Joel Diamond: The Year in Review

It’s that time of year. Every legitimate news outlet airs or publishes its “Top Stories of the Year” piece. Since I’ve yet to see a good one for healthcare IT, I thought that this would be the time to start a new tradition here at HIStalk. So without further ado, I bring you the six most compelling news events as related to our industry in 2012.

US Doctors Accept Payments to Use Electronic Records

In one of the top stories this year, a widespread bribery scandal continues to unfold. It is now evident that millions of dollars have been slipped into the pockets of soiled white coats, outdated sport jackets, and questionably needed scrubs throughout the nation. 

Investigators confirm that these payments were made to a group calling themselves the “Eligible Providers,” apparently putting the lives of patients lives at risk by coercing doctors to use computers in their practices. 

One of the ringleaders in the bribery scandal, Farzad “The Enforcer” Mostashari, was heard in a federal wiretap saying, “Yeah, this year they should accept our generous offer, if not they will be payin’ us… big time. After that, we start breakin’ kneecaps.”

Justice Department officials have estimated that upwards of 45 percent of US physicians have heroically rejected this extortion, but fear that those numbers may be dwindling.

Meaningful Use

In a shocking blow to physician autonomy, new draconian regulations threaten to bring an otherwise efficient healthcare system to its knees. One of the more controversial requirements includes forcing doctors to record rarely-used data such as patient vital signs, allergies, and medications.  An unnamed spokesperson for the AMA is quoted as saying, “This kind of needless oversight is unconscionable. What’s next? Making us keep a list of current medical problems?“  

Jack Meihoff, chairman of the Center to Promote Continued Medical Errors, says the legislation is illegal. He adds, “If the Founding Fathers intended doctors to e-prescribe, then why did they sign the Constitution with a feather pen?” 

It appears that the new rules don’t stop here. Rumors are spreading in Washington that new legislation might require providers to care for patients with chronic diseases using well-established guidelines.

ICD-10 Delayed

ICD-10 was endorsed by the Forty-Third World Health Assembly in May 1990 and came into use in WHO Member States in 1994. It is therefore not surprising that implementation has been further postponed to 2014. 

Using an odd analogy, Ben Dover, spokesman for the Central Association of Hospital Organizations Not Enough Standards (CAHONES), says, “After 22 years, it’s kinda like a 400-pound guy losing 30 pounds after getting a lap band. Who’s gonna notice?”

Elected Officials Agree — US Healthcare is Expensive, But You Get What You Pay For

The election year was marked by misstatements, exaggerations, and outright lies on both sides. But here’s one thing that Republicans and Democrats have no disagreement about. Our growing fiscal crises need not be concerned with healthcare because our system has its priorities in order. 

For instance, amongst OECD member countries, the US again ranks among the worst for strokes, heart attacks and infant mortality. But this year, it’s #1 in the number of MRI machines.

Black Friday Shopping Frenzy Leaves Dozens Dead

After sleeping out all night in the frigid Wisconsin air, hundreds of frenzied CIOs rushed the doors at the Madison EpicMart after Thanksgiving, hoping to be lucky enough land a new EHR this holiday season. Several people were trampled to death. 

“I don’t understand it,” said one shaken onlooker. “You can buy a system for millions of dollars cheaper. Why are these people doing this? I’m just trying to score a good deal on a flat screen.”

Meanwhile, Costco owners express satisfaction with the “steady but well-behaved shoppers” in the eClinicalWorks aisle.

ACOs Top CEO Wish Lists

A nationwide poll of top hospital executives shows ACOs edging out The Amazing Motorized Web Shooting Spider-Man Figure and the LEGO Hobbit Game as this season’s most sought-after gift. Retailers are bracing for heavy demand in the coming year as well. “We can’t seem to keep these ACOs on the shelf,” says one distributor. 

More concerning is that most new owners don’t realize the potential havoc their new purchase might cause once they get it home. A seasoned seller warns, “Don’t get any water on it, and never, never ever feed it after midnight.”

Industry insiders were stunned at the remarkable interest in ACOs. Many predicted that Big Data and the Furby would be the top sellers this year.

Seriously, I wish each and every one of you a very happy, peaceful, and most importantly healthy New Year.

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.

News 12/13/12

ONC advises Eligible Professionals (EPs) participating in the Medicare or Medicare 2012 MU programs that  that they must have completed their 90- or 365-day reporting period by December 31 to receive an incentive payment. Medicare EPs must complete attestation for the 2012 program year by February 28, 2013, but have the option to attest as soon as their reporting period is complete.

Also from ONC: analysts massage CDC’s recently reported EHR adoption numbers and conclude that more office-based physicians are using EHRs that have higher-level functionality to meet MU objectives. ONC notes that e-prescribing rates have more than doubled since 2009 and that two-thirds of physicians now use computerized tools such as electronic medication lists and drug interaction checks. The bottom line: MU is spurring EHR adoption.

ABQ Health Partners, New Mexico’s largest independent physician group, notifies an unspecified number of patients of a potential data breach following the loss or theft of a doctor’s laptop.

A Health Affairs-published study finds that ER usage is significantly lower for patients who have access to after-hours services with their primary care provider. They also have a lower rate of unmet medical needs.

The Orange County Register names Kareo a “Top Workplace in Orange County.”

Researchers find that overweight and obese adults may lose more weight when using a smartphone to track diet and exercise. Patients using a mobile device to record exercise and food intake, along with occasional phone coaching, lost an average of eight pounds more than those not using mobile devices to track behavior.

University of Utah Health Care offers online access to its database of 40,000 patient satisfaction surveys, including comments about its 1,200 physicians.

CMS asks physicians to provide feedback about the collection and use of patient experience measurements for Physician Compare, the consumer website that tracks and reports physician performance data.

HHS launches an educational initiative that includes online tools to help providers protect patient health information on laptops and mobile devices. Resources include videos, FAQs, and downloadable materials on everything from device encryption, stolen devices, and EHR access on mobile devices.

I haven’t mentioned this in a while, but we always welcome Readers Write contributions. The general guidelines: articles of up to 500 words in length, subject to editing for clarity and brevity. We only run original articles that have not appeared elsewhere and we can’t use anything that looks like a commercial pitch. For HIStalk Practice, we would be especially welcoming of contributions of interest to those in the ambulatory practice world. Everyone has an opinion or two on the HIT world that they are dying to express and we would be happy to provide you the perfect forum to share your musings.

E-mail Inga.

News 12/11/12

About 66 percent of office-based physicians will apply or have applied for MU incentives, according to a CDC survey, though only 27 percent of those have EMRs that can support the Stage 1 objectives of the 15 total. The 27 percent number sounds low to me, so I am wondering if (a) some respondents weren’t sure about the capabilities and certification status of their EMR, and (b) since the survey was done between February and July 2012, some practices may have been on an older release. EMR use by office-based physicians jumped from 48 percent in 2009 to 72 percent in 2012, though only 40 percent report having a system that meets the criteria for a basic system.

The Healthcare Information Xchange of New York recognizes Lansingburgh Family Practice with the Game Changer Award in recognition of its HIE participation, as well as MEDENT for connecting more practices to HIXNY than all other EMR companies combined.

Websites with health-specific content or services for physicians, such as Medscape, reach the highest percentage of physicians (81 percent) compared to other types of health sites. Though only about four percent of physicians visit EHR portals, doctors spend an average of 18 minutes on those sites versus 5.1 minutes on professional health content sites. The same report finds that physicians still use computers for work more than any other type of device, though most would like to use mobile phones and tablets.

Epocrates releases a native app for the iPad and iPad Mini tablets.

Rite Aid pharmacies will send patient immunization records to healthcare providers using The Surescripts Network for Clinical Interoperability.

MacPractice releases the MacPractice Check in App for iPad, a HIPAA-compliant app to automate check-in procedures.

ONC updates its Health IT Dashboard to include summary data on the EHR incentive program. It’s not really new data, but the maps and graphs are interactive and fun to manipulate if you like that kind of stuff.

By the way, EPs have collected about $223 million in EHR incentives from Medicare and Medicaid through the end of November.

e-MDs and eClinicalWorks join Orion Health and ICA to fund the country’s first HIE laboratory at the University of Texas at Austin.

DrFirst announces Akario, a free secure clinical messaging system for providers.

KLAS says it will announce its top-ranked software and service vendors for 2012 on Friday, December 14.

E-mail Inga.

DOCtalk by Dr. Gregg 12/7/12

The Center Scepter of Healthcare

I recently attended the Ohio Patient-Centered Primary Care Collaborative (OPCPCC) Fall Conference (which is, I suppose, the OPCPCCFC, for those keeping acronymic records). It was an entire day of people from all across the healthcare spectrum talking about putting the consumer at the center of their healthcare world.

Isn’t it rather strange that we have been dealing for so long with a system of healthcare that has placed everybody but the consumer at the center?

Oh, sure, providers have always needed consumers (i.e., “patients”) in order to have subjects upon which to “practice.” But, we providers of healthcare services traditionally presumed that we held the rights to the center of healthcare provision. Provider training has long included, either overtly or subliminally, the concept that we held the scepter in the Land of Healthcare. (We even built an ivory tower within which to wield it!) We were the ultimate power, the primary axle around which healthcare spun.

But then the costs of healthcare provision grew so awe-inspiringly that it was perhaps unavoidable when the moneymen and their bottom line mentalities began to think that they held the rights to the center of the healthcare world. Thus, in recent decades, there was a fairly successful usurpation of the healthcare focal point by the “moneychangers.” Indeed, the whole healthcare system is built upon the wallets of healthcare consumers, but it is the middlemen who control the ebb and flow of these dollars (i.e., the IRS, CMS, third-party payers, employers, and such). It is they who have usurped the crown. They now own the center spot.

More recently, though, we’ve added yet another middleman to the mix, another axle within the axle around which healthcare delivery revolves: health information technology. Some of these HIT/EHR companies, as handlers or carriers of healthcare data, imagined that they could make a rightful claim to ownership of that data. They did so, of course, knowing that whoever controls the information controls the money. (This concept that controlling the data allows for access to, and control of, the flow of healthcare funds was always apparent to the moneychangers.) The HIT middlemen sought to wedge their healthcare data facilitation role into a stakeholder’s position at the center of the healthcare realm.

However, this additional claim to healthcare’s royal center by the techno-centric junta seems to have brought attention to the notion that a consumer’s healthcare data might actually belong neither to the consumer nor to the provider, but to the middlemen. When HIT tried to stake its claim to this power position, the absurdity of anyone other than the consumer owning ultimate rights to the information about their bodies and their health seems to have become clearer.

In fact, the notion that healthcare providers own a consumer’s health data now seems arrogant with this added clarity. Sure, providers assess the health status and assemble and compile the data, but ultimately the data is intimate to one stakeholder and one stakeholder only – the consumer. Everyone else is but a pretender to the crown.

The patient-centered medical home (PCMH) model that is gaining wider and wider recognition now is basically a returning of the scepter back to the one rightful and true heir to throne of healthcare – the consumer. After all, the individual is the ultimate source for the health we’re all discussing, right? Their lives are the headwaters for this whole industry, no? Aren’t they the real center, the ones about whom we’re all exchanging data and trading futures?

And, by the way, aren’t they – the consumers of healthcare – us?

From the trenches…

“America’s health care system is neither healthy, caring, nor a system.” – Walter Cronkite

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).

News 12/6/12

athenahealth agrees to pay $168.5 million for the 11-building Arsenal on the Charles complex owned by Harvard University, including the two buildings that currently serve as the company’s headquarters. The property includes 760,000 square feet, including 100,000 square feet currently unoccupied that athenahealth can take over immediately.

Field service technicians for Vitera Healthcare Solutions will transition to DecisionOne, an independent technology support organization. Vitera says DecisionOne will assume the hardware infrastructure and support operations for its clients nationwide. The company also notes that it has added more than 270 employees this year and anticipates filling another 200 positions.

Vermont’s eight FQHCs activate EHRs from Allscripts, eClinicalWorks, McKesson Practice Partners, GE Centricity, and NextGen with assistance from the Vermont Information Technology Leaders and Bi-State Primary Care Association.

NoteSwift announces the availability of NoteSwift for Amazing Charts EHR, which works with Nuance’s Dragon Medical Practice Edition.

Martin’s Point Health Care (ME/NH) selects athenahealth to provide EHR, billing, PM, and care coordination services for its 90 providers. The group will also use business intelligence services from Anodyne Health Partners, an athenahealth company.

An Annals of Internal Medicine article suggests that interactive alerts from clinical decision support systems improve outcomes for HIV patients more than static alerts.

EMR vendor Modernizing Medicine raises $12 million in Series B financing to expand into the orthopedic and ENT markets.

A JAMA article finds that the average dentist now out-earns the average physician ($69.60/hour compared to $67.30/hour.) Between 1987 and 2010 the average physician’s salary grew 9.6 percent compared to other health professionals’ average salary increases of 44 percent.

A Black Book survey reveals that 87 percent of e-prescribing providers believe that use of e-prescribing technologies will reduce prescription fraud; 84 percent say e-Rx has a strong effect on therapeutic decision-making; and, 92 percent think it facilitates better decision-making. Practice Fusion earned top honors in customer experience and satisfaction among EHR-based e-prescribing module users and DrFirst was the top stand-alone vendor. Emdeon was recognized for outstanding developments in clinical exchange solutions.

E-mail Inga.