News 3/6/12

From MUse “Re: Stage 2 for EPs. Don’t know if you have seen this but American Medical News has a good summary of how the proposed Stage 2 rule will impact eligible providers.” Thanks. The article highlights some of the major differences between Stage 1 and Stage 2 requirements for EPs, including the higher thresholds for several measures.

MGMA asks HHS Secretary Kathleen Sebelius to consider adding due diligence to the ICD-10 timeline and limit its required adoption to hospitals if possible.  MGMA also urges HHS to consider adding several steps to its timeline before making ICD-10 mandatory and include a cost benefit analysis, a pilot, staggered implementation dates, and an evaluation of alternate code set approaches.

Doctors having online access to patients’ tests in the ambulatory care setting are more likely to order imaging and lab tests, according to a Health Affairs-published study. Researchers found that point-of-care access to electronic imaging results were associated with a 40-70% great likelihood that an imaging test was ordered; the study also notes that women receive more imaging studies overall and that surgeons and other specialists are more likely to order imaging tests than primary care physicians.

TriState Neurological Surgeons (PA) selects the ChartLogic EHR suite for its 11 provider office.

SRS EHR customer Pediatric Associates of Savannah (GA) chooses SRS Patient Portal for its 10 provider practice.

Medical malpractice insurance company the Doctors Company reports that 30% of physicians have implemented EHR that Meaningful Use criteria, 14% intend to do so within the next three years, and 17% have no plans to use an EHR in their practice. The same survey of 5,105 finds that 14% of doctors plan to participate in an ACO, 57% are undecided, and 29% do not plan to participate.

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The 26-physician Radiological Consultants Association (TX) selects Zotec Partners to provide medical billing and practice management.

HIMSS and MGMA release an Ambulatory HIE Toolkit to educate physician offices on participation in health information exchanges. The toolkit includes details on business and financial models, leadership and governance, technical architecture, and value proposition.

Medical liability experts offer some tips for reducing liability risks when using EMRs. Pointers include: refrain from copying and posting EMR data; do not become overly dependent on electronic diagnosis tools; and, keep meticulous electronic notes and take time to document each patient encounter.

E-mail Inga.

News 3/1/12

Alexander Orthopaedic Associates (FL) selects White Plume Technologies’ AccelaSMART resolution engine to bridge the gap between its Exscribe EHR and ADP’s AdvancedMD’s PM system.

Speaking of ADP AdvancedMD, the company announces integration of its PM product with digiChart’s EHR.

The Association of Medical Directors of Information Systems (AMDIS) estimates that 27,000 EPs will attest for MU in 2012.

The South Carolina Medical Association makes DocBookMD’s smart phone communication app available to its 5,000 members at no charge.

Anesthesia Consultants of Indianapolis sign a multi-year billing services contract with Zotec Partners.

Practice marketing firm MedMarketer releases PracticeApps, a custom mobile app that interfaces with MedMarketer’s e-mail marketing product. MedMarketer charges a one-time $499 setup fee to design a practice’s custom app, plus $99 a month to host the app and provide e-mail marketing to up to 500 subscribers.

The AMA releases a how-to manual for evaluating emerging payment models.

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Black Book Rankings announces its vendor rankings based on customer experience. The top-rated systems include:

• Care360 Quest Diagnostics (single physician practices)
• ADP AdvancedMD (2-5 physician group practices)
• Aprima (6-25 physician group practices)
• Greenway Medical (26-99 physician group practices)
• MED3OOO (100-249 physician group practices)
• NextGen (250+ physician group practices)

Primary Health Medical Group (ID) and eClinicalWorks join the Idaho Health Data Exchange, which is powered by the Optum HIE platform.

In a Boston Globe interview, athenahealth CEO Jonathan Bush says that this is the year his company will reach the tipping point in becoming a backbone for national health information. Bush also gives this analogy to clarify athenahealth’s current position in the market:

Everywhere we’re a little, snippy kind of overconfident Chihuahua jumping up and trying to nip at the tails of the Dobermans.

Shareable Ink announces partnerships with Greenway, NextEMR, and VoiceHIT for its handwriting recognition technology.

Coastal Cardiovascular Consultants (NJ) selects SRS for its six providers, which the company says they chose instead of the alternative, a hospital-subsidized EMR.

The 100-physician Oregon Medical Group announces that 15 positions have been cut as a result of workflow changes stemming from the practice’s moved to EMR. Over the last year, the organization also added seven positions in IT.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

News 2/28/12

Thanks Dr. Gregg for keeping HIStalk Practice rolling last week while I was crazy busy at HIMSS. I love the annual conference, I am glad it only comes around once a year. Though the in-patient world is king at HIMSS, the ambulatory world was well-represented by such ambulatory-only vendors as eClinicalWorks, athenahealth, Practice Fusion, and Vitera. Marketing departments were working overtime churning out press releases, including much of the news below. I am still wading through my in-box but here are some of the more newsworthy items from last week.

eClinicalWorks announces Community Analytics, a data analytics solution for communities and ACOs that provides reporting, alerting, and messaging capabilities to manage population health. eCW also introduces its Care Coordination Portal for ACOs and PCMHs that ties into eCW’s or other EMRs. The portal is designed to enable care coordination and reporting and includes tools for care management, patient engagement, home-monitoring device integration, and transition of care plan management.  Finally, eCW announces that Greater Baltimore Medical Center expands its relationship with eCW to include the Coordination Portal and Community Analytics modules.

CareCloud appoints athenaheath’s former director of global corporate communications John Hallock as VP of corporate communications.

Radiology Associates of Atlanta selects Zotec Partners as its billing services provider.

Quest Diagnostics announces a 30-day EHR implementation guarantee to enable bi-directional data exchange between hospitals and ambulatory physicians using the Care360 EHR.

athenahealth is named to the 2012 TR50 Technology Review’s list of the world’s most innovative technology companies.

CVS Caremark’s MinuteClinic will transition from its proprietary EMR to AllscriptsMyWay EHR across its national chain of retail health clinics.  In addition, Humana subsidiary Concentra announces plans to implement Allscripts EHR at more than 310 Concentra Urgent Care locations across the country.

AT&T takes ownership and control over the AMA’s physician platform, which AT&T will integrate with its Healthcare Community Online HIE platform. Both the AMA’s Amagine platform and AT&T’s HIE run on technology created by Covisint.

Most physicians believe EHR use is valuable in improving quality and important to managing patient care, but less than half say EHR has not improved diagnosis accuracy or treatment planning. Cost and the burden of implementation continue to be the biggest barriers to EHR adoption. From the same Deloitte Center for Health Solutions study: only about 25% of physicians consider themselves on target to meet MU and 23% say they are unfamiliar with MU requirements.

Allscripts and MyCareTeam launch a diabetes management system that integrates the MyCareTeam application with Allscripts Enterprise EHR. The integrated platform allows patients to transmit their blood glucose readings from their glucose meters, along with vitals, to a database via the Internet.

A proposed rule would require physicians to return any improper payments within 60 days of notification and allow auditors to uncover overpayments as far back as 10 years from the date of payment.

InteGreat EHR earns BlackBook Rankings’ #1 spot for EHRs for physician groups with 100-249 physicians, as well as for EHRs for multi-specialty practices.

NextGen unveils its redesigned EHR that includes automated outcomes reported, enhanced disease management workflows, content for more than 25 specialties, and a new user interface. NextGen also launches its Performance Management suite for self-service analytics, NextPen for digital data collection, and NextGen Mobile.

Use of EHR computer-assisted decision tools can significantly increase identification, diagnosis, and counseling for overweight and obese children, according to a three-year study.

And in case you missed it, Mr. H prepared a high-level overview of the Stage 2 proposed Meaningful Use rules here.

E-mail Inga.

DOCtalk by Dr. Gregg 2/26/12

Home Alone 5

Breeeep…bzzzzz…bzzzzz…breeeep…bzzzz…bzzzz…breeeep…

You may have noticed the mournful silence around here the past several days. Not much but the sound of crickets to be heard here on the pages of HIStalk Practice.

The whole HIT world is currently focused upon the glam and glitz that is Vegas…er…I mean, the annual HIMSS conference…er…well, I guess it’s rather a moot point this year as they are pretty much twin entities. (Admit it: regardless of where HIMSS is actually holding its bacchanalia, there is a pretty strong resemblance between the HIMSS bash and the Vegas experience.) That focus includes the entire HIStalk ensemble who are working away in Nevada to keep up on all things HIMSS.

Back here on the home front this year, I’ve been fighting off intellectually challenged burglars, eating all the junk food I want, and watching whatever I want on TV until all hours of…oh…no…that’s not me. That was Kevin (as in the face-slapping “AAAAAHHHHH!” Kevin.)

Actually, despite the momentary twinges of envy I feel when I read about what friends and folks I know are up to in the bright lights and big city world of Vegas HIMSS, I’m finding it pretty cool to be watching from the home front this year. It allows a very different perspective than you can piece together amidst all the hubbub. Plus, thanks to all the hard efforts and late night typings of the goodly HIStalkers in attendance, I feel as if I’m gleaning all the best bits of HIT news, wisdom, and snark right here in the comfort of my cushy old armchair.

I guess the main reason I’m writing this is to talk to all those who didn’t make it to the Vegas strip this year. From being there in a too-much-information capacity before, I can tell you with a pretty fair surety that “watching” HIMSS from the pages of HIStalk gives you, by far, the best parts of HIMSS without the sore feet, hangovers, or aggravations of air travel and taxi stands. (OK, so you miss a lot of tchotchke…like you really need any of that?) The HIStalk gang provides all sorts of photos and insights and they let you skip over all the waste-of-space stuff. It’s even better than being there.

(Sigh)

OK, time for the truth. It’s a bit of a mixed bag. When you read how many sales folks prefer to keep their noses pointed toward their smart phones rather than engagingly towards the attendees and how some events, announcements, and HIMSS organizational choices leave a lot to be desired, it sort of does seem like skipping a year may be a pretty refreshing choice. On the other hand, HIMSS is full of fun and cool HIT people and all sorts of experiences you can’t get from the sidelines. The HIStalk folks do a TREMENDOUS job with their coverage and you really can get a good sense of the happenings from their above-and-beyond efforts, but there’s nothing like being at HIStalkapalooza…er…I mean HIMSS.

From the trenches…

“I think we’re getting scammed by a kindeygartener” – Harry (in “Home Alone”, the original, 1990)

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).

DOCtalk by Dr. Gregg 2/17/12

HIMSS, Mine & Ours

HIMSS

Not heading to HIMSS this year is a real drag…and, then again, maybe not so much. There are things I’ve grown to enjoy and people I’ll greatly miss seeing, but there are definitely both pros and cons to HIMSSing:

Things sadly missed:

• Real human-to-human, sans digital intermediary, connecting with friends and cohorts I don’t get a chance to see often.
• The “Ooo and Ahh” factor of all the glitz and showmanship that is HIMSS.
• The after-hours parties, especially HIStalkapalooza (and wearing my HIStalkapalooza sash.)

Things gladly missed:

• The morning after the after-hours parties (and the additional sleep deficit in my already miniscule sleep bank account.)
• Sore, oh-so-sore, feet (regardless of the choice of shoe fashion.)
• The guilt factor of knowing I’m helping to contribute to the gigundo national healthcare tab. (All that money comes from the same eventual place.)

MINE

At HIMSS, you’ll be hearing a new rallying cry coming from the e-patient folks: “Give Me My Damn Data!” You’ll be seeing them all over HIMSS this year. They’re looking to make some patient-empowered waves and I think they have the drive and chutzpah to do so.

The people (from around the world) who are driving this “e-Patient Spring”, like those over at the Society for Participatory Medicine, are some very active, very socially engaged, and very assertive folks. As with any social movement these days, they are taking advantage of Internet-enabled collaboration tools to promote their message(s). As with any social movement these days, they will not easily be denied their voice given the ease with which social connecting can now be accomplished.

Their basic cause is that they want to be considered a part of their healthcare, not a receivership nor a tangential. They want access to their own health data and they want providers who listen, discuss, and partner with them in their healthcare. (It is their health and healthcare system, after all.)

OURS

Considering both the HIMSS-related world and the just cause of the e-patient advocates, I feel a little bit caught in the middle. And, I’m not flying solo in my self-pity. I’ve heard similar sentiments from many colleagues. It really feels as if we providers are sometimes seen as the both the meal ticket and the root of all evil. Let me explain.

HIMSS razzle dazzle is exciting – and not meaning to rain on anyone’s parade-to-come in Vegas next week – but when I look at all the money spent there, I know where they get that money. When I look at the enormous facilities that Extormity Healthcare and others have built, I know where they get the financing. When I see all the faces of the pitchmen and pitchwomen who tout their HIT tools as the must-have to provide quality care and decrease healthcare costs, I know where they get their salaries. Ultimately, it’s all from patients and providers (some of it routed through the tax system.)

HMOs stepped into the healthcare lunch line some years back, promising to lower healthcare costs. They didn’t, but they sure made some millionaires and built some really large glass and steel high-rises to help manage all that “cost containment.” HIT vendors sometimes evidence a similar mojo.

On the patient engagement front, it makes a lot of sense and is, I think, an inevitability. But when I have to see so many patients per day just to pay all my costs, I have that nagging inner voice which reminds me that I don’t have the luxury of talking with them as much as I would prefer: I’m paid by volume. And that really sucks. I try to spend quality time, but if I’m sometimes too brief, it isn’t by desire.

Honestly, I think most docs, primary care docs especially, would prefer to spend more time discussing, explaining, and engaging with their patients. Heck, almost every one of us got into this field to try and help people. Of course we want to engage with our patients! But if you knew how many primary care medical practices, especially us small guys, are running in the red more and more each year, you wouldn’t be surprised by our seeming lack of time to chat. I want to chat more and engage more, but I don’t want to be doing it in a bread line or soup kitchen.

Considering the costs of technology adoption to the (rightful) desires of patients seeking more of a partnership in their healthcare, and — when you include the slimmer and slimmer reimbursements we’re given (and the still possible 27% SGR reduction, even if it’s now postponed 10 months) — it is starting to feel pretty durn tight in this little provider box. Sorta reminds me of that scene in Indiana Jones where the spiked walls and ceiling are closing in: closer, and closer, and closer…

To be clear, I have no desire to see HIT vendors nor HIMSS disappear. I love HIT and think it is one of the smartest moves medicine has made in years. HIMSS is a terribly fun 30,000-person party! And who doesn’t love a good geeky party now and again?

To be just as clear, I have no desire to withhold healthcare data and absolutely think engaged patients are the best patients. I have no desire to return to the days of paternalistic healthcare.

So please, as you hoist an IngaTini or as you raise awareness of the empowered patient, remember we’re all in this together. No part of this joint effort can survive without the health — both physical and financial — of the other: patients, HIT facilitators, and providers.

From the trenches…

“Boy, if this damn room would stop rolling around maybe I could find some place to be sick!” – Helen North (in “Yours, Mine and Ours” from 1968)

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).