DOCtalk by Dr. Gregg 10/14/11

The Future Comes at a Cost

I’d like to join the choir, just for a minute, to sing the dirge of the funereal march for Steve Jobs. Whatever issues folks may have with Apple or iTunes or even Mr. Jobs himself, it is undeniable that he changed our world in an uncommonly broad-sweeping way. I’m not so sure the Edison or Da Vinci comparisons fit, but he was certainly an inspirational powerhouse for our age and a true visionary. Such visionaries are rare, wonderful creatures. Steve’s vision helped us all see the future more clearly.

Speaking of the future, I’ve been underwater preparing for this year’s “Pediatric Office of the Future” (POF) annual exhibit at the American Academy of Pediatrics – National Conference& Exhibition. (Pardon me a minute while I crow.) Its growth has been phenomenal – over 500% in five years – and now features tech tools for all three “offices” where pediatricians work: outpatient, inpatient, and mobile. With 31 sponsors, including some of the biggest companies in HIT and/or the US, we’ve added loads more space and oodles more “toys” including telemedicine, robots (yes, plural), hospital gadgets, patient engagement & education, “personal HIE,” after-hours support, social media savvy, mobile gizmos, an additional “Hospital of the Future” booth, the new “Mobile” zone, and on and on. It should be a great show.

One of the coolest things we were able to add this year is the new Tech Talk Theater, featuring experts giving 15-minute “hit-and-run” talks at the top and bottom of every hour each day during the exhibition.

Of course, all this comes at some cost. Not to the attendees and not to our many generous sponsors. Well, OK, attendees have to pay to come to the convention and sponsors, well, they sponsor. But, the cost to which I referred is the cost to your humble narrator. And that cost is one which I think many of my colleagues will also have to pay in the near, if not immediate, future.

While HIT wonks and gurus are mostly focused upon getting docs digitized these days, one of the associated facets of going electronic involves meeting those digital demands and exploding expectations from increasingly savvy “e-patients.” To wit: social media.

I admit to being a bit behind in social media savoir faire: I infrequently Facebook, don’t DIGG, find much of YouTube blatantly bland, and am mindlessly missing something in my Motorola Photon’s Motoblur. I am LinkedIn, have Tweeted a tad, and have a practice web presence. (I’ve not implemented a patient portal yet as I didn’t like the existing interface of the one from my dying EHR, though I am looking forward to that functionality in my next system – still TBD.)

So why do I say that social media sense is a cost which my colleagues must soon bear? Two main reasons…

Number one: a great colleague sort of forced me to get friendly with Facebook and YouTube and to become even more of a Tweeter (more of a Twit?) by setting up such sites for the POF and then handing me the reins. He had done some of the basics, but he’s maybe even less social media literate than I, and it took a fair amount of doing to bring them to some sense of life. The learning curve is not steep, but it takes time. And time is one of the least available resources most docs have. (My efforts here and here. I’m sure they are amateurish, but it’s my beginning. Oh … and Tweets are from @PedsOfficeFutur.)

Number two: I have been happily watching the development of an amazing new tool, HealthTap. This very clever physician-patient facilitator platform is phenomenal. Not only does it help you reach your patients, expanding your educational outreach and practice marketing power, but it also provides immediate access to thousands of colleagues across all specialties whose real world experience and expert insights are like a multitude of mini curbside consults at your fingertips, on demand.

I’ve found these experiences enlightening – and powerful. I want to do more with all of them. But engaging with these social media tools in order to engage with patients and colleagues comes with the aforementioned cost: the cost of time (and some pre-mastery frustration.)

With all of the demands upon a physician’s time these days, from going electronic to getting social and then to all of that actual patient care and practice management stuff, it gets a mite overwhelming, even for a staunchly geekoid guy like me. I admit to some moments of aggravation and annoyance as I try to become knowledgeable about tools with which many of my patients and their parents are already quite adept. I’m guessing my colleagues have had, or will soon have, similar SMS (“Social Media Stress”) as we move beyond “going digital” into that great new future towards which we strive, where technology is merely background noise that is taken for granted in our day-to-day chores, not a focus of our daily duties.

That’s the future envisioned and so admirably enabled by Mr. Jobs. Personally, I look forward to it, regardless of the cost.

From the trenches…

“Being the richest man in the cemetery doesn’t matter to me. Going to bed at night saying we’ve done something wonderful, that’s what matters to me.” – Steve Jobs

(Rest, Steve. Well done.)

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 10/13/11

PedsPal, the physicians group purchasing program for Cook Children’s Health Care System (TX) collaborates with athenahealth, Microsoft, Sanofi Pasteur, and Merck to establish the use of 2D barcodes on vaccines. The technology will allow physicians using athenaClinicals to scan a vaccine’s barcode and have the information automatically added to a patient’s chart.

The employed physician group of Lehigh Valley Health Network (PA) selects Phytel’s care management tools for its 487 physician practice.

Hospitals and health systems continue to employ more physicians, with 70% planning to hire more over the next 12-18 months. Once employed, the majority of hospitals are linking quality outcomes to physician bonus compensation and providing non-monetary compensation in the form of IT and EHRs.

A reported 56 million US adult consumers have accessed their medical information on an EHR maintained by their physicians. That’s about 24% of the adult population, which definitely sounds much too high to me.  Regardless, consumers most likely to access their EHRs online include those that are younger, more educated, and more likely to use the Internet and own a smartphone.

Facey Medical Group (CA), a 150-provider multi-specialty group, engages LancetHealth to provide data analysis and BI consulting services.

On tap next week: HIStalk’s Must See Vendors for MGMA 2011. Our annual guide will include details on a number of giveaways (lots of iPads!) and contact information for several of our vendor sponsors who are attending but not exhibiting. I’ve already been invited to one party, which means I’m that much more excited to head to Vegas.

Kareo names Bob Nichols to its National Advisory Board. Nichols is president of Medical Billing Services & Solutions.

Healthcare Information Xchange of New York announces that it has successfully connected its HIE to athenaClinical EHR.

RepuCheck introduces technology that sounds promising because it offers a solution for practices needing  to increase new patient referrals. However, I’m not sure that RepuCheck’s Review Buildr quite hits the mark. The online tool includes various alerts to remind front-staff to encourage satisfied patients to complete online reviews. The program also offers back-end analytics. The objective is to increase the number of positive patient reviews, but simply reminding staff to remind patients doesn’t sound like a very effective strategy. Maybe I am missing something.

E-mail Inga.

News 10/11/11

eClinicalWorks takes the top stop on the Worcester Business Journal’s list of top-growing private regional companies for 2011. The publication profiles eClinicalWorks, which has grown from $1 million in revenue in 2003 and should hit $200 million for 2011. CEO Girish Navani says that eClinicalWorks has added 350 jobs and over the last year and predicts adding another 200 people in the near future.

The CEO of Pulse Systems says his company is preparing to release an iPhone app, a self-service patient kiosk, and an online patient portal.

Healthcare employment continues to rise with ambulatory health services adding 26,000 jobs in September and hospitals adding 13,300.

The 15-physician Primary Health Care Marshalltown Clinic (IA) goes live on GE Centricity EMR.

EMRapproved.com, a online EMR consulting resource, launches Tech Savvy Doc Directory, which is purported to be the “first-of-its-kind nationwide listing of physicians who offer EMR and communication tools in their practices.” The idea is that patients can enter their zip code and a specialty and find all the physicians in the area that use EMR. Sounds nifty but when I test-drove it the results were less than impressive (two physicians total in my zip code, which I know is way off.) I wonder how they intend to identify whether a doctors uses EMR?  More importantly, will the use of EMR really influence a patient to select one provider over another?

HIE provider Sandlot partners with EHR provider TactusMD to provide a package solution for pediatric healthcare communities that don’t have an integrated EHR and HIE solution.

Medical residents are the subject of intense recruiting activity, with 78% being contacted more than 50 times about job opportunities at hospitals or physician groups.  A third of the residents say they’d prefer to work for a hospital, while 28% claim a preference for working in a physician group as a partner.

More bleak news on the effect of rising healthcare costs: Americans are spending more on insurance premiums, co-pays, and deductibles, leaving them with less money to spend on out of pocket health services. As a results, patients are putting off doctors’ visits or medical procedures, declining tests, and ordering less expensive drugs.

athenahealth CEO Jonathan Bush tells an HIT Policy Committee Meaningful Use Workgroup that physicians should be required to submit actual performance data to CMS, rather than simply attest they have met Meaningful Use guidelines:

“To increase the integrity of the program and leverage data that should already be maintained in EHRs, CMS should aggressively pursue a registry-based submission process for provider attestation. Until Meaningful Use performance data can be electronically submitted from a provider’s EHR, attestation unnecessarily remains a subjective and qualitative measure of success–forcing undue stress on providers, creating the need for stringent and costly after-the-fact audits, and underutilizing the capabilities of EHRs.”

The Kansas Foundation for Medical Care reports that its REC is now working with 1,002 physicians and practitioners, including 911 primary care providers and 81 specialists.

E-mail Inga.

News 10/6/11

From Elvis 2.0: “Re: MGMA picks. MGMA has posted a series of ‘Webisodes’ highlighting the details of this year’s conference, exhibit hall events, and fun stuff to do while in Las Vegas. Thought you might be interested to know that on Sunday afternoon, you can watch Cirque du Soleil in the exhibit hall while drinking wine and beer.” I am so there. Elvis also recommends the Healthcare Innovation Pavilion, which features 20-minute educational sessions on a variety of topics. Sounds like a good pick, given my limited attention span.

In his latest blog post, SRS CEO Evan Steele  makes an interesting observation about customer satisfaction and company ownership. Turns out that in the latest KLAS rankings,  five of the six top EHR vendors are privately held, while the bottom six vendors are publically traded. Steele’s theory: publicly traded companies are beholden to Wall Street and may sacrifice product and support issues in favor of earnings, while privately held companies are accountable first and foremost to their clients. I am guessing one of the top three vendors is Greenway, which is the process of going public. Based on Steele’s theory, it will be interesting to compare their current rankings with those a year from now.

Speaking of SRS, the company announces a partnership with Omedix to incorporate Omedix’s patient portal technology into the SRS EHR.

RelayHealth adds Blue Button capability to its network, allowing patients to download, print, and share their health information with a single click.

NaviNet introduces the Doc Xchange program, which allows providers to exchange medical documents electronically with other providers, HIEs, and insurance companies.

3M Health Information Systems releases a new version of its 3M Coding and Reimbursement System, which includes an ICD-10 Readiness Tool. The upgrade, which is free to current 3M coding clients, features a translation window that allows coders to complete ICD-9 to ICD-10 code translations.

The local paper highlights Westport Family Medical Center’s (MA) September 12 implementation of eClinicalWorks. The office manager notes that, “Six months from now everyone will love it, but getting from A to B will be arduous,” while one of the doctor says, “This week’s much better than last week and I expect next week to be close to not a problem.” I’d say they have the right attitudes.

eClinicalWorks, by the way, introduced several new products at its National User Conference this week:

• Patient Apps, which will run on any Web-enabled service, and give patients the ability to set reminders for treatment compliance and record pertinent health data.
• Project Scribe,  which allows providers to enter data through dictation or typing free text and have the information automatically populate the patient progress note in the appropriate fields.
• Project Nimbus, which enables practices to view and update patient data during outages.
• eClinicalWorks for iPad.

Almost half of all physicians admit to seeing encounter diagnostic errors in their practice at least monthly, while 75% are “confident” that decision support tools and artificial intelligence aids will help prevent diagnostic errors in the future.

E-mail Inga.

News 10/4/11

From Savvy Shopper: “Re: KLAS ratings. In a quick check of KLAS ratings for some of the top EMR vendors, I was surprised to see athenaclinicals and Greenway PrimeSuite significantly ahead of the likes of eClinicalWorks, Allscripts MyWay, and NextGen.” I have to admit I find the KLAS ratings fascinating to read, especially the user comments. It’s fun to learn what makes users fall in love with their vendors, as well as read details of their dirty laundry. In my vendor days, we always encouraged our happiest clients to rate us and crossed our fingers that those impossible-to-please types would not find the KLAS Web site. Though I know most vendors probably have similar strategies, in the end KLAS seems to do a pretty good job of capturing  both the good and the bad. Congrats to athena and Greenway for a strong showing.

eClinicalWorks President Girish Kumar Navani welcomes 2,700 customers to his company’s annual National Users Conference in Scottsdale. The event includes 140 educational sessions, as well as some dancing Monday night (those are the pics I want to see.) eCW announced several new clients, including Florida State University’s Student Health Services, the 165-provider Women’s Care Florida, and the 12-location Denver Nephrology.

Greenway Medical, which recently filed for a $100 million IPO, expects to add 400 jobs over the next three years at its Carrollton, GA headquarters. According to state officials, the company will also undertake a $12 million expansion and take advantage of $7.55 million in state job tax credits and a $126,000 break in sales and use tax.

Praxis aligns with CollaborateMD as a preferred EMR/EHR partner and will offer CollaborateMD’s PM software integrated with Praxis EMR. CollaborativeMD clients will also be eligible for special pricing on Praxis EMR.

Clearwave Corporation, a provider of patient information exchange software, partners with Zepherella to offer Clearwave customers access to Zepherella’s PatientPay online payment service.

Four out of five physicians use smart phones, tablets, and medical apps to practice medicine, with ER docs the most likely to use to use digital technology. Cardiologists, urologists, and nephrologists are the next biggest techies.

RCM provider Navicure announces that by the end of October, it will be sending claims to all Medicare payers in the HIPAA Version 5010 format. The company will also continue to accept 4010-formatted claims beyond the January 1, 2012 deadline.

The American Academy of Ophthalmology partners with Sophrona Solutions to provide eye care practices access to the Academy’s patient-education materials through Sophrona’s Web-based patient-communication patient portal.

Covisint announces that it is accepting PQRS submissions through its Covisint DocSite service. For 2011, CMS is paying eligible providers a financial incentive of 1% of their total allowed charges for care provided to Medicare Part B fee-for-service patients.

E-mail Inga.