Joel Diamond 7/19/11

Technology Reflections of the Past Decade

Ahhh, the dog days of summer. Hot afternoons followed by soothing evening breezes, with care-free children chasing fireflies.

The recent summer solstice sadly reminds me that 2011 is halfway gone, and I reflect on the past decade. So much has changed. The fear of Y2K was quickly overshadowed by 9/11. Technology seems to be no longer an accessory, but an intrinsic part of our day-to-day (rather, second-to-second) frenzied lives, deeply woven into our culture.

So with the first half of the first year of the second decade of the second millennium nearly over, let us look back on the incredible changes that have taken place in the past ten years—as well as the amazing transformation of physicians’ attitude towards information technology.

• Over the past decade, heart disease deaths have decreased dramatically by 40%. The routine use of cardiac stents and statin drugs have much to do with this.
• 10 years ago, cardiologist actually wrote illegible progress notes on paper. A decade later, the quality of ink in pens has markedly improved, making these records appear more vibrant and “easier to read.”

• The rise in information technology has shown a fascinating trend over the past 10 years. Some estimate that the use of CPOE has approached the remarkable 10% level.
• A decade ago, most physicians obtained pornography by looking in magazines or renting VCRs. This has vastly disappeared today, as doctor compliance with Internet pornography approaches 98%.

• Speaking of VCRs, the last 10 years has resulted in their eradication, much like dracunculiasis (also known as the Guinea worm.) Even the DVD has largely been replaced by newer technologies. The soon-starting medical student class of 2016 is completely unfamiliar with the phrase, “Programming my VCR is so difficult that only a brain surgeon could do it,”
• Despite loss of financial incentives and eventual penalties looming in 2016, the majority of neurosurgeons do not have current plans to adopt EMR technology. However, most report greater job satisfaction in 2011 despite long work hours since they seldom miss their favorite shows now that they can “TiVo them.”

• In 2011, a fascinated audience watched a computer named Watson successfully compete on the game show Jeopardy, reflecting a new era of Natural Language Processing and the prospect of vital data mining from spoken and written word. In parallel, health care analytics attained new heights as more discrete EMR data became available.
• While other industries have moved from a quaint vision of subservient secretaries “taking dictation,” doctors in 2011 have maintained this charming tradition with an unrelenting grip on their olde worlde “Dictaphone.” Some icons are worth holding onto in this gadget-crazed world of ours.

• In the year 2000, the Human Genome Project finalized the mapping of our entire DNA, leading to exciting advances in targeted gene therapy and personalized medicine.
• Today, 90% of doctors use Google Maps. Advances in Global Positioning Satellite technology have allowed many of these practitioners to use these digital maps to guide them through the complicated route from home to hospital. Interestingly, less than 1% of these clinicians report the similar use of handheld devices to routinely access vital patient data. By contrast, gene technology is beginning to see clinical benefits in 2011, although the wearing of jean shorts (or as couture designers refer to them, “jorts”) has been largely confined to clinicians in rural Kentucky.

As summer fades and days get shorter, don’t forget to raise a frosty mug to the next decade. Let’s hope that our industry, which is ranked lower in productivity than the US Post Office, will change its perspective and just try a little harder to keep pace with the rest of the world.

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.

News 7/19/11

Greenway Medical Technologies will raise up to $100 million in a planned IPO. The company’s financial performance has been improving: a $926,000 loss on $38.8 million in revenue in fiscal 2008; $955,000 net income on $48.7 million in revenue in 2009; and $2.9 million net income on $64.6 million in revenue in 2010.

Speaking of Greenway, despite sporting a Greenway logo on his shirt, PGA golfer Jason Dufner failed to make the cut  following the second round of the British Open.

A reader forwarded me a copy of the results of AAFP’s 2011 EHR User Satisfaction survey, which includes the opinions of 2,719 family physicians. AAFP is careful to point out the limitations of the survey (it did not consider software release levels, participants were self-selected, sample sizes were small for some products) and notes that its goal was not to identify “winners.” Still, there are a few interesting nuggets to consider:

• The highest overall levels of satisfaction came from users of MEDENT, Amazing Charts, e-MDs, Praxis, and EpicCare Ambulatory.
• The lowest satisfaction ratings came from users of MediNotes (formerly Charting Plus), Misys EMR, Horizon Ambulatory Care, and Medinformatix.
• Praxis, Practice Fusion, and Amazing Charts had the highest scores for training and support; MediNotes, MPM, and Misys EMR had the lowest.
• EHR vendor support was the area in which users were least satisfied.
• About 14% of the respondents had switched EHR systems at least once because of system dissatisfaction.

Holy Name Medical Center (NJ) will offer Aprima EHR, PM, and RCM software to its 800 hospital-affiliated physicians.

The British Medical Association recommends that healthcare professionals and medical students “politely refuse” Facebook friend requests from patients. The AMA, by the way does not explicitly recommend refusing social networking requests from patients, but advises physicians to maintain boundaries “appropriate” for the patient-physician relationship.

Phil Suiter, the new president and CEO of EMR vendor digiChart, says he was hired to perform a “strategic repositioning” of the company. The Nashville Medical News profiles Suiter, who has founded or led multiple healthcare businesses over the years. He notes that digiChart’s revenue has been stuck at the $10 million level for some time. The company is now rolling out PracticeSmart, a combined EHR/PM solution, and will continue its focus on the OB/GYN market. With the industry consolidation trend, Suiter is no doubt positioning the company for potential acquisition:

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News 7/14/11

Sermo releases a mobile version of its online networking site. Sermo Mobile includes a feature called iConsult, which allows a physician to take a photograph of a physical finding, add a question, and send it to relevant specialists in the Sermo network.  The demo looks pretty slick. I must say I would have loved to have that capability when I was self-diagnosing my bed bug bites last month.

On this day in history: CMS issued Stage 1 Meaningful Use rules one year ago. Since that time, CMS has paid $94 million in Medicare EHR incentives and 14 states have paid $166 in Medicaid EHR incentives.

Greenway Medical Technologies lends its support to PGA Tour professional Jason Dufner, who will display the Greenway logo on his shirt in upcoming tournaments. I guess when your CEO’s name is Tee Green, it’s hard not to support golf.

The Bulletin Healthcare folks tell me that the iPhone and iPad continue to dominate the physician market. Bulletin’s research shows that 76% of physicians with smart devices utilize iPhones, 17% use iPads, and 6% have Androids. Bulletin also notes that the use of mobile devices to read Bulletin’s daily eNewsBriefings (which includes 400,000 physician subscribers) has jumped 65% over the last year.

The Physicians Foundation awards the University of North Carolina at Chapel Hill a $750,000 grant to  to develop a projection model to track physician shortages across the country.

NaviNet introduces NaviNet Doc Exchange, a solution to enable electronic document exchange among healthcare providers, insurers, and other recipients. Don’t doctors’ offices already have fax machines to handle that?

digiChart promotes Stephen Faris from VP of technology to chief technology officer. The company also named Melissa Harris VP of client services and Fred Aiken VP of account management. Harris joins the company from Healthways and Stinger Medical; Aikens most recently worked at Informa.

Lourdes Imaging Associates (NJ) contracts with Healthcare Administrative Partners for its medical billing services.

Practice Fusion is hosting its free Practice Fusion Connect 2011 meeting November 11th in San Francisco. The company also announces that over 100,000 medical professionals are using its services, up from 55,000 at the start of the year.

ClearPractice launches Eden, a cloud-based PM/EMR solution for Mac, iPhone, and iPad devices.

Physician RCM provider Avisena names Joseph P. Radigan its CEO.  Radigan is a former Hygenia COO and an EVP with Beach Street Corporation. Avisena recently closed on $2.5 million of additional debt facility to support growth and expansion.

Red Herring names PM software provider CareCloud one of North America’s top 100 tech start-ups.

Physician incomes in 2010 were flat compared to previous years, according to physician recruiting company The Medicus Firm. Average compensation fell 0.14%, though emergency medicine doctors saw a 5.5% increase and psychiatrists earned 11.5% more. Declining re-imbursements were cited as one of the major factors affecting income.

Allscripts adds four senior execs to its leadership team including Cliff Meltzer as EVP of solutions development, Steve Shute as EVP of sales, Jackie Studer as SVP and general counsel, and John Guevara as CIO. Meltzer is an Apple, Cisco, IBM, and CA Technologies veteran and replaces the now retired John Gomez. Long-time IBM-er Shute replaces Jeff Surges, the current CEO of Merge Healthcare. Studer (GE Healthcare) takes over for Kent Alexander, and Guevara (Microsoft, Intermec, Siemens) is Allscripts’ first CIO.  Allscripts also announced the department of COO Eileen McPartland, who is leaving to become CEO of a private company outside of the healthcare industry. Finally, Allscripts provided preliminary Q2 financial numbers, which included expected bookings of about $240 million and profits and revenue above analysts’ expectations.

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DOCtalk by Dr. Gregg 7/12/11

Still Stupid Simple

In my continuing quest for a new EHR, I’ve been seeing lots of demos, reading lots of brochures, and gawking at all kinds of PR stuff. Recently, some of it caused me to reflect upon my old friend, Stupid Simple.

I’ve developed such an adoring admiration for Stupid Simple that I have actually adopted his name for my personal mantra. Usually this works quite well as I sit in Padmasana (full Lotus pose) chanting, “Stupid Simple, Stupid Simple, Stupid Simple…” I typically find mindlessness with relative ease and have actually levitated on an occasion or two when invoking his powerful mantric name.

Today, though, evil forces must have been wafting through the ether of my meditation zone. Far from nearing Nirvana, I found my consciousness most vilely preoccupied with thoughts about health IT Marketing and Sales… ack! Talk about a meditative letdown.

I tried Siddhasana and even Swastikasana poses, but I could not evade these disruptive mental intrusions. Thus, I silenced my Stupid Simple-ness and listened to an internal dialogue rage within my head. What I heard was Stupid Simple taking on the unnamed evil forces of crappy HIT Sales and Marketing. (I’ll call them “S&M” for now.) It went something like this:

S&M: “Customers can’t recognize the reworked diatribe we use and/or steal from all the others like us. We all use the same regurgitated crap just wrapped up with different branding. HIT customers are too stupid to know.”

STUPID SIMPLE: “HIT customers are not stupid. Just because you try to fluff your way to a sale, doesn’t mean customers won’t eventually realize that your vaporous claims and “best of breed” assertions won’t eventually be seen for what they are…or I should say, for what little they really are.”

S&M: “Oh, yeah? Well then how come we keep making sales? How come people keep coming to look at our products?”

STUPID SIMPLE: “If you only give your dog slop to eat, he’ll eat it. But, you’ll lose him if someone starts handing out prime rib.”

S&M: “But, they are sooo dumb. They keep asking the same dumb questions like, ‘What does SaaS mean? What does ASP mean? What’s the difference between SaaS, ASP, and a cloud offering?’ They are sooo slow!”

STUPID SIMPLE: “Just because you throw a bunch of acronyms around doesn’t make you smart. Heck, most of the time, when someone well-versed in a particular vernacular or jargon uses such acronyms or industry-specific terms when talking with people less well-versed, it’s to make themselves feel as if they’re smarter or to make the others feel inferior.”

S&M: “Oh, yeah? Well, AAMOF, IMNSHO, you’re just a collocated de-acronized quip. You’re FOS, a WOBTAM, and a PONA.”

STUPID SIMPLE: “Yes, and your fecal encephalopathy is showing your SBI.”

S&M: “Huh?”

STUPID SIMPLE: “See? While it may help to facilitate internal communications, jargon and industry-specific acronyms don’t help endear customers. Nor does ‘biz speak.’ Corporate communications are fine if it makes you feel professional, but we are all still people. If you’re trying to reach out to others who may not be so familiar with your world, translate. Use real language, common terms – ‘people-speak’.”

S&M: “So, you’re saying I need to dumb myself down to the level of the ignorant masses?”

STUPID SIMPLE: “Not at all. I’m saying that to meet the needs of your customers, help them ease their pain points, stop talking down to them, and start talking with them. Help them understand how you can help them by helping them feel less helpless. (Notice the accent on the word “help”?) Oh, and can the huff and fluff stuff. Get real.”

S&M: “What?! Are you nuts? This whole industry is built upon useless white papers and collateral crap. We’d collapse if it weren’t for overpromising and underdelivering.”

STUPID SIMPLE: “Nuh uh. I mean, nuh uh, it won’t collapse. You are correct that HIT has a long and almost legendary history of providing vastly less than it promises. S&M teams have built entire companies that have very little worthwhile product behind them. But, this house of cards is just waiting for the wrong breeze to blow. Lord knows, if HITECH hadn’t come along…”

S&M: “Yes, indeedy! HITECH was a major boon for us blow-hards! Plus, it’s helped drive a stake into the hearts of the real innovators! Long live ARRA!!”

STUPID SIMPLE: “But, ARRA funds won’t last. People will eventually start to find that underdelivered products don’t work. How many times do you think you can get away with saying ‘We’ll help you deliver better care and make more money’ before people see that you aren’t capable of either? How long before those who are truly innovating create the ‘real deal’ and show just how vaporous you’ve been for so long?”

S&M: “Don’t know. Don’t care. I’m getting’ mine now and I could care less about the end users long-term woes. Don’t care if it doesn’t deliver. Don’t care if it makes their lives harder. As long as my razzle dazzle befuddles them long enough to get the sale, I’m ka-chinging my way to the bank.”

STUPID SIMPLE: “Such a waste. I’m outta here. I’m gonna go find a real EHR with honest marketing and sales folks who want to talk to me like a real person. I need a company that understands the value of me, Stupid Simple. AMYOYO, pal.”

S&M: “Yeah? Well…you are “stupid simple” aren’t you?”

STUPID SIMPLE: (Proudly) “Yes. Yes, I am.”

As the two foes drifted out opposite ears, I felt proud of my buddy, Stupid Simple. I know the challenge of finding those who understand him. But, I believe that he’s right and that there are folks out there who really do get the value of our version of the KISS Principle: Keep It Stupid Simple. Many S&M-ers, just like many HIT developers, however, just don’t get it. It’s wonderful when you find those who do.

From the trenches…

Postscript: I just found hard evidence of the suspected intrusion of those aforementioned evil forces: someone – or more likely something – scribbled “Extormity Rocks” in the sand of my desktop Zen garden!

“I want that they should bury me upside down, so my critics can kiss my ass.” – Bobby Knight

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 7/12/11

From Micki Tripathi “Re: Massachusetts E-Health Project. Thought you might find this interesting.” Micki is the president and CEO of the MA e-Health Collaborative (MAeHC) and a noted HIStalk Practice contributor. He forwarded a link to an AHRQ-funded study on the physician use of clinical registries before and after the implementation of EHR. The study found that physicians who participated in MAeHC’s EHR implementation initiative increased their ability to generate registries for lab results and medication use. The authors conclude that Massachusetts’ 4-year, $50 million HIT program may be a viable model to improve the quality of care.

MGMA names Susan Turney, MD its president and CEO, succeeding the retiring William F. Jessee, MD. Turney, who is an internist, has served as CEO of the Wisconsin Medical Society since 2004 and founded and chaired the Wisconsin Statewide HIE.  I’m planning to attend MGMA’s annual conference (late October in Las Vegas) and I look forward to hearing more about Turney. I must admit I’ll miss Dr. Jessee, who I have always found to be very insightful and articulate.

In case you are feeling Meaningful Use-challenged, CMS is offering a teleconference for providers July 14th to walk through the basics of the program. The call will cover eligibility, calculating incentives, attesting, and Q&A.

Greenway Medical reports that of the 40 RECs with established operations, more than 80% include Greenway’s PrimeSUITE EHR as a solution of choice.

Allscripts business partner CHMB pays $2 million cash for the assets of Davis & Associates, a provider of medical billing and technology to physician practices.

Telepsychiatry is not catching on as fast as other telemedicine offerings and money may be the reason. Insurance companies, including Medicare and Medicaid, typically pay less for Web-based mental health counseling than in-person therapy, meaning patients must pay more out-of-pocket. And, some carriers do not offer any reimburse for telepsychiatry services. Craziness.

Physicians in private practice are twice as likely to practice defensive medicine than their federally-employed peers. Unlike physicians in private practice, the Federal Tort Claims Act protects government-contracted physicians against personal financial liability. Makes you wonder how much healthcare spending could be trimmed if private physicians were better protected against lawsuits and didn’t feel compelled to order all those CYA-type services.

Health IT Services Group announces that over 1,000 nephrologists now use its Acumen nEHR.

Practices with less than 20 physicians on average use about 20% of the care processes that are considered required for medical homes, including care coordination, electronic disease registries, e-prescribing, and online communication with patients. In general, the smaller the practice, the less likely it is to have implemented HIT processes. I noticed, however, that the data for this Health Affairs-published study was compiled between July 2007 and March 2009. Perhaps it’s overly optimistic to assume that today a much larger percentage of small and medium-sized practices are embracing HIT processes.

Fun facts you can share with folks around the water cooler and look really smart (or nerdy):

• The Medicare EHR incentive program has paid over $94 million in incentives through June 30th
• Over $166 million in Medicaid EHR incentives have been paid through June 30th
• There are over 68,000 active registrations of EPs and hospitals for the Medicare and Medicaid EHR programs.

E-mail Inga.