DOCtalk by Dr. Gregg 6/22/13

In the Kingdom of Happy Healthcare

Once upon a time, in a land far, far away, Eric Henry Roberts V went looking for a wife. Since he was the prince of the entire Kingdom of Happy Healthcare, he knew he would be able to find a wonderful wife. What woman wouldn’t want to marry the handsome prince and share this wonderful kingdom from atop EHR Mountain within the glorious walls of EHR Castle, the grandest castle in all the land?

EHR Castle had been built by Eric’s great, great grandfather who was known as Pen. He ruled at a time when the land was rife with outlaws and hooligans. At that time, the kingdom was a vast jungle. It was divided into many small lands ruled by warlords and chieftains. None of them spoke in person with the others and they rarely shared. They were the kings of their parts of the jungle and, by a long-held and poorly understood tradition, they all wrote decrees to each other on parchment. Thus, they were known as the “Paper Lions.”

The Paper Lions’ paper decrees had many problems. They were, by tradition, the only way the various tribal leaders spoke with the nearby leaders, discussing treaties and the like, but they were often more trouble than treaty. Their papers were often lost, hard to read, or so poorly written that many a war was started over the years simply due to poor communication.

Pen was one of the Paper Lions, but he developed a bigger vision than his fellow chieftains. He saw the value of working more cooperatively with others outside of his clan. He knew that resources abounded in other areas of the jungle that he could not access. He knew, too, that he held riches within his domain that others would want. He was the first to step away from the Paper Lions and develop a new way of connecting with his fellow warlords. He developed “The Talk.”

Pen figured out a clever way to make messages between tribes more reliable. He strung a network of wires running through the jungle from tribe to tribe. They put their decrees and other inter-tribe messages into little holders and sent them careening through the trees on these long wire pathways. Messages got to where they were intended. Plus, he developed a standard message format that all tribe leaders agreed to use to insure that everyone could read and understand the messages. The fellow chieftains dubbed this system “The Talk.”

The Talk worked. As tribes communicated more effectively, barriers between them fell. They worked together more. They eventually grew together, taming their vast jungle and joining forces under the wise leadership of Pen.

Pen was crowned king of the entire land of Happy Healthcare and adopted the kingly name, Eric Henry Roberts. All the generations since have proudly carried the E.H.R. (version II, II,IV, etc.) moniker.

Now Eric Henry Roberts V needed a wife. The word went out and many a comely woman aspired to his attentions. However, just as he was setting his sights upon the loveliest and gentlest among them, the Kingdom of Happy Healthcare was attacked by neighboring enemies. The attack was fierce and all of Prince Eric’s advisors beseeched him to use his Solomon-esque skills to assuage the enemy. Eric knew what he had to do.

The marauders were from the Land of Efficient Healthcare; they had long argued with their Happy Healthcare neighbors to the north. Eric knew that the ruler of their enemy was a good woman, though she had grown up indoctrinated with family values, values that included a longstanding feud mindset with the Kingdom of Happy Healthcare. No one even remembered what had started the feud, but it has burned ever more hotly through the years as Eric’s predecessors had driven the improvements and camaraderie within their kingdom. Now they had invaded. They were envious of what the E.H.R.s had built.

Eric also knew that the Queen of the Land of Efficient Healthcare had accomplished many of the same feats he and his forebears had; she had banded together disparate tribes within their land and brought peaceful coexistence and prosperity through cooperation and enhanced inter-tribal communication.

He also knew she had an exquisite daughter.

Prince Eric sent a special envoy to Queen Eleanor. The envoy rode non-stop to deliver the message. Eric had used the same message protocol that his great, great grandfather had established years ago with the warlords. His hope was that the message clarity would insure accurate communications between the leaders, just as it had done so many years ago.

This fact was not lost on Queen Eleanor. She understood and she accepted Prince Eric’s proposal; she dispatched her beautiful daughter the very next day.

Queen Eleanor’s daughter arrived in the Kingdom of Happy Healthcare within a fortnight. She dutifully married the handsome Prince Eric the very next day. The warring nations were now joined by royal matrimony and peace was declared.

As the newlyweds retired to the royal bedchambers on their honeymoon night, they noticed that the maidservants had arranged the boudoir with all of the new couple’s personalized accoutrements. One among them stood out to both Eric and his lovely new bride: monogrammed pillow cases with the initials “E.H.R.” on them.

The new bride looked surprised and apologized to her new husband, “My lord, I most humbly beg your forgiveness. My servants have snubbed thee and for that I beg thy mercy.”

Eric was perplexed. “Why sayeth thou so, dear wife?” he asked.

“My ladies in waiting have placed only my pillows upon our bridal bed. They have neglected your royal highness’ seal,” she replied.

Said Eric, “But, dear bride, these are my marks. I fear they have neglected thine.”

Suddenly, as the awareness dawned upon him, Eric realized he knew not the full name of his betrothed. “Beloved,” he asked, “pray, tell me thy fullest name.”

“Why, Eleanor Hermione Rothwell, of course. The same as my mother, and her mother before her, and her mother before her,” she answered. “It is a proud maternal tradition of our land.”

“Aw,” said the goodly prince. “Now ‘tis clear. I see we are both well represented in our chambers as I am Eric Henry Roberts V. The royal ‘E.H.R.’ monograms connect us both.“

Eleanor smiled when Eric then strode toward her with a knowing (and not exactly royal) twinkle in his eye and said, “Let us now connect two lands, two peoples, and two E.H.R.s!”

The moral of the story? When EHRs connect, Happy and Efficient Healthcare finally get it on!

From the trenches…

“To the royal guards of this realm, we are all victims in-waiting.” – Cheshire Cat

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 6/20/13

From Guppy: “Re: KLAS scores. KLAS always seems to hand-pick the largest vendors as winners. It was interesting to look at the data you reported because it would appear that a number of the small, specialty-specific vendors do a much better job at usability than the big fish – shocking!”  “Usability” is not necessarily the same thing as customer satisfaction, which is the metric KLAS is measuring. Regardless, the KLAS scores always stir up plenty of controversy. At least in the ambulatory EMR segment, several of the smaller vendors did quite well, including PCC, SRS, and Sevocity.

The 110-provider Oregon Medical Group will implement Phytel’s Outreach, Insight, and Coordinate modules for population health management.

Technology could improve treatment outcomes for children with chronic illnesses, according to a report from Boston Children’s Hospital and the Verizon Foundation. The white paper stresses the need for technology that improves coordination among members of the care team; improves care management by providing appropriate data required for decision-making; facilitates the education of care team members on available resources; and incents providers to adopt technology that focuses on the patient and family rather than a traditional physician-centric model.

CMS publishes updated 2014 clinical quality measures for EPs, which are categorized based on the agency’s priorities for patient and family engagement, patient safety, care coordination, population health, efficient use of resources, and clinical effectiveness.

Yesterday I stopped by my optometrist’s office to pick up some contacts. While the tech was hunting for my order, he took a phone call. As I became increasingly impatient for him to get off the phone and finish helping me, another employee explained that the tech was talking to the doctor. When I finally walked out the door, I wondered to myself who should have been the tech’s priority: the customer/patient or the doctor?  Anyone?

Robert M. Wah, MD, the ONC’s first deputy national coordinator and a retired Navy captain, is named president-elect of the AMA.

E-mail Inga.

News 6/18/13

From RyanS: “Re: KLAS Mid-Term Report. Physician’s Computer Company earned the top customer satisfaction scores in both the ambulatory PM and EHR software categories.” The Mid-Term report is based on performance scores gathered over the previous 12 months. RyanS provided a few other highlights, including:

• PCC Partner PM (1-10 physicians) blew away the practice management competition with a score of 95; Epic Resolute/Prelude/Cadence (> 75 physicians) was next with a score of 88.7;  Greenway PrimeSuite Practice (11-75 physicians) was third at  88.6.
• Top performers in the ambulatory EMR segment were PCC EHR (1-10 physicians) with a score of 95.5; EpicCare Ambulatory (over 75 physicians) at 88.3; and SRSsoft EHR (11-75 physicians) at 86.7.
• Top clearinghouse providers were Navicure (92.3), ZirMed (92.5), Office Alley (91.1), and Practice Insight (90.1).
• KLAS recognized McKesson Practice Partner (11-75 physicians) as the product demonstrating the biggest improvement since its December, 2012 awards, jumping 13 percent to 56.7. AdvancedMD EHR (1-10 physicians) gained 12 percent to 76.2.

Vitera Healthcare Solutions announces that it has acquired Birmingham, AL-based SuccessEHS, which offers PM/EHR, electronic dental record, dental imaging, and revenue cycle solutions. SuccessEHS, which has doubled in size in the past two years, will be operated as a division of Vitera and expand Vitera’s user base to  10,500 organizations, 415,000 medical professionals, and 85,000 physicians.

CureMD offers discounted subscription rates, and free implementation, training, and data migration for the 4,400 users of the Mitochon Systems EHR platform. Last month Mitochon announced it was exiting the physician EHR market and would no longer market its free EHR product.

The office manager for Summersville Pediatrics (SC) shares her practice’s experience migrating from MyWay to Aprima Medical’s EMR with assistance from Aprima dealer ConXit Technology Group.

CareCloud hires Tom Cady (athenahealth) as VP of professional services.

Nature Coast ACO (FL) expands its relationship with eClinicalWorks to include eCW’s Care Coordination Medical Record.

Nuance releases a new version of Dragon Medical Practice designed for smaller practices that includes voice shortcuts to aid searches for medical information and more than 90 specialized medical vocabularies.

A computer outage in the Canadian province of Alberta caused about 202 medical clinics to lose access to patients’ health information for more than five hours last week. “Thousands” of patients were affected and many practices turned patients away. One physician told a local paper, “When this happens it cripples you. We didn’t even have Internet access. This is also a financial loss for physicians.” The EHR vendor blames the outage on a faulty network device that routes data to the clinics.

e-MDs relocates and expands its headquarters and will operate out of a 30,000 square foot administrative campus in Cedar Park, TX, a 40,600 square foot technology campus in Austin, TX, and a separate data center providing business continuity and disaster recovery services.

Vitera Healthcare releases Vitera Medical Manager EHR, a Web-based EHR, analytics, and transaction platform for current Vitera Medical Manager customs.

The primary motivator for becoming an ACO or PCMH is to improve patient outcomes, according to a survey by eClinicalWorks. Almost all respondents believe that an integrated EHR would be the most valuable HIT feature for an ACO or PCMH.

An MGMA report provides more evidence that ICD-10 readiness is moving slowly. The greatest concern is the lack of communication and critical coordination between physician practices and their EHR/PM/clearinghouse vendors  regarding software updates and testing. Less than five percent of practices report they have made significant progress when rating their overall readiness for ICD-10 implementation.

Emdeon acquires Goold Health Systems, a provider of pharmacy benefits and related services to state Medicaid agencies.

Forty-two percent of practicing physicians are dissatisfied with their jobs, leading many to consider leaving medicine and taking early retirement. Decreasing autonomy, low reimbursement, and administrative hassles were the key drivers of dissatisfaction.

The number of retail medical clinics is predicted to climb from 1,418 at the end of 2012 to 2,868 in 2015.

In an AAFP News interview, Farzad Mostashari, MD discusses EHRs, ROIs, productivity, improved patient care, and more. Regarding productivity:

If physicians just replicate the existing paper-based processes in a digital way, they probably are not going to get huge productivity gains. But if they redesign the care flow to designate what things are done by people versus what’s done through the EHR technology, then that really adds to productivity. That’s how I would summarize the experience of folks who have made EHR implementation a wonderful business decision.

E-mail Inga.

News 6/13/13

CMS releases the 2011 PQRS and e-Prescribing Incentive Program Experience Report, which includes the following highlights:

• The PQRS program paid 280,229 EPs a total of $262 million in incentives
• The eRx program paid 282,382 EPs a total of $285 million in incentives
• 135,931 EPs were subject to 2012 eRx payment adjustments because they did not meet the reporting requirements in the first half of 2011, or didn’t qualify for an exemption, or didn’t meet the exclusion criteria for the adjustment.

King’s Ridge Christian School (GA) becomes the first student health clinic to implement simplifyMD’s EHR software.

CureMD Healthcare will make Mitochon Systems’ clinical content platform available within its EHR. What is particularly interesting about this announcement is that last month Mitochon announced it was exiting the EHR market. The press release that Mitochon emailed me today suggests the company has a new business model, though its not reflected on its Website.

Physician compensation is increasingly tied to measures of quality and patient satisfaction according to an MGMA report on 2012 physician compensation. Quality metrics accounted for three percent of primary care physicians’ median compensation of $216,462 and two percent of specialists’ median compensation of $388,199.

Swedish Covenant Hospital (IL) selects eClinicalWorks EHR and RCM solutions for its 150 employed physicians with Swedish Covenant Medical Group.

The AHRQ publishes a guide for primary care practices connecting to RHIOs and addresses such topics as organizational readiness when connecting an EHR to a RHIO, clinician buy-in for information exchange, technical issues, and modifying clinician workflows.

EHRs have the potential to facilitate patient-physician communication and enhance collaboration according to an opinion piece published in JAMA. The physician-authors encourage clinicians to introduce the EHR in the exam room with a verbal explanation and invite patients to view the screen to review test results and other data:

“Self-motivated and empowered patients are likely to regard the invitation to view their electronic chart as an act of transparency that enhances the collaborative nature of the patient-physician relationship.”

As a “self-motivated and empowered” patient, I must agree. Last month I met with a specialist following a procedure. He spent most of the exam in front of the computer but I loved that he invited me to look at the photos he had taken of my esophagus (which confirmed my suspicion that my esophagus is not my best feature.)  I left feeling pretty good about my doctor and better informed about my health.

Piedmont Eye Center (VA) selects SRS EHR for its seven physicians.

Pulse Systems hires Samuel Ambrose (VeriTeQ) as chief marketing officer.

NextGen reseller ITelagen will market its support and services package with IMO Problem (IT) Terminology from Intelligent Medical Objects.

E-mail Inga.

News 6/11/13

As of the end of April, approximately one out of every two Medicare EPs were meaningful users of EHRs. Other key stats reported by the HIT Policy Committee last week:

• 63 percent of all Medicaid EPs have received an EHR incentive payment, though only 10 percent are meaningful users
• EPs have been paid over $5.9 billion from Medicare and Medicaid since the inception of the EHR incentive program
• Of the 194,080 EPs that have attested for MU, only 213 were unsuccessful.

Horizon Health Center (NJ) expands its relationship with eClinicalWorks to include eClinicalWorks Care Coordination Medical Record for advancing its ACO objectives.

iMDsoft and Anesthesia Business Consultants (ABC) partner to offer iMDsoft’s mobile solution for electronic documentation with ABC’s F1RSTUse EHR platform.

Black Canyon Surgical Center (CO) goes live on Cyramed EHR (previously known as Source Plus EHR) by Mountain Medical Technologies.

Clinigence, a 2013 PQRS Qualified EHR Data Submission vendor, will offer PQRS reporting capabilities to SpringCharts EHR users.

athenahealth ranks 13th on Forbes Fast Tech 25 2013, which includes the fastest-growing publically traded technology companies with minimum revenues of $150 million, minimum market value of $500 million, and sales growth of at least 10 percent for each of the past three fiscal years.

EHR and PM provider MEDENT adds Surescripts’ Basic Messaging and Communications offering for the secure transmission of patient health information.

Endo Health Solutions considers selling its HealthTronics division, which develops and markets the meridianEMR and UroChartEMR platforms used by over 2,000 urologists. Such uncertainty is never fun for end users, not to mention sales people.

A Kansas newspaper profiles two physicians who are on opposite ends of the spectrum in terms of embracing technology. The first doctor is 85 and dictates his notes to an assistant, who handwrites the notes into patients’ charts. The second physician is 32, uses a free EMR, communicates with patients through email and Twitter, and conducts appointments through Skype and FaceTime. He also expresses frustration with the poor design of most EMRs.

“When you’re used to using very clean designs — a MacBook, an iPhone, Twitter, Facebook — and you sit down on an EMR (electronic medical record system), it’s like stepping back in time 15 or 20 years.”

Athenahealth scores highest in ambulatory EMR usability according to a new KLAS report. Success in achieving high usability in different EHRs ranged from 55 percent (McKesson) to 85 percent (athenahealth), while athenahealth and eClinicalWorks had the best usability “out of the gate.”

MyMedical Records agrees to dismiss its patent infringement lawsuit against WebMD and settle the dispute out of court. Meanwhile, MyMedicalRecords initiates a similar lawsuit against Allscripts subsidiary Jardogs. In case you missed it, earlier this year Mr. H interviewed MyMedical Records CEO Robert Lorsch  who said his company sends out “somewhere between 600 and 750 letters as week” to providers and PHR vendors about potential infringement. He also reiterated that, “we are not trolling with these patents.”

I wonder if MyMedicalRecords has sent one of its letters to Cleveland Clinic. Cleveland Clinic announced last week that  it will add physician notes, images, pathology reports, and results to its Epic MyChart patient portal. I personally can’t wait for the day I can log onto my doctor’s Website and download my records. Just this morning I called my doctor’s office to request a copy of a report. I spent 10 minutes navigating the phone system, only to leave a message. I got a call back within an hour, which pleased me. However, I was told  they could not email me the report, but could mail it to me if I signed a release, which they could fax me (not email me) and I could fax it back. Great, except I haven’t had a fax machine in at least five years. Guess I will be driving across town to the doctor’s office if I want the report any time soon.

E-mail Inga.