DOCtalk by Dr. Gregg 4/27/12

Odd and Ends

There’s an odd thing I noticed recently while in Chicago for dual meetings of the exec/advisory boards of the Council on Clinical Information Technology (COCIT) and Child Health Informatics Center (CHIC) at the American Academy of Pediatrics (AAP). In each, the conversations have taken a noticeable — and I think encouraging — turn.

As most of you are aware, HIT conversations over the past couple of years have revolved around Meaningful Use, Meaningful Use, Meaningful Use, and more Meaningful Use. On the vendors’ side, conversations – and entire developmental timetables – have been almost exclusively redirected to meeting and matching MU criteria. For users, though they’re still looking for functionality, MU standards and MU hoops through which to jump have also substantially overtaken most all IT-related tête-à-têtes.

So, too, have recent COCIT and CHIC chats been mostly MU-oriented. However, over the past couple of sunny days here in the City of the Big Shoulders, I’ve noticed a rather encouraging change. Amongst people who are exclusively focused upon HIT as relates to pediatrics, MU has sort of moved into the backseat, and in a very good way.

A few highlights of conversational topics may help to illustrate this point:

• During one meeting, we had a presentation from a member who had gone to Japan to assess emergency responses to the recent horrific earthquake / tsunami / nuclear meltdown disaster trifecta. Japan’s amazing response to this terrible tragedy, including the impact of information management in such an event, was compared to the dismal and disappointing responses to the recent hurricane and flooding of New Orleans. How HIT impacts, or how HIT is impacted by, such enormous catastrophes can be very challenging considerations.
• Another member was intimately involved with emergency services to the recent earthquake in Haiti. He described the heart-wrenching story of a student trapped for a week who survived by drinking the dripping blood from her fellow students whose dead bodies lay above her in the wreckage. Heartbreakingly, or perhaps mercifully, she later to died due to complications from her nightmare. (Though I doubt HIT may have helped this poor girl, the Haitian disaster has tremendous lessons to teach about dealing with less-developed countries who suffer such calamities.)
• A third physician spoke of the political suicide he experienced by standing up to his institution’s decision to implement a system which he felt was inappropriate for their needs. He described being taken out into the hall by their CMIO and scolded for not getting on the implementation bus. Not one who is known for sharing such inner personal emotions often, his description of the institutional loneliness he has experienced over the past two years as he held to his opinion for the inappropriateness of this system was moving. (He did note a slight indication of vindication recently — others are starting to understand his concerns as the implementation process has proceeded.)
• In reevaluating the priorities for both groups’ efforts, instead of just talking about how we help AAP members to adopt/implement HIT and meet Meaningful Use criteria, we were instead discussing ways to provide AAP expert content via web services to both members and vendors, how to identify and help members use their digital talents to assist their colleagues, and how to expand upon the wonderful, expanded support we’ve been receiving from the upper AAP echelon to promote all things Peds HIT.

In other words, we were talking about providing value: value to the children and families we serve; value to our colleagues; value to HIT vendors looking to resource our expertise, and; value to ourselves. Barely a mention of MU during days of non-stop meetings and post-meeting dinner chats. Refreshing, I must say, though that’s not at all to say that I (or we) are against MU. It’s just nice to get back to discussing and working on all those things toward which MU is designed to help us move.

As to the “Ends” part of this post’s title, this weekend marked the end of service for some very wonderful people. After serving between six and nine years, Drs. Jeannie Marcus, George Kim, Michael Leu, and Alan Zuckerman have come to the end of their COCIT Executive Committee term limits. Though some fresh blood is always good, the leadership and value each of them provided is undeniable. (Knowing them, I’m betting their contributions will continue well past their “title” time.) Thanks, guys.

There’s another of the “Ends” I will especially miss. After eight years, Jennifer Mansour will be leaving the AAP and, from a completely “how does this impact me” mindset, will no longer be my cohort in crime with the Pediatric Office of the Future (POF) exhibit. Jen has done so much more than that in her role as Health Information Technology Initiatives Manager, but her deep understanding of the world of pediatric HIT, rock-solid reliability, wonderful attention to detail, abilities for handling difficult doctors (cough, cough), and her political adeptness were perhaps some of the most important factors leading to the over 500% growth of the POF exhibit.

It has not yet been officially announced anywhere, but the POF will be quite operationally different this October in New Orleans. It’ll have a new name, fantastic new features and values for our attendees, marketing and PR light years beyond anything we’ve ever done, and will be far more accessible to any and all exhibitors (no longer “sponsors”). There will be much more bang per buck for both attendees and vendors. Again, much of this continued evolution has Jen at its core. Thanks for everything, Jen.

The folks filling her shoes seem pretty wonderful, too, I must admit. I just hope they have big enough feet!

From the trenches…

“You know an odd feeling? Sitting on the toilet eating a candy bar.” – George Carlin

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 4/26/12

Quality Systems, the parent company of NextGen, acquires Matrix Management Solutions, a NextGen reseller that provides RCM, implementation, and support services. Quality Systems says the acquisition will “enable NextGen Practice Solutions to expand its footprint among private and hospital-based physicians and groups by leveraging Matrix’s RCM expertise.”

Emdeon completes the re-pricing of its existing senior secured credit facilities and borrows $80 million of additional term loans for general corporate purposes, including potential acquisitions.

Phreesia adds an electronic version of the M-CHAT autism screening tool for toddlers to its patient check-in system.

Cokingtin Eye Center (KS) goes live on MedInformatix’s EMR on May 1.

eClinicalWorks opens a Chicago office to provide a central US presence.

Hawaii Island Beacon Community implements a physician practice redesign program to transform up to 30 independent primary care physician practices into PCMHs. Participating practices will receive at no charge practice assessments, educational tools, and PCMH recognition upon program completion.

The Houston Chronicle reports that that Medicare has overpaid physicians millions of dollars in bonuses, including $33 million in 2010 alone. The overpaid physicians practiced in areas that were once considered underserved but which have since been reclassified. The federal Health Resources and Services Administration is responsible for updating the records of qualified communities, but failed to adjust its lists from 2003 until November 2011. As a result, physicians in at least 311 communities have been incorrectly paid bonuses equal to 10% of each Medicare claim filed. Good luck getting those funds back.

Even though as many as 91% of US physicians were eligible to participate in the Meaningful Use program last year based on Medicare revenue or Medicaid volume, only 11% of EPs had both an EHR with at least 10 of the 15 capabilities required for Stage 1 and had plans to apply for incentives. That’s a far lower participation rate that CMS originally estimated (as high as 36% for the Medicare MU program and 47% for Medicaid’s.)

Overall physician compensation fell in from 2010 to 2011, though the  average pay in several specialties averaged more than $300,000. Radiologists had the highest average compensation ($315,000) and pediatricians the lowest ($158,000.)

Occasional HIStalk Practice contributor Lyle Berkowitz, MD is profiled here discussing Healthfinch, an HIT start-up company he co-founded. Healthfinch’s productivity apps include RefillWizard, which connects to a practice’s EMR and runs prescription refill requests through a Web service.

E-mail Inga.

News 4/24/12

Through the end of March, the EHR Meaningful Use program paid Eligible Providers $1.4 billion in incentives. Of the 39,000 MDs or osteopaths receiving checks, 17,000 were specialists in family practice or internal medicine.

Cuyuna Regional Medical Center (MN) selects PatientKeeper technology to aggregate data from the MEDITECH system used by the hospital and the  ambulatory care offices’ Allscripts system.

The US e-prescribing market is predicted to reach $205 million by 2017, which is far less than the $508 million forecasted for Europe for the same period.

Meritas Health Corporation (MO) chooses eClinicalWorks’ EHR for it 72 employed physicians. Meritas will interface eCW with its inpatient Cerner system, as well as LabCorp and Quest.

Wide River Technology Extension Center, Nebraska’s REC, announces that it has surpassed its goal of registering 1,000 primary care providers for its program. The REC has over 670 physicians live on EHRs and 145 have met Stage One MU requirements.

The 90-physician Allied Pediatrics (NY) selects Isabel Healthcare’s diagnosis decision support technology, which will be integrated with Allied’s EMR (GE Centricity I believe.)

Midwest Radiology Associates (OK) signs a long-term agreement with Affiliated Professional Services to provide billing and practice management services.

Brad Blakey, former VP of sales for NextGen, joins CareCloud as VP of sales.

Minnesota Eye Consultants selects the NextGen Ambulatory EHR for its 22 providers.

Lakeside Orthopedics (NE) contracts with SRS for EHR.

I am thrilled to announce simplifyMD as HIStalk Practice’s newest platinum sponsor. The six-year old company is based in Atlanta and offers an ONC-ATCB-certified EMR platform that’s been deployed by doctors in 27 specialties and thousands of end-users. The EHR is cloud-based, but practices also have the option to store data on a local server in their offices, just in case the Internet is temporarily unavailable. Unlike most traditional software vendors, simplifyMD offers a “pay as you go” option that can be discontinued at any time and costs a mere $395 per month. Last November the company announced it had secured $4.5 million in funding and named former McKesson SVP Mike Brozino as president. Founder Matt Ethington once sent me a photo of his very young son wearing some very red shoes, so I already had warm fuzzy feelings for this company. Many thanks for simplifyMD for supporting HIStalk Practice!

Every week I read new stories about medical office employees who are caught stealing thousands of dollars from their employers. This article, however, caught my eye because of the total lack of checks and balances in the practice. The Mandeville, LA woman, who has pled guilty of embezzling over $700,000 in less than four years, was in charge of payroll and over-compensated herself. She was also responsible for paying the plastic surgery practice’s American Express credit card and routinely used the card to cover personal expenses. Additionally she had access to the practice’s bank accounts and regularly transferred money to pay her rent and phone bills. Finally, she was the only employee authorized to make bank deposits and over time stole at least $60,000 in cash. Crazy.

2K Networking (PA) partners with gloStream to offer gloStream’s EMR solutions.

E-mail Inga.

News 4/19/12

Orthopedic urgent care franchise OrthoNow selects CareCloud’s practice management solution for its network of facilities.

Practice Fusion introduces a messaging feature that allows providers to communicate securely with one another. The service is available at no charge to both Practice Fusion EMR users and non-users. It does not support sending chart notes or referrals, but that enhancement is in the works.

Louisiana becomes the first state to make Year Two Medicaid Meaningful Use payments, issuing its first check to SuccessEHS client Winn Community Health Center.

Emdeon CEO George Lazenby will head an IT Recruitment Task Force sponsored by the Nashville Area Chamber of Commerce. The initiative aims to attract workers to fill the 1,000 available IT jobs in the region.

Phoenix Cardiac Surgery (AZ) agrees to pay HHS a $100,000 settlement for failing to comply with HIPAA privacy and security rules. In addition to posting clinical and surgical appointments on an Internet-based calendar that was publically accessible, the practice failed to implement policies and procedures to safeguard PHI, did not document training of employees on HIPAA rules, and neglected to obtain business associate agreements with the Internet-based e-mail provider.

MGMA opens registration for its 2012 Annual Conference. See you in San Antonio October 21-24!

TransEngen announces new integrations of its Revenue Maximizer platform with practice management systems from GE, NextGen, Medisoft, and Cerner.

PM and EHR provider eCareSoft releases an Android application for its Nimbo product.

Tampa Eye Clinic (FL) partners with TSI Healthcare to deploy NextGen EPM and EHR for its 10-provider practice.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

News 4/17/12

Southern Orthopaedic Surgeons (AL) selects the SRS EHR for its 11 providers.

eClinicalWorks recognizes several customers for achieving NCQA Level 3 Physician Practice Connections PCMH status, including solo physician Salvatore Volpe MD (NY) and Ninth Street Internal Medicine Associates (PA.)

The e-MDs folks let me know they’ve got a brand new Web site which features improved navigation and easier access to information. While checking it out, I noticed that e-MDs is hosting is 8th Annual User Conference & Symposium June 21-23 in Austin, TX.

Former Medical Present Value CEO Tom Stampiglia joins RCM/BI provider Origin Healthcare Solutions as CEO. He was also previously president and COO of WebMD’s practice services division.

Physicians will ignore medication alerts if: (a) their EMR generates too many of them; (b) the alerts to not apply to a particular patient situation (e.g., the patient has already been taking the medication without problems); or (c) the alert provides too much information. That’s the conclusion of a VA/Regenstrief Institute study of 30 prescribers in 13 clinics. The authors recommend that systems provide only the details users need to make decisions.

American Medical News profiles a couple of physicians who have converted a portion of their homes into a medical office. There’s nothing IT related to this story, but since I work out of my house, I appreciate the benefits of having a 20-yard commute between my bedroom and work space. The downside, which the doctors didn’t mention, is that it’s sometimes hard to step away from the office.

Medicomp Systems promotes Dave Lareau  from COO to CEO. Company founder Peter Goltra will remain as chairman and president.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.