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?

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News 12/10/13

Practice Fusion closes a $15 million Series D round led by Qualcomm Ventures, bringing the company’s total funding raised to date to $149 million. Practice Fusion reports it now has over 300 employees, connects with 300 lab partners, and is actively used by 100,000 “medical professionals.”

Private physician offices are predicted to net profit margins of 12.7 percent in 2013, beating the 9.1 percent predicted for all private companies.

Patients in Fort Meyers, FL experience the longest in-office wait times in the country, according to the physician review and rating service ZocDoc, while Seattle patients have  the shortest wait times. For 2013, more patients in Detroit used ZocDoc’s mobile apps to schedule appointments than in any other city.

PerfectServe introduces Clinical Event Push, which automatically informs physicians of important clinical events, such as patients presenting to the ED, patients admissions or discharges, lab test availability, and new consult orders.

From CMS: 75 percent of Medicaid EPs (106,000) have received an EHR incentive payment, though only 17 percent are meaningful users (disconcerting?) Medicaid EPs are not required to attest to MU to earn initial payments, unlike the 60 percent of Medicare EPs (220,000) who are considered meaningful users and have received an EHR incentive payment. Through the end of October, the government paid almost $17 billion in MU incentives, including $6.7 billion to EPs.

An autism module added to an EHR’s clinical decision support system improves screening rates for autism spectrum disorders, according to a study published in Infants & Young Children. Seventy percent of the study participants agreed that the automation of the screening process helped them adhere to recommended screening guidelines.

CMS proposes a revised MU timeline that would extend Stage 2 through 2016 and would begin Stage 3 in 2017 for providers who have completed at least two years in Stage 2. The start date for Stage 2 would not change – just the end date – though the Stage 3 start date would be delayed a year. The ONC says the goal is two-fold:

To allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.

CMS is expected to release proposed rulemaking for Stage 3 and the certification criteria in the fall of 2014.

Aprima Medical integrates DMEhub into its EHR, allowing physicians to write orders for durable medical equipment directly from their Aprima EHR.

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News 12/5/13

From Boeing: “Re: McKesson Seattle. McKesson is closing its Seattle office, the original home of Practice Partner, the EHR product McKesson acquired several years ago.” While not officially confirmed by McKesson, Boeing provided us with internal McKesson communications as verification. Apparently McKesson intends to continue distributing, supporting, and developing the Practice Partner EHR and will allow Seattle support personnel to work remotely from home. Some development staff are being asked to relocate to Atlanta.

Two-thirds of US primary care physicians reported using EMRs in 2012, up for 46 percent in 2009, according to findings from the 2012 Commonwealth Fund International Health Policy Survey. In comparison, more than 90 percent of primary care physicians in the Netherlands, Norway, New Zealand, the UK, and Australia reported using EMRs in 2012. More than a third of US physicians allow patients to request prescription refills online or email medical questions.

San Diego Orthopaedic Associates Medical Group (CA) selects SRS EHR for its nine providers and two offices.

CareCloud and Quantia name Bernard Abbott, MD, CMIO of Family Health Centers (MD), the winner of their Health IT Case Study Challenge contest based on the organization’s success using technology to improve the practice’s financial and operational health.

Greenway Medical Technologies will integrate data analytic tools from Inovalon into its PrimeSUITE EHR platform.

Texting while doctoring could create a patient safety hazard, according to an opinion piece in the Annals of Internal Medicine. Physicians typing in an EHR during a patient encounter may miss signals of depression, disagreement, and lack of understanding. The physician-authors blame Stage 2 MU criteria, which require doctors to type in their own orders, and suggest a technologically-supported, team-based model of care may allow physicians to give patients their undivided attention.

Outpatient physicians report more emotional exhaustion than inpatient physicians according to a review and meta-analysis of 54 studies on physician burnout. Personally I always find a teeny bit of comfort (not to mention smugness) knowing that I really do have it worse than the next guy..

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News 12/3/13

CMS finalizes the 2014 Medicare Physician Fee Schedule, which includes a 24 percent payment cut if the SGR formula is not amended. CMS also proposes a policy beginning in 2015 to support care management outside of routine office interactions by establishing separate payments for managing the care of certain Medicare patients. The final rule also includes provisions regarding physician quality programs and the Physician Value-Based Payment Modifier.

In a separate announcement, CMS says it will pay providers a flat rate for Medicare visits to outpatient clinics, regardless of the severity of the patient’s condition.

EMR/PM provider CureMD acquires medical billing company AviaraMD.

Elmwood Health Center (NY) becomes the first practice to submit immunization data to the New York State Immunization System across the HEALTHeLINK HIE.

EHRs offer more than just a handy way to store patient notes, according to researchers from the Palo Alto Medical Foundation Research Institute and the University of Minnesota. Researchers conclude that patient data from EHRs provide reliable measures of the process of care and the patient-centeredness of a primary care practice. They also found that the volume of electronic messages between clinicians and  the frequency of in-person patient visits were associated with better patient health outcomes.

CMS publishes an interactive tool to help providers determine their eligibility for various ehealth programs.

Entrada, a developer of workflow products that are integrated with EHRs from athenahealth, Allscripts, Greenway, and NextGen, raises $1.12 million in new equity.

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News 11/26/13

From Ralph N: “Re: Practice manager interview. That interview sounded like a paid advertisement from athena.” While Erin was clearly enthusiastic about her billing and EMR provider, be assured that vendors never pay us for interviews, Readers Writes, or other posts. On HIStalk we have a section that is clearly labeled “Sponsor Updates” that includes items that may not be considered “hard news.” Often our sponsors ask us to consider interviews with their CEOs or clients – which we do not always agree to do – but in this case athenahealth is not a sponsor. Recently we asked multiple ambulatory EMR vendors for the names of potential interview candidates who were successfully using EHRs in their practice and appreciate athenahealth’s assistance in connecting us with Erin.

Nuance Communications announces the general availability of Dragon Medical 360 l Network Edition 2.0, which allows clinicians to document using multiple devices and provides an accuracy level of 98 percent or higher out of the box.

A Virginia gastroenterologist shares his transition from an academic practice to a small private group that he labels a “medical oasis.” He finds particular pleasure in the office’s low-tech set-up and absence of an EMR, which he calls old-school, unacceptable, and effective:

I write, by hand, notes that contain the information I need to help you feel better. When I finish our visit, I dictate a letter and often call or text your referring physician to let them know what’s going on. I bill based on the notes, but no one’s costing out the "elements of the encounter."

He is happier in his work and claims his patients are as well. Somehow the story makes me sad.

CMS publishes a tip sheet for EPs on Stage 2 HIE requirements. The document outlines the required data elements and provides guidance on data sharing objectives for summary of care documents, clinical summaries, and patient electronic access. EPs that have completed at least two years of Stage 1 MU can begin Stage 2 in 2014.

The use of secure messaging portals in EHRs may not improve outcomes or costs, according to a review published in the Annals of Internal Medicine. Researchers, who considered findings from 46 studies, conclude that “portals represent a new technology with benefits that are still unclear.”

A study of 215 primary care physicians reveals a significant decline in lab ordering rates when providers have a real-time display of cost information within their EMRs.

As Mr. H mentioned on HIStalk over the weekend, we are about to hit the traditionally slow news time in HIT.  If you are like me, your to-do list for the next few weeks includes not only work, but also plenty of holiday merriment, cooking, shopping, and decorating. Be assured that we won’t keep you away from the eggnog any longer than necessary by padding our posts with irrelevant news. 

On that note, I’m not sure if there will be enough news for a second news post this week. Just in case, best wishes for a very happy Thanksgiving!

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