DOCtalk by Dr. Gregg 3/11/12

The eeMoment

eThis. iThat. Seems like anything even semi-associated with something digital or web-related has been given an uncapped vowel prefix, doesn’t it?

Well, I’ve got one more. With apologies to those who have used a similar term elsewhere – “eMoment” which is typically related to “e”ngaged teaching moments or “e”motional moments (also known as “emo-moments”) – I hereby declare a new term: “eeMoment”. (“ee” as in EEK!)

ee-Mo-ment: [ee-moh-muhnt] noun

1. the instant when one finally realizes that the tech tool they have been trying to use, be it software (e.g., EHR, Netscape, Windows?, etc.), Software-as-a-Service (e.g., Google Health, Netflix?, etc.), or hardware (e.g., Atari, Palm Pilot, Zeos PC, etc.) is now or soon to be dinosaurian

2. the instant one realizes that the rude and/or worthless tech support from any of #1 above has become completely and irrevocably insufferable

3. the instant one realizes that the vast quantity of money and/or inordinate amount of time invested in either #1 or #2 above has reached “OMG, OOH” status (i.e., Oh My God, Out Of Here)

I’ve had my share of eeMoments: some from days of yore, like with Windows ME or IBM’s ViaVoice; some more recent, as with my dear, loveable Palm Pre (RIP).

I had an eeMoment recently that made me think about all those other poor souls out there who are busily readying themselves – and spending huge sums of irretrievable monies – in blind preparation for some pretty monumental eeMoments of their own. To wit: rapid EHR choices and investments in companies who will be gone soon with nothing but the lingering echoes of their rabid cash-taking left behind.

Poorly designed EHRs, EMRs based upon dated technology that won’t last the test of techno-time (which is quantumly faster than standard time), systems that attract with glam and glitz but have no solid tech support touchpoints post-sale, and systems that “eat it” as they get “eaten” themselves in acquisitional feasts – these are but some of the eeMoment precursors which loom so ominously for more providers and hospital end users than I care to consider in the Meaningful Use frenzy of today.

It’s sorta sad, really. HITECH and MU have driven lots of EHR adoption. And that’s good (says the true digital believer in me). But, they’ve also carried with them the increased onslaught of impending eeMoments for many, many unsuspecting providers (even for some of us who are “suspecting” providers.)

What’s that? You wonder what was my recent eeMoment? I’m reluctant to say as I have friends I still admire and trust at the offending eeMomenter company. But, I will say that it was particularly sad for me as what had once, in my eyes, been a beacon of what’s good in “techdom”/”tech supportdom” has now become but another not-so-shining example of how sour the eeMoment can be.

From the trenches…

“The secret of life is honesty and fair dealing. If you can fake that, you’ve got it made.” – Groucho Marx.

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 3/8/12

From MeaningfulDoc “Re: Summary of Stage 2 Rule. Thanks for the link to the Stage 2 summary for EPs. Here is another I found, written by a couple of physicians.” John Crankshaw, MD and Jonathan Ploudre, MD publish a two-page interpretation of the rules on Ploudre’s www.Unchart.com Website. Ploudre is a self-proclaimed “Geek,”  an e-MD client, and a blogger who writes about practice improvement and technology.

The Visiting Physicians Association rolls out Aprima Medical Software’s EHR across its 30 offices and 170 physicians.

SynaMed partners with StenTel to combine StenTel’s clinical documentation solution with SynaMed’s EMR platform.

RCM company MediGain acquires MedOptima, a provider of RCM and PM consulting.

The Corvallis Clinic and Samaritan Health (OR) introduce patient portals, giving patients online access to their medical history, schedule appointments, and renew prescriptions.

Vitera Healthcare Solutions customer Southaven Internal Medicine (MS) becomes the first practice in the country to successfully submit PQRS measures for the 2011 reporting period.

US doctors charge two to three times more than their peers from France and Germany for the same services. Outcomes, however, are generally not better. Somehow I doubt US physicians are willing to slash their fees 50%  in order to be in line with other countries.

National Coordinator for HIT Farzad Mostashari, MD takes issue with the recently published study that found doctors having online access to patients’ charts ordered more imaging tests, leading to higher healthcare costs. Mostashari contends the study tells little about the ability of EHRs to reduce cost and nothing about the impact of EHRs on improving care. Other points:

• Since the study was based on 2008, “certified” EHRs were not yet in place. Certified EHRs require clinical decision support and the ability to exchange clinical data electronically. Thus providers were unlikely to be using advanced tools to make appropriate care recommendations.
• The study does not examine several factors which could impact physician behavior including the overall health of the patient population, level of physician training, approach to defensive medicine, and financial arrangements.
• The study did not consider the appropriateness of the imaging tests ordered.
• EHRs use can lead to improved care coordination and quality of care, which in turns prevents unnecessary and costly complications and hospitalizations. Reducing test orders is not the appropriate solution for cutting healthcare costs.

E-mail Inga.

News 3/6/12

From MUse “Re: Stage 2 for EPs. Don’t know if you have seen this but American Medical News has a good summary of how the proposed Stage 2 rule will impact eligible providers.” Thanks. The article highlights some of the major differences between Stage 1 and Stage 2 requirements for EPs, including the higher thresholds for several measures.

MGMA asks HHS Secretary Kathleen Sebelius to consider adding due diligence to the ICD-10 timeline and limit its required adoption to hospitals if possible.  MGMA also urges HHS to consider adding several steps to its timeline before making ICD-10 mandatory and include a cost benefit analysis, a pilot, staggered implementation dates, and an evaluation of alternate code set approaches.

Doctors having online access to patients’ tests in the ambulatory care setting are more likely to order imaging and lab tests, according to a Health Affairs-published study. Researchers found that point-of-care access to electronic imaging results were associated with a 40-70% great likelihood that an imaging test was ordered; the study also notes that women receive more imaging studies overall and that surgeons and other specialists are more likely to order imaging tests than primary care physicians.

TriState Neurological Surgeons (PA) selects the ChartLogic EHR suite for its 11 provider office.

SRS EHR customer Pediatric Associates of Savannah (GA) chooses SRS Patient Portal for its 10 provider practice.

Medical malpractice insurance company the Doctors Company reports that 30% of physicians have implemented EHR that Meaningful Use criteria, 14% intend to do so within the next three years, and 17% have no plans to use an EHR in their practice. The same survey of 5,105 finds that 14% of doctors plan to participate in an ACO, 57% are undecided, and 29% do not plan to participate.

Reminder: we are conducting our annual HIStalk Practice reader survey and would appreciate two minutes of your time to give us feedback. Thanks.

The 26-physician Radiological Consultants Association (TX) selects Zotec Partners to provide medical billing and practice management.

HIMSS and MGMA release an Ambulatory HIE Toolkit to educate physician offices on participation in health information exchanges. The toolkit includes details on business and financial models, leadership and governance, technical architecture, and value proposition.

Medical liability experts offer some tips for reducing liability risks when using EMRs. Pointers include: refrain from copying and posting EMR data; do not become overly dependent on electronic diagnosis tools; and, keep meticulous electronic notes and take time to document each patient encounter.

E-mail Inga.

News 3/1/12

Alexander Orthopaedic Associates (FL) selects White Plume Technologies’ AccelaSMART resolution engine to bridge the gap between its Exscribe EHR and ADP’s AdvancedMD’s PM system.

Speaking of ADP AdvancedMD, the company announces integration of its PM product with digiChart’s EHR.

The Association of Medical Directors of Information Systems (AMDIS) estimates that 27,000 EPs will attest for MU in 2012.

The South Carolina Medical Association makes DocBookMD’s smart phone communication app available to its 5,000 members at no charge.

Anesthesia Consultants of Indianapolis sign a multi-year billing services contract with Zotec Partners.

Practice marketing firm MedMarketer releases PracticeApps, a custom mobile app that interfaces with MedMarketer’s e-mail marketing product. MedMarketer charges a one-time $499 setup fee to design a practice’s custom app, plus $99 a month to host the app and provide e-mail marketing to up to 500 subscribers.

The AMA releases a how-to manual for evaluating emerging payment models.

Could you spare two minutes to complete our annual HIStalk Practice reader survey? We do it just once a year and your input helps us to improve the content of the site. Thanks for helping us out.

Black Book Rankings announces its vendor rankings based on customer experience. The top-rated systems include:

• Care360 Quest Diagnostics (single physician practices)
• ADP AdvancedMD (2-5 physician group practices)
• Aprima (6-25 physician group practices)
• Greenway Medical (26-99 physician group practices)
• MED3OOO (100-249 physician group practices)
• NextGen (250+ physician group practices)

Primary Health Medical Group (ID) and eClinicalWorks join the Idaho Health Data Exchange, which is powered by the Optum HIE platform.

In a Boston Globe interview, athenahealth CEO Jonathan Bush says that this is the year his company will reach the tipping point in becoming a backbone for national health information. Bush also gives this analogy to clarify athenahealth’s current position in the market:

Everywhere we’re a little, snippy kind of overconfident Chihuahua jumping up and trying to nip at the tails of the Dobermans.

Shareable Ink announces partnerships with Greenway, NextEMR, and VoiceHIT for its handwriting recognition technology.

Coastal Cardiovascular Consultants (NJ) selects SRS for its six providers, which the company says they chose instead of the alternative, a hospital-subsidized EMR.

The 100-physician Oregon Medical Group announces that 15 positions have been cut as a result of workflow changes stemming from the practice’s moved to EMR. Over the last year, the organization also added seven positions in IT.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

News 2/28/12

Thanks Dr. Gregg for keeping HIStalk Practice rolling last week while I was crazy busy at HIMSS. I love the annual conference, I am glad it only comes around once a year. Though the in-patient world is king at HIMSS, the ambulatory world was well-represented by such ambulatory-only vendors as eClinicalWorks, athenahealth, Practice Fusion, and Vitera. Marketing departments were working overtime churning out press releases, including much of the news below. I am still wading through my in-box but here are some of the more newsworthy items from last week.

eClinicalWorks announces Community Analytics, a data analytics solution for communities and ACOs that provides reporting, alerting, and messaging capabilities to manage population health. eCW also introduces its Care Coordination Portal for ACOs and PCMHs that ties into eCW’s or other EMRs. The portal is designed to enable care coordination and reporting and includes tools for care management, patient engagement, home-monitoring device integration, and transition of care plan management.  Finally, eCW announces that Greater Baltimore Medical Center expands its relationship with eCW to include the Coordination Portal and Community Analytics modules.

CareCloud appoints athenaheath’s former director of global corporate communications John Hallock as VP of corporate communications.

Radiology Associates of Atlanta selects Zotec Partners as its billing services provider.

Quest Diagnostics announces a 30-day EHR implementation guarantee to enable bi-directional data exchange between hospitals and ambulatory physicians using the Care360 EHR.

athenahealth is named to the 2012 TR50 Technology Review’s list of the world’s most innovative technology companies.

CVS Caremark’s MinuteClinic will transition from its proprietary EMR to AllscriptsMyWay EHR across its national chain of retail health clinics.  In addition, Humana subsidiary Concentra announces plans to implement Allscripts EHR at more than 310 Concentra Urgent Care locations across the country.

AT&T takes ownership and control over the AMA’s physician platform, which AT&T will integrate with its Healthcare Community Online HIE platform. Both the AMA’s Amagine platform and AT&T’s HIE run on technology created by Covisint.

Most physicians believe EHR use is valuable in improving quality and important to managing patient care, but less than half say EHR has not improved diagnosis accuracy or treatment planning. Cost and the burden of implementation continue to be the biggest barriers to EHR adoption. From the same Deloitte Center for Health Solutions study: only about 25% of physicians consider themselves on target to meet MU and 23% say they are unfamiliar with MU requirements.

Allscripts and MyCareTeam launch a diabetes management system that integrates the MyCareTeam application with Allscripts Enterprise EHR. The integrated platform allows patients to transmit their blood glucose readings from their glucose meters, along with vitals, to a database via the Internet.

A proposed rule would require physicians to return any improper payments within 60 days of notification and allow auditors to uncover overpayments as far back as 10 years from the date of payment.

InteGreat EHR earns BlackBook Rankings’ #1 spot for EHRs for physician groups with 100-249 physicians, as well as for EHRs for multi-specialty practices.

NextGen unveils its redesigned EHR that includes automated outcomes reported, enhanced disease management workflows, content for more than 25 specialties, and a new user interface. NextGen also launches its Performance Management suite for self-service analytics, NextPen for digital data collection, and NextGen Mobile.

Use of EHR computer-assisted decision tools can significantly increase identification, diagnosis, and counseling for overweight and obese children, according to a three-year study.

And in case you missed it, Mr. H prepared a high-level overview of the Stage 2 proposed Meaningful Use rules here.

E-mail Inga.