Readers Write 5/15/12

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Health Informatics  [helth in-fer-mat-iks]: A Noun?
By Aaron Berdofe

Health informatics is a term that has garnered a multitude of definitions over the relatively short term it has been in use. Papers have even been written about it, positing definitions containing the synergistic relationship between the disciplines of medicine, operations management, human interaction, and computer science.  

They are all very complicated and important sounding, so I certainly don’t want to deride the academic effort that went into pondering the question of what health informatics is. But, having now completed all of my course work for the Masters of Health Informatics degree at the University of Minnesota, I feel obligated to offer an alternative.  

I am, in fact, now an expert at answering this question. My response has been whittled down from (a) a technical and philosophical lecture (did you know it was derived from the Russian word informátika?), which has eyes glazing over within the first few words, to (b) a succinct statement which induces a thoughtful, "Hmm" before moving on in the conversation.

I wish I could just say something simple, like "I’m a doctor," where people not only understand, but grasp the gravity of what you do. But I’m not one, so I cannot.  

Instead, I have settled for people being able to understand the general idea of what I have been pursuing higher education for and apply through my consulting career, but perhaps not quite being able to connect to how it relates to them.  This remains true even of people within the healthcare industry.  If a little mystery is what makes a man attractive, I am unquestionably worth a second look.

My definition is this:  health informatics is a study of the flow of information through healthcare and how that information is used. Do we deal with computers? You bet we deal with new-fangled technological tools! However, technology no more defines an informatician than a wrench does a plumber. Thus, why I don’t like to include it in my definition.  

The emphasis should be on the information, not necessarily the mechanisms that sometimes help it move.  Is health informatics a multi-disciplinary field?  Certainly, but so was everything else at one point or another. Health informatics is a new field that is diligently integrating itself into healthcare.

Right now, the industry is focused on obtaining clinical information with carrots and sticks (I’m looking at you, Meaningful Use!) through EHRs. Yet the dirty secret is that EHRs can’t actually be proven to be useful in terms of ROI, improved patient safety and outcomes, or practice efficiency. And it’s not the technology that is the problem. Creators of EHRs don’t know what problem their technological solution is trying to solve, but we’ve all agreed that the processes of healthcare should advance themselves into the digital age.  

Therein lies the problem that health informatics will have to solve.  How do we adjust the flow and processing of information throughout healthcare to improve the lives of patients and make it a sustainable business? This question is why I’m in health informatics.  

Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s medical and practice management suite and EMR design and development.

News 5/15/12

The AMA asks CMS to consider an additional one-year delay for the transition to ICD-10. Last month, HHS issued a proposed rule that would push the deadline back from October 1, 2013 to October 1, 2014. AMA believes that overwhelmed physicians need a deadline no sooner than October 1, 2015.

e-MDs hires former CO-REC director Robyn Leone as director of public policy and government initiatives.

Barrington Orthopedic Specialists (IL) selects NextGen’s EHR, PM, Portal, and other solutions for its 15-physician practice.

The percentage of doctors using tablets has nearly doubled since 2011, with 62% now claiming to use of some sort of tablet device. The Apple iPad is the preferred device for 81% of the tablet adopters.

ChartLogic announces that six orthopedic groups recently selected ChartLogic EHR Suite.

Twelve orthopedic and radiology practices select Merge Healthcare’s specialty EHR products.

KLAS takes a look at SaaS ambulatory EMRs, which are becoming more popular for providers who want minimal upfront cost and less IT involvement. Overall satisfaction scores were close for the top six vendors: CureMD, Practice Fusion, athenahealth, MIE, MedPlus, and Sevocity .

The 91-provider College Park Family Care Center (KS) contracts with eClinicalWorks for EHR.

A Texas ED doctor develops HealthCareWaitTime.com, a site that allows hospitals and physician offices to post patient wait times online and gives patients the option to schedule appointments and communicate securely with their providers.  Interestingly, Dr. Harvey Castro has developed more than 30 medical smartphone apps over the last few years.

The AMA submits a letter to CMS, asking for less-aggressive criteria to achieve Meaningful Use. Some of the specific suggestions:

• Give physicians the ability to opt out of requirements that don’t apply to their routine scopes of practices
• Limit requirements to actions within a physician’s control and not rely on patients or other third parties’ use of technology
• Eliminate penalties for not meeting MU standards by October, 2014.

Here’s something fun to kick-start your week. Nuesoft creates a parody of Jay-Z’s “99 Problems” to highlight physician frustrations with the ICD-10 transition. If you’d like to be a music video star, Nuesoft is soliciting additional video clips and photos to be edited into the above video.

E-mail Inga.

Practice Wise 5/13/12

IT Investment is Necessary

You’ve picked your EHR software. The vendor likely has provided you with a document outlining the hardware and network specifications needed to support your software. That’s just the beginning of what you ultimately need. It’s easy to be overwhelmed by the technical information about expensive hardware and network purchases and the plethora of individual computer choices. Don’t let overwhelm of the moment cause you to make decisions you don’t fully understand.

You are not alone in your inability make these decisions. That’s how many independent medical practices feel when they buy their EHR and then have to buy the hardware to access and optimize their software. They rely on their software and network support vendors to help them make the right choices for them. From an IT standpoint, this is a hard thing to advise people on, there are so many choices and reasons why some choices are better than others.

Starting with the individual computers, the most common question I hear is, “Should we buy tablets or laptops or full workstations? Thin clients for FAT clients?” Each of these has its pros and cons. There are many factors to consider, these are a few that are driven by individuality vs. technical specifications:

Providers and Clinical Staff

How mobile is their position?

• Nurse/MA: highly mobile, rooming patients, charting, ordering tests – they might be better served with a laptop or tablet.
• Provider: will they chart in the exam room, at a central workstation or go back to their office between encounters? Laptop or desktop purchase based on their individual charting preference, sometimes both are in order.

You want portability. You decided to use laptops. Now which ones? Weight is one of the defining factors for this choice. If you care carrying the machine around all day from room to room, you don’t want to be lugging an 8-pound, 15 -17” laptop.

• Consider an ultra-book. There are several good models on the market with solid state drives that are very light and quick to start up.
• Battery used to be the big decision point, but even those with ‘long life’ batteries end up plugging in throughout the day, so this is less of an issue than we once thought.

You need touch screen or full tablet handwriting capabilities.

• Pure tablets are light and portable, but screen real estate is small. Will the amount of charting and the functionality of your EHR bode well in that environment?
• Convertible tablets, heavier than the ultra-books, are an option for greater screen size than some pure tablets.
• Touch screen laptops. Some are lightweight and give you the option to click your screen and type without rotating the monitor position. Look for solid state drive machines for better performance. These are a good happy medium.
• There are straps that you can put on the base of the laptop/tablet that allow you to slide your hand between the strap and machine, providing a little bit of stability when holding the laptop in one hand and typing or writing with the other.

Front Desk, Billing Department, Admin Users

Stationary workstations work best – thin or fat clients.

• If scanning and taking webcam photos, fat clients work best in the long run. I know, I know — great tools such as remote scan exist, but they are not problem free.
• Consider dual monitors for the billers/payment posters.
• USB ports on the front of machines for ease of accessing temp file shares such as thumb drives.
• Do you need CD/DVD drives for providing electronic chart copies to patients to meet Meaningful Use?

Proactive network support is the biggest decision that is most often overlooked and under budgeted. I don’t know how to convey to small and medium practices that they need to bite the bullet and understand that IT is a sunk cost, and plan for it in their monthly budget. When you were running PM software only, although it was not best practice, you could get away with using your IT vendor for break/fix service calls and new hardware purchases. Now that you are running EHR, you can’t afford to not have a managed services contract with your IT vendor.

Short- and long-range plans for software upgrades and license management, hardware replacements, and ongoing patching and monitoring are all essential elements in maintaining your EHR. Items to consider in your managed services contract:

Asset Management (Both Software and Hardware)

• When Microsoft products upgrade, how long will your versions be supported? How quick is your EHR vendor to develop their product(s) to the latest versions available? This was a big issue with operating systems such as Windows XP. When it was no longer available, clinics needed to buy a new hardware and the EHR didn’t support Windows 7 (or the next versions going forward). Proper asset management includes plans to replace the operating system with any other underlying software that your EHR needs to run in conjunction with your EHR upgrade roadmap.
• Hardware that exceeds its warranty period. How easy will it be to obtain replacement parts? Most hardware vendors do not maintain inventory on outdated parts, forcing you to upgrade your hardware, which can be problematic when it is unplanned. Plan on replacing hardware around the time your warranties expire. The good news is that three years used to be the standard warranty period and most vendors are offering 4-5 year warranties on bigger hardware purchases such as servers.
• Patching and updates. Without someone paying close attention to the regular updates pushed by the software and hardware vendors of all your assets, you may miss vital high priority updates that put your organization at risk for down time, security breaches and data loss.

After 12 years doing this work, I continue to be astonished by the number of groups that don’t see the value of IT managed services contracts. Your EHR is the heart of your business, which is often a multi-million dollar business that supports the livelihood of providers, staff, and their families, as well the care of thousands of patients. Yet in order to save money on the front end, they are willing to risk losing their network and/or data. This is shortsighted thinking that I hope will not prove catastrophic to you in the end.

I’m not your IT vendor and have no financial gain in your decision, but I urge you to review your current IT management solution and get on a proactive managed services plan if you are not already on one.

Julie McGovern is CEO of Practice Wise, LLC.

News 5/10/12

e-MDs reports a 20% increase in revenue and a 10% increase in employee count over the last year. The company also says it was profitable for 2011, maintained cash reserves, and invested nearly 40% of its annual revenue into R&D.

CalHIPSO reports that over 7,700 enrolled providers are in various stages of EHR implementation, including 210 that have demonstrated MU. The REC also says it has initiated a second round of EHR vendor selection, building on its initial group of seven vendors.

Northeast Georgia Physicians Group selects Phytel’s Atmosphere platform to help transform its 30 ambulatory care clinics into PCMHs.

MHMD, the physician network of Memorial Hermann Healthcare System (TX), begins work with TransforMED to transform six of its medical practices into PCMHs.

The 17-physician Florida Cardiology selects dashboardMD to provide evidence-based PM management services, including BI dashboards and healthcare analytics.

Advanced Data Systems collaborates with clinical laboratory LabXpress to offer an orders and results interface between ADS’s MedicsDocAssistantEHR and LabXpress.

athenahealth earns the #4 spot on Forbes annual Fast Tech 25 list of “growth kings.” Quality Systems, the parent company of NextGen, was ranked 19th.

ONC launches the Health IT Dashboard, which presents key information about the impact of federal policies and programs related to HIT. I like pretty graphics, and this one detailing key performance indicators for RECs caught my eye. Although according to the numbers at the top, only 11% of providers enrolled in RECs have demonstrated MU, leaving me to wonder how that compares to the original goals of the ONC and RECs.

Sermo reveals that its Real-Time Medicine Mobile App for Physicians accounts for 45% of total traffic on its platform. One of the app’s most popular features is iConsult, which allows physicians to take or add a photograph at a patient’s bedside and ask for opinions from relevant specialists. Sermo says 77% of iConsults are answered within an hour and often as quick as one minute, with each inquiry averaging 12 responses.

ONC releases a handbook for physicians and their practice staff that discusses the importance of privacy and security to EHR MU and how to integrate best practices into daily operations.

Physician social networking site Doximity appoints Linked-in co-founder Konstantin Guericke to its board of directors.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

News 5/8/12

Allscripts’ Board of Directors approves a Stockholder Rights Plan that would allow stockholders to buy Allscripts’ common stock at a 50% discount in the event of a hostile takeover attempt. Allscripts says the move was not done in response to any current hostile takeover attempts, and, the current stock price does not adequately reflect the company’s long term potential. The plan effectively means management has to approve any takeover, which seems to favor the management team over shareholders. Perhaps a hostile takeover that includes a premium share price might be more financially beneficial in the eyes of some stockholders.

Apex Medical Group d/b/a Nephrology Consultants (TN) agrees to pay $4.36 million to settle allegations that it submitted false and fraudulent claims to government health programs through a pattern of up-coding for various physician services or billing for services never rendered. The case stems from a whistleblower lawsuit filed in 2005 which alleged that the physician owners-managers inaccurately filed claims to Medicare and TennCare for a variety dialysis services. The owners settled without admitting wrongdoing. The whistleblower will received over $400,000 as part of the settlement.

Emdeon acquires TC3 Health, a provider of cost containment solutions for healthcare payers.

Southern Brain & Spine (LA) selects SRS EHR for its 10 providers.

RCM provider PracticeMax acquires KLO Professional Billing, a provider of billing and PM services for physician offices.

The 25-doctor Valley ENT (AZ) selects ChartLogic’s EHR Suite.

Bloomberg Businessweek profiles eClinicalWorks CEO Girish Navani and his company’s community analytics offering, which provides reporting, alerting, and messaging capabilities for population health management. Navani, by the way, predicts eCW’s 2012 revenues will hit $250 million.

Physician offices added 5,500 of the healthcare industry’s 19,000 new jobs in April.

The AMA issues a reminder to physicians that June 30, 2012 is the deadline to report on at least 10 electronic prescriptions to avoid the 2013 Medicare e-prescribing program penalty. Physicians unable to meet the program requirements can apply for a hardship exemption by June 30.

E-mail Inga.