From MGMA 10/26/11

Tuesday

On Monday, ONC head Farzad Mostashari led a session on Meaningful Use and “other critical topics.” Only about 100 people attended, which surprised me a bit.  On the other hand, Meaningful Use and HIT are but one area of concern for practice administrators. A few highlights:

• HITECH is proving effective at spurring EHR adoption, with adoption expected to hit 40% by the end of the year.
• As EHR adoption grows, so will its benefits, including better care coordination, improved decision support, and better patient care.
• As payment models shift from fee for service, EHRs will prove invaluable for documenting quality care.
• Don’t expect the Stage 2 deadline to be pushed back.

Mostashari also took several questions from the audience. Based a few of them (regarding ICD-10, for example,) some audience members didn’t fully understand what the ONC really does. A few points from the Q&A:

• CMS would like to “harmonize” various quality initiatives to reduce administrative burdens.
• Progress has been made in establishing standards and protocols for information exchange, but work remains.
• In developing new clinical measurements, the priority is establishing those that matter across a wide range of specialties rather than for single specialties.

As a presenter, Mostashari is engaging, personable, and quick on his feet. It was definitely my favorite session of the conference.

Tuesday morning’s keynote speaker was Eric Dishman of Intel’s Digital Health Group. I am going to try to track him down because I think he’d be a great interview for HIStalk. His presentation was billed as "Home and Community-based care Technologies for Independent Living,” and he went into a fair amount of detail about various emerging technologies, such as kinetic motion monitoring, implantable medication compliance devices, and tools to automate the documentation process. Dishman made a great case for the need for technology that shifts patient care out traditional settings and seems confident that we’ll see a flood of innovation over the next 10 years.

I spent about 10 minutes in a remedial session on technology. Its content targeted individuals who were not IT experts, but were perhaps responsible for taking care of the office’s IT needs. I suppose it’s a great topic for certain office managers running small offices, but I walked out when the presenter began to explain the difference between a server and workstation.

As I walked down the hall looking for an alternate session on patient interaction technologies, I noticed a standing room only crowd for a session on building successful physician/hospital relationships. Obviously the average administrator is far more interested in that topic than the HIT stuff.

In the exhibit hall, I sat through a couple of 20-minutes sessions on PQRS at the Healthcare Innovations Pavilion, where I think it was only vendors presenting. The ones I saw were well done and perfect for my 20-minute attention span.

I’ll be doing a meeting wrap-up tomorrow, but here are a few more pics.

My collected swag. Best giveaway: the free flu shot from Passport Health.

athenahealth hosted a fun event Monday night at the Tao in the Venetian. I think the event was billed as the Opening of the Kimono, starring the kimono-adorned Jonathan Bush. After a few opening remarks, Bush opened his kimono and an image of athena’s Meaningful Use Dashboard was displayed onto the kimono (the picture on the right.) It was a tongue in cheek representation of athena’s push for EHR vendors to be more transparent and reveal their customers’ level of success fulfilling Meaningful Use requirements. Only Bush could get away with such a presentation.

MED3OOO and Phytel co-sponsored a reception for the Primary Care Assembly. Guests had an opportunity to sit in front of a green screen and videographers created a music video of them singing different hit songs. This pair was lip synching to Sweet Home Alabama for their personal video.

I also stopped by Greenway’s party, which was in a dueling piano bar at New York New York. The music was great and everyone seemed to be having good fun. I even had the opportunity to shake hands with CEO Tee Green and the dashing Justin Barnes.

Nice shoes AND nice calves.

E-mail Inga.

From MGMA 10/25/11

Monday

At the suggestion of a reader, I walked through the exhibit hall this morning, intent on identifying what HIT vendors may be talking about this year in addition to EHR and Meaningful Use. So, in no special order:

• Connecting. For example,  connecting physicians to each another; connecting physicians with hospitals, labs, pharmacies, and payers; connecting providers with patients.
• Improving EHR adoption. Obviously the EHR vendors were talking about this, but so were document imaging vendors, transcription services, and companies that offer ancillary tools that feed information into EHRs (speech recognition, card scanners, automated charge and code capture technologies, and HIE type offerings.)
• Patient communication tools. Examples include kiosks, patient portals, personal health records, and automated patient reminders.
• Revenue enhancement tools. Definitely not the sexiest of topics, but practices still care about products and services for RCM, code scrubbing, and ICD-10 conversions.

Most annoying entertainer: the singing Elvis on stilts at the Sage booth. I think he was at least as old as the real Elvis would be, but I doubt he ever had Elvis’s voice. I pitied the vendors surrounding Sage’s booth.

Speaking of Sage, an employee told me the company is changing its name. He says it won’t be Medical Manager.

I was pleasantly surprised by the morning keynote speaker, Marcus Buckingham. He has written a few books, including First Break All the Rules and Now, Discover Your Strengths, and was scheduled to discussed what the world’s best managers do differently. He covered the topic well and was very funny and entertaining. I thought he was a great pick for MGMA’s target audience.

I am in a bit of a time crunch, so I am unable to cover all the highlights of my day (including the presentation by the bowtie-adorned Dr. Mostashari) but a few highlights in pictures:

Before I gave it all back to the Hilton.

John Hallock (on right) is director of communications for athenhaealth. He assured me that his boss, Jonathan Bush, hadn’t been drinking when he selected today’s outfit.

That’s me on the right, posing with a George Clooney lookalike. Wish I had been smiling.

In the hotel gift shop. I wonder if Mr. H will notice if I happen to add this to my expense report?

I find this knight creepy, regardless of the marketing message it’s suppose to be sending.

E-mail Inga.

From MGMA 10/24/11

If you saw Elvis, then you must in in Las Vegas. Dueling Elvises (Elvi?) were on hand to entertain the MGMA crowds on the opening day. Personally, I thought the younger Elvis was way hotter than the more senior and rotund version. Young Elvis gave me his card, saying, “If you ever need an Elvis, I can hook you up.” Since HIMSS is heading to Vegas in February, I intend to keep his contact info, since one really doesn’t know when you might need an Elvis

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MGMA made a big push this year to get the crowds in the exhibit hall on the first day. There was very little competition in terms of educational speakers and the first 1,000 folks to enter the hall got “special” gifts. I must have been #1,001 because I got nada. The hall opened at 1:00 and free drinks and appetizers were on hand beginning at 3:00. Bribery apparently worked, as the traffic did appear heavier to me than in years past. Cirque du Soleil acrobats were also floating about, including this magician. They were fun and entertaining, even though I found the masks a bit creepy.

Plenty of magicians, money-grab booths, and massages were available to attract attendees into booths. My favorite entertainer was the chef at Zirmed, who was mixing up some bruschetta and juggling tomatoes, while also giving a spiel on Zirmed’s “recipe for success.” Now that’s talent.

I also enjoyed the balloon maker at the IDS booth (that’s an octopus above.) Creating balloon animals is also an enviable talent.

Sage is donating $5 to a cancer research organization for anyone who signs on their wall. And, Gateway is giving $5 to the Susan B. Komen for every card they swipe.  Thank you Sage and Gateway.

Another good cause: United Healthcare has markers, crayons, stickers, and all those other fun things you enjoyed in kindergarten and is encouraging attendees to create cards for service men and women. I made a little Christmas card that I thought was quite cheery.

Today’s shoe winner: these little alligator skin beauties worn by a doctor. Angela with CTG was a close second in her knee-high black patent leather boots (I’m sorry I didn’t get a picture.)

I mentioned that Sunday afternoon the exhibitors didn’t have much competition from the standard education sessions. However MGMA did offer 20 minute education sessions in  the Healthcare Innovations Pavilion, which was set up at the far end of the exhibit hall. They appeared to be pretty well attended.  I had intended to sit through a couple but by the time I found the Pavilion (did I mention it was at the far end of the hall?) I had already missed the sessions that most interested me.

I saw a good number of sponsors were displaying their “Power HIStalk” signs, including e-MDs, NextGen, Accusis, Culbert, and Gateway. If you see one of our signs (which are autographed by me, Mr. H, and Dr. Jayne), please join me in thanking the vendor for supporting HIStalk.

Speaking of sponsors, last year Mr. H bought me a monogramed lab coat to wear to our sponsors’ luncheon at HIMSS. I am now kind of wishing he had gotten me this sparkly silver coat instead. It also came in gold, which I think would look lovely on my BFF, Dr. Jayne.

Every HIT vendor was pitching its Meaningful Use certified status. Even the transcription companies were touting how their offerings could help practices achieve Meaningful Use.

In terms of technology, the best new offering I checked out came from Patient Point. The company has a care coordination platform that integrates clinical data from health plans, pharmacy benefit managers, and PM and EMR systems. The data can be used to create customized care plans, coordinate care, identify gaps in care, and monitor quality measures. The company also offers a point of service kiosk and online portal. It may not be the stuff the average practice is quite ready for, but as more organizations move towards PCMHs and ACOs, I can see increased demand for many of the tools they are introducing. Good stuff.

The opening reception was well-attended, which is not unexpected when the drinks are free and the food is good. The food choices were diverse, from sushi to pasta to chocolate-covered strawberries.

My picks for Tuesday: Farzad Mostashari leads a session on Meaningful Use and at least one of the many sessions on transitioning to 5010 and ICD-10. I have multiple party choices for this evening (thanks for the many invites) so I’ll be pacing myself (that’s my plan anyway.)

And finally, lest anyone forget, Vegas is always a excellent place to observe great fashion. As you can see, a girl can never go wrong wearing garter stockings with short shorts.

E-mail Inga.

News 10/20/11

Emdeon expands the capabilities of its Emdeon Office Suite to include a Meaningful Use portal, statement automation, electronic patient payments, and analytics reporting.

Phreesia adds SOAPware to its list of Certified Integration Partners following the successful integration between Phreesia’s patient check-in system and SOAPware’s EHR.

Office Ally, a provider of RCM, PM, and EHR software and services, announces the relocation of its headquarters from Vancouver, WA to San Antonio. Office Ally CEO Brian O’Neill says the move better accommodates growth and provides a “much more friendly business climate.” The company expects to hire 250 employees within six months of its November move.

Clinical documentation software and service provider InHealthCDS partners with MD-IT to offer the MD-IT EMR.

Bizmatics introduces an in-house billing service to complement its PrognoCIS EMR.

The American College of Physicians issues a policy paper that address the re-use of health data for research purposes. It includes a proposed privacy rule that maximizes appropriate uses of information to achieve scientific advances without compromising ethical obligations to protect individual welfare and privacy.

OptumInsight publishes an online guide, “Keep Patient Data Secure: Simple Actions for a Digital World.” The information is targeted to physicians and includes recommendations for  communicating with patients and fellow physicians, an explanation of de-identified data, and considerations for participating in a health information exchange.

EMR provider SynaMed partners with transcription company StenTel to offer a combined EMR/transcription platform. The offering will include StenTel’s integrated natural language processing technology to code dictation into discrete data fields for import into the SynaMed EMR.

CapitalCare Medical Group (NY) chooses ImplementHIT’s OptimizeHIT training platform to prepare its 110 providers for an Allscripts EHR upgrade.

HIT software and service provider iMedX Inc. acquires the assets of National Medical Transcription. iMedX sells the TurboRecord EMR and TurboRx e-prescribing products.

Radiology Medical Group (CA) outsources its medical billing operation to Zotec Partners, resulting in a 24-employee layoff. The 14-radiologist group blames the move on rising costs and declining reimbursements.

Lytec names MediPro its 2011 Value Added Reseller of the Year.

Forest Hill Family Health Associates (NJ) expands its partnership with PatientPort to include care coordination services.

Medflow partners with the American Academy of Ophthalmology to deliver the Academy’s patient education tools through Medflow’s EHR.

Physicians across all organizational settings should expect average salary increases of 2.5% in 2012, compared to 2011’s 2.7% increase. Group-based physician specialists should expect the highest salary increases at  4.5%.

E-mail Inga.

Joel Diamond 10/19/11

All That’s Good About Healthcare

There’s a new book by Candice Millard about the life and assassination—or better yet, death by medical malpractice– of President James A. Garfield. It turns out that his doctors’ refusal to wash their hands before probing his wounds after his shooting contributed more to his death than the bullet delivered by Charles Guiteau, which missed the president’s spinal cord and vital organs.

This travesty occurred despite the tireless campaign of Joseph Lister, who demonstrated that simple hand washing could save lives by preventing infection. And here we are, 130 years later, looking at technology and financial incentives to convince physicians to perform this simple act.

Ahh, but I am much too cynical. It’s so easy to point out what is wrong with medicine today. Instead, I’d like to change my usual tone, and focus on what’s good (and oh, there is so much good.)

• Laparoscopic surgery
• Immunotherapy’s profound effects on the treatment of rheumatologic and inflammatory bowel diseases
• Breast implants
• Robotic-assisted surgery
• Routine options for organ transplant
• Breast implants
• Advanced imaging technologies
• Cameras that when swallowed take Ansel Adams- like portraits of your bowels
• Breast implants
• Insulin pumps and patient-controlled analgesia
• And have you seen those TV commercials with former coach Jimmy Johnson for Extenze?

For those of you who insist on maintaining a cynical outlook, it is true that medical science now allows Bubba to eat pork rinds and pizza while never moving from his couch except to procreate– treating his acid reflux with OTC Prilosec, popping daily Cialis to help with the inbreeding, chasing it with Prozac because he’s bummed at “The Jersey Shore” hair-product line that messed with his Rogaine-induced mullet, while ultimately getting insurance to pay for his gastric bypass so he can fit through the door of his double-wide trailer.

But the reality is that Prilosec and other acid-blocking medicines have virtually eliminated the surgical treatment for peptic ulcer disease. Viagra and similar medicines have allowed Senator Bob Dole to keep Elizabeth happy. SSRI medicines have allowed millions of American to lead productive lives while decreasing the horrible stigma associated with mental health treatment. Laparoscopic bariatric surgery has finally reversed heretofore incurable obesity and its costly and devastating sequelae of diabetes, sleep apnea, and coronary disease.

Extending the analogy, medical technology has fueled its fair share of cynics. Like the television Dr. Oz, stethoscopes and scrubs seem to be more a fashion statement, as young physicians favor ordering echocardiograms than listening to heart murmurs, and it’s infrequent that they actually come into contact with blood and guts. Non-peer-reviewed Google searches have supplanted careful review of Harrison’s Textbook of Medicine, and template driven EMRs often get mistaken for a careful review of symptoms.

But ready access to imaging and information technology has markedly improved the way that new physicians approach diagnostic dilemmas, and a standardized approach to history and physical acquisition (along with improved decision support) will continue to drastically alter patient outcomes

Finally, let’s get back to hand washing initiatives (finally) taking placed in hospitals across the country. Along with other seemingly simple interventions such as marking the correct site before surgery, these measures represent an organized attempt to bring quality on a massive scale to an industry previously ignorant of evidence-based best practices.

Oh yeah, did I mention the new hair-removing laser that I got on eBay? I can finally say goodbye to those uncomfortable Brazilian waxes.

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.