News 9/1/11

CMS issues its final rule on changes to the e-prescribing incentive program and includes multiple hardship exemption categories for EPs. EPs have until November 1, 2011 to request a hardship exemption for the 2012 eRX payment adjustment. Categories that EPs may claim include:

• The practice is located in a rural area without high speed Internet access
• The practice is in an area without sufficient available pharmacies for e-prescribing
• The practice is registered to participate in the Medicare or Medicaid EHR incentive program
• Local, state, or Federal law prohibits e-prescribing
• The EP does limited prescribing
• The EP has insufficient opportunities to report the eRX measure due to limitations of the measure’s denominator.

PriMed (CT) expands its relationship with MED3OOO with the selection of InteGreat EHR for its 28 locations and 75 providers.

Crystal Run Healthcare (NY) contracts with DrScore.com to provide patient satisfaction survey services for its 200 providers. When I was on Crystal Run’s Web site, I noticed they have temporarily closed their Goshen office as a result of Hurricane Irene-related damage.

athenahealth launches athenaCoordinator to facilitate care delivery among hospitals, practices, and other caregivers. It’s based on technology from Proxsys, a Birmingham, AL-based company that athenahealth recently acquired.

HealthFusion introduces MediDraw, a Web-based tool that allows physicians to draw directly on a patient’s photo or an anatomical outline image of a body part.  Providers can upload images via a smartphone or PC camera and store the image in MediTouch’s EHR. I found the above foot on HealthFusion’s Web site. I don’t know much about foot anomalies, so I just annotated the toes a pretty shade of red.

The HIMSS EHR Association urges CMS Administrator Donald Berwick, MD to reconsider the proposal to require the submission of patient-level data as it pilots the electronic submission of clinical quality measures (CQMs.) The Association claims the proposed rule for the 2012 Medicare Fee Schedule would put too much of a burden on provider organizations and recommends that CMS rely on the reporting of aggregate data instead.

The Orthopaedic Institute of Central Jersey and Orthpaedic Spine Institute select SRS EHR for their combined 19 providers.

Greenway Medical releases its remote clinical and financial product, PrimeMobile, as a native application for Apple’s iPad.

A number of ambulatory EHR vendors are hosting user group conferences over the next couple of months. A few were kind enough to flatter me with an invite – thank you. Though I’d love to skip out on the day job and attend each of them, one user meeting plus MGMA in Las Vegas will have to satisfy my fall travel bug.  Here’s a quick run-down of some of the upcoming conferences:

• Greenway: September 8-11, Orlando
• MED3OOO: September 21-23, Palm Springs
• SRS: September 21-23, Woodcliff Lake, NJ
• eClinicalWorks: October 1-4, Phoenix
• Ingenix CareTracker: October 5-7, Boston
• Practice Fusion: November 11, San Francisco
• Nextgen: November 14-16, Las Vegas

E-mail Inga.

News 8/30/11

athenahealth launches a patient-centered medical home (PCMH) accelerator program , which includes the loading of  pre-existing data into a practice’s EHR in order to speed the PCMH certification process.  athenahealth created this video highlighting how one of its clients achieved PCMH status.

The Allscripts Client Experience (ACE) kicked off Monday in Nashville with over 4,700 attendees. I watched a bit of the opening session, which was streamed live over the Web. ONC Coordinator Farzad Mostashari, MD participated remotely as a keynote speaker.

CDW Healthcare and HIMSS introduce plans for a series of eight educational sessions to provide support for physicians interested in qualifying for Meaningful Use incentives. The next session is August 31 in Seattle.

Sage announces that a dozen healthcare facilities have recently chosen to implement its EHR and PM software.

The 57-physician Capital Digestive Care (DC) selects gGastro by gMed as its EHR solution.

Retail medical clinics have grown from 175 in 2006 to 1,250 now. CVS dominates the market with 600, including 45 Minute Clinics opened this year. Eastern Maine Medical Center  bucks the trend with the announced closing of five Clinic at Walmart sites.

Marshfield Clinic (WI) attributes its success in CMS’s Physician Group Practice Demonstration to its well-developed EHR (Cattails, which is homegrown and now sold commercially.) Marshfield was one of only two large physician groups out of 10 participants to qualify for shared savings during each of the five performance years.

Medicomp announces the initial distribution of ICD-10 mappings and functionality in the new version of its MEDCIN Engine. It includes a new user interface to make it easier to use ICD-10 within EMRs, providing clinically contextual, problem-oriented views of incoming data using standard reference terminology.

Kareo introduces a Patient Billing and Portal service that will allow practices to e-mail statements to patients.

Speaking a Kareo, Mr. H and I would like to thank them for their decision to upgrade their  HIStalk Practice sponsorship from Gold to Platinum. Kareo offers Web-based practice management and medical billing software and does not charge setup fees for it services, requires no long-term contracts, and is available with an integration to Practice Fusion EHR. Note that if you are in the market for a medical billing option, Kareo is offering a 25% discount for HIStalk Practice readers through the end of October. For more details on the promo or company, click on their ad to the left. We appreciate Kareo’s support of HIStalk Practice!

eClinicalWorks customer New York City Department of Health & Mental Hygiene wins a 2011 HIMSS Public Health Davies Award of Excellence for its Primary Care Information Project, which includes 541 independent practices, 38 community health centers, and three hospitals.

Reston Radiology Consultants (VA), Washington Radiology Associates (VA), Shady Grove Radiological Consultants (MD), and Advanced Diagnostic Radiology (MD) add Merge Healthcare’s RIS.

Holston Medical Group (TN) selects Phreesia’s check-in solution to integrate with its Allscripts EHR.

Is it me or have there been very few reports of damage to physician offices and hospitals as a result of Hurricane Irene? Obviously even if medical facilities suffered little damage, plenty of homes and businesses weren’t as lucky. With officials suggesting that some areas may not have power restored for several days, the story of Irene is not quite finished.

E-mail Inga.

News 8/25/11

Children’s Clinics for Rehabilitative Services (AZ) deploys DigitalPersona Pro and U.are.U Fingerprint Readers for fingerprint biometrics and secure access to the practice’s NextGen EHR.

Millennium Healthcare Inc. signs a letter of intent to acquire billing and consulting firm Premier Technology Resources.

e-MDs launches e-MDs Rounds for the iPhone, giving doctors access to their EHR data via their mobile device.

Speaking of e-MDs, Acacia Research Corporation announces that e-MDs has signed a license agreement with Acacia subsidiary Document Generation Corporation and thus resolved pending litigation. Specific terms were not disclosed, though the litigation involved certain e-MD products and patents for Document Generation software.  Mr. H once called Acacia a “patent troll,” so I have to wonder if this lawsuit was really much ado about nothing.

Office Ally will integrate with Ideal Life’s monitoring systems.

Delaware Health Hub, a subsidiary of the Medical Society of Delaware, adds Aprima Medical Software as an approved vendor.

Almost half of all physicians worked with nurse practitioners, physician assistants, or certified nurse midwives in 2009, most commonly in practices that are larger, younger, and Medicaid-accepting.

The AMA issues a favorable response to CMS’s introduction of the Bundled Payments for Care Improvement initiative. AMA applauds the proposed flexibility and urges CMS to be prepared to provide technical assistance to interested physicians who do not have experience with bundled payment models.

Healthcare Blue Book introduces a free iPhone app that gives consumers the ability to check the price of common healthcare services. An enhanced app for employers allows employees to search for in-network providers offering the best value.

Jason Colquitt, Greenway Medical’s director of research services, is elected to a two-year term on the HIMSS EHR Association’s executive committee.

E-mail Inga.

News 8/23/11

Providers with Seton Healthcare Family (TX) receive $18K each from CMS for their Meaningful Use of eClinicalWorks EHR.

Urology EHR vendor meridianEMR files a lawsuit against competitor Intuitive Medical Software (UroChart), claiming UroChart cloned one of its servers and thereby gained illegal access to meridianEMR’s product and the protected health information stored by its clients. A federal judge denied meridianEMR’s request for a restraining order against UroChart, saying that it was not needed because a third party has control of the test server involved.  Update: meridianEMR sent us an e-mail saying that its request for a restraining order was not denied, but rather that the judge lifted the part of it involving the server that meridianEMR claims was used to copy its software. The court order requires IMS to turn the server over to a neutral third party.

While looking for more information on meridianEMR, I noticed the above chart on the company’s website. I must admit that if I were investing in an EMR, I’d be asking the vendor to provide this type information.  I like the transparency, even though 36 attestations (less than 4% of the company’s 1,000+ physician users)isn’t a terribly impressive figure.

Midwest Physicians Services (MN) selects Zotec Partners to provide billing services for its radiology clients.

About three-quarters of all US doctors will be sued for malpractice at some point in their career, though only about 22% of claims lead to payment. Surgeons, particularly neurosurgeons and obstetricians, have the highest risk of being sued. The average claim payment was about $275,000 in the 15-year, 41,000-physician study.

RCM provider PracticeMax acquires American Billing Services, which offers billing and PM services to physicians and hospitals.

Joint Commission designates AltaMed Health Services (CA) as the first organization to earn Primary Care Medical Home (PCMH) designation under its Ambulatory Care Accreditation Program.

GE Healthcare names Clerity Healthcare its exclusive systems integration solutions provider for GE Centricity Practice Solution and EMR.

Electronic Health Records of Rhode Island (EHRRI), a provider-led implementation services organization, donates its activities and operations to the Massachusetts eHealth Collaborative (MAeHC). Members of the former EHRRI team will provide a Rhode Island presence, provide EHR implementation and support, advisory services, and quality data warehousing and analysis via MAeHC’s proprietary Quality Data Center.

Hospitals are employing more physicians to grow market share and revenue, but the trend may lead to higher healthcare costs and does not guarantee clinical integration. That’s the conclusion of the Center for Studying Health System Change, which found that employed physicians face pressure from hospitals to order more expensive test alternatives  and that hospitals usually negotiate health plan contracts for their physicians at higher rates than physicians could negotiate independently.

E-mail Inga.

DOCtalk by Dr. Gregg 8/19/11

Academies, Vendors, and Medical Wagon Wheels

In this month’s AAP News, the American Academy of Pediatrics’ Department of Practice announced the results of the very successful (and first) HIT vendor consortium held by the AAP’s Child Health Informatics Center (CHIC) in June. The meet was designed to explore ways to partner with electronic health record vendors to disseminate the AAP’s extensive pediatric knowledge base and expertise. As far as I am aware, this is a first for the AAP, and is not terribly common amongst medical academies in general.

Maybe it’s a bit different for pediatrics, as we do have lots of rather unique needs: multiple family members with multiple surnames and multiple caregivers all with blended or unblended family, social, and health histories; immunizations and tracking thereof; patient consent and privacy issues that are extra complex with child versus parental rights with which to contend; and more.

But I would wager that most areas of healthcare provision have some unique needs, too. Plus I know for certain that they all have volume upon volume of unique expertise that could benefit all if only it could be easily accessed.

It makes great sense –  to me, anyway – that medical academies of all sorts should reach out to vendors to help share their wealth of specialty-specific health expertise and work with the vendors to guide their contingent’s special EHR needs. We certainly don’t need hundreds of EHR vendors trying to recreate every healthcare “wheel” if there are best practice ways to do so.

Defining those best practices may be challenging, and converting reams of medical reference materials to a distributable digital format will be a lengthy and costly process, but doing so together will likely get us to the most functional wheels for our joint healthcare “wagon” faster and more economically.

A longstanding roadblock to this collaboration is the resistance of medical academies to show any sort of preference or participation with capitalistically-driven vendors. I’ve seen this firsthand as the director for the AAP’s “Pediatric Office of the Future” (POF) exhibit for their annual National Conference & Exhibition. The AAP has some pretty strict rules and regs for associating the AAP name with outside sources such as technology vendors. Understandably, they don’t want to appear to endorse any particular corporate brand name tool/service or seem to have any untoward influences from same.

This can be tricky when engaging sponsors for the POF, which is strictly an educational exhibit and not a sales booth. We want and need their support, but we cannot appear to be showing any endorsement. But by watching where we step, we have followed all the rules and still grown some 500% in five years. The learning opportunities for our attendees – both via hands-on demonstrations and our nearly 30 short topic talks in our new “Education Theater” – are almost exponentially larger.

I have become convinced that working with technology vendors to advance technological literacy among healthcare professionals can be done without conflicts of interest or implied endorsements.

And now, the AAP via CHIC has successfully reached out to the first round of 11 EHR vendors to start the conversation around ways that pediatric-specific knowledge and standards of care might be digitally distributed to promote child health. From the Bright Futures child health guidelines to the patient-centered medical home (a concept originated by the AAP in 1967) to forms standardization to the unique needs of pediatric EHRs, CHIC and the vendors in attendance all agreed that “the Academy’s first step in working to develop partnerships with the EHR vendor community to advance child health informatics” was both welcomed and useful.

I was particularly impressed by the enthusiasm the vendors expressed when we first broached them with the idea. They loved the thought of receiving this type of expertise and knowledge sharing. And, this was just a first step. CHIC plans on a much broader reach out to EHR vendors.

I can’t really speak for other Academies, though from personal experience I know that the American Osteopathic Association and the American Academy of Family Physicians do have some history of working with EHR vendors or associated entities to further their unique needs. I believe there have been some other vendor/academy collaborations, but generally limited. Maybe some of you out there can offer some other examples where such academic orgs have found successful corporate cooperation without integrity compromise…?

I’m very happy to see this sort of progress, and hopefully we’ll see lots more of it. I look forward to the bigger, better digital medical expertise “wheel” which could roll us all into a joint electronic future more effectively.

From the trenches…

“Coming together is a beginning. Keeping together is progress. Working together is success.” – Henry Ford

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).