DOCtalk by Dr. Gregg 2/26/12

Home Alone 5

Breeeep…bzzzzz…bzzzzz…breeeep…bzzzz…bzzzz…breeeep…

You may have noticed the mournful silence around here the past several days. Not much but the sound of crickets to be heard here on the pages of HIStalk Practice.

The whole HIT world is currently focused upon the glam and glitz that is Vegas…er…I mean, the annual HIMSS conference…er…well, I guess it’s rather a moot point this year as they are pretty much twin entities. (Admit it: regardless of where HIMSS is actually holding its bacchanalia, there is a pretty strong resemblance between the HIMSS bash and the Vegas experience.) That focus includes the entire HIStalk ensemble who are working away in Nevada to keep up on all things HIMSS.

Back here on the home front this year, I’ve been fighting off intellectually challenged burglars, eating all the junk food I want, and watching whatever I want on TV until all hours of…oh…no…that’s not me. That was Kevin (as in the face-slapping “AAAAAHHHHH!” Kevin.)

Actually, despite the momentary twinges of envy I feel when I read about what friends and folks I know are up to in the bright lights and big city world of Vegas HIMSS, I’m finding it pretty cool to be watching from the home front this year. It allows a very different perspective than you can piece together amidst all the hubbub. Plus, thanks to all the hard efforts and late night typings of the goodly HIStalkers in attendance, I feel as if I’m gleaning all the best bits of HIT news, wisdom, and snark right here in the comfort of my cushy old armchair.

I guess the main reason I’m writing this is to talk to all those who didn’t make it to the Vegas strip this year. From being there in a too-much-information capacity before, I can tell you with a pretty fair surety that “watching” HIMSS from the pages of HIStalk gives you, by far, the best parts of HIMSS without the sore feet, hangovers, or aggravations of air travel and taxi stands. (OK, so you miss a lot of tchotchke…like you really need any of that?) The HIStalk gang provides all sorts of photos and insights and they let you skip over all the waste-of-space stuff. It’s even better than being there.

(Sigh)

OK, time for the truth. It’s a bit of a mixed bag. When you read how many sales folks prefer to keep their noses pointed toward their smart phones rather than engagingly towards the attendees and how some events, announcements, and HIMSS organizational choices leave a lot to be desired, it sort of does seem like skipping a year may be a pretty refreshing choice. On the other hand, HIMSS is full of fun and cool HIT people and all sorts of experiences you can’t get from the sidelines. The HIStalk folks do a TREMENDOUS job with their coverage and you really can get a good sense of the happenings from their above-and-beyond efforts, but there’s nothing like being at HIStalkapalooza…er…I mean HIMSS.

From the trenches…

“I think we’re getting scammed by a kindeygartener” – Harry (in “Home Alone”, the original, 1990)

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).

DOCtalk by Dr. Gregg 2/17/12

HIMSS, Mine & Ours

HIMSS

Not heading to HIMSS this year is a real drag…and, then again, maybe not so much. There are things I’ve grown to enjoy and people I’ll greatly miss seeing, but there are definitely both pros and cons to HIMSSing:

Things sadly missed:

• Real human-to-human, sans digital intermediary, connecting with friends and cohorts I don’t get a chance to see often.
• The “Ooo and Ahh” factor of all the glitz and showmanship that is HIMSS.
• The after-hours parties, especially HIStalkapalooza (and wearing my HIStalkapalooza sash.)

Things gladly missed:

• The morning after the after-hours parties (and the additional sleep deficit in my already miniscule sleep bank account.)
• Sore, oh-so-sore, feet (regardless of the choice of shoe fashion.)
• The guilt factor of knowing I’m helping to contribute to the gigundo national healthcare tab. (All that money comes from the same eventual place.)

MINE

At HIMSS, you’ll be hearing a new rallying cry coming from the e-patient folks: “Give Me My Damn Data!” You’ll be seeing them all over HIMSS this year. They’re looking to make some patient-empowered waves and I think they have the drive and chutzpah to do so.

The people (from around the world) who are driving this “e-Patient Spring”, like those over at the Society for Participatory Medicine, are some very active, very socially engaged, and very assertive folks. As with any social movement these days, they are taking advantage of Internet-enabled collaboration tools to promote their message(s). As with any social movement these days, they will not easily be denied their voice given the ease with which social connecting can now be accomplished.

Their basic cause is that they want to be considered a part of their healthcare, not a receivership nor a tangential. They want access to their own health data and they want providers who listen, discuss, and partner with them in their healthcare. (It is their health and healthcare system, after all.)

OURS

Considering both the HIMSS-related world and the just cause of the e-patient advocates, I feel a little bit caught in the middle. And, I’m not flying solo in my self-pity. I’ve heard similar sentiments from many colleagues. It really feels as if we providers are sometimes seen as the both the meal ticket and the root of all evil. Let me explain.

HIMSS razzle dazzle is exciting – and not meaning to rain on anyone’s parade-to-come in Vegas next week – but when I look at all the money spent there, I know where they get that money. When I look at the enormous facilities that Extormity Healthcare and others have built, I know where they get the financing. When I see all the faces of the pitchmen and pitchwomen who tout their HIT tools as the must-have to provide quality care and decrease healthcare costs, I know where they get their salaries. Ultimately, it’s all from patients and providers (some of it routed through the tax system.)

HMOs stepped into the healthcare lunch line some years back, promising to lower healthcare costs. They didn’t, but they sure made some millionaires and built some really large glass and steel high-rises to help manage all that “cost containment.” HIT vendors sometimes evidence a similar mojo.

On the patient engagement front, it makes a lot of sense and is, I think, an inevitability. But when I have to see so many patients per day just to pay all my costs, I have that nagging inner voice which reminds me that I don’t have the luxury of talking with them as much as I would prefer: I’m paid by volume. And that really sucks. I try to spend quality time, but if I’m sometimes too brief, it isn’t by desire.

Honestly, I think most docs, primary care docs especially, would prefer to spend more time discussing, explaining, and engaging with their patients. Heck, almost every one of us got into this field to try and help people. Of course we want to engage with our patients! But if you knew how many primary care medical practices, especially us small guys, are running in the red more and more each year, you wouldn’t be surprised by our seeming lack of time to chat. I want to chat more and engage more, but I don’t want to be doing it in a bread line or soup kitchen.

Considering the costs of technology adoption to the (rightful) desires of patients seeking more of a partnership in their healthcare, and — when you include the slimmer and slimmer reimbursements we’re given (and the still possible 27% SGR reduction, even if it’s now postponed 10 months) — it is starting to feel pretty durn tight in this little provider box. Sorta reminds me of that scene in Indiana Jones where the spiked walls and ceiling are closing in: closer, and closer, and closer…

To be clear, I have no desire to see HIT vendors nor HIMSS disappear. I love HIT and think it is one of the smartest moves medicine has made in years. HIMSS is a terribly fun 30,000-person party! And who doesn’t love a good geeky party now and again?

To be just as clear, I have no desire to withhold healthcare data and absolutely think engaged patients are the best patients. I have no desire to return to the days of paternalistic healthcare.

So please, as you hoist an IngaTini or as you raise awareness of the empowered patient, remember we’re all in this together. No part of this joint effort can survive without the health — both physical and financial — of the other: patients, HIT facilitators, and providers.

From the trenches…

“Boy, if this damn room would stop rolling around maybe I could find some place to be sick!” – Helen North (in “Yours, Mine and Ours” from 1968)

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 2/16/12

From Scott’s Boy: “Re: where’s the love? You don’t want to stop by our booth and check out what’s going on? Shout-outs to our fair and worthy competitors but not us really hurts my feelings. Come by and talk to our folks. And be careful in those heels!” Last week I mentioned the names of a few ambulatory EHR vendors I would visit at the HIMSS conference and of course couldn’t include all 250+ that are exhibiting. I’m flattered by the invite and of course will stop by and look at your latest offerings. I am happy to share my impressions with readers and promise not to be overly influenced by the quality of the trinkets.

athenahealth releases its Q4 and 2011 financials: quarterly revenue jumped 33% to $92.5 million, but GAAP net income fell to $5.3 million ($0.15/share) compared to last year’s $7.3 million ($0.21/share.) For the full year, revenue grew 32% to $324.1 million; income rose from 2010’s $12.7 million to $19 million.

Medical imaging provider MIDI, LLC contracts with MMP for for billing and practice management services.

Humana signs an agreement with NextGen to participate in its Medical Home EHR Rewards Program, which provides financial assistance to selected physicians for the purchase of ambulatory EHRs. Providers using NextGen will be able to exchange clinical information, receive payer transaction details from Humana, and then populate transaction data into the patient’s record.

The 330-physician DuPage Medical Group (IL) adds Merge iConnect Access and the Merge Eye Care Suite, which will integrate with DuPage’s Epic EMR.

Family HealthCare Center (ND) contracts with Intelligent InSites to provide RTLS solutions for tracking, managing, and displaying the real-time location and status of patients, staff and equipment.

HIT adoption in the US is nearly equal among primary care doctors and specialists, according to a report from Accenture. The eight-country study also finds that the US is a leader in HIT use and adoption among physicians, compared to Australia, Canada, England, France, Germany, Singapore, and Spain. The majority of US physicians use e-prescribing and enter notes electronically, and almost half enter orders electronically.

The Ohio Health Information Partnership reports it has signed up more than 6,000 primary care physicians to use EHRs, which is more than any other REC in the nation.

Greenway Medical Technologies launches Greenway Marketplace, which allows technology partners to build on Greenway’s PrimeSUITE’s application programing interface to deliver new technology to its users.

Ridgeview Medical Center (MN) selects Allscripts EHR and PM solution for its 300 employed and affiliated physicians. Ridgeview will also implement Allscripts Community Record powered by dbMotion.

Acting CMS Administrator Marilyn Tavenner tells an AMA audience that CMS is considering an extension of the ICD-10 implementation timeline. Tavenner says her office will office will make a formal announcement about regulation changes within the next few days.

CMS creates a new page on its EHR Web site dedicated to the clinical quality measures (CQM) and their role in the EHR incentive programs. The page includes general program definitions and CQM reporting requirements for EPs and critical access hospitals.

EHR-based alerts can inadvertently lead to information overload for providers, according to a VA study. While many alerts may be valuable, too many alerts forces providers to wade through irrelevant data. Researchers concluded that less than 20% of the words contained in EHR alerts are considered to be relevant.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

News 2/14/12

ADP AdvancedMD and ChartLogic announce a combined best-of-breed offering that includes ADP’s PM system and ChartLogic’s EMR.

The local paper profiles United Community and Family Services, a 13-provider community health center in Norwich, CT, which last month selected Greenway Medical’s EMR.

The 50-provider Imperial Calcasieu Medical Group (LA) selects Encoda’s BackOffice EDI technology.

The Bureau of Labor Statistics predicts that the number of jobs in the ambulatory care setting will grow 32.7%, which is faster than for inpatient services and other sectors in the economy. Job creation will be driven primarily by new positions for managers, PAs, nurses, medical assistants, financial clerks, administrators, and physicians and surgeons.

The AAFP’s TransforMED subsidiary publishes an updated version of its Medical Home Implementation Quotient, a free online tool to measure a practice’s progress towards implementation of a patient-centered medical home. The toolkit is based on the elements included in the NCQA PCMH 2011 Standards and Guidelines.

A Vitera Healthcare survey finds that 25% of practices are not aware of the required transition to ICD-10, though larger organizations appear more aware and have a greater sense of urgency. Fifty-nine percent of the respondents say they will upgrade their existing PM product or purchase a new solution to fulfill ICD-10 requirements. The press release does not provide details of the survey methodology and does not indicate whether or not the respondents were Vitera customers.

PM and RCM service and software provider MTBC acquires United Physicians Management Services, a provider of outsource and consulting services for physicians.

Medinova Physicians (NY) expands its partnership with PatientPoint to include care coordination technology and NCQA PCMH consulting services. Medinova will deploy PatientPoint’s HealthSync Care Coordination platform, which will integrate with the practice’s existing PM/EHR.

CCHIT says that 71% of complete EHRs used by EPs and hospitals that have successfully attested for MU are dually certified under both the ONC-ATCB and CCHIT Certified programs.

HHS announces a $9.1 million initiative aimed at encouraging medical students to serve as primary care doctors.  The plan requires MDs or DOs to serve three years of full-time or six years of half-time service in rural and urban areas of greatest need. In return, the students will be provided with loan assistance of up to $120,000.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

From the Consultant’s Corner 2/11/12

Success Strategies for Extending IT to Community Practices

Any time a hospital or integrated delivery network decides to extend electronic health record (EHR) and practice management technology to community physicians, there typically are two main goals: 1) improve patient care sharing clinical information across a common HER, and 2) strengthen relationships with the referral base.

It may sound easy, but extending information technology (IT) can be as difficult as winning the Super Bowl if you don’t avoid some major pitfalls along the way. So let me play “coach” for a minute. Here’s my playbook for how to successfully extend your organization’s IT capabilities to referring physicians in your community:

• Understand the fears of a community practice. When a physician group considers tying into your system, it’s usually afraid of losing a little bit of control over practice operations, and giving the sponsoring entity access to financial information. They sure as heck don’t want to run the risk of having competing providers gain access to their patient database and fee schedules. In addition, they’re almost always concerned that cash flow might take a hit during the transition period. So Job #1 is to erase—or at least ease—these fears from the get-go.
• Sell the benefits. There are obviously a host of benefits in having a shared EHR. The community practice gets instant access to things like hospital discharge summaries. Conversely, the hospital gains access to all primary care information. Of course, community practices enjoy major financial benefits; they don’t have to fork over the purchase price for an EHR.
• Determine how much customization is really needed. Private practices often don’t need as many bells and whistles as your employed specialists do. Instead of the familiar 80/20 rule, in many cases you can adhere to a 95/5 rule: 95% of what you provide can be a standardized solution; the other 5% may need tweaking. For example, if you’ve already customized a system for your well-respected in-house pediatric group, leverage it by offering it to your referral base, too.
• Use special teams when necessary. Every football coach knows the importance of special teams. So my advice is to create special teams for HIT: one for your employed physicians, the other for private practices in your area. Consider this thought: If a large percentage of your on-staff orthopedic surgeons aren’t currently getting custom IT solutions from you, they’ll be irate if you offer custom solutions to unaffiliated surgeons in your community first. The answer is to create one support team for your in-house providers and a separate consulting team to work with referring physicians. That way each group of physicians gets VIP treatment. You can even create a special billing team, bringing in a third-party expert to help the community practices avoid revenue cycle problems.
• Don’t take shortcuts in training. No athlete ever reaches the pinnacle without a lot of training. In similar fashion, community physicians will need more than a few hours of online training to master the new system you’re extending. Don’t leave your referring practices in training limbo. Get some super-users on board and be responsive to their concerns. Otherwise, your help desk will get flooded with angry calls.
• Quickly identify revenue cycle problems. As a private practice gets accustomed to a new IT system, there’s often a short-term impact on productivity and profitability. And guess what? They’ll blame you for any revenue cycle slowdowns. Since that defeats one of the main purposes for extending your system in the first place—strengthening relationships—it’s imperative that you also extend resources to help practices keep their revenue cycles humming.

Most of the referring practices in your community already are sold on the idea of integrating technologically with other providers and facilities in the community. They have a good grasp of the major benefits. You’re halfway home already. With these coaching tips, you’ll be well on your way to achieving success in extending IT to referring practices in your area.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation, and information technology.