HIStalk Practice Interviews David Whitlinger, Executive Director, NYeC

David Whitlinger is executive director of New York eHealth Collaborative.

Give me an overview of NYeC and its various initiatives.

The New York eHealth Collaborative is the state-designated entity for the State of New York. It is responsible for establishing healthcare IT across the state. It has a couple of key programs. One of them, of course, is adoption of electronic health records in general, and we do that as one of the two regional extension centers for the state. The other is the New York City Regional Extension Center. We work tightly together.

NYeC is also building a statewide network in conjunction with the Department of Health and various RHIOs from around the state. The first two predominant capabilities that the statewide network will support are patient record lookup – the ability to query for a patient record across the network — as well as Direct, the ability to use a single hit in the SHIN-NY network to support point-to-point communication between two provider organizations.

In support of that, we have a couple of other initiatives we kicked off in order to further substantiate the markets towards usage of the SHIN-NY, including interoperability workgroups. We — with several other states and a collection of HIE vendors and EHR vendors — came together to form an organization that will work on tight plug-and-play interoperability technical specifications for patient record lookup and Direct.

That work now is coming into culmination. The test specs are done and we’re in the final throes of working with an ONC-certified test house to be the test body for products that meet those requirements. For New York, we expect that’s going to be a mandatory requirement for EHR vendors such that their products are SHIN-NY-ready and they’re ready to be on the state network plug and play.

The other program that we anticipate starting to bear fruit next year is an accelerator program. Those companies are accelerating products on top of the SHIN-NY network, using the SHIN-NY services for products geared towards team-based or collaborative care.

One of the biggest struggles for HIEs financial viability. What is SHIN-NY’s financial model and how is it faring?

Let me talk about it from several different aspects. The way our model is constructed today is as a retail model. In other words, those that use the network pay for the usage of the network – both payers and providers. That’s the model that we put together.

That being said, we have done a couple of things in putting this cost structure together and two things of note. New York City and the surrounding area is one of the densest healthcare delivery geographies in the country. By loading up the volume of usage of the network and driving the cost of delivery of that network down to a very low level, we are able to provide the per-unit cost to those that are paying for it at a public utility or commoditized level. We went into this as to substantiate the services with an expectation that we were going for volume and that the per-unit cost was going to be at a public utility or commoditized rate.

And so where are you today financially or is it still too early to tell?

It’s too early to give you some numbers or to quote figures but we are on target for the volumes or the adoption rate that’s necessary to succeed with our financial model. Where we need to be in a year from now is a full commercial model as that’s roughly when grants resolve. We’re on track for that.

What were you look for in companies to be part of your accelerator program?

I’ll try to give you four areas that were identified by our provider community as focus areas or capabilities that are necessary to support team-based or collaborative care.

One is care plan management. That’s the idea of having a single care plan for a patient with multiple providers that are using that care plan and contributing to it and looking at it with each other or prescribing for the patient simultaneously. There’s an ability of coordination between the provider community and all are working on the same patient at the same time. A lot of the products that we’ve seen and that are being accelerated for our program have to do with community communication: how do you notify and allow the different providers to know what each other are doing?

The second focus area is around analytics and being able to manage patients at the provider level in a panel. If a provider is seeking to be proactive and address their high-utilization patients, what are the reports that you can run and know what the other providers in that community are also doing with these patients? If you’re proactive, the reports that you use help dictate the work that you do with those patients.

The third area has to do with alerting. We received a lot of feedback, and a lot of interesting companies have come in to the accelerator with ideas around this. In the alerting ideas, you might have patients that end up in the wrong place for receiving care and there are care managers who are looking out for those patients. If they knew that the patient was in a high-cost location for care, they could intercede before the patient gets overworked and the financial mechanism gets overdrawn. A classic example is a patient showing up at an ER and the ER doesn’t know anything about the patient, so they don’t have any choice but to do a full workup, run all the tests, and do all the necessary treatments. If the care manager has a good depth of knowledge of that individual, they could be alerted and contact the ER. After the patient is stable, they could spend more time getting the patient transitioned to a better form of care, and not just ER services.

The last category, which is the Holy Grail, is patient engagement. We’re looking for and have found some companies that are really seeking to get patients engaged more in their own care, be more proactive in their care plan, and be more proactive in their engagement with their providers.

Were your applicant companies New York-based or are they from all over?

About half of the companies that applied are New York-based. The rest are outside of New York or outside of US altogether and across the world.

A recent CMS report indicates that only about 12 percent of physicians who signed up with an REC have attested to Meaningful Use. How does your REC’s record compare?

I hate to brag, but I will. We’re oversubscribed for our REC services. We are signed up for about 5,107. That was our contract number, and we now have around 5,500. We’re about 10 percent overprescribed for services.

We are now somewhere around 1,200 that have achieved Meaningful Use. If you understand some of the Meaningful Use program, you know we’re in a lull right now as to when people can attest and how they can attest and report. We’re expecting – and we’re very much on top of this with our provider community – a big wave at the end of the year here.

By the time all of the accounting mechanisms get caught up, we expect our Meaningful Use number to be around 3,000 or 3,100 in the January-February timeframe, so we’re doing well. We’re on track. The provider community is doing their part. The vendor community is doing their part. Our REC agents going in and working with the practices are doing a tremendous job.

What do you find to be the biggest challenges for physicians in terms EHR adoption?

You know, I think there’s a little bit of EHR fatigue. There’s a lot of work that’s going on in bringing themselves up to speed. There’s a lot to digest and understand. There’s a lot of work going into practices and helping them understand what’s important when doing an EHR implementation and focus on those things, and then grow the usage using the Meaningful Use measures as guide after they get there. It’s overwhelming at first blush. We spend a lot time getting them to understand it all in digestible chunks.

Would you like to add any additional comments?

The state of New York, because of the tremendous investment that it has had for the last couple of years, is working to provide a very robust HIE network as a public utility. We are doing something that the public should look at as for the public good and as a public utility that is available to all of them. It’s in the community, owned by the community, governed by the community. That’s really what we’re about here at NYeC.

To that end, we are looking at putting a consumer- or patient-facing portal up in the early part of next year that really is going to benefit the general public. That will be also coinciding with Meaningful Use Stage 2 requirements of patient access to their record. We’re looking forward to the healthcare providers in the state of New York really being able to leverage that, not only for the Meaningful Use Stage 2 requirement, but because it’s the right thing to do for their patients. It brings patients access to all of their records and not just the records of any one provider.

News 11/1/12

From Evan Steele: “Re: SRS and Sandy. A tree fell and took down a telephone pole right by our office, so we are without power. Our phone system is in the cloud, so any employee with power and Internet is working from home (they just plug their office phone into their cable modem and their extension works). Employees without power and Internet are working out of a conference room in a hotel. We haven’t missed a beat and are fully servicing our clients – AMAZING!” It is truly amazing, given the reports that more than eight million people from North Caroline to Maine lost power at some point during the storm. SRS, which is based in Montvale, NJ,  may be headquartered in a hotel conference room for a few more days — the local utility provider says it will take 10 days to restore power to the remaining 225,000 affected people.

Pulse Systems co-founders and brothers Basil Hourani and Alif Hourani resign from their posts as CEO (Basil) and CTO (Alif) and CFO Jeff Burton takes over as president and CEO. The French technology company Cegedim purchased the company two years ago for $61 million.

An AHIMA-published article explores what physicians want in ambulatory EHRs and why, until recently, HIT vendors have ignored their needs. A Mayo Clinic study previously concluded that vendors need to include several specific features and functionality in order to increase EHR adoption in practices, including:

• a flexible, customizable, virtual workspace
• workflows that mimic paper-based processes
• intuitive and easy-to-use interfaces
• the ability to work on multiple platforms, including mobile devices
• integrated clinical guidance

The evolution of cloud-based computing and smart mobile platforms are now making EHRs more affordable and attractive to physicians and spurring EHR use in practices. I’d add the obvious observation that MU and similar financial incentives are also impacting adoption.

October has been a record month at HIStalk Practice in terms of readership, which of course makes me happy. Site traffic spiked during MGMA and will help push us over 12,000 visits and 22,000 views for the month. Our wonderfully supportive sponsors also appreciate readers stopping by, especially those that take a moment to click on their ads and check out their offerings. If you find the reading worthwhile, the biggest compliment you can pay us is to tell a couple of colleagues about our sites and advise them that reading all things HIStalk will make them smarter, hipper, and better looking (the latter only applies to readers willing to adhere to my occasional fashion tips.) Thanks for reading.

East Bay Eye Specialists (CA) selects SRS EHR for its four-physician practice.

CMS releases its list of 24 EHR Direct vendors that have qualified to submit quality data to CMS by EPs for the  2013 PQRS program year.

E-mail Inga.

News 10/30/12

DigiChart founder William Bates, MD will step down from his role as chairman, assuming the title of chairman emeritus.

Huntington Medical Foundation selects Allscripts RCM services for its 50 providers.

The AMA solicits members to participate in a survey to rate EHR systems. I am not clear on the survey process or how the rankings were derived, but they seem consistent with similar findings by other sources.

eClinicalWorks hosted 4,500 attendees at its 2012 National Users Conference last week in Washington, DC. Keynotes included Surgeon General Regina M. Benjamin, MD and National Coordinator Farzad Mostashari, MD.

The Phoenix Business Journal profiles Desert Ridge Family Physicians, a six-physician practice that says its effective use of (NextGen’s) EHR has resulted in numerous efficiencies, including the ability to message patients securely, maintain a low staff member to physician ratio (2:1 compared to an industry average 5:1), and lower its no-show rate to three percent versus the industry average of 15 percent.

Adult Primary Care Associates (GA) contracts with ProviDyn for private cloud services for its Allscripts EHR and PM software.

Resurgens Orthopaedics (GA) selects Merge Honeycomb Archive as its patient image archiving and long-term disaster recovery solution.

Athenahealth is considering metro Atlanta as the site of its southeast hub, which would create about 400 jobs in that area. Meanwhile, the company is negotiating with Harvard University for the purchase of the $200 million, 11-building campus that includes athenahealth’s current headquarters. CEO Jonathan Bush says the company is considering at least three options that would expand its headquarters from 330,000 square feet to as much as one million square feet.

Impact Advisor’s Carol Slone recommends that practices establish basic goals prior to EHR adoption and measure the implementation success based on results. Typical benchmarks include quality of documentation, job reassignment, ease of use, level of staff complaints, and productivity.

A small study finds that 85 percent of oncologists and primary care physicians use social media at least once a week or once a day to scan or explore health information, and sixty percent of providers say social media improves the care they deliver. The numbers sound high to me, but clearly social media is having an impact on the way physicians are practicing medicine.

Beginning November 1, physicians can submit requests for significant hardship exemptions from the 2013 e-prescribing penalty. Requests will be reviewed case by case and all decisions will be final.

E-mail Inga.

DOCtalk by Dr. Gregg 10/28/12

If It Was a Wonderful Life

Whoa … it was seriously disturbing hearing that voice coming from Summer, our beautiful, sweet, genteel Golden Doodle. She’s not prone to any noisemaking, rarely even a bark, no less the raspy, smoke-ravaged voice of my old spiritualist and now occasional spirit guide, Madame Blavatsky. You can imagine my non-intoxicated – honest! – surprise. (She’s a bit of a mischievous disembodied soul, reading my thoughts without permission, popping into my reality without invitation.)

“So,” she starts in her husky Ukrainian, semi-masculine voice, “you vant to see vhat the vorld vould be like if HIT had started vith a plan, a grand design, huh?”

I nodded at Summer, remembering how I had recently wondered just such a “what if.” Still, I was somewhat uncertain if this was a waking ghostly emanation or some mini-stroke, epileptiform fantasy my neural synapses were concocting. I was pretty sure Summer hadn’t been raised anywhere near Odessa, thus the accent seemed to clinch the fact that this wasn’t really my dog speaking. The sound of the football game on the TV semi-assured me that I was still sitting on my couch. The cool feel of the Pepsi in my hand seemed to imply that I wasn’t comatose or stroking out.

“So, you vant to see vhat could be, huh? You vant to know vhat you’re missing? Well, so be it, my little Solnyshko,” she semi-growled.

With a wag of her tale and a blink of my eyes, I was suddenly standing at a work counter in my office, looking down at a tablet computer. But it was unlike anything I’d ever seen…

The user interface was gorgeous! Everything I needed was right there, without extraneous clutter. Everything I wanted was accessible, without extravagant effort. Everything was clean and friendly and visually pleasing … and it made sense, stupid simple sense.

I touched the tablet and useable items popped in and out without screen refreshes or wasted motions. I wanted a lab result: it was a click away. I needed to check an old note: pop, there it was, without covering my current view. I wanted to track BMI and blood pressure trends: tap, click, there it was in beautiful Technicolor clarity.

Somehow I knew I needed to see a specialist’s consult note. I also somehow knew it wasn’t necessary for it to have been “sent” to me; it was available in the cloud. I tapped the referral reference and, blip, there was the note, pulled from the common HIE platform. Even better, it was easy to read – not too short, not too long; it was plain old Goldilocks “just right.” I could easily see the provider’s overall intent and just as easily drill down to see the deeper story details. I could sense the deep connection to the core values around which all had been built, the grand design of HIT grandfather, Larry Weed. It was SOAP note structure and straightforwardness empowered by well-designed HIT “steroids.”

I tapped the screen to place an order and was suddenly sucked through a Matrix-esque screen of descending green code, going deep into the digital bowels of the system. There I saw the pure simplicity of the surface world replaced by complex yet smart digital wizardry. Systems spoke with each other in incessant ones and zeroes, but they all spoke one seamless language. I could sense there was no interface mumbo jumbo and no translational transgressions; everything was stupid smart. It was designed from the ground up to work as one system. Every section of the system complemented every other section. Data flowed like grease through a goose.

Speaking of waterfowl, I had the distinct impression that I was looking at the feet of a duck paddling furiously under the water while knowing that on the surface of this medical computer network “pond,” the EHR “duck” appeared to be gliding effortlessly across the clear, still surface. It was HIT as it should be. It all worked. It was all connected. It was all accessible. And, it was all absolutely wonderful!

The sound of my cell phone yanked me from my reverie. I was pulled, unwillingly, back through the Matrixian coded channels to current reality. It was an after-hours call from a distressed parent.

I tried to pull up their child’s record on my home PC, but something had failed and I was unable to connect with my EHR server. It was a moot issue anyway, as this parent’s question revolved around the psychologist’s recommendations from their evaluation two weeks ago and I just knew I wouldn’t have access to any such documentation – not now and possibly not in the foreseeable future.

As I did my best to answer this pleasant parent’s anxious queries based upon the limited information to which I had access, I looked over at Summer and could swear she winked at me as I saw a white lotus reflected in her eye. Blavatsky…er…Summer, even appeared to be smirking as she rasped one last vocalization: “George Bailey you’re not, Solnyshko, but vhat’re you gonna do?”

From the trenches…

“After enlightenment, the laundry.” – Zen proverb

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 Today! exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

MGMA12 Wrap-Up 10/25/12

I am back home, drowning in emails, and feeling a bit stressed. On the one hand I kind of wish I could attend more conferences (RSNA and a few of the larger vendor meetings come to mind) but then my body reminds me how exhausting it is to learn and network all day, socialize and network all night, and then wake up way too early in the morning to write a post.

I already shared most of my pictures, but I managed to dig up a couple more goodies. Hang on for my somewhat rambling assortment of observations and impressions.

I’ll start with a shout out to all the HIStalk sponsors who displayed their signs in support of HIStalk. A big thank you to Vitalize, Sandlot, Capario, MedAssets, White Plume, Culbert, IMO, M*Modal, Versus, MedAptus, Gateway, SRS, eClinicalWorks, and IngeniousMed. I am quite sure there were more since my notes aren’t perfect (nor necessarily legible.)

I stood in line with a gentleman who ran an anesthesia-focused MSO and was surprised by his comment that most of his physicians used scribes in the surgical suite. Maybe that’s not particularly uncommon and I just incorrectly assumed most physicians in this area were entering their own notes.

I mentioned earlier that the Iatric rep produced a nice, concise elevator pitch. I also had a chance to meet CynergisTek CEO Mac McMillan, who was in the Iatric booth when I stopped by (the companies jointly offer an automated solution for monitoring access to patient data.) McMillan modestly shared that he is often an educational presenter on privacy and security for local HIMSS chapters and other professional organizations. I figured out later than he is actually chair of the HIMSS Privacy  & Security Policy Task Force, making him one of the authorities on the topic. I have thus added him to my list of HIT brushes with greatness.

NextGen had a smaller and more open booth than I recall in years past. It was so welcoming that I decided I needed demo, having not seen their EHR in a few years. NextGen has long had a reputation as one of the premier ambulatory EHRs, and rightfully so. However, I must say I was a little disappointed in the product. Graphically it looks dated. Even though the gentleman doing the demo – who did an excellent job – was able to move around the system quickly any time I asked to see a particular feature, it seemed as if it took at least three to five clicks to navigate anywhere. I understand that the EHR has a great deal of flexibility in its templates, but the basic patient summary screen seemed lacking. For example, the default view did not show a patient’s complete history on a single screen. You could click on tabs to see problems, medications, and other detail but at a glance you could not determine if the patient actually had any data attached to those tabs. For a specialist it might be work perfectly well but I can see how a primary care provider could become frustrated with the workflow.

Meanwhile, I checked out CareCloud’s new EHR and I must admit it looked beautiful. Navigation was very intuitive with lots of drag and drop options and a look and feel similar to Facebook. I think they are on to something. However, the product was just released in January and currently fewer than 100 doctors are on the platform. The current templates seem better-suited for primary care and my impression is that for now CareCloud intends to focus on the core product, versus developing features to address the needs of every specialty. I also noted a few product gaps, such as limited clinical decision support utilities (the rep said they are still deciding whether to build or buy that functionality.) I should add that a doctor friend of mine looked at the product as well and was very impressed with the functionality, though was concerned that the company is still relatively young.

Most of the booth “gimmicks” weren’t too original: photo booths, money booths, spinning roulette wheels for prizes, etc. The give-aways included Kindles, iPads, Starbuck gift cards, and cold hard cash (my favorite, though I didn’t win any.) I’m happy with my $5 Starbucks gift card, courtesy of Emdeon.

I suppose I knew this before, but after hearing a few MGMA-led sessions, it’s obvious the organization spends considerable time and effort lobbying for its members in Washington.

MGMA reports total attendance was about 5,100, including representatives from 356 exhibitors. On Monday I inadvertently Tweeted that attendance was 51,000 (what’s an extra zero here and there?) and was horrified the number was re-Tweeted multiple times before I noticed my error. Whoops.

I had forgotten about this picture. These mariachi guys provided some Sunday afternoon entertainment in the convention center. I have no idea why Ronald McDonald was sitting on a bench in the middle of the convention center (I didn’t notice a  McDonald’s), but he was clearly enjoying himself.

I think I have a small gal-crush on MGMA president Dr. Turney. Not only does she like shoes, she is a self-proclaimed “data geek.” Got to love that.

Kudos to Gateway for donating $5 to breast cancer research for every badge swipe.

Here’s the iPractice Group booth, which was one of my favorites for its openness and good use of a relatively small space.

MGMA published results of a member survey that found only 18 percent of group practices were participating in new Medicare payment delivery models or demonstrations. The lack of predictability in current Medicare payments is the primary barrier impeding practices’ ability to experiment in new payment models, while other practices note a lack of applicability to their particular size, specialty, or location. If a degree of stability returns to the Medicare payment system, 82 percent of practices say they’ll explore new payment and delivery models.

I took a peak at Intuit Health’s mobile patient portal app. Truth be told, Intuit had these fabulous foot massage chairs and I asked to sit in one. I was unable to see a regular demo from the massage chair so the sales guy handed me his iPhone and let me walk through it on my own. I wish my physicians had something similar for appointment scheduling, prescription refills, and sending secure communications. It was super easy to use. And the foot massage was incredible.

Intuit was not the only vendor offering patient engagement tools. I attended a session on healthcare social media with David Harlow of the Harlow Group and I believe he was the one who pointed out that new federal laws will continue to drive patient engagement. Not surprisingly both niche vendors and the traditional EHR/PM companies were promoting patient engagement options, including mobile versions.

I sat down for a few minutes with athenahealth CEO Jonathan Bush. He was his typical irreverent and rambling self – and happened to be wearing Batman cuff links. I will be writing up a separate summary of that conversation.

A few of the vendor announcements this week include:

• An ADP AdvancedMD survey finds that 74 percent of physicians do not feel they have control over the financial aspects of their businesses. In addition, over half see their patient count increasing.
• Almost half of the practices participating in a SuccessEHS survey report an annual loss of revenue in excess of $25,000 due to preventable denials.
• eClinicalWorks launches an all-inclusive RCM service that includes its eCW’s PM/EHR at a cost of 2.9 percent of monthly collections.
• Navicure adds 280 new practice locations in the third quarter of 2012 and increases revenues 30 percent from a year ago.

E-mail Inga.