News 1/28/14

From Ross Thomas: “Re: HIT vendor series. I was surprised by the quality of the responses from one or two of the folks (all men, I noticed), but not at all surprised by a few.” It makes me sad that not one of the 12 vendors had a female executive participate. Was this just a fluke or are women in HIT still hitting the glass ceiling in middle management? As to Ross’s veiled comment on quality, I think it’s fair to say that too often vendors obfuscate their message by incorporating too much marketing-speak and not enough straight talk. That being said, I enjoyed reading all the contributions and found many to be very enlightening. Thanks to all the participants.

In a case considered a key test of the FTC’s efforts to block hospital acquisitions of doctor groups, a federal judge rules that St. Luke’s Health System (ID) must divest itself of the 40-doctor Saltzer Medical physician group. The judge found that the hospital’s ownership of 80 percent of the primary care doctors in Nampa, ID would give the health system an unfair bargaining position with insurance companies, even though the intent of the merger was to improve patient outcomes. The ruling marks the first time the federal courts have decided an FTC case against a physician practice deal.

Despite the considerable rise in EHR adoption in physician practices between 2009 and 2012, solo physicians lag behind larger groups in terms of implementing certain functions, such as electronic data exchange with other providers. Overall EHR use by primary care physicians rose from 46 percent in 2009 to 69 percent in 2012 according to a Commonwealth Fund study, but EHR adoption in solo practices remained below 50 percent. Physicians associated with integrated delivery systems had the highest rates of HIT adoption.

An AHRQ-sponsored study finds that adding telemonitoring to the routine care of primary care patients with diabetes did not significantly change outcomes.

CMS reminds EPs that the last day to register and attest to demonstrating MU for the 2013 Medicare EHR incentive program is February 28, 2014.

3M Health Information Systems releases an enhanced version of its Code Translation Tool to convert ICD-9-based custom problem lists into ICD-10 coded problem lists for import back into a provider’s existing EHR.

CareCloud ranks 28 and Kareo 65 on Forbes annual list of America’s 100 Most Promising Companies, which includes high-growth, privately-held companies with under $250 million in revenue.

Doctors spend about one-third of their time looking at their computer when using an EHR in an exam room, according to a study published in the International Journal of Medicine. Researchers conclude that when doctors spend that much time focused on their EHR, patients have difficulty getting their physician’s attention and physicians are less able to listen, problem-solve, and think creatively.

Navicure reports a 24 percent increase in revenue in 2013 to $63.3 million.

Email Inga.

HIT Vendor Executives on Expectations and Plans for 2014 – Part Three of a Series

We asked several vendor executives a series of three questions related to their expectations and plans for 2014.

What new technologies are on your company’s road map for 2014?

Raul Villar, president, ADP AdvancedMD

AdvancedInsight is an all-new reporting suite, available this year from ADP AdvancedMD. Private and solo practices will be able to access big data and business intelligence, previously reserved for enterprise level systems, through AdvancedMD’s multi-tenant cloud. Private practitioners will be able to make the right financial decisions based on the right information at the right time with a 360-degree view of their practice’s financial health and key performance indicators.

Jim Hewitt, VP of solutions development, Allscripts

We are investing heavily in analytics, population health, and proactive patient engagement.  You will also see new solutions around mobility for patients and providers, virtual patient visits, health and wellness, and genomics.

Todd Rothenhaus, MD, CMO, athenahealth

Well, the good news for us is that it’s no longer cool for CIOs to get their picture taken in front of a datacenter. Provider organizations at all levels are swiftly and confidently moving to the cloud and will continue to do so, because it’s the most open platform from which they can access and share information across health care, because it’s the most nimble platform to adapt to and meet the relentless pace of change for what’s required in health care, because its requires the least amount of capital expenditure and work to get up and running, and finally, because it’s from the cloud that innovation can most quickly grow and become available. Lucky for us, we’ve been there for the past 15 years.

At athenahealth we’ve nearly perfected the art of tracking claims and managing documents for physician practices across the US, we have the top rated patient portal in the country, the most usable EHR according to KLAS, and now we’re taking on bigger, thornier problems. We’re tackling population health and care coordination. Our focus is the leverage our national cloud network to provide clinical and financial visibility into the lifeblood of care, to help our clients (physician practices and health systems) to identify patients in need, to help with engagement and outreach, and to help manage and keep view into the whole care cycle. We want to manage the transitions of care and bridge the information gaps that currently exist. We know we can do this through our unique model of software, knowledge and work. This is our roadmap for 2014.

Albert Santalo, CEO, CareCloud

2014 is shaping up to host the most aggressive phase of product roll out in CareCloud’s history. We are launching significant expansions around our mobile offering in the coming months, as well a new billing rules product that will be provided to our revenue cycle clients at no additional charge. We feel the latter release will dramatically enhance our ability to drive results for clients across our revenue cycle management platform.

Lastly, given what is underway in the market, we will be making significant enhancements to our analytics offering. This will mean more flexible and ad hoc reporting, in addition to scorecards, dashboards and other important capabilities.  We are also working to make reporting much faster and more scalable for our larger clients.

Stephen Ober, MD, chief medical officer, Emdeon

• Big Data analytics (numerous versions)
• Mobile technologies

Patrick Hall, EVP of business development, e-MDs

e-MDs is launching a unique, patent-pending ICD-10 coding tool. The uniqueness is the approach being taken to help medical professionals derive the correct code.  Many vendor tools are simply arriving at a selection of potential ICD-10 codes based upon publicly available and somewhat generalized mapping tools and which can spawn potentially hundreds of possible matches. These will slow down clinical and billing efficiency and raise costs and denial rates. The e-MDs’ approach focuses on natively deriving the ICD-10 code and provides an opportunity to solve the feared ICD-10 implementation nightmare.

e-MDs is also launching our Cloud Solutions true-SaaS, web-native EHR which has been extremely well received in pilot sites. Our Revenue Cycle Management service is also growing and will be able to accelerate even faster with the Cloud Solutions PM.

Tee Green, CEO, Greenway Medical Technologies

In late 2013, Greenway strengthened its position as an industry leader by bringing together three innovative solution providers — Greenway Medical Technologies, Vitera Healthcare Solutions, and SuccessEHS. As a result, we now serve a significant percentage of physicians nationwide through our highly integrated clinical, financial and administrative solutions. Thanks to the consolidation of our proven expertise, industry reach and resources, we can provide end-to-end solutions that prepare physicians for a future where electronification, consumerism, and population health are the key drivers of success. We are also investing resources at an industry-leading rate into research and development to build on the strength of our existing solutions. We also continue to focus on providing the ultimate in data liquidity through our interoperability engine, PrimeEXCHANGE. In fact, it is our aim to make this solution one of the largest health information exchanges in the country.

Tom Giannulli, MD, CMIO, Kareo

Kareo is continuing to expand the features of our EHR and practice management solutions all the time. The big challenge is balancing market-driven features with requirements like MU. I am most excited about the potential of new mobile technologies like Google Glass and the emergence of technology that allows for the use of virtual scribes within the small practice.

Nick van Terheyden, MD, CMIO, Nuance

We will continue to develop our Clinitegrity 360 suite of solutions and services – providing end-to-end clinical documentation that enables physicians to properly document care and be reimbursed, while working within their existing workflow without distraction from the patient and patient care. These offerings help clinicians capture detailed information that’s necessary for ICD-10, as well as population health management and quality reporting.

In addition, we will continue to advance our mobile speech and clinical language understanding solutions. With these, clinicians are able to document at the point of care – which keeps patient records up-to-date and eliminates hours of charting after each shift. In addition, we continue to partner with innovative companies who are driving change through mobile health – such as our recent partnership with Sharecare on the AskMD app that connects patients with providers helping them take an active role in managing their own care.

Irtaza Barlas, director of software engineering NueMD

New technologies on company’s road map:

a) Integrating wearable technologies (such as Google Glass) into the physicians’ encounter experience in a secure and hassle-free way. The main intent here is to help the physician interact with the patient and potentially use the capabilities of the Glass at the same time. And at all times still be connected to their Practice Management system (NueMD).

b) New claims-processing techniques to significantly reduce billing errors and rejections.

c) Developing tools to help billers and physicians communicate in a timely manner.

Chip Hart, director of strategic marketing/sales director, Physician’s Computer Company

Perhaps I’ll be the lone vendor to not try to overextend our position, but there isn’t some truly _new_ technology in our world that will be introduced in 2014. Every Asimovian prediction I can think of has already been played with by us (heck, we were doing remote EHR work on the Newton back in the 90s!), so it’s not really new. For PCC, it’s about improving the engagement with our clients and our clients’ clients on the various platforms they use to communicate.

I suppose one place where we are different is that our patient portal was designed for smartphones from the ground up. Our clients are pediatricians and the model we’ve designed to is the young mom, with a kid or two in tow, who wants to get signed up to get her kids records while in 30 seconds at the checkout window, not wait a few days for something to arrive in the mail and log into her PC. She may not HAVE a PC. So, we’ve got an  extremely iPhone/Android friendly-app that patients can log into at the check out window.

Michael Brozino, president and CEO, simplifyMD

simplifyMD will be upgrading their solution to offer a few enhancements to help physicians work more efficiently and productively, while complying with new and impending regulatory and industry changes. These features are:

• simplifyMD Charge Capture which streamlines the billing process with automated diagnosis and procedure codes that are generated during the clinical encounter and then pushed to the PM system or billing company for faster claims submittal and reimbursement.
• simplifyMD simpleForms that offers providers the flexibility to edit and update EHR forms on any desktop or mobile device as well as data capture capabilities to help physicians create highly detailed reports in only a few clicks.
•  Enhanced Computerized Physician Order Entry built to help physicians meet Meaningful Use Stage 2 core objectives by electronically submitting lab, medication and radiology lab orders, including to vendors such as LabCorp, Quest Diagnostics and Solstas. Physicians will also have the capability to email or e-fax orders to any radiology center, imaging facility or specialty lab right from the simplifyMD EHR.

News 1/23/14

A new KLAS report says Epic, athenahealth, and Greenway lead the 11-75 physician practice segment. Allscripts, McKesson, and Vitera have the highest percentage of unhappy customers who will stick to the EMR they bought even though they wouldn’t buy it again. Other notable findings:

• Epic was noted for its consistent delivery in larger, hospital-based practices
• athenahealth was seen as a disruptive option with nimble deployment and more frequent updates
• Greenway was recognized for great service to smaller, independent practices
• SRS tied with Epic and athenahealth for the highest percentage of customers (90) that plan to stick with their EMR and would buy again.

CMS posts the 2014 PQRS measure codes.

Researchers find EMRs helped to improve the identification and follow-up of infants born to mothers with hepatitis C virus infections. The study, which was published in The Pediatric Infectious Disease Journal, found that utilizing certain EMR features, such as problem lists, electronic messaging, and test monitoring contributed to an increase in identification rates from 53 to 71 percent and follow-up rates from eight to 50 percent.

Medical Professional Services (CT) selects athenahealth’s Population Health Management platform for its 450-provider IPA.

Etransmedia acquires RCM-provider Medigistics and reports plans to announce additional acquisitions soon.

Kareo intends to grow its marketing and sales efforts following the closure of  $29.5 million in growth capital, led by Greenspring Associates.

MGMA adds healthcare payment solution provider Navicure to its executive partnership program.

Healthstat, a provider of on-site workplace health centers, will implement eClinicalWorks EHR across more than 350 sites. Healthstat will also integrate Pro-Change Behavior System’s evidence-based health behavior change algorithms into the eCW EHR platform.

Email Inga.

News 1/21/14

In 2013, 78 percent of office-based physicians used some sort of EHR, up from 18 percent in 2001, according to the CDC’s National Center for Health Statistics. Other key findings:

• Almost half of physicians reported using a system that met the criteria for a “basic” system, up from 11 percent in 2006.
• About  69 percent  of physicians intended to participate in the MU program; however only 13 percent of these physicians had an EHR system capable of supporting 14 of the 17 Stage 2 Core Set objectives. While the second point suggests physicians have a long way to go to be ready for Stage 2, it’s important to to note that the findings were based on data collection from February to June of 2013. I assume the state of readiness today is better.
• Twelve percent of physicians said they did not intend to participate in the MU program.

Provider engagement and administrative issues present the biggest challenges to practices adopting and implementing EHRs, according to data collected by 55 RECs throughout 2012. The most challenging MU measure:clinical summaries measure.

Navicure adds about 200 new customers after PM provider Healthwind selects Navicure as its preferred clearinghouse partner.

Office Ally reports that more than 11,000 providers now use its EHR 24/7 product.

A Cleveland Clinic survey reveals that what aggravates patients most about their doctor is having to wait a long time in their office. Other complaints: doctors sharing details of patients’ medical histories with others; feeling rushed by their doctor; and limited office hours. Overall what patients want most from their doctors is empathy.

The 22-provider Eye Center of Central PA goes live on Medflow v8.1, the company’s 2014 MU-certified EHR.

NextGen Healthcare will integrate Inovalon’s healthcare data analytics products with the NextGen Share interoperability platform.

eClinicalWorks CEO Girish Navani discusses his management style in a New York Times interview and explains why titles don’t matter. He also mentions that he often works at a conference table right outside his small office. I visited the eCW headquarters in 2011 and in my write-up of the visit I mentioned that setup, which I thought suggested “the availability and willingness of execs to be in the trenches with their employees.”

CMS offers EPs the opportunity to participate in the  2013 PQRS-Medicare EHR Incentive Pilot, which allows providers to meet the clinical quality measure reporting requirement for the Medicare EHR incentive program through electronic submission while also reporting for the PQRS program. Participating EPs have until February 28 to submit 12 months of CQM data.

Email Inga.

HIT Vendor Executives on Expectations and Plans for 2014 – Part Two of a Series

We asked several vendor executives a series of three questions related to their expectations and plans for 2014.

What emerging technologies will have the biggest impact on physician practices over the next 12-18 months?

Raul Villar, president, ADP AdvancedMD

“Big data” technology will grow significantly. With a continued push on Meaningful Use and the rise of ACOs, business intelligence and big data will have a profound impact on preventative care and on financial management of health care organizations including independent practices. With new technology, doctors will be able to immediately identify their at-risk patients, track and manage patients more closely, monitor the spread of diseases, and take preventative measures to keep patients from graduating to chronic diseases.

Mobile technology adoption will continue to increase over the next 12-18 months although we expect Apple and the iPad in particular to maintain dominance. This adoption will greatly contribute to physician freedom and flexibility and stronger patient care.

Jim Hewitt, VP of solutions development, Allscripts

Clients are telling us that population health management is a strategic imperative. Technology must be able to aggregate and harmonize data from multiple disparate systems and provide real-time reporting and alerts.

We’re also seeing a proliferation of third-party apps that have powerful possibilities in personalized medicine. Technologies that harness genetic and genomic information, for example, can help providers make better clinical decisions.

Todd Rothenhaus, MD, CMO, athenahealth

There will be a new class of technology and most important to note, a new class of services that will emerge. The big honking software systems that cost millions of dollars and take years to deploy are showing massive vulnerabilities. They’re too expensive, too taxing to run and update, they have gaps in their ability to truly manage populations of patients outside of single health systems, and they only get physician practices so far when it comes to plugging into the care ecosystem with which patients seek and get care.

While it’s taken too long in health care, it’s becoming clear that everyone does not need to be on the same system to share information and gain a complete view of care. Technology supported by services, will emerge that will make it possible for information to surround the patient as he or she moves between care settings, so physician practices can better connect, co-exist, and coordinate with hospitals. This new class of technology and services will make true care coordination possible and will provide the financial and clinical visibility necessary to manage risk contracts.

Physicians need to be looking for technology and services that can help them identify patients in need of care or adjustments in care, engage in proactive outreach to those patients, and steward them through their experience of care. It’s about advancing connectivity which static software can’t and won’t do.

When you look at all the start-ups and venture funding going into health care it’s all aimed toward the cloud. Many enterprise software systems are failing in a public way and because of these failures, as well as the capital expenditures they require, they’re no longer a low-risk move for CIOs. The cloud, and service oriented vendors, will have the biggest impact on all of health care in the next 12-18 months.

Albert Santalo, CEO, CareCloud

Mobile capability for an EHR or practice management system has obviously become vital for any vendor to offer their clients. Enhanced analytics and giving practices greater insight into their operations and provision of care will become paramount as well. We are doubling down on both these fronts in 2014.

Stephen Ober, MD, chief medical officer, Emdeon

Twelve to 18 months is a long time in the technology world.  During this time frame I believe we will see a variety of IT solutions:

1) An explosion of real-time apps informing a physician of critical information to improve care delivery. These will most likely come via mobile platforms. An example:  your patient is in the OR and ready for the procedure, here are the labs on your patient from this morning, your patient John Smith needs a refill of his prescription for Amoxicillin 250 mg QID.

2) Big Data analytics will also impact provider practices in 2014. For the first time, the industry can actually aggregate patient level data and provide feedback to providers with information on an individual patient’s overall health risk, etc. These systems can push out preventive care alerts (no flu shot was given to this patient) and also focus on chronic care (this patient hasn’t received an HbA1C this year). These results will be aggregated and can affect their overall reimbursement in 2014.

Patrick Hall, EVP of business development, e-MDs

Patient-facing tools will continue to become more robust, more expected (by patients), and potentially offer tremendous time and cost-savings for practices.  Practices will need to determine which technologies they can adopt.

Much like dealing with the omnipresent pharma marketing that has been known to have sometimes negative effects on the doctor:patient relationship, physicians will also need to learn how to communicate with patients about which technologies are useful, and which are not.

Tee Green, CEO, Greenway Medical Technologies

To address the previously mentioned challenges, physician practices will need to create a foundation for improved quality and efficiency by implementing an integrated system that streamlines electronic health records and practice management functions.

New technology solutions will also be required to extend important functionality to consumers, including patient engagement tools such as portals and care coordination resources.

Finally, there will be a variety of emerging technologies that help physicians better manage the clinical and financial challenges resulting from new value-based care models. These include population health management platforms, advanced analytics and clinically driven revenue cycle management systems that close the loop between clinical, administrative and financial processes. Together, these new technologies will help physicians better manage populations of patients as opposed to transactions of care while improving the financial sustainability of their practices.

Tom Giannulli, MD, CMIO, Kareo

I really believe that truly mobile EHR is finally having its day in the sun. This trend will only grow over the coming year. The technology has finally caught up with what physicians want. EHR vendors are now offering a full-featured native app for the iPad that allows providers to do almost everything on a tablet. The ease of use and simplicity of the truly mobile EHR allows providers to really engage patients instead of getting swivel chair fatigue as they turn back and forth from the desktop to the patient.

Nick van Terheyden, MD, CMIO, Nuance

MHealth and mobile speech will be the biggest technological enabler in allowing physicians to engage with patients. Patient engagement is the blockbuster drug of the 21^st century. Having patients regularly participate and contribute to their own care through mobile devices and apps, as opposed to being observers and receivers of care, will bring seismic changes to healthcare. Through mobile health, we will see a huge wave of people empowered in their care and the care of their loved ones, and ensuring everyone is fully engaged and part of the process will revolutionize the delivery of medicine.

This increased engagement will go hand-in-hand with the industry’s shift away from the current fee-for-service model. Coupled with the increased granularity that will result from the transition to ICD-10, these changes will transform the way we practice medicine. Emerging and existing technologies that enable these transitions and ease the burden on physicians during the evolution will be crucial investments for practices to make.

Irtaza Barlas, director of software engineering NueMD

Biggest impact of emerging technologies:

a) Online portals, EHRs, PHRs will reduce the waiting-room paper work. This potentially will also produce better quality data that will be used by data-mining companies to detect patterns and behaviors to empower the physician as well as the patients.

b) Wearable technologies’ (such as step counters, sleep monitors, etc) generated data may see more integration into the medical records systems.

c) Cloud-based PM systems will meet the challenges posed by ICD-10 transitions and MU2 interactivity requirements better then the older stand-alone, or client-server type systems.

d) Big data may become overwhelming. Developers and physicians will need to work together to sort pertinent data from irrelevant data and be able to present it in a clear, focused way. This will be imperative to have big data make a physician’s job easier as opposed to overwhelming.

Chip Hart, director of strategic marketing/sales director, Physician’s Computer Company

Medicine moves so slowly as a rule that it’s only now that fairly common and established technologies – texting, mobile phones, tablets – are poised to make the biggest impacts.

In our primary care world, “social media” is the elephant in the room. Some practices are starting to get savvy with Facebook, blogging, and Twitter, for example, and reaping the rewards.  The others will be left behind.

Michael Brozino, president and CEO, simplifyMD

Over the next 12 to 18 months we will witness practices continuing to replace their antiquated, server-based technologies with more efficient, flexible, cloud-based softwares that allow physicians to use their preferred workflows.

These more efficient, nimble technologies will offer physicians additional tools to access, manage and analyze clinical and financial data to better monitor patient populations. As government and commercial health insurers pursue payment models that reward physicians for achieving clinical quality metrics across populations, such as Accountable Care Organizations, Patient-Centered Medical Homes, and Meaningful Use of EHRs, data capture and analysis is crucial.

Physicians will need to incorporate technologies, such as EHR and PM systems, that will support their success in those programs by facilitating and, in some cases, streamlining their proven, effective practice workflows so productivity will be unaffected by increased data capture and reporting demands.