Practice Wise 11/12/11

How is IT like Medicine?

When you have an issue with your software or on your network, what do you do? If you are a clinician or clinical support tech in a medical practice, you call for IT technical support.

When your patients have medical problems, what do they do? They call you. Patients hope that you will have all the answers and will be able to fix their problem in one phone call or office visit. You hope that tech support will push a button and fix your problem in one call.

How likely are you to find the etiology of the patient’s problem the first time you investigate it? How often do you expect that your tech support will? The old adage is that if you put 10 IT engineers in a room and give them all the same problem, you’ll get 10 different ways to approach it.

I don’t often hear this about medical providers, and I think that’s because medicine is a mature practice, IT as a well-defined discipline is still in its infancy.

Over the years, it’s been my mission to (a) help medical practices understand the nature of IT issues and how difficult they can be to resolve, and (b) to help the tech support community understand how to communicate technical information to the practices in a language they can understand.

Lately I’ve started using medical problem metaphors when describing technical issues to clinical staff. By gosh, they get it! Troubleshooting IT issues is a lot like diagnosing medical problems. When a patient presents at the doctor’s office, they rarely know their ICD-9 code. When a medical staff person calls their IT support desk, they rarely state that they’ve lost connection to their database server due to a failed ODBC connection or the loss of the local area network.

Both parties simply state that something is causing them pain. They can describe the pain in terms that they understand. In both cases, it’s our job to interpret that pain and alleviate it.

How does tech support do this? Start acting like doctors. EHR tech support can practice what they preach – apply EHR vernacular to EHR problems. Encourage the practice staff to start acting like patients in describing their symptoms.

Follow the flow of a visit note when troubl shooting IT issues:

• Chief Complaint: clinic staff – state what your pain is.
• History of Present Illness: what were you doing when the issue started, what were the behaviors (symptoms) that made you realize you had an issue?
• Physical Exam: IT staff, observe the user in their environment. Ask if they can reproduce the problem.
• Review Of Systems: IT staff – evaluate the problem by looking at the software, the user profile, the computer, the network, the server, etc.
• Past Medical History: Has this user/computer had problems in the past? Has the network had problems? Does the application have a history of problems? These are possible keys to what is happening now.
• Diagnosis: This is often a best guess, both for doctors – that’s why there are “rule out” diagnosis codes – and technical support staff. The art of diagnosis is a hard-won battle. Have patience. Sometimes the answer is not clear until much testing (trial and error) has been done.
• Rx: IT prescribes parts or processes to fix the issue. Patients follow the directions prescribed. If tech support tells you not to click on something and you click on it anyway, then you choose to break it. If you tell a hypertensive patient to change their lifestyle and take their blood pressure medication and they don’t, well then, they made a choice. It’s hard to keep people from causing their own pain.
• Services Performed: Communicate to the end user what you have done in terms that they can understand. A patient doesn’t understand the complexities of Latin diagnosis-speak. Clinical staff don’t understand the geek speak of TCP IP and database language either. Remember to use the KISS (Keep it Simple Stupid) method. Bring the explanation down to their level. You don’t look smarter just because you speak in a language your audience doesn’t understand.
• Services Ordered: If you as the local IT technician can’t fix it, you contact the vendor (hardware or software) for additional parts or support.
• Assessment and Plan: Tech support — summarize what you’ve found in clear, understandable terms and how you will work together to solve the problem. Client, adhere to your maintenance plan.
• Results: Measure the effectiveness of what you’ve done. Have you fixed the problem? Do you need to do more to get things working again? Is there a cure or ongoing management?

Today’s software products are exceedingly complex. The human body is, too. Both require that we listen to the complaint and work towards a mutually acceptable solution. Sometimes you have a diagnosis without a cure.

I’m not a doctor or an engineer, but I am someone who has travelled in both the clinical and IT worlds professionally. I know that this is a global communication issue that is easy to fix if we realize that we all speak the same language — sorta kinda.

ulie McGovern is CEO of Practice Wise, LLC.

News 11/10/11

Over 52% of office-based doctors (291,000) are currently e-prescribing, compared to less than 10% three years earlier. An analysis of 2010 data showed that Massachusetts had the highest rate (41% of all prescriptions), followed by Delaware and Michigan. Other key statistics compiled by Surescripts:

• Electronic responses to requests for prescription benefit information grew 125% from 188 million in 2009 to 423 million in 2010.
• Prescription histories delivered to prescribers grew 184% from 81 million in 2009 to 230 million in 2010.
• Prescriptions routed electron­ically grew 72% from 191 million in 2009 to 326 mil­lion in 2010.
• About 79 percent of prescribers used EMRs versus standalone e-prescribing options in 2010, up from 70% in 2009.

Kareo launches an electronic patient statements and payment portal using InstaMed’s healthcare payments network.

The 12-physician Kleinert Kutz Hand Care Center (KY) selects ChartLogic EHR Suite. I see in the same press release that ChartLogic serves more than 1,000 physicians and that 25 “customers” have qualified for Meaningful Use payments. I sure hope that each customer has lots of physicians because 25 customers doesn’t sound like a big number. Regardless, I am glad to see ChartLogic include the stats.

Ophthalmology EMR/PM provider NexTech Systems partners with patient education software vendor Eyemaginations to integrate NextTech Practice 2011 and Eyemaginations LUMA software.

Associated Purchasing selects Greenway Medical’s PrimeSUITE 2011 as one of nine preferred solutions for physicians seeking EHR implementation through the Kansas and Missouri REC programs. PrimeSUITE is also a preferred EHR for at least 10 other RECs.

I am all about free stuff, so this little contest caught my eye. Apple reseller MacMall launches a contest strictly for medical offices and features an office “makeover.” Some of the winning prizes include Nuance medical dictation, Ergotron carts, HP workstations, and Fujitsu scanners. OK, so it’s not like a day at the spa, but it still would be fun to win. The contest runs through January 16, 2012 and includes over $23,000 in prizes.

A new report finds Allscripts to have the largest share of the ambulatory EMR market out of the more than 750 companies offering EMR products. The combined ambulatory and inpatient EMR market is expected to grow to over $8.3 billion by 2016.

HHS’s Office for Civil Rights will begin HIPAA compliance audits this month for office-based physicians, hospitals, and health plans. Twenty audits will be performed in the initial round and selected entities will be notified in writing within 10 days. Officials will visit the audited sites within 30 to 90 days of notification.

E-mail Inga.

News 11/8/11

North Shore Medical Labs will donate Nortec EHR to approximately 100 providers in medically underserved communities and small practices in Alabama, Mississippi, and North Carolina as part of AHIMA’s and HHS’s initiative to foster EHR adoption in underserved areas. AHIMA will offer providers six hours of Web-based training.

Massachusetts lawmakers consider legislation that would authorize the operation of casinos, while earmarking 23% of license fees to promote EHR adoption. Should the law pass, the state could raise about $50 million to advance the use of EHR statewide.

Rosemarie Nelson of MGMA’s Health Care Consulting Group offers some practical and very hands-on recommendations for practices adopting EHRs.  In addition to some great suggestions on setup and training , she also throws in these logical reminders:

• One size does not fit all
• Everyone is at a different stage with different “wants”
• The key to optimization is personalization — get out into the patient care area and find the trick that works for each individual.

athenahealth wins the #29 spot for Top Places to Work in Boston for medium-sized employers.

Covisint reminds physician practices that Meaningful Use and PQRS incentives can be obtained in the same year and that the PQRS submission process takes only a few hours. Last year 6,800 providers earned over $9 million in bonuses participating in PQRS through Covisint’s Docsite registry.

In October, physician offices added 8,000 of the 12,000 new jobs created in healthcare.

The Practice Fusion folks tell me they earned the top ranking for e-prescribing and keeping users on track to achieve Meaningful Use in Brown-Wilson’s Black Book Rankings. A total of 224 EMRs were included in the study.

E-mail Inga.

From the Consultant’s Corner 11/4/11

5010: Just the Tip of the Iceberg

I’m still firmly stuck in October and all the fiscal year activities that go with it. But my kids already are looking forward, getting excited about the holidays just around the corner. And that got me thinking. Ready or not, the 5010 transaction standards will be in place in just a couple of months.

It really is time to look forward. Not just to 5010, which will bring more clarity and consistency to claims transactions, but also to the conversion to the ICD-10 code sets. Together, these two changes will support more granular healthcare data capture in the future.

Ultimately, that will help us shift healthcare toward reimbursement based on quality outcomes—instead of today’s volume-based “eat what you treat” reimbursement mentality. On the administrative side, these changes should aid efforts to reduce costs and gain more accurate coding, billing, and reimbursement. On the clinical side, all of this should lead to better patient care quality.

But contrary to popular belief, compliance with 5010 doesn’t get you halfway down the road to ICD-10 compliance. Although the two initiatives are related, ICD-10 is far more complex. 5010 readiness is just the tip of the iceberg. Expect ICD-10 to encompass every asset used to treat patients, bill for services, and receive appropriate payment.

Where 5010 affects only electronic claims and remittances, ICD-10 will radically alter the workflow of literally every clinical and operational procedure in healthcare. It will significantly impact the way physicians capture and document clinical data, and will affect the data flow from the electronic health record (EHR) to all other clinical, administrative and billing systems—and all the interfaces in between. Every third-party interface or tool will require testing, evaluation, upgrades and staff training.

Everyone now is intently focused on the fast-approaching 5010 compliance deadline and Meaningful Use. And it’s true that for a short while, meeting Meaningful Use can make some incentive money for you. But ICD-10 can bankrupt you if you’re not prepared.

The level of preparedness varies among industry stakeholders. Some progressive healthcare organizations — including many of our clients—already are getting down to work. One provider I recently visited has budgeted $10 million for ICD-10 so far and considers the investment to be “worth every penny.” Another, an organization that offers a variety of specialties and subspecialties, has more than 1,000 custom-designed EHR templates that need to be redesigned by 2012.

Unfortunately, too many providers expect practice management system (PMS) and EHR vendors to take the initiative. Some PMS and EHR providers are, in fact, well along in their plans and efforts to educate clients about testing and implementation timelines. Others haven’t yet shared their plans. Suffice it to say, if you’re expecting your software vendors to do all the heavy lifting, you may be in for a rude awakening.

You must plan and budget for this massive workload now. I recommend that all healthcare organizations:

1) be cognizant of ICD-10 as they plan all of their upcoming initiatives, and

2) understand their budget constraints and balance resources for ICD-10 appropriately.

Another initiative I recommend for many organizations is to work with payers proactively to negotiate terms to protect cash flow during transition periods based on your claims history (volume, type of services, reimbursement history, etc.). In my experience, some payers will agree to guarantee a percentage of a provider’s account volume according to prior reimbursement levels. At the end of a mutually agreed-upon timeframe, the two parties “settle up” any differences. Obviously, if you’re a large organization with a significant market share, you’ll have more leverage in this kind of negotiation. But because the potential risk to cash flow is so great with ICD-10, it may be an idea worth pursuing.

Like it or not, the 5010 and ICD-10 transitions will strain healthcare IT resources, staff resources, administrators, providers, and capital budgets. But we don’t have a choice about compliance with Meaningful Use, 5010 standards, ICD-10 diagnosis codes, and other government regulations. Savvy providers, IT professionals, administrators, and vendors realize the importance of conducting impact assessments, budgeting for IT and other resources, and planning framework changes to support ICD-10 code sets. Those that do not are in danger of going the way of the Titanic.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation, and information technology.

News 11/3/11

The New Jersey HITEC and Chicago HITREC  sign agreements with Welch Allyn to provide that company’s EHR Prep-Select services to their members.

Blackstone completes its acquisition of Emdeon in a transaction valued at approximately $3 billion.

athenahealth and its recruitment marketing agency HireClix win an onrec Award for Best College Recruiting Program. Last May athenahealth sponsored a mobile food truck and gave away free organic meals during the breaks between MIT final exams. During the event,  recruiters and software developers encouraged students to apply for open positions.

An estimated 20% more physician practices will be involved in mergers and acquisitions this year compared to 2010. As of the end of the third quarter, the number of 2011 deals involving physician practices hit 70, compared to 60 for all of 2010.

OrthoArkansas (AR) selects the SRS EHR for its 33 providers.

CMS issues a final rule updating 2012 payment polices and rates for Medicare providers and upholds the current SGR payment reduction. CMS Administrator Donald Berwick stresses that unless Congress fixes the SGR formula, provider reimbursement will fall 27.4% and create a situation with “dire consequences.”

eClinicalWorks employees come together in honor of Breast Cancer Awareness month. OK, I am a few days late, but it’s still a great cause worth mentioning.

The Florida Academy of Family Physicians names Point of Care Solutions’ Agile Medical Platform a recommended EHR/PM solution for its members. Point of Care Solutions, whose offering includes Practice Fusion’s EHR, will extend a discounted monthly subscription rate to Academy members.

Several providers speak out in favor of digital pen technology as a means of capturing clinical data and streamlining documentation. Shareable Ink CEO Steve Hau notes that digital pen applications have an accuracy rate of nearly 100% for checked boxes and 94% for free text.

Most physicians believe EHRs are safer than paper records, though patients are unsure. A GfK Roper survey finds that 54% of doctors think EHRs are safer, though only 39% of patients agree. Both physicians and patients cite accessibility as a top EHR benefit.

The AMA launches an online group for practices, payers, and intermediaries  to share tips, questions, and success stories on getting claims processed and paid electronically.

CMS adds a number of new FAQs about the EHR incentive program, including this one: does a provider have to record all clinical data in their certified EHR technology in order to accurately report complete clinical quality measure data for the Medicare and Medicaid EHR Incentive Programs? The bottom line answer is that currently CMS does not require providers to record all clinical quality measures, in part because many providers aren’t able to capture all the data in their EHR. Instead, CMS is requiring providers to report the clinical quality measure data exactly as it is generated as output from the EHR in order to successfully demonstrate Meaningful Use. CMS recognizes that this may yield numerator, denominator, and exclusion values for measures in the EHR  that are not identical to the values generated from other methods (such as record extraction.) If I am interpreting this right, CMS is saying that in order to demonstrate Meaningful Use, you may have to report meaningless data. Nice.

 E-mail Inga.