News 7/6/10

Doctors continue to opt out of private practices to join health care systems. The spokesperson for Parkview Health (IN), a hospital that just picked up 11 new doctors, suggests technology assistance is one reason the hospital-owned practice model is increasingly popular. Other factors include administrative support and expertise managing the complexities of health care reform, Medicare, and Medicaid.

The California Medical Association partners with Heartland Payment Systems to offer members payment processing services, including payroll and check management.

SmartBusiness profiles Gateway EDI and CEO Charlotte A. Martin. Since she took the job in 2000, the clearinghouse has experienced 30% per year top-line revenue growth and added 200 employees. Gateway has also significantly grown the number of practices served from 5,000 five years ago to 14,000 today and acquired two companies. One of Martin’s top goals: maintaining the flexibility and intimacy of a small company.

Oregon physicians speak out against a state plan to put EMRs in place by 2015. Physicians participating in a public forum told members of a state HIT oversight committee that current EMRs are flawed and expensive and that doctors can’t afford the time to train employees and deal with software problems. I’m not sure of all the specifics in this case, but I agree that EMRs are not perfect and they cost practices time and money. However, why keep fighting the inevitable, especially when there are potential subsidies available to help make the transition more affordable? Why do so many providers keep forgetting that paper systems are also flawed and imperfect?

Here’s some stuff that sounds perfect for the next Michael Palmer novel. Medical experts speculate that devices such as pacemakers and infusion pumps are vulnerable to unauthorized programming and manipulation. Many medical devices use wireless connections for monitoring and programming, but those communication channels are at risk for malicious access to private information or manipulation of device functions. Maybe I have been reading too much about Russian spies of late, but the medical intrigue possibilities are fascinating, in a twisted sort of way.

ENT and Allergy Associates (NY) expands its EMR to 21 of its 31 practice sites. I surfed a bit trying to figure out what EMR these guys were running, but came up empty.

I’m hoping that HHS will announce the final Meaningful Use guidelines this week, which is traditionally one of the slowest HIT news weeks of the year. It’s the post-Independence Day lull which precedes a couple of crazy months of user conferences and related press releases on new products. I suppose I should appreciate the quiet, though in the end I am just an HIT geek looking for the latest industry scoop.

E-mail Inga HIT scoop (or forward vacation pics)

News 7/1/10

CMS wants to integrate their PQRI program with the EHR Meaningful Use incentives. Assuming the effort would reduce duplicate reporting requirements, it sounds like a win for providers. Look for the final ruling in July.

Physicians at Tufts Medical Center are using the Web to conduct live medical consultations to patients in Haiti. Students from Tufts University School of Medicine are in Haiti and providing the on-site medical services, while faculty physicians are providing real-time consults using American Wells’ Online Care technology. And the medical world gets a little flatter.

Arizona Integrated Physicians (AIP) selects eClinicalWorks EMR/PM system for its 600 physicians. AIP member physicians will be eligible for preferred pricing and receive the eCW software via a SaaS model. Post-implementation support services will be handled by AIP.

Fifty thousand participants are now receiving weekly text messages from Text4baby. The free Text4Baby service provides both English and Spanish updates to women from early pregnancy through the babies’ first year.

According to MGMA members, the top three challenges of running a group practice are dealing with rising operating costs, managing finances with uncertain Medicare rates, and, selecting and implementing a new EHR. Interesting to note that compared to previous years, implementing a patient-centered medical home model is a much bigger concern. Surveyed members ranked medical homes as their 12th biggest challenge, compared to 22 last year.

RCM provider Capario enters a preferred partnership with software billing developer Healthpac Computer systems.

Greenway Medical Technologies is awarded a patent for its custom clinical template builder. Over the last few months a number HIT vendors have announced patent awards, making me wonder if companies seek patents because they want to product truly unique technology, or, because it’s a good marketing tool. I am hoping someone smarter than me will advise.

NeuroCenter Medical Clinic (CA) selects Acentec to provide IT services, including MedInformatix software and integrated Dragon voice recognition.

Enforcement of Red Flags rules for physicians may be delayed yet again as the FTC works through several lawsuits with medical associations and societies. FTC chair John Leibowitz says that members of the AMA, American Osteopathic Association, and state medical societies will be not be required to follow the rules until 90 days after a decision is handed down through the federal court. In case you are counting, the FTC has delayed physician enforcement five times already.

HIStalk Practice had a big month in June with over 10,000 views. In the last six months readership has jumped a whopping 35%, which makes both Mr.  H and me very happy. We appreciate readers stopping by, and, are very grateful to our terrific sponsors for keeping the keyboards clicking.

Happy Independence Day to all!

E-mail Inga.

News 6/29/10

Healthcare providers participating in the health alliance Better Health Greater Cleveland believe the use of EMRs has helped improve the quality of care for patients with chronic conditions. The organization reports that patients who received care at sites with EMRs tended to improve at a faster rate than those using paper records. One physician exec says:

Electronic health record systems provide tools for physicians to increase the likelihood that their patients receive the right care at the right time. In addition, clinical practice leaders can use these tools to identify changes they can make in their medical offices to do a better job.

St. Cloud Medical Group (MN) contracts with Greenway Medical Technology for EHR and practice management. The 55-provider group will implement Greenway’s PrimeSuite software, as well as online portal PrimePatient and remote clinic PrimeMobile.

Physicians’ Alliance of America selects iMedicor’s secure messaging as its recommended communications systems for members. The 20,000 network members will be eligible for a 25% discount off the regular $20/month subscription rate.

Score one for doing things the old-fashioned way. A physician with Robert Wood Johnson University Medical Group finds that patient no-show rates were lower if an actual person made an appointment reminder call, versus an automated machine reminder. However, no show rates were even higher when no phone calls were made, suggesting an automated call is better than no call at all.

Bayer Healthcare Pharmaceuticals launches a free mobile app for hemophilia A that helps patients track and record hemophilia factor VIII infusions. Another cool smart phone app: MIT Media Lab develops a smart-phone based eye exam tool designed to make exams more affordable in developing countries.

The incident of real-time claims adjudication and processing could improve with wider adoption of EMR. If physicians are able to enter clinical data at the point of care using an EMR, data could be immediately forwarded to insurance companies. One Harvard economics professor believes that administrative costs could be reduced $125 to $150 billion within five years with real-time adjudication. Sounds good. Unfortunately, too few practices find point of care charting a viable option.

RealMed introduces two new RCM products, REALCLEAN and REALASSURE. REALCLEAN (love the name) provides claims editing tools and REALSSURE helps manage the patient collection process.

Beginning July 1st, Indiana providers leaving health records illegally unsecured will be subject to fines. Additionally, state’s attorney general’s office will have the right to obtain and secure the abandoned records.

gloStream introduces a new sales promotion that targets the EMR replacement market. gloStream will give practices a $7,500 in practice management software for “free” if they upgrade from a competing EMR. I couldn’t say if that’s a great deal or not, but, it does point to the fact that the EMR replacement market is growing.

The AMA advocates for insurance payment for all non-face-to-face electronic visits. The AMA House of Delegates says that insurers need to recognize that telemedicine “is going to be a true form of health care delivery, not just a convenience.”

Medical billing service ECCO Health selects Kareo as its billing software solution.

Pulse Systems unveils a number of new products at its recent Knowledge Forum, including a patient web portal, Mobile MD for iPhone, a self-service kiosk solution, and solutions for use with iPads.

Primary care providers saw a 3% increase in their 2009 compensation, though OB/Gyns experienced a 1% decline, according to an MGMA survey.  Dermatologists earned the largest compensation increase, bringing in an additional 12% over the previous year.

E-mail Inga.

News 6/24/10

Privately held AdvancedMD announces Q1 revenue of $8 million, a 29% increase over last year. The company closed on the purchase of PracticeOne EHR in December, so I assume some of the revenue growth can be attributed to that acquisition. The company also claims 26th consecutive quarters of revenue growth. Reading the financial highlights, I am reminded of one of the biggest advantages of being privately held: you can be much more creative in how you spin your results. AdvancedMD mentions big gains in revenues and clients, but I’m left wondering why there’s nothing said about profitability (or lack of it).

Speaking of spin, Practice Fusion reports a 72% jump in its EMR users so far in 2010, adding 200 medical professionals each day. Practice Fusion’s software is free and can be downloaded over the Internet (presumably only if you are a licensed provider). So just how many of those 200 new professionals a day are downloading the software and just taking it for a test drive? How many of the 43,000 users really “use” the system?

I don’t mean to pick on AdvancedMD and Practice Fusion because I know they aren’t the only companies, in HIT or elsewhere, that use their creative licenses to paint things especially rosy. I guess I’m just having one of those days when I’m weary of wading through the fluff.

Sounds like this West Virginia practice might have benefitted from a bit more fluff-filtering before they outsourced its IT services. The physician office is suing its former IT company, claiming backups were improperly performed and were withheld from them. Reps claimed the company had experience supporting eClinicalWorks software. The practice says they were lying and wants compensatory and punitive damages.

Electronic clearinghouse provider Health-e-Web expands its operations with the purchase of a competitor, Electronic Translations and Transmittals Corporation (ET&T).

Patients using a wireless electronic pill bottle to remind them to take medication have 27% higher medication adherence rates, according to findings from the Center for Connected Health. The study focused on patients with high blood pressure and utilized Vitality’s wireless GlowCap product.

United Healthcare and Centura Health launch Connected Care to provide rural medical facilities access to services using telehealth technology. Patients at four facilities in remote areas of Colorado will soon be able to connect with physicians in Denver, Littleton, and Pueblo for routine and specialty care.

Five new practices contract with PatientPoint for its patient kiosk solutions.

EMRs, better follow-up care, and more collaboration with patients and families would help pediatricians avoid errors in diagnosing illnesses, according to research from the Baylor College of Medicine and VA. Surveyed physicians admit to making diagnostic errors at least once or twice a month. These same doctors believe errors could be reduced with EMRs because they provide better care coordination and make clinical data more readily available.

E-mail Inga.

Joel Diamond 6/23/10

Random Thoughts on e-Prescribing

A few years ago, I admitted a 35-year-old man to the hospital with severe dehydration and electrolyte disturbance due uncontrolled diarrhea. The poor guy started out with fairly mild symptoms. After using his neighbor’s bathroom, he looked in the medicine cabinet and saw a drug labeled colchicine. The instructions read “Take every 1 hour– gout relief or diarrhea”.

For those of you unfamiliar with this old but effective treatment, you literally take it every hour until painful gout resolves, or stop taking it when you get the side effects of diarrhea. I will not comment on this gentleman’s intelligence or judgment, but somehow he misinterpreted the instructions as a treatment FOR diarrhea. Worse than that, as his symptoms got worse, he diligently followed the instructions and continued taking more, and more, and more… every one hour for the next 24 hours.

Sort of reminds me of the old lady who was prescribed a rectal suppository for symptoms of nausea. She called saying the medicine didn’t work. “And while I’m at it, how did you expect me to take that giant pill? And if you must know, it tasted awful!” I guess it’s not as bad as the elderly woman who didn’t enjoy the taste of the “Kentucky Jelly” on her toast in the morning. (K-Y Jelly is usually used for other purposes).

Clearly, the Sig (i.e. instructions) portion of a prescription is extremely important. Practitioners claim that the unstructured format in handwritten prescriptions offers more flexibility. For instance, writing complex dosing for a tapering course of medication can be difficult in an EMR.  This is commonly cited as an obstacle to widespread adoption of electronic prescribing. But in the end (pardon the pun), I suppose that the above suppository story could have been averted if the instructions had read “carefully place the huge waxy tablet firmly up your ass.”

Speaking of which, a colleague of mine told me of the time he once prescribed drops for a baby with an earache. The instructions were: “Put two drops in right ear every four hours” with right abbreviated as an R with a circle around it. The mother returned when the child did not get better. She showed the doctor the baby’s wet rectum as evidence of complying with the prescribed treatment. It turns out the pharmacy printed the instructions as “Put two drops in R ear every 4 hours”.

I’m a huge advocate of electronic prescribing. Elimination of handwriting errors, dose range checking, and monitoring drug-drug interactions are but a few of its virtues. My patients definitely appreciate having prescriptions waiting for them at the pharmacy.

As an aside, several years ago when I started e-prescribing, a pharmacist I knew told me that the drug store pharmacies were worried that this convenience would cause them to lose revenue. It seems that waiting around is precisely why they put the pharmacy there in the first place — to make you shop for other stuff during the 30 minutes it takes to put 30 tablets in a bottle.

Progress can oftentimes be thwarted by outdated legal issues. I still can’t figure out why I can call in prescriptions for Vicodin and Xanax over the phone (or worse, fax them), but I am not allowed to e-prescribe these controlled substances and significantly decrease illegal prescription diversion.

Speaking of old fashioned, one of my old mentors told me that he had an agreement with the local pharmacist back in the day. Whenever he had a hypochondriac in the office, he prescribed Obecalp for whatever ailed them. The pharmacist would fill the script with the biggest vitamin capsule he had in stock. (Obecalp is placebo spelled backwards). I often wish for that drug to appear in my EMR’s drop-down list. Talk about “Primum non nocere” –First do no harm (The Hippocratic Oath).

Frequently,  I just miss what might be the last bastion of the lost art of medicine … pulling a leather-bound prescription pad out of my pocket and writing Latin instructions with a fountain pen as closure to a satisfying doctor-patient encounter.

And then getting a call from the pharmacist telling me the drug isn’t on formulary!

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.