News 1/7/14

McKesson announces the general availability of its Paragon Ambulatory Care Practice Management solution, which is an extension of its single database HIS for inpatient facilities and designed for hospital-owned practices. I understand the PM module was developed internally, as opposed to a bolt-on of one of McKesson’s acquired products and that an EHR module is also in the works. Sounds like McKesson is positioning itself to compete with Epic and Cerner in the IDN space.

A 16-provider dermatology practice in Massachusetts agrees to a $150,000 payment and a corrective action plan after admitting to potential HIPAA violations. In October, 2011 an unencrypted thumb containing the PHI of 2,200 patients was stolen from an employee’s car. The provider promptly reported the breach to HHS and patients; HHS then informed the practice that the Office of Civil Rights would launch a compliance review. The OCR concluded that the practice had not conducted an accurate and thorough analysis of potential risk and vulnerabilities as part of its security management process; failed to have written policies and procedures for in compliance with the Breach Notification Rule; and, had not trained its employees on security processes.  The lesson for practices: encrypt those thumb drives, perform risk assessments, and be in compliance with policy and training requirements.

The majority of patients using a txt4health diabetes awareness app reported the tool made them more likely to make diet-related behavior changes and lose weight, though only 39 percent of the participants completed the 14 week program. Researchers concluded that the text messaging program has “potential to significantly influence people’s health habits,” but admits it “may not be appropriate for everyone.”

In a Kaiser Permanente study also involving diabetics, researchers found patients that refilled their medications using online portals increased their medication adherence and improved their cholesterol levels. Medication non-adherence and poorly controlled cholesterol declined six percent among exclusive users of the online refill function, compared to occasional users or non-users.

University Hospital (GA) reports that 16,000 patients from University and its affiliated practices are accessing their medical records through the health system’s Epic patient portal.

HIMSS Analytics awards 14 ambulatory clinics associated with Cincinnati Children’s Hospital (OH) with Stage 7 Ambulatory Awards for EMR adoption. Children’s also earned Stage 7 for its inpatient setting.

Brightree and athenahealth will coordinate the patient referral process for providers using athenaClinicals and athenaCoordinator services and post-acute providers using Brightree’s clinical and billing platform.

Good news for telehealth providers: as of January 1, a new Montana law requires state-regulated insurance companies to reimburse providers for telehealth services at the same rate as in-person visits.

Speaking of telehealth, the California-based Telecure is waiving its $25 telemedicine visit fee for patients who share details of the experience on Twitter or Facebook. The company’s CEO says Telecure is wanting to raise “awareness of alternative ways of receiving quality healthcare.” Am I the only person who is more leery of  taking advantage of medical care that is discounted to “free” versus?

Blue Cross and Blue Shield of Kansas City estimates that 55 percent of area physicians are now employed by hospitals, including virtually all cardiologists and most cancer specialists. Dr. Gregg, by the way, provides some insight on why many physicians are choosing to ignore the trend and remain independent.

Almost three-fourths of physicians using EHRs in 2011 reported clinical benefits, according to a Health Services Research report. The majority of physicians said the EHR alerted them of a potential medication error or critical lab value, while one-third claimed the EHR helped identify needed tests or communicate with patients.

The School of Business at the University of Miami and CareCloud launch CareCloud Scholars, a program to engage graduate students with South Florida’s healthcare community and promote healthcare innovation.

Email Inga.

News 12/26/13

Good news for physicians: CMS adopts final rules extending the Stark exception sunset date from December 31, 2013 to December 31, 2021. The amendment allows healthcare entities to continue subsidizing physician purchases of EHRs and addresses additional rule modifications, including:

• The exclusion of lab companies from donating EHR items and services
• The elimination of the e-prescribing capability requirement
• Updates to the interoperable provision
• Clarification of the requirement prohibiting any action that limits or restricts the use, compatibility, or interoperability of donated items or services.

Ownership of an e-prescribing system jumped from 30 percent in 2007 to more than 56 percent in 2010, according to data from the National Ambulatory Medical Care Survey. Of those practices with e-prescribing capabilities, 85 percent of the providers actually sent prescriptions electronically in 2010. Family medicine providers had the highest ownership rate at 68 percent; psychiatrists had the lowest rate with less than 32 percent.

The Mercy health system (MO) says that use of its e-visits service has quadrupled over the last few months. More than 400,000 Mercy patients have signed up for MyMercy, which also allows patients to schedule appointments, email providers, track medical histories, and pay bills.

Greenway Medical Technologies wins the 2013 Intel Innovation Award for its PrimeMOBILE app for Windows 8.

This week tends to be one of the slowest of the year for HIT news, even though most providers don’t get too much of a holiday break. If you are in the trenches providing care, thanks for your dedication.

Email Inga.

News 12/19/13

Over time the use of open notes will become the standard of care, predicts that the authors of a NEJM-published op-ed. The clinician-authors note that increasing patient engagement through transparent medical records contributes to improvements in health, care, and costs, and that patients who access their notes have better recall and understanding of their care plans and better medication adherence.

E-MDs Cloud Solutions v. Cirrus achieves ONC-ACB certification for MU Stage 1 and 2 and is compliant as a Complete EHR 2014.

Deloitte includes Kareo on its Technology Fast 500 list of fastest growing technology, media, telecommunications, life sciences, and clean technology companies in North America based on its 797 percent growth over the last five years. Kareo was ranked fifth in HIT and 156th overall.

Troubling: the healthcare industry is making slow progress on preparing for ICD-10, according to a WEDI readiness survey. About 20 percent of vendors claim they are halfway or less complete with product development, while about half of providers have yet not completed an impact assessment. Meanwhile, about one-third of health plans have not initiated internal testing; two-thirds have not started external testing.

Projected physician shortages can be substantially reduced by using new models of primary care, such as the PCMH and nurse-managed health center (NMHC) models, even without increases in the number of physicians, according to a RAND study. RAND projects that if the prevalence of PCMHs increases from 15 to 45 percent and NMHCs from .05 percent to 5 percent, physician shortages could be cut in half by 2025; researchers also believe that medical homes could handle 20 percent more patients through the use of technology and improved coordination.

Solo physician Stephen T. Imrie, MD handles a potential data breach in an arguably more efficient manner than many larger organizations with presumably more resources and available expertise. The San Jose-based physician sent an appropriately apologetic letter to 8,900 patients notifying them that a password-protected laptop was stolen from his home September 23. The computer included both clinical and financial details on patients, including patient social security numbers. Though no misuse of data has been reported, Imrie automatically signed up his patients for free credit monitoring.

CMS implements an informal review process for EPs and group practices who will be subject to the 2014 eRx payment adjustment. EPs/group practices have until February 28, 2014 to email eRxInformationReview@cmg.hhs.gov to request an informal review.

A big welcome to Optum, HIStalk Practice’s newest Platinum sponsor! Optum, which includes the OptumHealth, OptumInsight, and OptumRx divisions, offers a wide variety of products, tools, and services for various segments of the healthcare system. Their technology offerings for hospitals, physicians, and other stakeholders focus on the delivery of integrated, intelligent solutions for modernizing the healthcare system and improving health. Solutions for physician practices include Optum Claims Manager and Optum Intelligent EDI, which are designed to help practices submit clean claims the first time around and maximize reimbursements. Claims Manager can be directly integrated with third-party clearinghouses, billing systems, and PM systems, as well as with Intelligent EDI, Optum’s claims processing solution that successfully provides first-pass payment rates as high as 97.5 percent. Optum also sponsors HIStalk at the Platinum level and we thank them for supporting of our work.

Greenway Medical adds Digital Assent, a provider of patient satisfaction survey solutions, to its online Marketplace of value-added partners.

If you are a physician and looking for some moonlighting ideas to pay off those holiday bills, here are a few suggestions from Medscape. Options include telehealth consults (pays about $20 for a 10 minute consult); health insurance claims reviewer ($85-$200 an hour); and, cruise ship doctor ($150 a day plus free cruising for you and a guest.) Can’t imagine why anyone would choose to review insurance claims over a free cruise.

Email Inga.

News 12/17/13

The Louisiana Senior Care Coalition selects eClinicalWorks Care Coordination Medical Record as its population health management solution for advancing its ACO objectives.

Athenahealth will integrate Merge Healthcare’s iConnect Network into its athenaClinicals EHR to allow users to receive and view exam results and diagnostic-quality images.

US physicians apparently aren’t the only ones concerned with a decline in compensation. Salaried GPs in the UK made an average hourly rate of $61 this year, down from $75 in 2012. The average US doctor, by the way, earned $80 an hour in 2010, not including benefits.

Practice EMR vendor drchrono releases an API that will allow developers to extend and enhance its platform.

Wolters Kluwer Heath integrates its Health Language Provider Friendly Terminology with Epic EHR for mid-size to large practices, as well as for hospitals.

A mere seven percent of psychiatrists were awarded MU incentives last year, a lower percentage than in any other specialty. Industry analysts blame poor usability of EHR systems, the exclusion of mental health centers from program incentives, and a relative lack of EHR vendors specializing in psychiatry.

In an unrelated study published in JAMA Psychiatry, almost 45 percent of psychiatrics refuse private insurance or Medicare. Sounds like another pretty obvious reason why so few psychiatrists qualified for MU.

CMS issues a final rule that confirms physicians who assign their reimbursement and billing to a CAH under Method II are now eligible to participate in the MU program as EPs.

Physicians participating in a Western NY Beacon Community study used technology to help their patients better control their blood sugar levels and reduce the number of avoidable hospitalizations. Participating physicians implemented new technologies and upgraded their workflows. The Beacon Community also used EHRs to generate diabetes registries to track lab and test results and to generate preventative care reminders and guidance. Among the 57 participating practices, the percentage of diabetes patients with uncontrolled blood sugar levels improved by as much as 10 percent over a one-year period.

Congressmen Erik Paulsen (R-MN) and Jim Matheson (D-UT) propose legislation that would mandate the use of clinical decision support software by physicians receiving Medicare and Medicaid reimbursement when they order diagnostic imaging tests. The goal is to provide doctors with immediate feedback and recommendations for the appropriate tests to order. Sounds like a great idea that would likely create a few administrative nightmares.

Email Inga.

News 12/12/13

MGMA asks HHS to begin end-to-end ICD-10 testing with physician offices, saying that the scheduled front-end ICD-10 testing will be insufficient and “could result in operational problems similar to what HHS experienced with the roll-out of HealthCare.gov.”

The Orange County Register names Kareo a top workplace in Orange County in the mid-sized company category.

HealthTexas Provider Network, a multi-specialty group with over 590 employed physicians, pilots White Plume’s ePASS product suite to prepare its physicians for ICD-10.

The American College of Physicians supports the development of a national prescription drug monitoring program that would allow physicians and pharmacists to review a single database prior to prescribing controlled substances.

CMS publishes a tip sheet on conducting a practice security risk analysis, which is a requirement for meeting MU objectives in both Stage 1 and Stage 2.  I thought the myth versus fact section was particularly enlightening, including guidance on when an audit should be done and at what point any risk deficiencies should be corrected.

CMS says it will develop guidelines to ensure that  the practice of copying and pasting in EHRs is used appropriately, and intends to work with the ONC to develop “a comprehensive plan to detect and reduce fraud in EHRs.”  In terms of detection, I have to wonder how difficult it is to modify existing plagiarism detection technologies that academics have been using for years. I’m not a programmer, but why can’t this technology be modified to look for redundant phrases within clinical documentation?

Email Inga.