Readers Write 5/29/12

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Health Informatics [helth in-fer-mat-iks]: The Next Generation
By David Wellons

In Aaron Bordofe’s excellent article on May 15 discussing healthcare informatics, he accurately describes the struggle I’ve had defining and developing solutions that provide answers to improving information flow in healthcare so that it benefits the patient, provider, and payer.

I was the director of healthcare marketing for a large telecommunications company. From my prior decade of HIT experience in PMS/billing, EMR/PHR, and QM/UM/CM/DM systems, I worked on solutions for the NHIN and RHIO structures in the 1998-2006 timeframe. Those RHIO concepts have evolved into the current health information exchange (HIE).

One issue I then struggled with was the answer to a simple question. If my entire medical history from all 25+ disparate providers I’ve seen during my life was available in electronic format, just what meaningful clinical information would need to be displayed to a provider seeing me for the first time? What information would they be willing to wade through in order to treat me?

My conclusion was this: show them my current diagnoses, current medications, and recent vital signs. That would give them a starting point as a basis of treatment. My tonsillectomy at age 5 would not be of interest.

I still felt that something was missing from this data mix. I have only recently discovered the answer: provide the doctor with care and treatment opportunities based on my analyzed clinical information.

What if the system displaying the data to the provider also analyzed the data and, noting a diagnosis of diabetes, calculated that I had not had a foot exam and A1c and microalbumin tests in the last 12 months, and prompted the provider to perform them? I would get better care and the provider would have the incentive to review my consolidated record because it would allow them to practice better medicine and would present revenue opportunities to them. The payors would not object since, in the long run, their members would be healthier.

Where would I get reliable, meaningful clinical information that my caregiver and I could use to improve my health? First and foremost would be the EMR systems of providers, available through HIE networks and direct interfaces. Natural language processing (NLP) could be used to read transcribed notes, extract additional data values, and add lab and pharma data to complete the record.

Claims information would be a source of last resort. It would be used only to round out the record due to its great latency in receipt and unreliability as a source of accurate medical information.

Then, perform the analytics and display it to the provider.

The benefits of such a system to all three parties in healthcare would be immense. Add to this the ability to compile and monitor the progress of patients with certain disease states across all caregivers and our overall national health levels would benefit greatly. Another major benefit would be the measurement, reporting, and statistical capabilities that are a natural by-product of such a solution to support PCMH and ACO programs.

David Wellons is a 25-year veteran of the HIS industry involved in sales, marketing, and product development of solutions for payers and providers.

News 5/24/12

Humana notifies physicians and other providers of a system glitch that led to the rejection of 450,000 claims submitted through the Availity clearinghouse. The claims were originally submitted between April 26 and May 10 and rejected after Humana asked Availity to begin enforcing a new 5010 claims edit for linking diagnosis and procedure codes. CMS, however, recently announced it would reevaluate this particular edit requirement. Humana has now instructed Availity to relax the edit until CMS issues new guidance; the insurer also advises providers to resubmit any rejected claims.

Epocrates leads the market in the digital medical category, according to a Manhattan Research study. More than half of physicians use the app on a daily basis with drug references the most commonly accessed tool.

EMR/PM provider Cloud MDs signs a letter of intent to acquire Doctors Network of America, a Mississippi-based provider of physician billing consulting services.

Four Tennessee orthopedic practices agree to participate in a bundled payment system with BCBS of TN. The program will provide a set payment for an entire episode of care for total knee and hip replacements, including surgery, post care, and physical therapy. The TriZetto Group will supply a range of program components to support the payment bundling solution.

Lakeland Healthcare Group (IL) selects Merge Healthcare’s radiology solutions for its radiology practice.

The New York Times looks at the increasingly popular “direct primary care” model, which  is similar to the concierge model but less expensive. The article profiles Qliance, a direct primary care clinic in Washington state that charges patients $59 a month for unlimited doctor visits, 24-hour email access to medical staff, and same-day or next-day appointments.  That’s considerably less expensive than the $1,000-$2,000 per year fee charged by concierge practices for similar services. Call me a cynic but it sounds like the main difference between the two models is price. Of course the “direct primary care” label is probably more appealing to the masses, who may perceive that “concierge” practices are only for the wealthy and elite.

Pennsylvania Governor Tom Corbett announces that the state’s Medicaid program will begin covering telemedicine services to include consultations between patients and all physician specialists, who will be able to remotely diagnose patients, recommend and monitor treatment, order tests, and prescribe medication.

E-mail Inga.

News 5/22/12

From FastCar: “Re: drchrono. After almost selecting Practice Fusion, we are now considering drchrono. Our doctors like that it runs on the iPad and the billing and EHR are integrated. To get all the functionality we need will cost $400 a month per doctor. Do you have any readers that might be able to share any insights on the company or product?” Readers?

E-prescribing rates continue to rise, with adoption by office-based physicians hitting 58% by the end of 2011. Adoption rates were highest in smaller practices of six to 10 physicians (55%) and two to five physicians (53%.) Forty-six percent of solo physicians now e-prescribe compared to 31% at the end of 2010. Adoption rates were highest among internists (81%), endocrinologists (78%), cardiologists (76%), and family practitioners (75%.)

Vitera Healthcare Solutions appoints Shantanu Paul (Allscripts/Misys) SVP of product development.

EHR provider Pulse Systems completes its move to a new 24,000 square foot office in Wichita, KS.

Las Cruces Orthopaedic Associates (NM) selects the ChartLogic EHR Suite for its five-physician practice.

After a three-year decline, AMA membership grew about one percent in 2011 to approximately 217,000 members, including 8,577 first-year residents who were granted free memberships. The association also reported a 3.35% increase in profits to $24.8 million.

The 90-physician Illinois Bone and Joint Institute implements several Web-based documentation solutions from Emdat, include Emdata Mobile and ShadowScribe speech understanding technology.

Dr. Oz and 75 medical students perform physicals on 1,000 Philadelphians in an hour and enter results into Practice Fusion’s EMR. Practice Fusion then compared the results with data from other large cities. In addition to raising health awareness, the Dr. Oz Show episode underscored the impact an EHR, combined with data analytics, can have on public health. More than two-third of the Philadelphians, by the way, were overweight and almost half had high blood pressure.

ONC announces the Ocular Imaging Challenge, a contest to encourage the development of applications that improve interoperability among office-based ophthalmic imaging devices, measurement devices, and EHRs. I recall from my vendor days that the lack of device integration was biggest EHR adoption barrier for ophthalmologists, so I applaud this initiative. The winning development team takes home a $100,000 award.

A healthcare attorney suggests that physicians ban the snapping of smart phone pictures by patients and declare their practices “picture-free” zones. He argues that a no-photos policy reduces the risk of violating other patients’ privacy. My opinion: ridiculous. While I appreciate the privacy concerns, I have spent a considerable amount of idle time in waiting rooms and exam rooms over the last couple months. Once I have checked e-mail, read an article or two, and caught up on my latest Scrabble game, my iPhone camera has allowed me stay amused while snapping pictures of paper charts, nurses’ shoes, and ancient desktop PCs. We’ve become a society addicted to snapping pics to document our every activity, especially if we have extra time on our hands. Maybe I’d have a different opinion if doctor office visits involved less waiting.

E-mail Inga.

DOCtalk by Dr. Gregg 5/19/12

Data Tsunami and a 9-Year-Old

Two recent stories on very different topics from two very different sources sort set off some strange sounding sirens of synchronicity in my cerebrum recently.

The first was a post on PhysBizTech.com entitled “The Data Tsunami,” written by Medicomp’s CEO, Dave Lareau. The second was from Inc. com entitled “What a 9-Year-Old Can Teach You About Selling,” written by Tom Searcy, author, consultant, and large account sales expert.

The former was all HIT. Dave discussed the fact that the first phase of health data collection is well underway. It’s sort of like the recession of the ocean just before a giant tidal wave rolls in and inundates everything in sight. The tsunami itself will be washing through as health information exchanges (HIEs) really start to exchange health information… in a meaningful way, that is.

Dave contends (and I agree) that HIEs and standards such as SNOMED, LOINC, HL7, ICD –XX, etc., will soon bring about an inundation of our clinical shores with tidal waves of data. Providers, as well as most current EHR/EMR systems, are ill prepared to contend with this pending onslaught. His take home is all about the need for efficient tools to help end users actually understand and contend with all that data. If the flood of newly accessible data isn’t managed, if it isn’t provided to providers with something I’ve previously called “Meaningful Views”, then the data tsunami will surely send us all out, head over heels, lost and adrift, into our newly created “Sea of Stats.”

The latter blog post I mentioned, the one by Mr. Searcy, was centered on selling, but I found it just as fitting for HIT. The article’s tagline was, “If you want your conversations to have real impact, you need to simplify your message.” He uses his innocent young daughter’s probing, though simplistic, questions to illustrate the need for clarifying and keeping messaging simple. In order to help buyers who may lack context (and the seller’s expertise) to truly understand the messages you are trying to convey, simple messages work best. He provides some great examples and I highly recommend reading his short and sweet missive to gather the full flavor. As he points out, both complex messages and simple messages may each be accurate, “but that doesn’t make them right.”

Doing a little two-and-two work seems pretty apparent when you put these articles side by side. That is, in the coming data-drenched world that HIT and HIE are bringing, if we don’t keep true to meaningful views for providers, we’ll all drown in a meaningful-less mess of metadata and it’s mother at the bottom of an ocean that’ll make the Marianas Trench look like a mud puddle.

To follow Mr. Searcy’s advice, we need to keep it Stupid Simple, at least on the surface. Users don’t need to know – and don’t really care – about all the under-the-covers complexities. We just want our meaningful views via those efficient tools mentioned by Mr. Lareau.

From the trenches…

“Most of the fundamental ideas of science are essentially simple, and may, as a rule, be expressed in a language comprehensible to everyone.” – Albert Einstein

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).

HIStalk Practice Interviews John McConnell

John McConnell is president and owner of McConnell Golf. He co-founded Medic Computer Systems (acquired by Misys in 1997 for $923 million, now part of Allscripts) and was chairman and CEO of A4 Health Systems (acquired by Allscripts in 2006 for $272 million). 

You left Allscripts and the HIT world four years ago. What have you been doing since then? 

I started McConnell Golf in 2003 when I purchased Raleigh Country Club while also being CEO of A4 Health Systems. After that company’s sale to Allscripts in 2006, I wanted to pursue a new industry challenge and have focused on growing McConnell Golf. Today we own eight clubs and employ over 500 people. McConnell Golf  hosts the Wyndham Championship, which is a PGA event at one of our clubs in August,  as well as a Nationwide Tour event in June.

Do you think today’s business and HIT environment could support startup companies similar to the ones you built with Medic and A4?   

There will always be room for new companies and new products. At Medic, we developed most of our products when I was with that company. At A4, we were much smaller than Medic and other competitors, so we acquired other businesses with established technology in order to get to market faster at lower costs. 

I see the same opportunities today for smaller businesses to be acquired by larger HIT entities due to time and the research and development investment required to create and execute on new ideas. On numerous occasions, I am asked to review new products that small startups are developing, and many are very good ideas that can fulfill a niche in HIT. Certainly I think developing large-scale, enterprise-wide solutions would not be the best place for small companies to invest and compete today.

If you were starting an HIT company today, what area would you choose?  

Analytics. Information from the various HIT systems tied together to help reduce costs, eliminate service redundancy, identify fraud, and improve patient care will be huge.

Is healthcare software becoming as commoditized as hardware? 

Most mature systems are very comparable today, and I see a continued lower-margin business for most of the vendors in their software sales. Service revenue is the future for most HIT companies, which is similar to how IBM moved from hardware into consulting as margins in their historic business eroded. 

The same business rules apply today as in the past. Those companies that can gain customers with efficient marketing and implement their solutions in a timely and cost-effective manner will gain market share. Pricing will continue to drive a lot of buying decisions. Web-based solutions are quicker to build, implement, and maintain, so lower pricing should be the norm for the customers.

What are the good and bad aspects of Meaningful Use? 

I think Meaningful Use will help control the ongoing rise in healthcare costs going forward if it is given time to succeed. Having greater automation and less paper will be good for everyone. Technology helps reduce costs and errors in delivering healthcare services, so those are positive benefits. 

Bad aspects may be that caregivers spend more time documenting and looking at computer screens than with the patients. I also see the trend for the older physicians to retire sooner than later as their reimbursements are reduced further by not implementing technology.

Who in the industry do you really admire? 

My top three in no order of preference are Neal Patterson from Cerner, as he had a long-term vision for HIT and never let the Wall Street crowd interfere with it. I admire Judy Faulkner at Epic because of her emphasis on software, company culture, and maintaining the private company status. Patrick Hampson at MED3OOO  has reinvented that business at least three times from its founding in 1995 to adapt to industry dynamics, so that takes sincere leadership skills.

What ugly lessons did you learn running publicly traded companies? 

The biggest issue that I found for myself personally was that I started managing the business to meet Wall Street expectations instead of our customer ones. Each quarter end became challenging for our business and employees because of the pressure and pride we felt not wanting to lose any money for investors that bought our stock. Quite honestly, that caused us to make some poor business decisions in granting discounts or other incentives to our prospective customers at quarter end that we most likely would not have offered as a private business. 

Today I sit on one public board, and the government regulations now in place for public companies are very challenging and expensive to manage. Personally, I also see more investors looking for short-term results in stocks that they buy instead of valuing the company’s long-term potential. However, even with the negative issues that I have outlined, public markets provide valuable capital to businesses to grow to new levels that benefit many.

Allscripts is in the midst of a rough patch with its recent board turnover, missed earnings, and drop in stock price. Do you think this is just a bump in the road or do you predict more turmoil in coming months? 

I have been off the Allscripts board since 2008, so my familiarity with the business is not very current. Their management team has certainly built an impressive business in both revenues and customers, so they enjoy a very strong position in the industry.

Integrating large acquisitions and different product lines in a short period of time will be challenging for any company. That is most likely the major reason why Allscripts recently hit a bump in the road in their business financial results and significant loss of shareholder value. With any board, you often have diverse opinions on the business strategy to pursue, so that can create major conflicts among its members.