DOCtalk by Dr. Gregg 3/18/12

Between Heaven and Earth

L-L-L-L-LET’S GET READY TO RUMBL-L-L-L-L-LE!!!

In the main HIT arena …weighing in at a hefty XX pounds …with more paper system knockouts over recent decades than current scorers have been able to track …the current world champ for health information technology …. LOCAL ”HEAVYWEIGHT” HOSTI-N-N-N-N-N-N-G!!!!

And, the challenger …tipping the scales at ….well, no one’s really sure how much a cloud weighs …with a nearly perfect record in just over decade (or just under depending on who’s keeping the scorecard) …the number one contender … CLOUD ”FLOAT LIKE A BUTTERFLY” COMPUTIN-N-N-N-N-N-G!!!!

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In a fun verbal match the other day, I was sparring with one of my mostest favoritest ever tech support gurus over the value of local hosting for HIT versus the developing wave (some might say tsunami) of cloud-based services and tools.

His opening shot was that cloud-based services were great for certain things, but not so much in the world of health.

I countered that cloud-ed services and tools were so end user friendly, especially for us onesy-twosy docs, as they’re much easier on our limited tech support capacities and paycheck-to-paycheck incomes.

His shot to my right kidney was that if your Internet access goes down, you’re hosed.

I covered with my right elbow and the fact that redundant Internet access avenues could almost always allow a quick reconnect to Web resources.

Starting a ringing that continues in my left ear today, he connected with an uppercutting, “Even though cloud server farms are redundant and backup generators with stored fuel are on hand to last for weeks, it has occurred that cloud services have gone dark, even for some techno-giants.” He landed with his “Complex systems have complex failures; that’s cloud computing” quote.

I tried to protect my head with a rising left and a “Being prepared for when the cloud REALLY fails” reference along with the fact that there are clouds that can protect clouds, like Backupify, (though it isn’t designed to do any of the cloud chores we were brawling about).

He shot a roundhouse from the right. “It may be OK for some companies to be down for a bit, but are you OK with the possibility that you could go down? I mean, it sounds good for the vendor to say ‘We have a 99.9% up time,’ right? But, that small percent becomes humongous if it happens to you in the middle of a busy practice. What if you have no access to any patient data for an hour, two, maybe a day or two?”

I gave him a fairly feeble body blow with my, “Well, we just pull out the old pencils and paper and struggle on the old-fashioned way for a bit. We still remember how to write”

Jab, jab…”That may be OK for you as you’re just one guy, but what if you had several or dozens of providers? If the disconnect lasted for any length of time, like with Microsoft’s Azure failure last month, that could lead to a whole heap of data re-entry and a whole lot of ‘best guess’ health provision with clinicians unable to access relevant patient data during those interim pen-and-paper patient visits.”

Bob, weave, duck and cover…”I guess I can’t answer for everybody, but from the cost and upkeep involved with local hosting, it’s gotta be easier and more cost-efficient to live life in the cloud. Sure, I do really like knowing I have my patients’ data right here in my office, but it’s not as if I haven’t had our own server troubles. I mean, we’ve had downtime, too. ”

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I had to get back to patients, so the call, and the bout, ended. Judges scored it 10-9, 9-10, 10-10: a draw.

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However, it led me to an idea, probably springing from my ever-growing “app me, baby” orientation: Why couldn’t there be a middle ground, something between the cloud and the local host? Why couldn’t there be an app that would, if my cloud turned dark or Internet connection failed, allow me to continue to at least enter patient health and PM data into a local digital barebones skeleton? That local app could allow the temporary, locally-stored data to be extracted and directed into the correct slots in the real system once the Internet was back or the cloud had again become accessible (i.e., white and fluffy)…you know, without the pen-and-paper intermediary.

Sure, access to historical patient data might be temporarily unavailable, but back in the day I never put off a patient when their paper chart got misplaced. And, it wouldn’t have to be completely seamless; it might take a little personnel time to get the data swapped over. But, it would make it far less cumbersome than a paper-based backtrack. Such a local app could easily minimize the disruption to seeing patients, allow ongoing digital data entry, and facilitate data reconnect thus enabling the advantages of, and minimizing one of the objections to, the cloud for us little guys – maybe even for bigger folks, too.

This could be a real haymaker punch for cloud-based EHRs. Something between the cloud and the local host. Something between heaven and earth.

From the trenches…

(PS – I understand MediNotes used to have something similar, but that’s sort of moot, eh?)

“Sure, there have been injuries and deaths in boxing – but none of them serious.” – Alan Minter

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

News 3/15/12

KLAS looks at customer satisfaction by EMR specialty and identifies  internal medicine as the most satisfied specialty, followed by family medicine, pediatrics, and OB/Gyn. Ophthalmologists were the least satisfied. Of the fully rated vendors, Cerner and Epic were found to offer the most comprehensive and highly rated EMR solutions across multiple disciplines.

Thirteen employees of The Everett Clinic (WA) are fired on HIPAA violations and the practice is still investigating another 11 employees. The 400-physician practice reports that it suspects violations of 55 patient records, which were viewed by 43 employees; some employees, however, may have had a legitimate reason for viewing the records and may be cleared. The snooping employees were flagged by a newly installed electronic monitoring system.

Surescripts awards Pulse Systems its White Coat of Quality for prescription accuracy and completeness.

Sales of EMRs grew an estimated 14.2% in 2011, making it a $17.9 billion market.

Northwestern Health Sciences University (MN) selects BackChart EHR for its University clinics.

AHRQ proposes a 27-month, $793,456 information collection project focused on assessing how HIT affects the quality of care in small to medium-sized physician practices.

AHIMA, MGMA-ACMPE, and several other healthcare groups introduce informational brochures to promote the understanding and use of PRHs among consumers and clinicians.

Greenway Medical Technologies announces its first quarterly results as a publicly traded company: revenue up 30% to $29 million, EPS –$0.01. Shares closed Tuesday at $13.75, up from February’s IPO price of $10 but down from their high of just over $15.00 on March 1.

Medical billing and EHR provider Zeus Healthcare appoints Larry Havelis CEO. Havelis previously served as VP of sales for Quest Diagnostics and VP of sales for Allscripts.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

News 3/13/12

Walgreens announces that it will use clinical interoperability services from Surescripts to electronically deliver clinical summaries and immunization records to primary care providers and immunization reporting to state and local public health agencies.

OrthoKansas, PA (KS) selects SRS for its 12 providers.

Solo and small practices are outpacing larger practices in EHR adoption, with single-doctor office adoption growing from 31% to 37% in the second half of 2011. Overall EHR adoption rates are increasing as the number of physicians practicing at each site rises.

The 150-physician Holston Medical Group (TN) selects Humedica MinedShare as its clinical intelligence solution.

Physician offices added 9,500 jobs in February, according government statistics. The healthcare sector as a whole gained 49,000 jobs, including 15,400 in hospitals and 28,200 in ambulatory services.

The Michigan State Medical Society makes the DocBookMD secure mobile communication app available to its members at no cost.

American Medical News profiles the 39-physician Midwest Center for Women’s HealthCare and its use of EMR to join clinical trials to supplement the practice’s income. Having an EMR helps the practice identify potential research subjects in minutes and pinpoint the most common medical issues in the practice. The practice also relies on its EMR to capture and transmit research data.

Billing firm Medical Practice Management partners with HIT service provider Evolution Technology Group to form ClinicAnywhere.

Athenahealth reports that its final 2011 Stage 1 Medicare MU attestation rate was 85%.

AMGA takes a look at physician retention and finds turnover rates of 12.6% for PAs and NPs, compared to six percent for physicians. Practices use flexible schedules as a top incentive for physicians, with one in five male physicians and 44% of female physicians report working part time. In addition 75% of the AMGA groups report offering four-day, full-time work weeks. Physician retention is big business: turnover can cost as much as $1 million per physician, including costs for recruitment and start-up and costs from lost revenue.

I was intrigued by this story of 57- year-old allergist / immunologist Michael L. Steinberg, who made the unusual decision to shutter his 23-year-old practice and join the army. Economic conditions drove Steinberg to seek alternatives for keeping his practice open, but he wasn’t interested in the offers from health systems. After completing his basic training, Steinberg will become a lieutenant colonel stationed at Fort Knox.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

DOCtalk by Dr. Gregg 3/11/12

The eeMoment

eThis. iThat. Seems like anything even semi-associated with something digital or web-related has been given an uncapped vowel prefix, doesn’t it?

Well, I’ve got one more. With apologies to those who have used a similar term elsewhere – “eMoment” which is typically related to “e”ngaged teaching moments or “e”motional moments (also known as “emo-moments”) – I hereby declare a new term: “eeMoment”. (“ee” as in EEK!)

ee-Mo-ment: [ee-moh-muhnt] noun

1. the instant when one finally realizes that the tech tool they have been trying to use, be it software (e.g., EHR, Netscape, Windows?, etc.), Software-as-a-Service (e.g., Google Health, Netflix?, etc.), or hardware (e.g., Atari, Palm Pilot, Zeos PC, etc.) is now or soon to be dinosaurian

2. the instant one realizes that the rude and/or worthless tech support from any of #1 above has become completely and irrevocably insufferable

3. the instant one realizes that the vast quantity of money and/or inordinate amount of time invested in either #1 or #2 above has reached “OMG, OOH” status (i.e., Oh My God, Out Of Here)

I’ve had my share of eeMoments: some from days of yore, like with Windows ME or IBM’s ViaVoice; some more recent, as with my dear, loveable Palm Pre (RIP).

I had an eeMoment recently that made me think about all those other poor souls out there who are busily readying themselves – and spending huge sums of irretrievable monies – in blind preparation for some pretty monumental eeMoments of their own. To wit: rapid EHR choices and investments in companies who will be gone soon with nothing but the lingering echoes of their rabid cash-taking left behind.

Poorly designed EHRs, EMRs based upon dated technology that won’t last the test of techno-time (which is quantumly faster than standard time), systems that attract with glam and glitz but have no solid tech support touchpoints post-sale, and systems that “eat it” as they get “eaten” themselves in acquisitional feasts – these are but some of the eeMoment precursors which loom so ominously for more providers and hospital end users than I care to consider in the Meaningful Use frenzy of today.

It’s sorta sad, really. HITECH and MU have driven lots of EHR adoption. And that’s good (says the true digital believer in me). But, they’ve also carried with them the increased onslaught of impending eeMoments for many, many unsuspecting providers (even for some of us who are “suspecting” providers.)

What’s that? You wonder what was my recent eeMoment? I’m reluctant to say as I have friends I still admire and trust at the offending eeMomenter company. But, I will say that it was particularly sad for me as what had once, in my eyes, been a beacon of what’s good in “techdom”/”tech supportdom” has now become but another not-so-shining example of how sour the eeMoment can be.

From the trenches…

“The secret of life is honesty and fair dealing. If you can fake that, you’ve got it made.” – Groucho Marx.

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

News 3/8/12

From MeaningfulDoc “Re: Summary of Stage 2 Rule. Thanks for the link to the Stage 2 summary for EPs. Here is another I found, written by a couple of physicians.” John Crankshaw, MD and Jonathan Ploudre, MD publish a two-page interpretation of the rules on Ploudre’s www.Unchart.com Website. Ploudre is a self-proclaimed “Geek,”  an e-MD client, and a blogger who writes about practice improvement and technology.

The Visiting Physicians Association rolls out Aprima Medical Software’s EHR across its 30 offices and 170 physicians.

SynaMed partners with StenTel to combine StenTel’s clinical documentation solution with SynaMed’s EMR platform.

RCM company MediGain acquires MedOptima, a provider of RCM and PM consulting.

The Corvallis Clinic and Samaritan Health (OR) introduce patient portals, giving patients online access to their medical history, schedule appointments, and renew prescriptions.

Vitera Healthcare Solutions customer Southaven Internal Medicine (MS) becomes the first practice in the country to successfully submit PQRS measures for the 2011 reporting period.

US doctors charge two to three times more than their peers from France and Germany for the same services. Outcomes, however, are generally not better. Somehow I doubt US physicians are willing to slash their fees 50%  in order to be in line with other countries.

National Coordinator for HIT Farzad Mostashari, MD takes issue with the recently published study that found doctors having online access to patients’ charts ordered more imaging tests, leading to higher healthcare costs. Mostashari contends the study tells little about the ability of EHRs to reduce cost and nothing about the impact of EHRs on improving care. Other points:

• Since the study was based on 2008, “certified” EHRs were not yet in place. Certified EHRs require clinical decision support and the ability to exchange clinical data electronically. Thus providers were unlikely to be using advanced tools to make appropriate care recommendations.
• The study does not examine several factors which could impact physician behavior including the overall health of the patient population, level of physician training, approach to defensive medicine, and financial arrangements.
• The study did not consider the appropriateness of the imaging tests ordered.
• EHRs use can lead to improved care coordination and quality of care, which in turns prevents unnecessary and costly complications and hospitalizations. Reducing test orders is not the appropriate solution for cutting healthcare costs.

E-mail Inga.