Health Delivery “G-Lab” which worked with him for months helping him evaluate and deploy better business tools specific to the needs in Nairobi. I was lucky enough, along with the wonderful Drs. Dan Feiten of Denver and Larry Rosen of New Jersey (himself, an MIT alum) to consult with their project.

On top of this, he is the director of their pediatric endocrinology fellowship, sponsored by the World Diabetes Foundation, which brings volunteer visiting professors from Canada and the U.S. each month to help train African pediatricians. He is pioneering similar initiatives to establish fellowship programs in Africa in Infectious Diseases, Emergency Pediatrics, and Pediatric Cardiology, Gastroenterology, Neurology, and Pulmonology over the next five years.

There is more work with charitable and volunteer efforts to advance child health in Africa with which Sid is engaged than I could begin to cover here. He is planning on sharing some his amazing work this year at the American Academy of Pediatrics (AAP) National Conference and Exhibition (NCE) in October, specifically, at the “Pediatric Office of the Future” (POF) educational exhibit in a section called “Future Pediatrics International.” (I am the director of the POF, for full disclosure’s sake.)

He is truly an inspiration for me and, I’ll wager, for many, many more folks around his native Kenya. He’s a joy with whom to talk and constant source of “what others are striving to do with far less resources and far greater challenges.” He helps me remember what’s important.

But, Sid could use some help. He is springing to bring himself to America for this event, but as any pediatrician anywhere in the world will tell you, we’re not the rich boys of medicine. So, if any of you good folks out there would be able to help my friend by helping him cover just the costs of the exhibit expenses, I will do everything I can to help promote your sponsorship. Expenses cover his presentation, PC, exhibit accessories, large screen monitor rental, etc. – pricey exhibit hall fees – at the conference site, totaling around $3,000.

(FYI – The POF is doing well and getting so much love from the AAP, we’re just finishing our own web site within the NCE site – somewhat unique – which highlights, and links to, our generous sponsors. The site’s a work in progress, but you’ll see the foundation. Plus, the AAP blasts emails to some 60,000 pediatricians and has great onsite marketing providing great exposure.)

Besides the marketing potential you’ll receive, you’ll be helping one very good man. His vision and his tireless efforts to advance HIT as he seeks to help the children of Africa are those of a true pioneer.

If you can help my friend, please contact me as soon as possible here in the trenches…

“There has to be this pioneer, the individual who has the courage, the ambition to overcome the obstacles that always develop when one tries to do something worthwhile, especially when it is new and different.” – Alfred P. Sloan

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.

Joel Diamond 8/13/10

Lies, Damned Lies, and Statistics

Would you be nervous if I told you that using a phone doubles your risk of contracting a particular illness? What if I told you that the chance of getting this condition is one in a gazillion? To most, it might seem absurd to give up your phone just to cut your risk to two in a gazillion, but certainly there are others who would call for a federal ban on phone usage.

Patient access to the Internet continues to confuse a well-intentioned but often unlearned public. One of the biggest misunderstandings results from ignorance of absolute versus relative risk. Patients frequently are fearful of a particular treatment, “if it increases my chance of developing some rare condition by 5%.” Reported side effects of medications greatly worry my patients, who unfortunately have little knowledge of comparative placebo-controlled trials.

In fact, daily activities that we hardly think of day to day confer much higher risk. Yet dramatically better odds, when referring to medical risks, have an amazingly different effect on decision making.

Let me give you an example. Did you know that statistically speaking, walking a mile is 19 times or 1,900 percent more dangerous than driving a mile in a recalled Toyota?

Now let me show how statistics, when expressed differently, can have a profound effect on perception of health and disease.

Several years ago, a 62-year-old male patient of mine came in with the chief complaint of “something personal.” Since we’re dealing with statistics today, 90% of the time this translates into, “I’m here to get a prescription for Viagra”. Sure enough, this gentleman was highly distressed that the frequency of sexual intercourse with his wife had declined “by 50%” in the past several months.

Seeking additional history, I asked him what this translated to in encounters per week. “Well you know how it is doc, like everyone, the Mrs. and I usually had sex every night before we went to sleep and of course again every morning when we got up”. Dejectedly he added, “Now we just do at each night”.

I’m not joking when I tell you that he actually waved his hand in front of my speechless and disbelieving stare. “Doc, doc… are you listening to me? Did you hear what I said?” Regaining my professionalism, I replied, “I’m sorry, for a minute there I thought you said that you’re sex life has gone from 14 times per week to seven.” “Exactly!” he replied.

I explained to him that half of men over age 60 reported having sex once per month (admittedly a statistic out of context). He boldly strode out of my exam room with a new sense of youth and virility.

I’ve taken the liberty to assemble some (not so) related statistics. I leave it to you to draw your own conclusions from the data.

• 1: 4 – incidence of orthopedic surgeons who will cut the wrong limb at some point in their career
• 1:1000 – incidence of general pediatricians who will operate on the wrong appendage
• 1:2 – ratio of average salary of pediatricians compared to orthopedic surgeons
• 278 – number of bacteria colonies that are exchanged during a kiss
• 45 – percentage of tongue piercings that show signs of infection
• 2 and 63 – percentage of staph infections resistant to methicillin (MRSA) reported in 1973 and 2004, respectively
• 8 – percent increase in average hospital cost for unhelmeted motorcyclists involved in crashes compared to helmeted riders
• 8 – average percent savings on six pack of Pabst Blue Ribbon during ‘Bike Week’ promotional event
• 100 – number of cases of diphalia (two penises) reported, ever
• 50,000 – number of women in the US with didelphic uterus (two uteri and often two vaginas)

The power of analytics that will result from increasing codifiable EMR data will no doubt markedly transform medicine. Physicians themselves will have increasing difficulty comprehending this information without new approaches to reporting and representation.

It is our patients, however, who will be poorly prepared for this new (tidal) wave of information. I shudder to think how Personal Health Records will compound the problem.

 

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.

News 8/12/10

From TypO: “Re: EHR Challenges. HemOnc Today has a good read on the challenges and benefits of EHRs.” This article offers a balanced view of the good and the bad that accompany an EHR implementation, regardless of the specialty. I particularly liked the comments from Michael Kiernan, MD, the physician EHR champion at Tulane University Medical School, who doesn’t mince words about his EHR project:

On a good day, it does many good things. It eliminates many common, annoying problems, like illegible handwriting. Transmission of information is much faster, and the EHR makes tracking and handling results much easier…when it works. On the bad days, the lab data do not always show up. I’ve been looking at EHRs for a long time, and my impression is that the global overview of EHRs is that they’re going to solve many problems and eliminate lots of medical errors. My experience is that they rarely do that. They simply change the kind of errors that occur and create new problems to replace they ones they’re solving. Overall, they move us in a better direction, but they’re not a panacea.

SRS expresses support for the American Academy of Orthopaedic Surgeons and its soon-to-be-released EMR Position Statement. The AAOS argues that orthopaedic surgeons will have great difficulty meeting the current 25 Meaningful Use standards. It also points out that different specialties have different needs and uses for an EHR.

Need to identify possible adverse events associated with drug treatment or from medical devices? There’s an app for that, thanks to the Center for Biomedical Informatics at The Children’s Hospital of Philadelphia. CTCAE 4.0 is a free app for the iPhone, iPod Touch, and iPad that helps providers identify possible side effects and their severity.

AirStrip Technologies secures an unspecified amount of funding from Sequoia Capital. The investment will help drive adoption of the AirStrip OB product and accelerate further development and marketing efforts for the AirStrip Remote Patient Monitoring solutions.

The president of the Osceola County Medical Society (FL) estimates that 20 to 30% of the primary care physicians in his area will retire over the next few years rather than adopt  an EHR. However, the University of Central Florida College of Medicine says 400 area physicians have signed up for EHR implementation assistance through its REC program.

Dr. Jennifer Dyer of Nationwide Children’s Hospital (OH) finds that weekly text messages improve medication adherence in diabetic teens. Obviously Dr. Dyer has had a teenager or two in her waiting room and observed that texting is the communication medium of choice for teenagers.

The four-provider Family Practice of Holyoke (CO) goes live on NextGen EMR.

Here’s some news that’s not too surprising, given the aging of baby boomers. Office visits for patients aged 45 and over account for 57% of all office visits, up from 49% ten years ago. This age group also increased their lead over younger patients in terms of total medications prescribed, imaging tests performed, and total time spent with a physician. Patients over the age of 65 had relatively smaller gains: visit rates grew 13% over the decade and prescriptions jumped 31%.

A survey of medical students reveals that the vast majority believe technology, including video games, aids higher learning and provide educational value. Students also support online role-playing in a virtual healthcare setting. Somehow that makes me feel old.

However, I might not mind being the oldest medical student at Stanford University. All 91 of its first-year medical  school and masters of medicine students will receive iPads, which will include digital textbooks, syllabi, and other course content.  And if the professor gets boring, you can always pull up Doodle Buddy.

E-mail Inga.

News 8/10/10

From Paging Dr. F: “Re: paging. Do doctors still use pagers? Or do smart phones give them all the functionality they need?” That’s a great question and I am curious to hear readers’ input on this. I’ve read estimates suggesting 65% to 90% of physicians have smart phones, which in my mind make pagers obsolete. Or, do pagers offer some sort of unique functionality of which I’m not aware?

Central Illinois Hematology Oncology Center selects Rabbit Healthcare Systems for its integrated EHR, LIS, and PM solution.

The American Board of Medical Specialties (ABMS) wants its 750,000 certified physicians to be tech-savvy, so it is incorporating Meaningful Use into its Maintenance of Certification program. Though HIT knowledge will not be a requirement for re-certification, ABMS want physicians to use new self-assessment tools to evaluate how well they incorporate evidence-based medicine into their practices and how effectively they use technology for data collection, decision support, and reporting.

Hill Physicians Medical Group (CA) adds 120 doctors from Physicians Integrated Medical Group. The CEO of Physicians Integrated Medical Group suggests the move was necessary to provide high-quality and comprehensive support for physicians and patients.

You have to be large enough to provide sophisticated technology and infrastructure, while remaining focused on the needs of individual patients and the independent medical practice.

Hill Physicians, by the way, offers NextGen EMR and PM to its 3,000 physicians.

A federal jury convicts Randeep Mann on seven counts related to the February 2009 car bomb attack on the head of the medical board of Arkansas. He originally faced medical board disciplinary action for multiple issues and now could receive life in prison.

In honor of National Health Center Week, Sage Healthcare employees are volunteering at several clinics, including Health Linc (IN) and New Hanover Health Center (NC). At HealthLinc, Sage employees will host a back-to-school fair and carnival that’s giving free sports physicals and immunizations. At New Hanover, the volunteers will scan paper records into the clinic’s electronic system (could it be a Sage EMR?)

SRS announces that Sandhills Pediatrics (SC) has selected its hybrid EMR for its 14-provider practice. I thought the practice name sounded familiar and realized I interviewed Dr. Chrisoph Diasio about a year ago. It’s actually worth a read (or re-read) if you are so inclined, as Dr. Diasio shares some great insights on his EMR use, coding, documentation, and ARRA. His best line: “ARRA funding is the ultimate vaporware.”  I’m curious if he still holds this view. (Follow up note: a reader shared that Dr. Diasio is actually with a different Sandhills Pediatrics in North Carolina, not South Carolina.  Also an SRS client. Sorry for the mistake. Regardless, Dr. Diasio offered plenty of spicy words in his interview.)

Allscripts completes its ACE conference in Las Vegas, which was attended by Mr. H and 3,500 others. Over on HIStalk, Mr. H shares the lowdown, including an observation that the crowd seemed more concerned with reimbursement than HITECH. He shared this additional thought with me today:

I smelled fear from some of the small practices. They are counting every penny. Some of the mid-sized ones said their older doctors are probably just going to retire, which they also said would probably boost EMR usage since the older docs are the holdouts. They sweat every Allscripts charge for upgrade help and even the Stimulus Pack was a sore spot for Enterprise users since Allscripts is charging for it under some circumstances. It’s funny since hospital people never seem to fuss about infinitely higher prices, so it was refreshing to see customers pushing back on their vendor a little.

Mr. H later added that attendees did more chatting about Meaningful Use in the exhibit area, but more along the lines of whether or not the government would actually pay anything. Apparently there’s widespread distrust that they’ll find ways to avoid paying, which is not unusual with healthcare payments.

Speaking of Allscripts, the company names former Emory University General Counsel Kent Alexander as its new EVP and general counsel.

athenahealth and Humana team up to subsidize the cost of athenaClinicals for 100 physician practices representing 1,000 physicians. Humana will cover 85% of implementation costs, representing about $4,000, plus pay doctors as much as 20% for meeting certain performance standards.

Meanwhile, Highmark, Inc. says they’ll increase reimbursements $3 to $9 per claim, depending on physicians meeting quality benchmarks. Benchmarks include such things as having EMRs and e-prescribing capabilities.

New: a version of Ingenix’s CareTracker PM/EHR with functionality for Federally Qualified Health Centers. Ingenix is also extending interest-free financing and Meaningful Use guarantees.

Physician offices add 1,100 jobs in July, representing a mere 0.1% growth.

EMR usage in community care centers is on the rise. Eighty-four percent of members in the Association of Community Cancer Centers reported EMR use in 2009, compared to 64% in 2008.

NextGen selects eduTrax as a preferred medical coding and educational content provider and will offer 38 educational courses for NextGen customers.

HHS honors Text4baby with its HHS Innovates award for providing its free mobile educational service for pregnant mothers and mothers of newborns

Newly proposed legislation extends medical technology incentives to mental health providers who demonstrate meaningful use of EHRs and e-prescribing. Crazy (no pun intended) that psychologists and clinical social works were not included as eligible providers in the original legislation.

E-mail Inga.

Intelligent Healthcare Information Integration 8/9/10

Not So Strange Bedfellows

An article in the Wall Street Journal recently reported on the increasing cohabitation of health insurers and electronic medical record companies. In moves that would surprise most of us about as much as hearing that Coke and Diet Coke are actually made by the same company, several large inscos have joined forces with EHR vendors to “help” docs with the transition to digitization.

OK, I admit that last sentence sounds as if I’m skeptical of the reasons behind these collaborations. And, well…I am…but, maybe not as much as I would have thought. After also reading about Surescripts partnering with Microsoft to offer Web-based access to prescription histories for consumers and about the health units of both GE and Intel getting together to form a new company focused upon “telehealth and independent living,” it occurred to me that in this mountainous mishmash we call our healthcare system here in the US, perhaps a little more collaboration might be a good thing.

Seriously, I think the majority of companies currently having even a foot within the healthcare sandbox would get Fs on their report cards to date in the “learning to work and play with others” category. Between proprietary this and antiquated that, it’s downright impossible to move along down the digital roadway until more players (and payers) learn that we all gain when we work together. Remember that little thing we all portend to care about — patients? Aren’t they better served when your tool plays well with mine? (Keep your minds out of the gutter.)

In her WSJ piece, author Avery Johnson (out of the gutter, I said) quotes the illustrious patient privacy rights advocate Dr. Deborah Peel, who has concerns about conflicts of interest which may put personal health data at risk. I see her point, but I also feel there is just way too much to gain and far too much we could do with all this data medically if we could access it more effectively. The inscos already have oodles of patient data; I’d love to be able to actually see what they see to see if I see what they see the same as they see it. See?

Aetna and IBM say their system will pool patient records, lab, and claims data to help docs “measure their care against national quality standards” and that the insurer won’t have access to the data, just the docs will. Wellpoint plans on helping rural hospitals build out IT, but won’t tie their billing into the EHR the hospital chooses.

Humana and athenahealth are getting even more skin into my game (“my” meaning the collective physician world) by helping to cover 85% (Stark?) of the costs of implementation and then actually paying up to 20% more if users show they can hurdle certain performance standards. (This is, I’ve heard, above and beyond any HITECH funds, but don’t quote me on that.)

Deborah, I agree that we really need to keep a very close eye on folks who have access to our patient data. But, if they are going to share what data they gather back with me so that I can watch them watching me, I think that way beats out the current system where they have it all and I’ve no clue about what data they’re using to make payer decisions.

Like it or not, until we have a monogamous, single payer relationship (coughs, harrumphs heard all around,) these are the Bobs and Carols and Teds and Alices with whom we are snuggled. We’re polygamous; we might as well admit it and figure out how to make this ménage a multitude work. Unless you want to start talking seriously about that single payer idea…

From the trenches…

“When I played in the sandbox, the cat kept covering me up.” – Rodney Dangerfield

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.