News 7/23/09

Zynx Health and eClinicalWorks announce a partnership to provide Zynx AmbulatoryCare order sets to ECW clients.

Healthy Advice Networks launches PracticeWire, a wireless solution that delivers real-time health content to physicians all day via wall-mounted flat-screen monitors. The monitors are placed in a practice’s back office where it displays medical news throughout the day. Practices can also incorporate their own content, such as details on standards of care and regulatory guidelines.

The HIMSS Electronic Health Record Association re-elects Greenway’s Justin Barnes as chair, adds GE’s Mark Segal as vice chair, and appoints Epic’s Carl Dvorak as an executive committee member.

Sound advice from CPA and consultant Reed Tinsely on what it takes to successfully implement EMR: “A large part of success/failure is that someone of authority in the practice has to take accountability to direct all the physicians that EMR is either go/no go for the entire group…the organization cannot be divided once an implementation decision has been reached.”  More here on Reed’s blog.

Allscripts-Misys releases its fourth quarter number and beats Street expectations for both non-GAAP EPS and revenue. Non-GAAP EPS was $0.16, above the expected $0.15, and total revenue was $166.2 million, compared to the $160.5 million expectation. Meanwhile Allscripts and Medfusion announce a strategic agreement to provide the Medfusion patient portal for Allscripts EHR/PM clients. At the same time, Medfusion announced its purchase of Medem’s health services operations.

The number of residency graduates who are immigrants are on the rise, especially in the fields of pediatrics, internal medicine, and family practice. AAFP President Ted Epperly believes primary care specialties are less appealing to US-trained doctors because it pays significantly less than other fields. Nationally about 25% of residency graduates begin their medical training abroad. In primary care, almost half are foreign-trained.

WebMD introduces Medscape Mobile, a free medical information application for use on the iPhone or iPod Touch. Medscape Mobile includes drug information, clinical reference tools, medical news, and CME opportunities. The application will be available for Blackberries later this year.

Hayes Management Consulting and Aternity partner to help improve physician adoption of EHRs. The companies will combine the rapid prototype methodology of Hayes with Aternity’s Frontline Performance Intelligence Platform to organizations increase implementation efficiencies.

A former South Carolina office manager is sentenced to two years prison after admitting she opened a credit card in her employer’s name to buy personal items, wrote check’s from the company’s account, and took money from the company’s bank deposits. Jane Wyatt-Scott pleaded guilty to breach of trust, financial transaction card theft, and financial identity theft. In addition to prison, she must pay over $158,000 in restitution.

3M Health Information Systems and CodeRyte ink a deal to integrate CodeRyte’s outpatient computer-assisted coding technology with 3M’s Codefinder software. The new product will be referred to as 3M Codefinder Auto Edition, powered by CodeRyte technology. Rolls right off the tongue.

Advantage Healthcare Solutions and Physicians’ Service Center combine their practice management and billing operations. With the merger, the new entity will provide services to over 120 physician groups and employ almost 300 associates.

Half of consumers indicate they are willing to seek healthcare through the Internet as a substitute for face-to-face, non-emergency visits. That, according to a PriceWaterhouseCoopers report. Nearly 73% of the 1,000 surveyed would be willing to take advantage of tele-health services to track their conditions and vital signs.

And, according to BCBS of Florida, digital doctor services are on the rise. BCBS first began paying for e-visits about five years ago and today about 1,000 providers have signed up to provide e-visit services. The most common digital applications embraced by doctors and patients include scheduling appointments, sending lab results, and paying bills.

A UK study concludes that pay-for-performance programs fail to provide sustainable long-term gains in care. In a pilot program, P4P measures did result in short-term improvements in asthma and diabetes care after one year, but the rate of improvement reached a plateau by the fourth year. Also, the P4P program had no overall effect on heart disease care.

With the proliferation of on-line rating sites that include the review of physicians, more doctors are going on the defense. More than 40 websites now include doctor ratings, prompting some physicians to sign agreements that prohibit online postings or media commentary without the doctor’s prior written consent.

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News 7/21/09

Half of all physician practices, medical billers, and billing offices are unable to estimate the amount due at the time of service. And, doctors collect only about half of the balance due from patients, with the balance going to bad debt. In other words, each year doctors are not collecting $14 to $30 billion of the money they are due. A few companies now offer tools to calculate the patient responsible portion at the time of service. As consumers pick up a bigger portion of their health care costs, look for increased adoption of these type technologies.

Google Health now supports document scanning, allowing patients to upload paper medical records. Google is also partnering with Caring Connections to allow users to download free advance directive forms.

Mednax pays cash for Mid-Tennessee Neonatology Associates, a 24-provider group serving NICUs in the Nashville area.

I happened upon this blog written by an ophthalmologist who also apparently runs a practice management and consulting firm. Dr. Peter Polack offers some sound advice on ways to ensure medical records remain legally sound, once doctors transition from paper charts to EMR.  The key is ensuring EMRs are not altered, which requires automated audit features to track who accesses a patient record and when. I find it curious that Dr. Polack used the phrase “remain legally sound,” which somewhat suggests a paper chart cannot be altered. I’m pretty sure I’ve never seen an automated tracking system for paper charts, either.

Providers in Minnesota are now required by law to submit all insurance claims electronically, including those for private and governmental carriers. The state hopes to save about $60 million in administrative costs once all 60,000 providers have made the switch from paper. I’d actually like to see that math. I’m sure most larger clinics have already been submitting claims electronically for years. Is the $60 million a “real” number or just one that Minnesota legislators hope will impress their constituents?

EMR does not necessarily kill the use of pen and paper. So concludes a researcher from Roudebush VA Medical Center (IN). Clinicians often use sticky notes, index  cards, and notebooks to improve workflow efficiency, as well as for memory aids. Don’t dump that Bic stock just yet.

A Phoenix-area OB/Gyn practice bans e-mail on Fridays to encourage more interpersonal communications. The 16-doctor, 130-employee group now have “Conversation Fridays” to promote more personal interaction among employees.

A Kaiser pediatrician shares his thoughts on EHR in an LA Times opinion piece. He admits that EHR doesn’t save time or money, though it does allow him to work remotely from home after the kids go to bed. He’s also enthusiastic about the efficiency of e-mail consults, which can reduce errors and boost care. He concludes, “Ultimately, getting away from a pen and paper is better for my patients.”  Ahhh…so EHR isn’t just about stimulus money.

ENT and Allergy Associates (NY/NJ) announces they’ve expanded the use of their NextGen EMR system to 10 of its 30 practice sites. The practice includes about 90 physicians.

Fairfield County Community Health (OH) makes plans to purchase a PM/EMR solution after being awarded a $250,000 federal grant.

Parents claim that when their children’s care is coordinated through a medical home, their children have fewer hospitalizations and fewer school absences. Parents also worry less about their children’s health. The findings are based on a three-year New Hampshire survey that examined the effectiveness of using medical homes to coordinate pediatric care.

Disturbing: the Congressional Budget Office estimates that HR 3200 (America’s Affordable Health Choices Act 2009) would grow the deficit by a net $239 billion between 2010 and 2019.

The family of an elderly patient sues his dentist for allegedly dropping tools down the patient’s throat on two separate occasions. The  suit claims the dentist dropped an implant screwdriver tool in 2006 and a mini-wrench in 2007. The 90-year patient had several medical procedures to remove the tools but never recovered.

E-mail Inga

Intelligent Healthcare Information Integration 7/20/09

The Six Degrees of Integration

Tipping points and network theory. Malcolm Gladwell and Kevin Bacon. If short books and the Science Channel have taught me anything, it’s this: while I may not have all the answers, it is only a hop, skip, and a jump to where the answers lie and simple things may have the biggest impact (TV and the Web reaffirm this daily).

Have you noticed that no matter where you look, someone is promising the grand digitization of healthcare in the oh-so-near future. I’m starting to chafe from the tipping point upon which we’re supposedly perched. However, a look at the percentages of full-blown HIT users, either provider-side or consumer, doesn’t seem to tilt the impression that mass adoption is all that imminent.

Still, with Facebook at nearly a quarter of a billion users and Twitter plotting its plan to become the first Internet site to reach a billion users, it is apparent that providing people with a tool they: a) understand; b) find simple to use, and: c) find real, immediate use for has major power to quickly topple a tool over into mass adoption. If healthcare IT could get off its high horse and learn a lesson or three from these more “common” contrivances, maybe we could actually reach the Promised Land of Healthcare Information Integration.

Enter Kevin Bacon. HIT struggles virtually non-stop to understand how to integrate all the data we derive daily, be it patient care info, new medical knowledge, or business numbers management. And, from Kalamazoo to Cocoa Beach, everyone is trying to figure it out almost independently. Well, Kevin says we are all only separated by some six degrees or less. What if we take a part of Mr. Bacon’s recipe, sprinkle in some of Facebook’s Gladwellian success spices, stir it all up within the HIT pot, and then dump the whole stew out upside down?

Instead of Six Degrees of Separation, what if healthcare information integration chose to focus upon the reverse view that we are all within “Six Degrees of Integration”? We are not separated so much anymore as we are integrated. A quick breeze about the HIT blogs brings up some pretty interesting observations along these lines from both the more notorious as well as some lesser-known HIT brainstormers.

Many of them are now bandying about notions related to direct-to-consumer healthcare information integration management beyond PHRs and EHRs. After all, every person on the planet has health which needs care at some point or another, just as most everyone has social networks with whom they want to keep connected. If simple social networking tools are able to empower such rapid adoption and end user deployment, then haven’t they demonstrated the fast, focused force available for integration of healthcare info if we only harness similar motivating energies?

To promote this reverse view of the Six Degrees for HIT, I propose a new organization: Pursuers of Integration’s Six Degrees, to be more affectionately known as PISD. If you don’t want to wait for the trickle down of big, siloed systems, consider becoming a PISD member. Help all of America, even all of the world, become PISD so we can get beyond the abrasive point upon which we tip.

The unwitting modern day Moses, Kevin Bacon, has shown us the Promised Land past the HIT Tipping Point. Now, if we could just pass over.

“If you’re not scared or angry at the thought of a human brain being controlled remotely, then it could be this prototype of mine is finally starting to work.” – John Alejandro King

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.

News 07/16/09

iMedica changes its name to Aprima Medical  Software to avoid confusion with several other similarly-titled healthcare companies. The company also rolled out a new website, aprimaehr.com.

The HIMSS Electronic Health Records Association (EHRA) sends a letter to the ONC recommending, among other things, that CCHIT be “the single certifying entity to avoid duplication of effort, unnecessary expense and confusion in the market.” In case you need a refresher course on how these various entities are intertwined, here’s some background. CCHIT was spawned from HIMSS. The EHRA is comprised of EHR vendors, most of whom are CCHIT-certified. CCHIT’s operations are largely funded from the monies vendors must pay to apply for CCHIT certification. Certification fees are $28,000. So, it makes perfect sense that the EHRA members want to preserve their investment by supporting CCHIT. It certainly helps keep the riff-raff out of the game.

One vendor definitely not in favor of mandatory CCHIT certification is SRSsoft, who just announced Northern California Medical Associates as its latest client. The 21-location, 50-provider group displaced two CCHIT-certified EMRs in place of the SRS EMR product.

Doctors at Gaston Medical Group (NC) contact police claiming more than $333,000 has been embezzled from the practice. The six-doctor group claim the money was stolen using counterfeit payroll checks.

DocSite announces that six state medical associations are now offering its PQRI product to facilitate PQRI reporting. Medical societies in Colorado, Tennessee, Idaho, Nebraska, Iowa and New Hampshire are now offering the product to members.

e-MDs releases its 6.3.0 Solution SeriesTM solution, which incorporates such enhancements as a First DataBank’s drug database solution, upgrades to the Surescripts e-rx application, abd support for continuity of care documents.

It’s hard not to be sucked into the Michael Jackson medical drama since the media is constantly providing “breaking news!” with the latest scandalous details. Today’s headlines include word that at least nine doctors are under investigation for their role in providing Jackson prescription drugs.

Allscripts announces it is working with the AMA to offer an AMA-branded e-prescribing tool. The tool will be available at no cost to subscribers of a new online solution being developed by the AMA, with help from Covisint.

TetriDyn Solutions is now a certified VAR for McKesson’s Practice Partner EHR solution. TetriDyn also offers its own small-practice EHR solution, AeroMD, and is a Medisoft PM reseller.

XM Satellite Radio fans now have a new source for advice on improving physician practice management. Practice Success is a practice management radio show featured on ReachMD’s channel 160. Karen Zupko of KarenZupko & Associates is hosting the program, which will offer practical practice management advice for physicians and their staff.

The consumer price index for physician services rose 3.3% for the 12 months ending in June, which is a tad more than the 2.8% increase the previous year. Physician office prices rose .2% in June, compared to a .1% decline in May.

A Washington state oncologist files suit against Olympic Medical Center, charging the hospital’s hiring of employed physicians constitutes a monopoly. Dr. Robert Witham claims that the medical center’s direct hiring of doctors violates the law by creating unfair competition with private physicians. The case could be interesting to follow, especially with more and more practices selling themselves to hospital systems.

The HHS announces plans to develop an electronic family history tool that will help doctors identify women at risk for having preterm labor or delivering a child with a birth defect. The web-enabled My Family Health Portrait program will allow patients to enter data via computerized tablets, which would then be analyzed electronically.

Lori Heim, AAFP’s president-elect, tells Congress that healthcare reform will not succeed without an adequate supply of primary care physicians. The AAFP is calling for measures that would boost the number of primary care physicians to at least 45% of the healthcare workforce, and include an immediate increase in primary care physician payment.

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News 7/14/09

Louisiana continues its efforts to advance the use of electronic medical records. Governor Bobby Jindal signs a new law establishing an EHR loan program that gives the state government authority to apply for and administer $25 million in federal stimulus funds and $5 million in state monies.

Cook Children’s Health Care System (TX) collaborates with athenahealth and Microsoft to provide athenaClinicals and athenaCollector for its 350 providers. Cook Children’s will also implement the Amalga Unified Intelligence System (UIS) 2009 to create a community-wide patient record. In addition, the purchasing organization of Cook Childrens, PedsPal, will offer preferred pricing for the athenahealth solutions to its 1,100 affiliated physicians.

Ophthalmologists may want to consider delaying a decision on buying an EMR, according to AAO’s medical director for health policy. The words of caution from Dr. William L. Rich stem from the fact that no ophthalmology-specific EMRs are currently CCHIT-certified. Rich believes that without certification, eye care providers will be unable to qualify for any stimulus money. The AAO is also urging Congress to delay the incentive programs until CCHIT-certified eye care EMRs become available. Obviously Rich and the AAO are convinced CCHIT-certification will be a requirement for stimulus funds, even though the ONC has yet to clarify that point.

Three Wichita, KS health clinics will benefit from over $2 million in federal stimulus money, a portion of which will be used to fund EHR projects. The clinics serve low-income and underinsured patients.

A Kaiser Permanente paper concludes specialty care physicians can improve the health of high-risk patients by reviewing EHRs and pro-actively providing e-consults and treatment plan recommendations with primary care physicians. A reader had asked Mr. H for his impressions, to which he shared: “I truly believe that once the pain of getting EMRs running as data collection appliances is over (meaning we’ve got data collection clerks known as doctors and nurses in place, which is the ‘pain’ part), the benefit will be incredible.” More insight here.

About 45,000 US physicians could each receive up to $63,750 in Medicaid incentive payments if they demonstrate meaningful use of an EHR and at least 30% of their patients are Medicaid recipients. This according to a study by The George Washington University. Total dollars from taxpayers: about 2.8 billion.

After a mere two-year partnership, Sermo and the AMA are in the midst of a nasty divorce. Sermo published the results of a survey in which its members expressed declining support for the AMA. Seventy-five percent of the doctors said they are not AMA members and 89% claim the AMA does not speak for them. The AMA critics charge that the organization has not advocated for them on a number of policy issues. The Sermo folks also dislike the fact that the AMA makes millions of dollars licensing CPT codes. Someone smarter than me will have to explain why the world is not big enough for both organizations.

Epocrates announces a new OTC drug module that can be loaded on mobile computing devices.

In what would be a boon for EHR vendors, CMS  considers expanding PQRI to include data on quality measures submitted from EHRs, rather than simply claims data. CMS is determining if it is feasible to include the EHR-based reporting mechanism in the 2010 PRQI program.

Arizona Governor Jan Brewer signs a bill making it harder to successfully sue emergency medical providers for malpractice. The new law raises the legal burden of proof required to win legal claims of negligent care.

In an article highlighting the leadership of Massachusetts in digitizing healthcare, ECW’s Girish Navani says his company is hiring twice as fast as it would have without the economic stimulus and will add 200 new employees this year. John Halamka, CIO at CareGroup Healthcare System, is quoted as saying his state has an EMR adoption rate between 30 and 50%, which is significantly higher than the national average.

President Obama names Dr. Regina Benjamin US surgeon general. Benjamin is a family physician from Alabama who established a rural health clinic in an underserved shrimping community. The clinic was destroyed in Hurricane Katrina, rebuilt, and then burned down right before it was to re-open. She’s also served as president of her state’s medical society and last September won a $500,000 “genius award” from the John D. and Catherine T. MacArthur Foundation.

E-mail Inga.