News 6/12/12

HIMSS Analytics introduces the Ambulatory EMR Adoption Model to track IT adoption in more than 28,000 ambulatory facilities that are part of hospitals or hospital systems. Current data indicates that of the 9,247 ambulatory facilities currently providing data to the HIMSS Analytics database, 48% are paper-based (Stage 0), one-third are Stage 2, 1.2% are Stage 6, and none are Stage 7.

The 59-provider Ohio Orthopedic Center of Excellence selects eClinicalWorks EHR.

AHRQ develops an e-prescribing implementation toolset for physician offices that includes guidance on various implementation topics and offers tools to facilitate adoption.

Practice Fusion CEO Ryan Howard, along with the VC firm Founders Fund, invest $750,000 in seed funding for Ringadoc, a provider of virtual medical visits. The company will use the funds to build a new product offering for physicians to use directly in their offices.

drchrono announces it is incorporating iPhone patient payment processing and adding real-time patient health insurance eligibility checks to its iPhone, iPod touch, iPad, and EHR platform.

Health-e Connection, Arizona’s REC, adds Aprima to its list of Tier 1 status EHR vendors. As part of its Tier 1 commitment, Aprima will offer preferred pricing and provider education to REC members.

CareFirst BCBS announces that almost 60% of the eligible primary care panels participating in CareFirst’s PCMH program met 2011 quality and cost performance goals. The qualifying providers will receive increased fees for certain services starting July 1.

MGMA Health care Consulting Group’s Rosemarie Nelson provides a simple and easy-to-understand explanation of cloud computing for physician offices and outlines a few of the benefits, including lower start-up costs, less IT infrastructure requirements, and better data protection.

Speaking of the cloud, Forbes explores the rise of cloud computing in healthcare. athenahealth, eClinicalWorks, and Practice Fusion are cited as some of the more established providers in the market, while CareCloud is portrayed as the newer and more nimble player. Ryan Champlin (above), VP of operations for the physicians network at Cook Children’s Healthcare System (TX), offered this gem of a dig directed to Epic CEO Judy Faulkner:

“The question is: who is going to produce better health for a given dollar? I bet my money it’s cloud. Judy will say it’s crazy, there’s no track record, but stone tablets used to work well too.”

Today I happened upon this article about a “new breed of physicians” who text messages to patients, as well as track disease trends in Twitter and identify medical problems on Facebook pages. It reminded me that just last week I accompanied a family member to outpatient surgery and was thrilled when the surgeon offered his cell number and instructed us to text him if there were any questions or complications.  I ended having one little question, so I overcame my guilt for interrupting the doctor’s personal time and sent a quick text. Without the hassles of  phone tag, I had my answer in under a minute. Technology CAN increase healthcare efficiency.

E-mail Inga.

Healthcare Informatics 6/8/12

Healthcare Infrastructure Data Models

Let’s assume for a moment that the current craze surrounding EHRs is completely effective and every physician in America is meaningfully utilizing one in the near future (hurray for blind optimism!). There are two purposes for doing this, despite the numerous reasons that have been thrown out there. 

One is the public health motivation, where we can query all healthcare providers and come up with aggregated metrics to better understand the health status of those who seek care. This would probably be as close to real-time analysis that we can get to for a while. Post-analysis, we can provide better recommendations for best practices and get those implemented a lot faster than the current glacial pace. This is in fact why most other industries made the move to digital: to measure, analyze, and make improvements based on the analysis. 

The other PH motivation is for record portability. This one gets all the press, probably because journalists can tie it to the ‘P’ in HIPAA and it is one of those things the general public is generally confused about why this is not already possible in the first place.

Given these two purposes — aggregated counts and whole (or at least CCD) record portability — how are we going to achieve both at the same time? Three options have been knocked around for quite a few years and we’re finally getting to a point where they may be realizable. Needless to say, this is a very exciting time, but what are we getting ourselves into? 

In this three-part series, I’ll be taking a look at the top contenders, but I will warn you that the answer/the solution is always a combination of the options available.

Option 1: The Centralized Repository

All data gets sent to a single local database which then gets passed up to a larger database and so on and so forth. Honestly, I think this is the model that a large number of people assume will be put in place when we talk about “information” or “data.” Yet keep in mind this is not how the Internet works. 

This more replicates the mainframe days of yore or a wagon wheel metaphor, where the information all flows to the central axle. Visually it is clean, but perhaps not in line with today’s infrastructure reality.The big positive of this model is that it would be insanely easy to analyze the data out of the database and to send aggregated numbers up the chain.

Public health departments generally work from disparate registries that are nothing more than centralized repositories specific to their concentration (i.e. cancer, vaccinations, STDs, etc.) This is why you send your vaccination data to the state vaccination registry and not just to the public health department’s main office. 

So why not just have a big ol’ relational database that everything gets sent to and pull what you need from there? The allure of easy analysis is probably why the ONC has started a number of Beacon Programs across the nation. The negative is that… well, no one really trusts the government to do these sorts of things.

Additionally, record sharing between these centralized repositories is still a bit of a hang-up. The Beacon Program in SE Minnesota, for example, connects various healthcare organizations through an HIE and the NwHIN to pass records throughout the area in addition to dumping everything into a centralized repository.

In the end this, model embodies a Bon Jovi song, only putting us halfway there. Analysis: yes. Record portability: no.  

Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s’s Medical and Practice Management Suite and EHR design and development.

News 6/7/12

New York Governor Andrew Cuomo announces a new drug reform law requiring all prescriptions, including most controlled substances,  to be electronically transmitted.

CareCloud names Joseph P. Sawyer VP of marketing. Sawyer most recently served as VP of marketing at tele-health provider American Well.

Earlier this week eClinicalWorks CEO Girish Navani and staff served ice cream to employees who donated food and other comforts of home for the troops. Staffers from eCW’s Westborough, MA office brought treats ranging from candy and cookies, to magazines and Dr. Scholl inserts. Like.

PDR Network announces that it has strategic partnerships with 18 EMR vendors representing 75,000 EHR prescribers and 250,000 additional end users.

Consult A Doctor introduces iDr 24/7,  a telemedicine app for the iPhone that instantly connects mobile users with board certified physicians. iDr 24/7 is an extension of Consult A Doctor 24/7 services, which include doctor consults by phone, email, and video.

Practice Fusion releases a 10,000  record HIPAA-compliant dataset and launches a data challenge to solve public health issues. Winners of the challenge are eligible for up to $20,000 in cash prizes, plus beta access to Practice Fusion’s API, Dell Computers, and consultations with Practice Fusion’s founders.

E-mail Inga.

News 6/5/12

EHR/PM provider SuccessEHS acquires Integrated Physician Services, a provider of RCM, business services, and consulting.

Christie Clinic (IL) selects eClinicalWorks for its 150-provider practice.

The flow of money to providers for their Meaningful Use of EMRs continues. Through the end of April, Medicare paid eligible physicians $953 million in incentives, while Medicaid has issued an additional $736 million. The government has paid EPs and hospitals a combined $5 billion since the program’s inception.

I can’t decide if this headline was intentionally tongue-in-cheek or just an unfortunate choice of words.

Six-provider Alpine Orthopedics (MT) selects ChartLogic’s EHR Suite.

If you read HIStalk, you may have noticed a recent request for participants in a new HIStalk Practice Advisory Panel. If you are a practicing physician or work in the ambulatory space, and willing to respond to a few e-mail questions every month or so, let me know. The questions will focus on product issues and needs, cool technology in use at your practice, and other issues affecting physician offices. If you have the occasional few minutes to spare now and then, please e-mail me.

Physician offices added 9,900 of healthcare’s 32,800 new jobs in May.

The Wyoming Department of Health partners with Medical Informatics Engineering to offer Medicaid providers a free, certified EHR solution.

EHR provider Spring Medical Systems introduces SpringCharts PM, which will integrate with SpringCharts EHR. I quickly looked at Spring’s Website and surprisingly found no mention on SpringCharts PM, but did notice the company partners with at least four PM vendors.

Consumer Reports collaborates with Massachusetts Health Quality Partners (MHQP) to offer a rating service for Massachusetts’ 500 primary care physician groups. The ratings are  based on surveys conducted by MHQP over the last 12 years and consider physician communication, care coordination, and patient willingness to recommend their doctor to friends and family.

E=mail Inga.

DOCtalk by Dr. Gregg 6/4/12

Blnk – Bridge Between Clinical Labs and Point of Care 

Anybody heard of Blnk Medical Technologies, whose tagline is “Bridging the Gap Between Clinical Labs and Point of Care?” I did an HIStalk search and didn’t come up with any results. Looked like something Mr. H might really dig.

I came across them from a recently new acquaintance, Marcelo Cardarelli MD, MPH. He and I connected via the Hispanic Healthcare Leaders Network on LinkedIn. (No, I know I don’t look Hispanic…and I’m not. I was asked to join by a colleague related to other work I do. Nice group of people, though, who’ve been very kind and helpful.)

Marcelo responded to an ask I placed for some medical content Spanish translation verification help. We’ve e-mailed numerous times in recent months, but one he sent recently week caught me a little by surprise.

He said he had been Googling about looking for info and contacts for a startup company he’s involved with. He was searching “Health Information Exchange” and my name popped up. He wrote and asked about my connection to CliniSync, the HIE from the Ohio Health Information Partnership. I responded and also asked about his startup. To this query, he replied with the following (I doubt he’ll mind if I quote him here):

With the help of former University of Maryland colleagues (smarter than myself), we developed a bedside monitor for critical laboratory values to be used on ICU and ED patients. It has the capability to connect directly to a hospital Lab Information System (or to a Health Information Exchange) with an HL7 interface. It displays the data as added value information, trended for 48h, color-coded, in fish-bone format, etc. without login in over and over. It is always on, runs over Wi-Fi and it looks (and works) like a vital signs monitor.

I used it on my own cardiac surgery patients for 2 years and then we licensed the technology from the University and partner with them on our startup.

We are contacting HIEs in different states because we know that sustainability will become an issue. We have the financing to provide a monitor for every ICU and ED bed, plus servers and installation at no capital cost for the hospitals. Our business plan is based on a service or license fee per user (or rather per patient). There is a formula but it turns out to be a single charge of around $10 per ED admission and $10 per ICU patient. We work with HIEs to deploy it in the particular state and we share a part of the profit on a minimum 5 year contract. Longer contract = larger share of the profit for HIE. Maryland, North Carolina and Delaware are working with us to see how we can make this work for them.”

Marcelo’s got lots of street cred including a Masters in Public Health from Johns Hopkins University. You can see more about him here. I love one of the lines there about his interest in “the development of disruptive informatics’ tools that will allow physicians working in critical care areas of the hospital to develop a true sense of ‘situational awareness,’ improving patient safety while reducing the cost of healthcare.”

I’m not a hospital-based clinician, but I still remember enough from my ICU and ER days in training to know that this looks pretty intriguing, even if you overlook the attractive monetary paragraph above.

I’d love to hear from any of you hospital-ians to get your take.

(A moment please: I hope that on the Memorial Day recently passed that each of you took time to reflect upon those brave men and women who have sacrificed more than many of us can imagine. I for one am very grateful for what they’ve given.)

From the trenches…

“There can be as much value in the blink of an eye as in months of rational analysis.” – Malcolm Gladwell

 

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).