DOCtalk by Dr. Gregg 5/5/13

Dumbing Down and Smartening Up

Both sides of the healthcare provider/consumer “aisle” are talking about patient engagement and patient empowerment these days. The most interesting part of the recent momentum around these agenda items is that there doesn’t seem to be a whole lot of consensus on exactly what those two terms mean nor how they should be addressed.

On the patient empowerment side, people are talking about putting more emphasis on patient-centered care, making the patient the center of healthcare rather than having the provider or the institution or the insurance company or the technology vendor at the focal point. This seems like a no-brainer considering that the definition of “health” according to Merriam-Webster is “the condition of being sound in body, mind, or spirit.”

I’m not sure how anyone could see health and its care as anything other than a very personal, “patient-centered” issue. After all, body, mind, and spirit are unique to the individual. But, debates continue around who controls a person’s health data and how much access or input a person is allowed into their own care.

On the patient engagement issue, most people are focused on tech tools allowing providers to connect with patients and patients to connect with their health care data. This is important, but it seems to me that it’s not unlike the idea of giving everyone an iPad, but one with a DOS-like user interface. How “engaging” would that be? In other words, what good are patient engagement tools if the information and user experience (UX) aren’t “engaging?”

One thing seems clear: people on both sides are talking about making complex health information easier for non-medically trained people to understand. The impact of helping people to understand their health issues has been validated in numerous studies; when people understand their health issues (i.e., when their health literacy is higher), their health outcomes are better.

I’ve long been an advocate of simplifying medical information into “human-ese” to give patients the best chance of understanding complex medical information. I learned this years ago when making my own patient newsletters, back in the days when “desktop publishing” and “WYSIWYG” word processing were big buzzwords. (Yikes! Self-dating!!) Taking complicated health issues and trying to make them easy to understand and hopefully engaging for non-medically trained folks – and to do so for several such topics all on one side of a single piece of paper – was quite the challenge.

But, there are two sides to every aisle. The needs for understandable medical information in lay terms for lay people are quite different from the needs of providers for using medically complex jargon to communicate profession to professional.

The contentions of those who oppose “dumbing down” medical information have some valid arguments. If all of our medical documentation is to be available via patient portals and their ilk, providers fear that taking time to write all their notes in terms simple enough for patients to understand will take an ungodly amount of time. (And, providers’ time is precious enough as it is, what with all the coding and bullet points and mouse clicks and all!) Plus, some providers fear that the communication of professional concepts will be hampered, impeded even, if all of the complex medical terms used in patient records must be broken down into lay terms. (Imagine trying to sum up the tauopathy known as progressive supranuclear palsy – PSP, the cause of actor Dudley Moore’s death – into layman’s language when including it in a differential diagnosis!)

Me? I truly see both sides. I want my patients empowered; making things understandable for them helps that process. But, I also don’t want to see the simplicity of complicated conceptual discourse via sophisticated technical jargon fall prey to vocabulary Luddism.

It would seem that both sides of the aisle are correct. How we address this with a workable meet-in-the-middle approach is the real question. Bringing everyone onto a level health education and medical vocabulary playing field seems silly. Both of these so-called “smartening up” and “dumbing down” approaches have significant hurdles and/or negative impacts.

Thus, I propose a solution for which I’m far too uneducated (and, given my previous self-dating, likely far too old!):

• How about we set Watson, or a whole herd of smart humans and lesser computers, to the task of smartening up natural language processing to the point where I, as a doctor, can type any confoundedly complex medical lingo I want into a patient’s medical record and their patient portal spits out an NLP-derivation in regular old human-ese?
• Oh … and could we also task some UX experts to present that information in patient portals that are actually visually pleasing and truly engaging?

Just a dumb thought, from the trenches…

“I may be dumb, but I’m not stupid.” – Terry Bradshaw

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 5/2/13

Epocrates remains the most popular medical application on both smartphones (70 percent) and tablets (60 percent) among US physician app users. More than a third of the physicians launch Epocrates three or more times a day, with drug references being the primary resource accessed.

First-year guaranteed compensation for primary care physicians in 2012 averaged $180,000, up from $175,000 in 2011. Practices are offering a number of benefits to recruit physicians, including signing bonuses, paid relocation expenses, loan forgiveness, paid vacations, and continuing medical education.

Lahey Health (MA) selects athenaClarity for population health management.

TSI Healthcare recognizes Western Carolina Eye Associates (NC) with a Circle of Excellence award for its use of NextGen EHR to improve patient care.

Navicure reports that its first quarter revenues were 32 percent higher than the same period a year ago. Also in Q1, the company added 247 practices to its client base.

The American Society of Anesthesiologists sends a letter to CMS and ONC recommending that anesthesiologists continue be eligible for exemptions to the MU program. The ASA also asked for additional exemptions to specific MU criteria, such as providing patients with clinical summaries and electronic health copies, and implementing drug-drug and drug-allergy checks.

The 16-physician Steindler Orthopedic Clinic (IA) extends its RCM contract with MediRevv to include claims approval and appeals.

As of the end of March, 255,722 EPs had collected $5.2 billion in MU incentives, representing almost half of all EPs that have registered for the program.

The seven-clinic FQHC Christ Community Health Services (TN) contracts with Priority Management Group to provide RCM services, consulting, and coding training.

HealthTexas Provider Network partners with MediMobile to provide HealthTexas physician groups a mobile solution for billing, coding, and capturing data.

EClinicalWorks reports that 450 health centers, or 35 percent of all the country’s health centers, are eCW clients.

MMIC, a insurance liability provider that also offers HIT services and resells NextGen products, adds the InteliChart portal to its suite of EHR and PM offerings for physician practices.

The number of physician office jobs for medical billers, billing managers, and medical records clerks has declined 25 percent, 23 percent, and 37 percent respectively since 2011 as practices outsource more billing processes and add EHRs. At the same time, practices are now employing more professionals as care coordinators and nurse practitioners. While staff salaries have remained flat or declined in most areas, nurse managers are now earning 10 percent more than they were two years ago.

A Consumer Reports survey of 1,000 Americans finds the most bothersome aspect of doctor visits is unclear or incomplete explanations of problems. Other gripes include slow communication of test results, long waits in exam or waiting rooms, and doctors taking notes on devices without looking at patients.

An analysis of online reviews of healthcare providers finds that patients who post negative comments about their physicians are four times more likely to complain about poor customer service and bedside manner than about misdiagnoses and inadequate medical skills.

NextGen Healthcare launches Comparison Utility, a proprietary ICD-9/ICD-10 comparison tool that is available at no charge to its customers.

Greenway Medical revises its fiscal 2013 outlook because of declining sales and deferred revenues. For the year ending June 30, Greenway updates its earnings estimate of $0.10 to $0.17 on $145-$150 million in revenue to a loss of $0.11 to $0.13 on revenue of $132-$134 million.

E-mail Inga.

News 4/30/13

Syracuse Community Health Center (NY) selects NextGen’s EHR, PM, and EDR for its 16 locations.

The Massachusetts eHealth Collaborative will provide program management services for the Last Mile Program, a Massachusetts eHealth Institute initiative that will connect 50,000 providers to the state’s HIE over the next two years.

Athenahealth names St. Boniface Haiti Foundation the winner of its 2013 Vision Award for working to improve the lives of Haiti’s underserved by providing high-quality and affordable healthcare and education. Athenahealth will give the organization its athenaClinicals EHR solution.

A peer-reviewed article published by the CDC finds that the interface technology of Intelligent Medical Objects is superior to population classification techniques as a disease surveillance tool. The findings are based on a study that showed IMO terminology service was 32 to 42 percent more accurate in identifying coronary heart disease compared to algorithms using reimbursement coding and classification techniques in identifying coronary heart disease.

The Kansas Foundation for Medical care and the AAFP’s TransforMED align to help six Kansas providers adopt the PCMH model of primary care.

Online storage vendor Box takes an equity position in EHR vendor drchrono.

ARS Pediatrics (MO) selects the Benchmark Systems PM solution.

The Primary Care Coalition, which supports healthcare initiatives for the uninsured in Montgomery County, MD, partners with Adventist Healthcare to establish health information exchange between eight safety-net clinics.

The 118-provider South Metro Primary Care (CO) IPA will connect various EHR platforms to the CORHIO HIE beginning with practices running the Amazing Chart and Allscripts EHRs.

Tri-State Orthopaedics (IN) selects SRS EHR for its 24 providers.

Acumen Nephrology introduces Acumen PM, a PM product based on the eRenalMD PM system, to compliment its nephrology-focused nEHR solution.

Physicians are making more money this year than in 2012, but are spending more time than ever on paperwork, according to a recent study on physician compensation. Other key findings include:

• The average compensation for orthopedic surgeons, cardiologists, and radiologists was more than $300,0000, but those specialists also worked longer hours than many of their peers.
• Career satisfaction rates remain steady, with more than half of doctors saying they would choose the same career again.
• Almost 25 percent of physicians are either in an ACO or plan to be in one within a year, up from 10 percent a year ago.

E-mail Inga.

News 4/25/13

Compensation for medical directors is increasingly tied to quality metrics according to an MGMA report on medical directorship and on-call compensation. Almost 40 percent of medical directors say the scope of their responsibilities and duties are also becoming more aligned with quality metrics. Physicians also report that median compensation for on-call coverage ranges from $75 and $2,000 per day, depending on specialty.

Kareo offers insights from a small practice point of view on the six hottest topics from HIMSS 2013.

TSI Healthcare recognizes Tidewater Physicians Multispecialty Group (VA) with its Circle of Excellence Award for using NextGen EHR to provide a better patient care.

Attorney Paul R. DeMuro offers thoughtful insight into private practices that are successfully maintaining their independence. The practices that are thriving are those that are transforming themselves to newer payment models based on quality and cost-effective care, are making effective use of informatics, and are aligning themselves with hospitals and health plans as part of collaborative care teams.

Greenway Medical will add RemitDATA’s comparative analytics solution into its PrimeDATACLOUD Remittance Intelligence service, giving practices reimbursement and productivity insights and performance benchmarking.

Physicians engaging in Web-based messaging systems are advised to establish standards for response times so that patient satisfaction will not be negatively impacted and healthcare decision-making will not be compromised. Practices that are using secure messaging recommend establishing clear expectations with patients on the type of messages to send and on practice response times.

Providers using the Surescripts Clinical Interoperability network and participating in the Michigan Health Information Network Shared Services will soon be able to use the HIN platform to send electronic health information to the State of Michigan’s public health reporting system.

athenahealth launches athenahealth Marketplace, a site that includes consolidated information on technology and clinical exchange partners that offer products integrated within athenahealth’s network.

Speaking of athenahealth, the Boston Business Journal provides details of the company’s emergency response system,  which went into effect during last Friday’s manhunt for the alleged Boston Marathon bombers. A 15-person crisis management team was convened by conference call shortly after 4:30 a.m. By 5:30 a.m. employees were told via automated e-mails and phone calls that they should remain at home. Only a few glitches occurred, including a few inadvertent phone calls to former employees. Two early-rising employees did not get the message in time and were forced to remain in the office most of the day.

CMS and ONC post a joint fact sheet that breaks down the progress made since the passage of the HITECH Act. Some highlights:

• More than 388,000 EPs have registered for the EHR incentive programs, representing 73 percent of all providers eligible to participate. Over 230,000 (44 percent) had received incentive checks as of March 2013.
• RECs are providing EHR adoption assistance to more than 130,000 (44 percent) of primary care providers and 20,000 (48 percent) of NPs.
• E-prescribing adoption rates for office-based physicians have grown from less than one percent at the end of 2007 to 53 percent as of the end of January 2013.
• Physician adoption of EHR systems with advanced functionalities beyond Stage 1 requirements has grown from 17 percent in 2008 to 40 percent in 2012.

E-mail Inga.

News 4/23/13

A bipartisan group of senators unveils a discussion draft of a bill to create a nationwide electronic system for tracking the distribution of prescription drugs. The proposed measure would require every entity in the prescription drug supply chain to provide electronic transaction information when there is a change of ownership, plus shift the country from a lot-level drug tracing system to a unit-level tracing system.

The US market for EMRs is predicted to reach $20.7 billion in 2013, according to Kalorama Information. That’s a 15 percent increase from 2011 and includes revenues from ambulatory and inpatient EMRs and CPOE systems, and associated costs for implementation, training, support, and consulting.

Meanwhile, EMR adoption by primary care physicians in Canada has doubled from 23 percent in 2006 to 56 percent in 2012. The estimated value of increased adoption by community-based practices: $1.3 billion, based on increased efficiencies and improved patient care.

T-System, a provider of clinical and financial systems for emergency care, will deploy NextGen PM across its customer base.

Benchmark Systems announces several new clients including St. Louis Allergy Consultants (MO), Abingdon Obstetrics & Gynecology (VA), and James Redington, MD for Benchmark’s PM product, and Neurology Services (VA) for PM and EHR.

Practices that are considering selling out to a hospital because of financial issues or health reform concerns, or because of IT integration worries may have other options according to several practice management consultants. Some alternate hospital alignment models include:

• Limited alignment, including managed care networks, call coverage stipends, and medical directorships
• Moderate alignment, such as MSOs to provide IT or billing services; provider equity options; and, clinical co-management
• Full alignment, with physicians acting as self-employed, independent contractors and/or practices serving as hospital subsidiaries.

Coming soon: the first-ever HIStalk Webinar, Vendor Software Training: What Providers Should Demand, offered May 14 from 1:00 to 1:45 PM EDT and presented by Health Technology Training Solutions. Mr. H mentioned the Webinar in a recent HIStalk post but it’s such big news that I felt the need to give it an additional shout-out here. Hope you can join us.

E-mail Inga.