DOCtalk by Dr. Gregg 2/17/13

Byproduct versus Focus

Byproduct was walking merrily down Fifth Avenue when he ran smack dab into Focus.

“Hey! Focus, my old friend!” Byproduct bellowed. (He had always been a rather boisterous fellow, most notably when extolling his own virtues.)

“Hiya, Byproduct,” Focus smiled. “My, don’t you look fine in your William Fioravanti bespoke tailoring and sparkling Harry Winston accoutrements!”

Byproduct beamed unabashedly. “Yes, indeed. Times have been very good, very good, Focus. Here in the States, the whole healthcare digitization issue has had me rolling, simply rolling in it!” he exclaimed.

Focus could see Byproduct’s chest swell as he crowed of his success. Always keeping his eye on the ball, Focus drove straight past the huff and fluff to wring the core of Byproduct’s message to the fore when he said, “Yes, here in the U.S. documentation has been creating more mountains of offshoot data than anyone ever imagined. Too bad, isn’t it?”

“What?! Too bad?” roared Byproduct. “My God, man, this is the heyday of all heydays. Me and the missus are getting ready to purchase our fourth far-too-large mansion. We’ve a passle of private jets and a mountain of Maseratis. We’re heading off to tour the world for the next two months. If you call that “bad,” then I’m happy things are so bad!”

With a glint in his eye, Focus went on, unfazed by Byproduct’s blustering. “Well, my old friend,” Focus said, “I wouldn’t be away too long. It seems there are changes afoot in the world of healthcare documentation that may just derail your digital data heydays.”

Just the slightest bit of air slipped from Byproduct’s swollen chest as he asked, “What do you mean? What could possibly derail this wonderfully massive data capture behemoth I’ve masterminded?”

Focus replied, “Oh, it isn’t that capturing more and more data won’t continue, my dear Byproduct. It’s just that the glory days for healthcare data capture are waning; a new day for healthcare data is dawning and it’ll be all mine.”

“Bullhockey,” said Byproduct. “From coding and billing to Meaningful Use, what could be more important than data capture? Healthcare data piles are growing exponentially; if I was a stock, I’d be bigger than Apple.”

“True, my old pal, true. But from Imhotep and Hippocrates to Pasteur and Mostashari, healthcare data collection has never been the true driver. It’s always been a byproduct – a necessary element, for sure – but nonetheless an offshoot of the true mission of healthcare. That true mission,” continued Focus, “has and always will be the care of people’s health. That’s why it’s called ‘health care.’”

Byproduct looked momentarily flummoxed, but quickly regained his bravado. “Nice try, my naïve Focus, but this train is running full throttle. Everyone knows that it’s the data collection that gets paid. Data capture is what HIT is all about. The days of pen and paper created mountains of irretrievable pulp-based records that may have held interesting content, but which were becoming impossible to utilize. Everyone knows,” he continued, “that digital data capture is the key to making that content accessible.”

“You are, as always, so correct and yet so misguided, dear Byproduct,” came the now impassioned Focus. “Data capture is imperative for the logarithmic growth of health information. Information technology can do wonderful things with all that data, wonderful things which were previously unthinkable. The problem isn’t data capture, per se; the problem is that data capture has become the sole focus of so many who are now involved with healthcare.”

“So you’re saying that data capture is important, but not central?” Byproduct asked quizzically.

“Exactly,” replied Focus with emphasis. “People’s lives aren’t sets of data points; they’re stories, stories full of nuance and subtleties. The same is true for their health. That’s why they call them ‘medical histories.’ Technology has not been invented which can truly capture those stories and yet it’s those stories which provide the core of health meaning. It’s those stories with their vagaries which provide true value. It’s those stories which people tell to their doctors and nurses and such and it’s those stories which give those healthcare providers the keys to understanding, diagnosing, and treating.”

“But EHRs are all designed to capture discrete data, Focus. They are all predetermined, point-and-click input portals. Without that, it’s just uncapturable, typed-in text. How can you possibly create predefined elements to cover every possible nuance?” questioned Byproduct.

“Ahhh, my dear colleague and cohort, there indeed is the crux,” agreed Focus. “Perhaps it’s the design of data capture that has blurred the vision for HIT. If data input were rehumanized, allowing people to tell health stories instead of inputting predefined phrases and terms, then the true meaning of the data – the story – could be preserved. Data capture can be improved and can be done more on the back end, after the story has been told.”

“Not possible,” retorted Byproduct. “Everyone knows that it’s templates and dropdowns that rule the worlds of HIT data collection. Providers will just have to figure out another way to share your so-called ‘stories.’ You can’t template that.”

“No, not using your approach you can’t. But, there are new ways to document coming, new digital tools that can capture discrete data while allowing the medical story to be told. I’m betting your heydays are numbered, my old friend,” consoled Focus. “These new methods might just bring me, Focus, back to the fore of healthcare.”

“Balderdash!” snorted Byproduct. “I’m just too big to be stopped!”

“So were TWA and Pan Am at one time,” Focus replied. ”Have you seen Quippe? Or how about CLiX?”

From the trenches…

“It is very difficult to get people to focus on the most important things when you’re in boom times.” – Jeff Bezos

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 2/14/13

From Orpheu: “Re: HIMSS picks. Have you picked out any HIMSS sessions that be might better-suited for someone working in the ambulatory world?”  I’ve have just started wading through the HIMSS schedule and with over 300 session options it is a bit overwhelming. My must-see list so far is not ambulatory-focused: Bill Clinton, Farzad Mostashari, and James Carville and Karl Rove. HIMSS has dozens of options to appeal to physicians and practice administrators, including sessions on patient engagement, ACO participation, mobility, telehealth, and of course Meaningful Use. I am actually curious what sessions intrigue readers so drop me a note if you have suggestions.

CMS offers guidelines for individual eligible providers and group practices to avoid the 1.5 percent PQRS payment adjustment in 2015.

NYC Mayor Michael Bloomberg announces that the use of eClincialWorks EHR by 3,200 NYC primary care physicians has led to better outcomes in terms of high blood pressure management, diabetes, and tobacco control. EMR use also spurred a 290 percent increase in preventive care services between 2008 and 2011.

Southeastern Health (NC), which uses eClinicalWorks EHR across 30 locations, adds ecW’s Care Coordination Medical Record to advance its ACO-related objectives, coordinate care, and evaluate population health.

Greenway CEO T. Green reports that the company added 750 providers in its second quarter, up 30 percent from a year ago. Green also noted that over 300 customers are now using Greenway’s new RCM platform. Greenway’s Q2 results: revenues up 12 percent, EPS $0.00.

CVS leads Wal-Mart in the retail medical clinic race. CVS operates about 630 Minute Clinics and is opening an average of  three new facilities every week. Wal-Mart has less than 130 clinics and 26 fewer than a year ago. Both Walgreens and Target, which operate a combined 400 clinics, plan to open additional facilities this year.

E-mail Inga.

News 2/12/13

Capario realizes double-digit revenue growth from its provider base in 2012 and says it significantly increased adoption of its portal application. Capario also notes that 100 percent of its clients participating in KLAS’s annual satisfaction survey believe the company keeps it promises and say they would buy from Capario again.

Vitera Healthcare Solutions hires Kermit Randa (Surgical Information Systems) as EVP of sales and marketing.

Athenahealth earns the #8 spot on Fast Company’s list of the World’s Top 10 Most Innovative Companies in Healthcare. Forbes says athenahealth “stands out” among other EMR companies because theirs is “a system that doctors actually like to use.” Teledoc, a provider of phone and video medical consultations, came in at #9.

Practices should set expectations early for the distribution of MU payments, suggest industry consultants. The decision should ideally be made prior to attestation so providers know whether they are allowed to keep incentive funds or if they are expected to return monies to the practice.

TransforMED, the AAFP subsidiary that supports practices transitioning to PCMHs, announces the retirement of president and CEO Terry McGeeney, MD.

SimplifyMD launches simpleStart, a program that allows medical practices to  go from a demo of the simplfyMD EHR to live clinical use in the same day.

An AHRQ study finds that projects funded under the “Enabling Patient-Centered Care Through Health IT” initiative have shown that healthcare outcomes are positively impacted when HIT is used to create or enhance patient-centered care.

The Huron Valley Physicians Association selects e-MDs as a preferred partner to provide EMR solutions for its 500 physician members.

Don’t miss the interview we did this weekend with SRSsoft CEO Evan Steele, who discusses a range of topics, including Thoma Bravo’s recent investment in the company, “usable” EMRs,  and MU. Steele has been an outspoken critic of the MU program and shared a few of his concerns:

• The government’s Meaningful Use program has sapped innovation out of the EHR marketplace, and it will continue to do so for the foreseeable future if CMS continues churning out overly complex rules.
• The government has set the development roadmap for all EHR companies with its Meaningful Use certification requirements and the compressed timeframe for development and implementation.
• As Meaningful Use has piled on requirement after requirement, physicians are drowning in program-related minutiae.
• Not understanding the complex requirements has kept many from even attempting to participate, and many who are managing to muddle through are suffering tremendous losses in productivity.
• Dissatisfaction is even greater among specialists. They were included as an afterthought in what is basically a primary care program, and many resent reporting on requirements that are irrelevant to their practices.

E-mail Inga.

News 2/7/13

Forbes recognizes Kareo as the 58th most promising privately held, high-growth company in the country.

CAQH launches a universal electronic funds transfer (EFT) enrollment tool for allows providers to enroll with multiple payers through a single online process.

AHRQ and CMS announce a new EHR format for children’s health that includes recommendations for child-specific data elements such as vaccines, prenatal and newborn screening tests, growth data, and child abuse reporting. The format is designed for EHR developers and providers who wish to augment existing systems with additional features or to build new EHR systems for the care of children.

United Health Centers of the San Joaquin Valley (CA), an FQHC, selects WellFx’s online social platform for its patients and employees.

EClinicalWorks will invest $25 million over the next year to enhance and expand its patient engagement tools under its Health & Online Wellness (healow) business unit. The first product is a soon-to-be-available free mobile app for patients.

The Boston Globe, by the way, profiles eClinicalWorks and the launch of its patient engagement initiative.

Navicure extends its partnership with the MGMA AdminiServe Partner Network through 2015, which gives association member preferred pricing for Navicure’s claims management technology.

An AHIP survey finds that the percentage of medical claims filed electronically has increased from 44 percent in 2002 to 94 percent in 2011. In 2011, 93 percent of electronic claims and 79 percent of paper claims were processed within two weeks.

The Charlotte Observer looks at the shared medical appointment model that allows a single provider to treat a group of patients with similar medical conditions. Proponents say the model allows more patients to see a physician on shorter notice and gives patients the opportunity to learn from one another. Zeev Neuwirth, MD, CMO for Carolinas HealthCare’s physician services group, likes the shared appointment model, saying,

“Our research shows that patient satisfaction was as good as, if not better than, if patients are seen individually. And the outcomes are the same.”

E-mail Inga.

News 2/5/13

CMS awards Emdeon a contract to define the process for testing new HIPAA and ACA transaction standards.

Cerner will integrate Gateway EDI’s claims and remit systems within Cerner PM solutions.

Medicare administrative contractor Palmetto GBA posts the results of a prepayment review for CPT code 99214 (established office visit), which included denial rates between 44 and 65 percent. Documentation inadequacy and coding too high an intensity were the most frequent reasons for denials.

More than half of cardiology practices have sold or leased their practices to hospitals compared to 32 percent in 2011. The primary driver was business expenses.

Five practices within Stellaris Health Network deploy PatientKeeper Charge Capture to send charge information from Meditech to their NextGen billing system.

Mississippi House members approve legislation that would allow insurance companies to pay physicians who consult with rural doctors via telemedicine.

SimplifyMD reports that 100 percent of its customers choosing to file for MU attestation have completed the process.

A study finds that HIT adoption by FQHCs is associated with significant improvements in care quality. FQHCs with higher HIT capacity were found to be more likely to use discharge summaries, notify patients for preventive services and follow-up, and create timely appointments for specialty care.

Greenway Medical announces that is compliant with 37 ONC 2014 Edition criteria and is certified as an EHR Module by CCHIT.

eClinicalWorks announces the availability of billing services charged as 2.9 percent of monthly collected revenue.

E-mail Inga.