News 4/11/13

Athenahealth files a lawsuit against CareCloud, a four-year-old PM/EHR company that athena claims is infringing on one of its patents. The 2001 patent addresses the way claims processing rules are injected into athenahealth’s billing workflow. Above is a 2011 tweet from Jonathan Bush. Several former athenahealth employees now work for CareCloud. Athenahealth’s director of communication was unable to comment on the lawsuit, but CareCloud CEO Albert Santalo provided us with this statement:

“To the best of our knowledge Carecloud is not infringing on Athenahealth’s 13-year-old outdated method and we won’t be making any additional comment at this time.”

Main Line Health (PA) implements eClinicalWorks EHR across 42 practices.

The Polyclinic (WA) selects Phytel’s Population Health Management solution and Verisk Health’s Provider Intelligence program for population health management.

CMS creates a fact sheet to help providers if they are selected for EHR incentive program audits. CMS notes that documentation supporting attestation responses should be retained for six years and should support all payment calculations, such as cost report data.

Arkansas Heart Hospital selects eClinicalWorks EHR for its physician clinics.

HIMSS Analytics recognizes the ambulatory clinics of NorthShore University HealthSystem as the first group of ambulatory facilities to reach Stage 7 of the Ambulatory EMR Adoption Model.

Clinical effort, teaching, and research are named as the factors that most heavily influence physician compensation in academic settings in an MGMA report on academic practice compensation. Other factors influencing compensation: department rank, specialty, and geographic location.

Intuit Health announces that seven million patients have now registered for the Intuit Health Portal, including one million in the last six months.

Athenahealth celebrates the fifth anniversary of its Belfast, ME location, which now employs 570.

Bankruptcy attorneys and physicians blame a weak economy, shrinking reimbursements, changing regulations, and rising malpractice and drug costs for a recent spike in physician practices filing for bankruptcy. The American Bankruptcy Institute reports at least eight filings by physician practices in recent weeks.

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News 4/9/13

From SensibleShoes: “Re: Walgreens. This is absolutely insane. Walgreens has no idea what they are doing but they just found a way to sell more of their drugs on their shelves!” Walgreens becomes the first retail store chain to to offer diagnosing and treatment for patients with chronic conditions. Walgreens officials say they are not trying to take over primary care but instead are offering patients more access points for testing and care management. The AAFP does not welcome the news, saying it’s difficult to manage care when patients are treated in various settings. I am sure that AAFP’s objections have nothing to do with the fact that the 300+ retail clinics are staffed by PAs and NPs and not FPs.

Baylor Quality Alliance (TX) selects Greenway Medical to participate in its EHR program, which aids community physician practices in the evaluation, selection, and implementation of EHR applications.

The producers of NPR profile several physicians in rural Missouri, most of whom lack the necessary funds to transition to EHRs. Many practices are turning to large health systems for financial support while older providers are choosing to opt out of EHRs and use paper records until retirement.

The Chicago HIT REC introduces LAUNCH, an extension of its EHR adoption and training assistance program and available to both primary care physicians and specialists.

American Medical News offers physicians some tips for buying an EHR the second time around. I agree that one of the first things practices should do before jumping into a new system is identify what went wrong the first time to avoid repeating mistakes. Providers then need to prioritize their buying criteria and commit fully to the sometimes painful implementation process.

The AAP and AHRQ develop a set of instructions for EHR vendors that defines functionality and more than 700 requirements that are considered essential to pediatrics.

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News 4/4/13

Vitera launches Intergy Mobile, the iPad companion app to Intergy EHR.

CMS provides updated stats on the MU program, which has paid EPs and hospitals $12.7 billion in incentives though the end of February. A few other interesting tidbits:

• Of the estimated 527,000 EPs, 384,000 (73 percent) have registered to participate
• Over 230,000 EPs have been paid $4.5 billion in incentives. That’s almost 44 percent of all EPs and 57 percent of those registered
• Drug formulary, immunization registries, and patient list are the most popular menu objectives for EPs; transition of care summary and patient reminders the least popular.

Seven New York practices using MEDENT EMR are live on the Southern Tier HealthLink’s RHIO platform and able to use protocols for the Direct Project.

A report from the American Academy of Pediatrics recommends adoption of e-prescribing systems with pediatric functionality, noting that pediatric data supports the role of e-prescribing in mitigating medication errors, improving physician-pharmacist communications, and improving medication adherence.

Nearly 40 percent of physicians are burned out, according to Medscape’s Physician Lifestyle Report. ER and critical care physicians express the highest burnout levels; pediatricians, ophthalmologists, psychiatrists, and pathologists were among the least burned-out.

CMS posts the 2011 PQRS and eRx Incentive Program Experience Report, which summarizes program trends, including  participation and penalties breakdowns by specialty and geographic region.

Rep. Jim Dermott (D-WA) asks HHS to consider renewing its safe harbor provision that allows hospitals to subsidize EHR technology for its affiliated physicians under the federal Anti-Kickback Statute. The provision is set to expire at the end of 2013.

One last plea: please take a moment to complete our annual HIStalk Practice reader survey. Thanks.

E-mail Inga.

DOCtalk by Dr. Gregg 4/1/13

Sunny Side Up? Nope. Scrambled.

I’ve started to see that the world healthcare information technology is just one big pile of scrambled eggs – metaphorically speaking, of course.

Consider the metaphor: scrambled eggs are an amorphous conglomeration of congealed albumen and yolk, nutritive albumin protein and embryo all swirled up into one, often incompletely cooked, goo. Scrambled eggs often have lots of other non-egg-related matter thrown in – like ham, or onions, or cheese, maybe some spices or a little milk – all swirled together and intermingling haphazardly.

Now, compare and contrast time:

Consider the cooked egg world’s opposite – the sunny side up egg. It also may be incompletely cooked sometimes, but it is a structural antonym to its scrambled cohort. It has the lovely yellow yolk nestled serenely in the center, caressed and protected by the surrounding proteinaceous white. The two components are discrete, yet complementary. Together they make the dish, but their borders are well-defined.

Either scrambled or sunny side up eggs can be cooked fully or served up with just a touch of “slime” left. Some folks prefer the drier, “well done” type while some of us are happy with a little remaining mucusy texture. (I admit it sounds less appetizing when written as such.)

Now, metaphor hop back with me to the world of HIT:

Look through the multitude of realms which HIT involves or touches: healthcare, technology, legislative, financial, legal, and more. All of these can be further broken down into subgroups such as mHealth, telehealth, inpatient, outpatient, e-patient, privacy and security, insurance and billing, regulatory, education, etc. Each of these can be subdivided even further into things like mobile apps or client server tools, real-time or store-and-forward, acute care or long-term care, primary care or urgent care, empowerment or engagement, HIPAA or data sharing, and so on and so on and so on.

There is nothing about MU or HITECH or HIT (or, perhaps, even US healthcare in general!) that comes even close to a sunny side up, well-defined and harmonizing balance of distinct collaborative elements. It’s a mishmash. It is one giant pan full of goo and goop and value-add ingredients all churning about and “intermingling haphazardly.” And, it’s anything but fully cooked; there’s a slew of slime.

I know lots of well-intentioned folks are busy trying to get some regulations and some standards into place to help define and refine the hootenanny of interplaying elements in the enormous HIT space. And that’s probably good. But when I look around the massive HIT frying pan, I’m pretty sure we’re going to have to be happy eating our “eggs” scrambled for quite some time – and with plenty of mucus.

It’s been said that you can’t put toothpaste back in the tube. You actually can, but it’s a major pain in the tukhus. Similarly, it’s pretty near impossible to unscramble your eggs.

If the good folks trying to regulate and standardize are trying to regenerate sunny side up HIT eggs from our current scramble…well, doubtful. If they’re trying to harmonize the ingredients…well, that’s probably possible.

Of course, we could always throw away the current batch and start – more gently – with some new, fresh “eggs.”

(Yeah…right.)

From the trenches…

“The world is wrong side up. It needs to be turned upside down in order to be right side up.” – Billy Sunday

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 4/2/13

Rep. Diane Lynn Black (R-TN) proposes legislation that would amend certain requirements and penalties for the MU program. Some of the provisions  in the Electronic Medical Records Improvement Act include:

• An option for certain providers to participate in specialty registries that offer real-time data instead of reporting on nine or more clinical quality measures
• A shortened reporting period for Medicare EHR payment adjustment applications from two years to no more than one year
• An exemption from penalties in years 2015 to 2017 for EPs who are solo physicians or near retirement
• The ability for rural healthcare providers to be defined as EPs and participate in the MU program
• A more formalized appeals process for providers that receive penalties

Our HIStalk Practice reader survey will be open for just a few more days. Your feedback is important to us, so thanks for taking a moment to answer a dozen easy questions.

Legal experts recommend that physicians pay closer attention to requirements under the Americans with Disabilities Act (ADA) as practices shift to EHRs and other computerized tools. To avoid violations and lawsuits, providers must consider whether such tools as online scheduling, bill payment, or Webcasts will accommodate disabled patients and employees.

St. Louis Oncology will implement Benchmark Systems’ practice management system.

More physicians are suing former patients and their relatives over negative ratings and reviews posted on the Internet. Personal blogs, as well as consumer-driven Websites like Angie’s List and Yelp, allow patients to write critical comments about their physicians. Some lawsuits have resulted in patients removing the negative comments; other cases were dismissed because judges ruled that patients’ comments are protected under the First Amendment. Sounds like the real winners here are the attorneys.

E-mail Inga.