News 12/8/09

From Seeker of Truths: “Re: ARRA funding. All the EHR vendors I’m talking to lately tell me that practices can get their money right now. I’ve heard it so much that I’m beginning to doubt what I know to be true! Am I the only one?” I suppose I shouldn’t be surprised to hear that some vendors may be saying ARRA money is available today. Technically the government is handing out some money, though none of it has yet flowed to providers for their meaningful use of a certified EMR. Perhaps someone needs to remind those vendors that we’re still waiting on the final definitions for meaningful use and certified EMR.

The AMA expresses concern that easily accessible patient records could lead to a decline in care as doctors avoid the sickest patients to improve quality performance scores. I thought the AMA was suppose to advocate for physicians, not diss them. But, I agree that unintended consequences could occur as we rely more on EMRs to measure quality care improvement. I prefer to be optimistic that most doctors will remain more concerned with providing quality care than performance ratings.

Desert Cardiology (AZ) selects Medfusion for its patient-to-provider online communications solutions. Desert Cardiology is a six-location, 10-provider practice.

Hayes Management Consulting announces that more than 50,000 providers are now using its MDaudit Professional compliance audit software. They also just introduce a hospital version of the product.

Healthpac Computer Systems contracts with Alpha II to resell Alpha II’s ClaimStaker claims scrubber software to Healthpac’s office-based physician clients.

Shares in athenahealth hit a two-year high Friday afternoon after the company stated expectations of annual revenue growth (30%) and profits (40%) through 2014.

Cielo MedSolutions partners with DrFirst to provide e-prescribing functionality for practices using Cielo’s Clinic clinical quality management system. Dr. First’s Rcopia solution will be fully integrated into the Cielo Clinic application.

The Bureau of Labor Statistics says the healthcare sector added 28,500 jobs in October, including 4,800 jobs in physician offices and 10,000 in hospitals. A separate survey finds that 95% of the hospital CEOs claim they have a shortage of physicians, with a vacancy rate of 11%. In other words, more than one in 10 physician job openings are unfilled.

Related problem: if 40 million people suddenly get health insurance, rural areas don’t have nearly enough primary care doctors to see them. The reason is obvious: the doctors go into specialties and geographic areas where the pay is better.

The California Nurses Association, the MA Nurses Association, and some members of the United American Nurses combine to form National Nurses United. The new entity represents over 100,000 nurses.

The UK’s Medical Defence Union warns doctors not to respond to “flirtatious approaches” form patients on  social networking sites like Facebook. The MDU advises members of the importance of keeping relationships with patients on a “professional footing.” Could be that the Brits remain more formal than us since I haven’t heard any official warnings on this side of the pond.

Quantros and Allscripts integrate their respective products to create a Web-based care management solution.

The latest story of greed in healthcare comes from Canopy Financial, who provides software to help manage HSAs. Canopy filed for bankruptcy protection after the FBI began looking into alleged fraudulent financial statements that were created as part of a $75 million investment scheme. Co-founder Jeremy Blackburn recently resigned as president after the allegations came to light and his assets have since been frozen. KPMG first discovered the potential fraud after realizing Canopy was claiming that its financial statements were audited by KPMG. In fact, KPMG had never been retained by Canopy to audit its financials. Perhaps one day Blackburn and Charles McCall will have a chance to be roommates.

E-mail Inga.

News 12/3/09

From Golden Creeper” “Re: MD salaries. While doing some research on physician wages, I came across this blog. Found it interesting and just thought I’d tell you.” While not really HIT related, the MD $alaries has an interesting variety of income data, including comparative figures from various parts of the country and other countries, plus suggestions for boosting income (or reduce expenses). The latest post says that physician executives with an MBA earn 11% more than those without a post-graduate degree.

The Kerlan-Jobe Orthopaedic Clinic, which serves virtually all the professional sports organizations in Southern California, agrees to pay taxpayers $3 million to settle a federal lawsuit. The Justice Department charged it with taking illegal kickbacks from HealthSouth Corporation in the form of stock option grants, donations to the Kerlan-Jobe Foundation, and loan forgiveness on equipment leases.

CCHIT certifies four new products under the newest programs announced in October. ABELMed EHR-EMR/PM, Version 11 received certification under the CCHIT 2011 Comprehensive program, while eHealth Made EASY, KIS Track, and Medios earned Preliminary ARRA 2011 certification.

Here’s the difference between the two certifications: the Comprehensive certification program “provides a more rigorous inspection of integrated EHR functionality, interoperability, and security in addition to full compliance with Federal standards.” CCHIT also includes an inspection process in the Comprehensive program that considers successful use at live sites and good usability. Additional certification announcements are pending, per CCHIT. And OK, I admit it — I’ve never heard of any practices using any of these products.

Claims clearinghouse Navicure recognizes four clients for their substantial improvements in RCM and billing using Navicure solutions. Winners of The Biggest Gainer Awards (love the name) included the 24-physician North Atlanta Primary Care, which cut its A/R days by 43% (less than 18 days) and raised its collection rate to 97.4%. The single doctor Spinella Orthopaedics Association, which has a single FTE for billing, reduced its A/R by 30% and cut its over-90-day A/R by 67%. Here’s a nice spiff: all the winners receive six months of free Navicure services.

Johnson Memorial Hospital (IN) will offer eCW to its employed physicians and use eCW’s Electronic Health eXchange to allow access for other physicians and hospitals.

Participation in quality reporting programs requires resources with measurable costs, a fact supported by a recent study in Annals of Family Medicine. A major problem is lack of interoperability among IT systems. Participation is especially difficult for small primary care practices, who often need to hire outside consultants. Physicians in smaller practices also spend more of their personal time after hours collecting the required data.

SK3 Group signs a letter of intent to acquire Medical Billing Specialists for $4.1 million from its owner, Healthcare of Today.

Maryland is spending $100,000 of taxpayer dollars to train observers to keep an eye on doctors. Specifically, the program will teach certain hospital employees how to covertly monitor the hand washing practices of healthcare workers as they leave patients’ rooms. I’m all for clean hands, but can’t figure out why it costs $100,000 to train people to observe other people washing their hands. And why Maryland is using federal ARRA dollars, because I don’t see the connection with economic stimulation. When will the insanity end?

The 18-physician Naugatuck Valley Radiology Associates (CT) claims it’s now 100% paperless following the implementation of a MedInformatix RIS, DR Systems PACS, and Nuance PowerScribe voice recognition.

Dialog Medical expands its partnership with A.D.A.M. to include A.D.A.Ms’ QuickSheets patient education solution in its iMedConent application.

Ping Inga.

HIStalk Practice Interviews Mark Brown

Mark Brown, MD is an ophthalmologist with Vision Partners at Providence Park Hospital, with offices in Daphne and Mobile, AL and Biloxi, MS.

Give me some background on your practice.

We are a group of eight doctors, six ophthalmologists and two optometrists. We founded our practice eight years ago. A smaller core of us was on faculty at the local university and basically things were very restricted in terms of our desire to go more electronic and high-tech. And is often the case with universities, they’ve got their committees etc., and we just didn’t get to do what we wanted to do with it.

Ophthalmology in general is probably one of the more techie kind of subspecialties, and so the entire department left in 2000 — staff, doctors, clerks, everybody in the department. We basically created our own office called Vision Partners. Most of the doctors are fellowship trained and experts in their field. We built an office on a different hospital campus that was built to be paperless.

We had a kind of luxury because we decided when we were going to leave and they didn’t fire us. We had a year to plan and that was instrumental for a number of reasons. We had never done what we were about to do and we needed to choose practice management software and electronic medical records and build a building. We’d never done any of this. We were just kind of flying by the seat of our pants.

I spent the better part of nine months really looking at practice management software and medical records software. We built our building to be very much wired from a networking and computer perspective, and paperless from a perspective of no storage facility in the office at all. Every square foot we wanted to be productive, so we didn’t want to have 2,000 square feet of storage for charts. Over the past couple years, we’ve added on doctors. There were four or five of us when we started; there are eight now.

We have three offices. Our main office is in Mobile, Alabama. We’ve got an office downtown and an office in what’s considered across the bay in Eastern Shore. Basically, we rotate patients in various areas. It’s not quite as bad as New York, but patients desire to stay within two square blocks of their house and don’t want to go anywhere. That’s particularly true for the patients across the bay. Eastern Shore is the city that has been really written up in the news as a top retirement city in the United States. Those patients really look down their nose at coming over to Mobile for anything, so you have to provide services over there.

There was also an issue of how to have everything connected with charts going back and forth. That would be something we would never, never have been able to have done with paper charts. One of my biggest pet peeves at the university and why we wanted to have electronic medical records was my boss, who is now my partner, would notoriously take charts and put them in the back of his Ford Explorer, never to be seen again. I mean, the patient would come in and we have no idea why they were there. You’ve got no chart. The chart’s missing.

Then you have all of these human issues; people unable to follow the alphabet. They just can’t file charts correctly either numerically or alpha, and so the chart is misfiled. It’s there somewhere, but no one knows where it is. Or, the typical scenario is that it goes from surgery to billing to a doctor and it’s always en route from one place to another. You add into the wrinkle of, “Oh my God, it could be in a different office twenty minutes away.” It was just never going to work. We needed the digital copy.

Tell me what kind of technology are you using.

We use about four programs to do everything. I’ll tell you the history, briefly. About nine years ago when I looked for an integrated solution, an integrated practice management/medical record — the whole nine yards — didn’t exist. When one company did well on one, it didn’t do well on the other. The people that had practice management software really had crappy EMRs and I don’t think that’s changed.

I’ve lectured at the New Orleans Academy and I don’t think there’s a product, at least in ophthalmology, where you can get the best of both worlds. So we chose Medical Manager as a practice management software. At the time, they had the claim to fame of having set up a lot of practices and they had widespread customization available. I don’t particularly care for the company — Sage. There are enough freelance programmers out there that could do things if you wanted to be done.

We deployed Medical Manager on a Windows-based system and then we chose SRS medical records. We tied them together with a custom interface so that when a chart would be created in Medical Manager, they would appear in the medical records software automatically and all the demographics would come over on the schedule, the insurance, all of the details. That was important because one of the things we wanted to get with an EMR was not re-inventing the wheel every time with rewriting the patient’s Social Security number and insurance number on every form when we book a surgery or on a consent form or whatever. Those are what they describe as ‘mergeable.’ They come over, and then if you create a Word document, you can have those numbers drop into it automatically.

Two years ago, we stopped liking the clearinghouse Medical Manager had and we went to a product called Practice Insight, which enables us to track our claims and divvy up tasks based on rejected claims in a very systematic way that we never could do with Medical Manager. We initially went with a coding software that was part of Medical Manager, where you filled in the circle like you do on a standardized test.

Then two years ago we moved to a product called White Plume, which interfaces beautifully with SRS. We click the tab, the form comes up electronically, we tick off the buttons that we want. We can add the modifiers, we can see the patient’s insurance right there. We can do really sophisticated things with macros, so we can bundle an ICD-9 and a CPT code all at once. Our office exam rooms all have a computer and we can leverage the system very well. We do all the billing in the room and keep track of what needs to be done, without wasting paper for that matter, or losing charts.

Does White Plume interface with everything? Is it just for the charge ticket or is there a clinical component to it as well?

It’s an electronic charge ticket. When an appointment gets made in Medical Manager, it goes off two different ways. You get a charge ticket created in White Plume and you get an appointment created in SRS. So as soon as I walk into the patient’s room, I’ve got my schedule up on SRS of the patients I’m seeing today and I can sort it by name or by time or whatever I want. Then I launch the bill ticket just by clicking on one of the tabs in SRS. Each of the doctors has their own superbill and it’s seamless for the doctor.

I think that’s the whole thing — I wanted a system that wasn’t going to slow anyone down. Dr. Rich, the guy who was my boss and my partner, he’s at a real high volume. So when I was looking at these systems, he had a low tolerance for anything that was going cause him to see two less patients a day; that was inadequate. As for both the SRS and for the White Plume, it had to be at least as efficient as paper, if not more. So both of those systems had that criteria for us.

You mentioned difficulty finding an EHR that would work well with ophthalmology. What is it about SRS that worked better than some of the other ones out there?

I think the wish would be that you could have a system that doesn’t slow you down. Except that all of the systems out there slow you down. You look at the patient and you say, “Okay, you have a diagnosis of a corneal abrasion.” So I’m going to take my piece of paper through SRS or a paper chart, and I’m going to go to my exam form and I’m going to go to my form and mark corneal abrasion. That takes a microsecond, whereas so many other systems there are these drop-downs where you kind of have to go to the right section of the exam, then you choose anterior segment; and it’s in a series.

It’s a philosophy thing, of grouping or splitting, and so for it to work, you’ve got to split. So you choose anterior segment — that’s the front part of the eye — and then you choose cornea. There are four million things that could be wrong with a cornea and you’ve got to choose whichever one best fits. It’s all about clicks today and it’s one of my biggest gripes when I call up vendors and I say I don’t have any problem with your software — you missed the boat here when they do something that requires five clicks that could be done in one. I went through this with White Plume, asking why do I have to click ‘close’ and ‘save and close’? Why can’t I just click one button to save it all? And they’re like, ‘Well, every click matters.’

I’m under constant fire from the insurance companies for my reimbursements. Blue Cross just announced a 20% fee cut. I can’t make up 20% in my volume and it turns out that my employees don’t want a 20% pay cut. I’m not sure why.

And neither do you.

Yeah, and neither do I, and that’s a problem. It’s a huge problem because every click and everything that slows me down is not good. So I think the other thing about [our selection of SRS] is the reality that paper exists. I mean, let’s not deny this. The fact is, charts are going to come over from other offices that are paper. I looked at one of the companies, a very large company, that had an EMR and a practice management component together and I said, ‘Well, here’s this fax. Put it into your system.’ You know there’s like nine steps? They had to scan it, they had to name it, they had to put it in its place. On a day-to-day basis, there are just too many faxes to deal with that. It would just never be realistic. All of the medical clearance that we get from other medical offices are all paper. Hospitals all work with paper.

You know I’m not saying in ten years or fifteen years it might not be different. I guess we’ll have to wait and see, but I’d say for a long period of time, the standard is going to be an 8½ x 11 sheet of paper. So many of these other practice management software had no way to really bridge the gap between paper and digitized, but what every one of us liked about SRS was that it didn’t require us to change what we do. We still could write on paper and we’d have the PDFs, my built-in system. I don’t have to worry about the company going out of business. Everything’s a PDF. There’s nothing proprietary about it.

And, it’s intuitive. The first training session we had, I took a group of 20 people from the university. Generally, university employees are like government employees, you know? They’re just not the most motivated people. These people, they didn’t have computers at the University. I sat them down and they had never used a mouse, aside from people that had a computer at home. I mean, people were looking at me like, what was I thinking? It was a thirty-minute training session. I still haven’t read the manual on SRS. I’m sure there are other features that I could be using that I’m not. The reality is that we can hire new staff and say this is what it is and they can just kind of look at it and figure it out. It’s just intuitive, and that’s not the case for most software.

Has the passage of the ARRA legislation changed your focus at all in terms of your technology adoption and usage?

Well, it annoys me. I don’t remember signing up to be a government employee when I went to medical school. I’m very cynical about the whole premise that it’s going to save money. I see money being spent, but I don’t see money being saved. I think that capitalism should take over. It reminds me of when the HIPAA rule came out two or three years ago. We’re like, ‘Oh, I’ve got to have this piece of paper that I have my staff or my patients sign that I’m not going to share your information.” Well, I don’t know, the people in Washington decided that was important and so then I had to implement it.

I had to pay for those papers to be created and printed and passed out. I think that the first time that a doctor’s office sells their patient information, I bet that patient doesn’t go back to them. I just think well, I don’t get reimbursed to do that. It just seems like a common sense kind of thing, or common courtesy, or free market would take care of itself. So when you go and impose this, “This is how we want you to document your medical records.” Well, who is that saving money? Because it’s not that I’m going to get more money from Blue Cross or Medicare. I might get a less of a penalty, but it doesn’t translate into making my office better. It just serves their need of that’s what they want to do.

But let’s say we all did that. How does it really save anyone any money having everything — I mean, we’ve spent how many billions of dollars doing it now? Ten years later, everyone’s got an EMR. Has it saved the system money? I mean, I’m not really convinced that it has. With the exception, perhaps, of redundancy of ordering tests that have already been ordered. There are lots of other ways to deal with that. They could just put a penalty on you to say, you know what? If you order a test that another doctor ordered and you’ve repeated it because you were too lazy to look up the result, then you know, you get fined. That would prevent people from ordering tests that aren’t necessary or have already been ordered.

I think the government has a really bad track record of following through on the payments. I think the physician practice in this scenario is kind of being forced to take on a liability or a risk without really any guarantee of payment. I don’t think people that I’ve talked to have gotten their PQRI payments. The reason we went with an EMR was: a) to save money, and a) to be more productive. The ones that are qualifying to meet those criterion are going to slow me down, and so I’m not excited about it because if I have a lost productivity of seeing a couple patients less a day, it’s not worth it.

So you are saying you may not change anything and just forego the incentives?

That’s exactly what I’m saying, and I’m mad about it because I have an EMR and I have a system that I believe meets the realistic criterion. I don’t think that the people that are coming up with the criterion are in practice. Patients can easily get a copy of their medical record; it’s portable; I can have multiple copies of it. It’s a huge step up from the paper record, and yet it doesn’t change the way Mark Brown wants to be an eye doctor.

And by the way, patients, I don’t think, really care for the idea of my spending my consultative time staring at the computer ticking off boxes rather than making eye contact with a patient where I can do with a clipboard and a piece of paper. You can’t talk into the screen and have the patients hear you, and not to mention it’s rude. So now I’m looking at the patient and having a conversation, but normally I could be filling out a form at the same time, but now I’ve got to turn and document things after. Well, I guess I could hire a scribe to enter all that. That’s going to just be a drain of another salary per doctor. There are all these things that you could do to justify it, but the practice keeps absorbing the expenses. It’s not like I get reimbursed any more money. The rules that are imposed by the government only decrease our productivity.

You said one of your initial goals was to save money. Has that occurred?

Absolutely. We fired two people. I don’t want to get rid of every human being. I want to support the local economy, but we got rid of people that prepared the charts every day. What a ridiculous job. Day in and day out you go and you look for the chart and you put a blank piece of paper in, form the chart for the exam, sort and organize the chart. That was an entire salary at university.

The other is the charge entry. It’s all automated — it’s ready to go out the door. I think the biggest thing is the sanity factor. What we all like is the fact that the chart can be open. What typically happens in a practice is Mrs. Smith calls in with a complaint, the technician answers the phone, and now they’ve got to get the chart. Think about how much time that takes. They’ve got to find the chart and then they’ve got to review it. Then they’ve got to go pass the chart to the doctor and they’ve got to review it. Whereas with the SRS here, they could pull up the chart, they can either buzz me in my office or they can send me a message attached to the chart and I can just look at it. And, the chart can be open in two places at the same time. That can’t happen in a paper system.

As you know, overall EMR adoption is still pretty low. Why do you think that is the case? Why are so many of your colleagues still so resistant?

Initially, it is the upfront expense. Then you look at the past year and ask what the government is going to do. They are uncertain if these standards are really set. Are the standards going to change? What if I buy a system that’s not upgradeable? This isn’t done as a rebate system from what I understand, so I think potentially you’re talking about not getting the money that you want or think you’re going to get. I think that you’ve got an economy that’s not good and you’re asking the doctors to put up the money to do it. It’s one thing if you were already moving or built an office, but if you were going to outfit an entire office, it’s expensive. And, it’s a tremendous loss of production while you’re going through that transition.

If you look at the EMRs that are out there [versus SRS] and you say, ‘Well, OK, we have 100,000 charts.’ [For us, the transition was 100% transparent to the doctors.] We hired a bunch of college kids to start scanning the files and we did it for months. But, what does the average office do? How long does it take to roll into a new system and what do you do with all the old records in that time? You have no access to the old data, and so you’ve got a paper chart that you’re reviewing, and then you’re starting a new system. [With a CCHIT, we would be basically doubling our work as we reviewed patient’s notes on paper and then started their CCHIT chart.] I can tell you that during that first two years I bet our production [would have] dropped 30-40%  [compared to our old paper system] because we [would have been] basically doubling our work. No one’s going to want to do that.

The other issue is so many of these systems really are complicated and require an IT person. You get to have an EMR, then you get to hire someone at a $50,000 a year salary to babysit the computers because Windows needs updates and the network goes down. All of those things are reasons why people didn’t sign up for EMR.

Any other general impressions on the industry you’d like to share?

I think in general, SRS seems to be more unique in understanding what doctors do. Medical Manager is up to version 10 or so, so they’ve had enough years of feedback to be told. Other companies that we’ve dealt with, we say, well this is what we want to do, and they’re like, “Well, oh, we hadn’t thought of that” or “the programmer didn’t design it that way”.  I can’t speak to other products, but it’s the same thing over and over again with the companies and the programmers. There’s a disconnect between how the practice of medicine is performed. For some reason, it is not present in SRS. They seem more responsive and more in-tune.

I think the other companies that I’ve worked with, White Plume and Practice Insight, are responsive to my suggestions, which is good because of course, I always like my suggestions. But I’m often amazed by products, asking, “What were you thinking when you designed it that way?” I kind of hit my head against a wall sometimes. It’s just an example of someone who actually is designing from a computer perspective, and not from an IT perspective. I don’t know if it’s a matter of the industry needing more practicing physicians on their consultative boards and things like that.

You can look at me as the “doctor not for the $44,000.”

News 12/1/09

From EMR Doc: “Re: Health Industry Insight Reports. eClinicalWorks was the clear-cut ‘winner’ in this assessment, earning the best ratings in both the small/midsize and large practice EMR markets. The second-tier group for the small/midsize market included Allscripts Professional and MyWay, Sage Intergy, and athenaClinicals. In the large practice market, Allscripts Enterprise had the second best scores, followed by Sage and NextGen. I was surprised to see that EpicCare didn’t get very high marks and ranked lowest in the ‘fits market needs’ category.”

Quality Systems promotes Patrick Cline to president and chief strategy office, moving him up from his role as president of the company’s NextGen subsidiary. NextGen senior VP Scott Decker (above) takes over as NextGen president. Steven T. Plochocki drops his Quality Systems “president” title but remains CEO.

Portage Health (MI) selects eClinicalWorks EMR and PM solution for its 31 employed physicians. The eCW software will be interfaced with the hospital’s Meditech inpatient system.

At the annual RSNA meeting, Asim F. Choudhri, MD discusses the use of smart phones to diagnose appendicitis from a remote location. Using OsiriX Mobile medical image viewing software, radiologists can read scans with full resolution and little panning. I find this technology off-the-charts cool.

The KLAS folks report that demand for computed radiography equipment in physician practices and outpatient clinics is on the rise. Hospital sales are flat, but demand is increasing from physician offices, who are deploying lower-cost single-plate equipment.

The 340-provider Sanford Clinic (MN) takes its Worthington clinic live on Epic.

This UCLA study shows that patient-care performance ratings improved significantly following the launch of a launch of a P4P program, though not when the incentives focused on doctors’ productivity. The study included 25 medical groups across California and found that certain financial incentives to improve patient care, plus public reporting of performance ratings, positively effected the patient care experience. The greatest improvements were seen within those groups which placed less emphasis on physician productivity and greater emphasis on clinical quality and patient experience.

Welcome to Sage, a new Platinum sponsor of both HIStalk Practice and HIStalk. The Tampa, FL company offers a variety of physician systems, including the Sage Intergy EHR, practice management solutions, Sage Intergy RIS and PACS, community health applications, analytics tools, and EDI services. The Sage Intergy EHR Kit includes ARRA information, access to an online demo of Sage Intergy EHR and Sage Intergy, a presentation covering EHR benefits, and a practice case study. Thanks to Sage for their much-appreciated support of HIStalk Practice and HIStalk.

I hope everyone had a great Thanksgiving holiday. If you happened to take a break from your computer during the long weekend, be sure to catch up on the latest posts from Dr. Joel Diamond (who provides a refreshing reminder that ultimately this industry about healing) and Dr. Gregg Alexander (who examines the evolving pocket brain).

North Shore Gastroenterology and Endoscopy Center (OH) selects Wolter Kluwer Health’s ProVation software for procedure documentation and coding and ProVation EHR for clinical documentation.

Eastern Maine Healthcare Systems and Anthem BCBS in Maine are piloting an e-visit program, giving patients the ability to communicate with their provider via e-mail. The initial phase of the program involves PCPs at selected practices and is designed to accommodate non-emergent issues. Patients can also use the program to schedule appointments, check tests results, and request prescription refills. Having been to Maine in the winter, I can appreciate the convenience of e-mailing a doctor over getting out in the frigid weather.

Even though some medical liability insurers extend discounts for doctors using an EMR, little evidence exists that their use cuts liability risk, mostly because of low EMR adoption. Meanwhile,some attorneys worry that EMRs may actually increase risk because they provide too much information. Other legal experts say that on balance, EMRs do mitigate risk because they provide better accuracy and decrease errors. Any expert opinions?

E-mail Inga.

Intelligent Healthcare Information Integration 11/28/09

Announcing Peihcud: The EHR You’ve Been Waiting For!
Pre-Egged, iHipped, Cracked-up, and Droided

Boy, don’t I wish! Didn’t mean to get anyone’s hopes all atwitter with that brazen and completely fallacious pronouncement, but man, oh man, do I want to be able to see a similar such proclamation someday soon.

After playing with any of these little “smart phones” for any length of time, it’s getting pretty obvious that prolonging the “phone” part of the name is just legacy respect for their origins. They are pocket brains (PBs) that are smarter, faster, slicker, and way more everyday useful than any desktop, laptop, or netbook will ever be. Don’t get me wrong: I love my other systems. They have abilities and functionalities which will likely be difficult to soon replicate in any handheld. (Soon as I say that, you just know the next cool app genius or PB hardware savant will prove me wrong!)

But, for day-to-day, moment-to-moment, real life, “isn’t this how I’ve always wanted to be able to access info in my own poorly structured head usefulness”, there is nothing comes anywhere close to a highly-apped, fully-tweaked PB. You can get to what you need quickly, find what you want at will, share and connect, and entertain yourself ad nauseum. Plus, at least with my little Pre, reboots for any little Ghost in the Machine glitches take about a twentieth the wait time of my bigger toys.

Strikes me that all this tweakablity, all this rapidity of information gathering, incorporation, and integration into my daily life decisions is just exactly the prescription any doctor wants to fill for his or her next EHR.

Give me a basic tool that I can app. Give me a few data entry options for notes, allergies, medications, diagnoses, and demographics. Maybe scheduling, too. Then let me app it to my little heart’s content.

I want to ePrescribe? App. As a pediatrician, I need weight-based dosing with most encounters? App. I need to track multiple kids in a single family with multiple last names? App. I need to search for the insurance guarantor for divided familes? App. I want to search the AAP’s Redbook, Medline, or eMedicine for info on the differential diagnosis head-scratcher du jour? App. I have multiple offices and want to see who is in what rooms and waiting how long? App, maybe two. I want to pull up a Blaussen video to educate a new-onset asthmatic teenager about the disease in a short format that might actually present info to him in a way his now video-and-sound-bite focused brain might actually wrap around? App.

App happy? Yap … er, yep, I suppose I am. But, Heavens to Murgatroyd, Myrtle, these little PBs are so daggone end-user friendly! The app building to create a total tool that suits me to a “T” is just what the doctor ordered. I think the masses of yet pen and paper-based docs need just such a way to comfortably stick their toes into the digital waters, easing their way in to the silky swim of advanced information integration at their own “app”licable pace.

I know, I know. I’m underestimating. Healthcare IT is way too complicated for such a Keep It Stupid Simple approach. But, being of a John Gallian bent (and not just because he’s a retired pediatrician), I firmly believe in his diktat that, “A complex system that works is invariably found to have evolved from a simple system that worked.”

My apped-up Pre works, though it sure didn’t spring forth from some megasystem, do-all-things-for-everybody master plan. It grew, it evolved, from basic beginnings. Indeed, when Lars Magnus Ericsson first installed a telephone in his car in 1910, I can guarantee he never thought it would lead to me downloading a fully functional 45 language translator in less than a minute enabling a conversation about breastfeeding with a new Ukrainian mom who doesn’t speak a lick of American, but who sure smiled when she was able to receive the doctor’s guidance in her own native tongue.

From the trenches…

“It’s kind of fun to do the impossible.” – Walt Disney

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.