Healthcare Informatics 6/8/12

Healthcare Infrastructure Data Models

Let’s assume for a moment that the current craze surrounding EHRs is completely effective and every physician in America is meaningfully utilizing one in the near future (hurray for blind optimism!). There are two purposes for doing this, despite the numerous reasons that have been thrown out there. 

One is the public health motivation, where we can query all healthcare providers and come up with aggregated metrics to better understand the health status of those who seek care. This would probably be as close to real-time analysis that we can get to for a while. Post-analysis, we can provide better recommendations for best practices and get those implemented a lot faster than the current glacial pace. This is in fact why most other industries made the move to digital: to measure, analyze, and make improvements based on the analysis. 

The other PH motivation is for record portability. This one gets all the press, probably because journalists can tie it to the ‘P’ in HIPAA and it is one of those things the general public is generally confused about why this is not already possible in the first place.

Given these two purposes — aggregated counts and whole (or at least CCD) record portability — how are we going to achieve both at the same time? Three options have been knocked around for quite a few years and we’re finally getting to a point where they may be realizable. Needless to say, this is a very exciting time, but what are we getting ourselves into? 

In this three-part series, I’ll be taking a look at the top contenders, but I will warn you that the answer/the solution is always a combination of the options available.

Option 1: The Centralized Repository

All data gets sent to a single local database which then gets passed up to a larger database and so on and so forth. Honestly, I think this is the model that a large number of people assume will be put in place when we talk about “information” or “data.” Yet keep in mind this is not how the Internet works. 

This more replicates the mainframe days of yore or a wagon wheel metaphor, where the information all flows to the central axle. Visually it is clean, but perhaps not in line with today’s infrastructure reality.The big positive of this model is that it would be insanely easy to analyze the data out of the database and to send aggregated numbers up the chain.

Public health departments generally work from disparate registries that are nothing more than centralized repositories specific to their concentration (i.e. cancer, vaccinations, STDs, etc.) This is why you send your vaccination data to the state vaccination registry and not just to the public health department’s main office. 

So why not just have a big ol’ relational database that everything gets sent to and pull what you need from there? The allure of easy analysis is probably why the ONC has started a number of Beacon Programs across the nation. The negative is that… well, no one really trusts the government to do these sorts of things.

Additionally, record sharing between these centralized repositories is still a bit of a hang-up. The Beacon Program in SE Minnesota, for example, connects various healthcare organizations through an HIE and the NwHIN to pass records throughout the area in addition to dumping everything into a centralized repository.

In the end this, model embodies a Bon Jovi song, only putting us halfway there. Analysis: yes. Record portability: no.  

Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s’s Medical and Practice Management Suite and EHR design and development.

News 6/7/12

New York Governor Andrew Cuomo announces a new drug reform law requiring all prescriptions, including most controlled substances,  to be electronically transmitted.

CareCloud names Joseph P. Sawyer VP of marketing. Sawyer most recently served as VP of marketing at tele-health provider American Well.

Earlier this week eClinicalWorks CEO Girish Navani and staff served ice cream to employees who donated food and other comforts of home for the troops. Staffers from eCW’s Westborough, MA office brought treats ranging from candy and cookies, to magazines and Dr. Scholl inserts. Like.

PDR Network announces that it has strategic partnerships with 18 EMR vendors representing 75,000 EHR prescribers and 250,000 additional end users.

Consult A Doctor introduces iDr 24/7,  a telemedicine app for the iPhone that instantly connects mobile users with board certified physicians. iDr 24/7 is an extension of Consult A Doctor 24/7 services, which include doctor consults by phone, email, and video.

Practice Fusion releases a 10,000  record HIPAA-compliant dataset and launches a data challenge to solve public health issues. Winners of the challenge are eligible for up to $20,000 in cash prizes, plus beta access to Practice Fusion’s API, Dell Computers, and consultations with Practice Fusion’s founders.

E-mail Inga.

News 6/5/12

EHR/PM provider SuccessEHS acquires Integrated Physician Services, a provider of RCM, business services, and consulting.

Christie Clinic (IL) selects eClinicalWorks for its 150-provider practice.

The flow of money to providers for their Meaningful Use of EMRs continues. Through the end of April, Medicare paid eligible physicians $953 million in incentives, while Medicaid has issued an additional $736 million. The government has paid EPs and hospitals a combined $5 billion since the program’s inception.

I can’t decide if this headline was intentionally tongue-in-cheek or just an unfortunate choice of words.

Six-provider Alpine Orthopedics (MT) selects ChartLogic’s EHR Suite.

If you read HIStalk, you may have noticed a recent request for participants in a new HIStalk Practice Advisory Panel. If you are a practicing physician or work in the ambulatory space, and willing to respond to a few e-mail questions every month or so, let me know. The questions will focus on product issues and needs, cool technology in use at your practice, and other issues affecting physician offices. If you have the occasional few minutes to spare now and then, please e-mail me.

Physician offices added 9,900 of healthcare’s 32,800 new jobs in May.

The Wyoming Department of Health partners with Medical Informatics Engineering to offer Medicaid providers a free, certified EHR solution.

EHR provider Spring Medical Systems introduces SpringCharts PM, which will integrate with SpringCharts EHR. I quickly looked at Spring’s Website and surprisingly found no mention on SpringCharts PM, but did notice the company partners with at least four PM vendors.

Consumer Reports collaborates with Massachusetts Health Quality Partners (MHQP) to offer a rating service for Massachusetts’ 500 primary care physician groups. The ratings are  based on surveys conducted by MHQP over the last 12 years and consider physician communication, care coordination, and patient willingness to recommend their doctor to friends and family.

E=mail Inga.

DOCtalk by Dr. Gregg 6/4/12

Blnk – Bridge Between Clinical Labs and Point of Care 

Anybody heard of Blnk Medical Technologies, whose tagline is “Bridging the Gap Between Clinical Labs and Point of Care?” I did an HIStalk search and didn’t come up with any results. Looked like something Mr. H might really dig.

I came across them from a recently new acquaintance, Marcelo Cardarelli MD, MPH. He and I connected via the Hispanic Healthcare Leaders Network on LinkedIn. (No, I know I don’t look Hispanic…and I’m not. I was asked to join by a colleague related to other work I do. Nice group of people, though, who’ve been very kind and helpful.)

Marcelo responded to an ask I placed for some medical content Spanish translation verification help. We’ve e-mailed numerous times in recent months, but one he sent recently week caught me a little by surprise.

He said he had been Googling about looking for info and contacts for a startup company he’s involved with. He was searching “Health Information Exchange” and my name popped up. He wrote and asked about my connection to CliniSync, the HIE from the Ohio Health Information Partnership. I responded and also asked about his startup. To this query, he replied with the following (I doubt he’ll mind if I quote him here):

With the help of former University of Maryland colleagues (smarter than myself), we developed a bedside monitor for critical laboratory values to be used on ICU and ED patients. It has the capability to connect directly to a hospital Lab Information System (or to a Health Information Exchange) with an HL7 interface. It displays the data as added value information, trended for 48h, color-coded, in fish-bone format, etc. without login in over and over. It is always on, runs over Wi-Fi and it looks (and works) like a vital signs monitor.

I used it on my own cardiac surgery patients for 2 years and then we licensed the technology from the University and partner with them on our startup.

We are contacting HIEs in different states because we know that sustainability will become an issue. We have the financing to provide a monitor for every ICU and ED bed, plus servers and installation at no capital cost for the hospitals. Our business plan is based on a service or license fee per user (or rather per patient). There is a formula but it turns out to be a single charge of around $10 per ED admission and $10 per ICU patient. We work with HIEs to deploy it in the particular state and we share a part of the profit on a minimum 5 year contract. Longer contract = larger share of the profit for HIE. Maryland, North Carolina and Delaware are working with us to see how we can make this work for them.”

Marcelo’s got lots of street cred including a Masters in Public Health from Johns Hopkins University. You can see more about him here. I love one of the lines there about his interest in “the development of disruptive informatics’ tools that will allow physicians working in critical care areas of the hospital to develop a true sense of ‘situational awareness,’ improving patient safety while reducing the cost of healthcare.”

I’m not a hospital-based clinician, but I still remember enough from my ICU and ER days in training to know that this looks pretty intriguing, even if you overlook the attractive monetary paragraph above.

I’d love to hear from any of you hospital-ians to get your take.

(A moment please: I hope that on the Memorial Day recently passed that each of you took time to reflect upon those brave men and women who have sacrificed more than many of us can imagine. I for one am very grateful for what they’ve given.)

From the trenches…

“There can be as much value in the blink of an eye as in months of rational analysis.” – Malcolm Gladwell

 

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 5/31/12

Gateway EDI announces it has signed its 100,000th client and expanded its client base by 19% over the last year.

HHS’s Office of Inspector General reports that use of the two highest-level codes for established office visits has increased by 17% over the last decade, while use of high-level codes for ER visits has risen 21%. The OIG attributes the increase in part to the jump in overall services provided to patients. Wider use of EHRs have also made it easier for providers to meet billing requirements for higher codes.

e-MDs customer Orlando Heart Specialists earns Bridges to Excellence Cardiology Practice Recognition for providing superior patient care and is presented with the Florida Health Care Community Award. The clinic’s administrator says the practice’s use of e-MDs has facilitated data evaluation and has been instrumental to the winning of the awards.

IDC Health Insights releases a report on the ambulatory EMR/EHR market for small practices and assesses 11 products from nine vendors. It’s hard to glean much from the press release and the full details are only available to subscribers. However, I agree with this warning from IDC research director Judy Hanover:

“If providers allow the constraints of meaningful use to dictate their technology choices and limit the goals for implementation, they may only see the short-term incentives and not the long-term strategic advantage that EHR can bring to their practices and may fail to compete under healthcare reform.”

Hayes Management Consulting announces that its MDaudit software provides an E&M bell curve reporting module to help organizations identify providers who are consistently coding higher than their peers.

Over the last couple of months I have switched almost all my bills to online payments. I must say I am loving it and wondering what took me so long to get on board. I have established paperless billing with as many vendors as possible and appreciate the convenience of direct links to make payments, the auto-reminders, and the absence of paper, envelopes, and stamps. No surprise, but physician offices are way behind other industries in terms of offering online bill payment. For interested practices, American Medical News presents three options for establishing online bill payments for patients, including the relatively simple and cheap option of PayPal.

Premier Bone & Joint Centers (NE/WY) select SRS EHR for its 10 physician practice.

gloStream introduces gloSuite v7, which includes a practice portal for physician communication, secure direct messaging, and an option to run on an iPad.

E-mail Inga.