DOCtalk by Dr. Gregg 9/24/11

If It’s Good Enough for Abe …

Sometimes, as I’m sure most of you know, it is downright impossible to get any "just for fun" reading in these days between all the business briefs, e-mails, news snippets, Tweets, quoted sound bites, and … ahem … blogs. Video via YouTube, TV, Hulu, or Netflix (or Qwikster, should it survive the organizational faux pas fiascos of late) demand our time and attention while stimulating satisfying cerebral serotonin surges that far surpass anything an old-fashioned read can ever dream of delivering.

Thus for many of us, the simple pleasure of a good book or in-depth magazine article has become almost a fond, quaint, nostalgic notion from days long past – like the distant 1990s, if any of you can still remember that far back.

To my pure pleasure and enlightenment, I found time to read a wonderful little article – from start to finish! – today while flying to a conference. (Forced "unplug time"… I’m loving it! Well, until I decided to iPad this piece 37,000 feet over Oklahoma.)

Anyway, the story was in National Geographic‘s "Exploring History" and was on young Abraham Lincoln in his pre-presidential years. Describing young Abe as "born radical," it discussed the things, events, and circumstances – along with the personal predispositions – that made the most-hated man of his time also the most revered American president and one of the most-studied and quoted persons of all time. 

Most of us have the ingrained image from our school days inculcation of young Abe reading a book by firelight in his little log cabin. Maybe we remember he was good with an axe ("The Railsplitter") or that he was from Illinois (even though he actually Kentucky-born and Indiana-raised.)

But consider this: as a young man of 22 when he landed in New Salem, Illinois, a town populated by "roughs and bullies," Abe was described by one of the local residents to be "as rough a specimen of humanity as could be found." Also notable was his ability to remain poor, even "penniless," and mired in his own, self-described "national debt" for years. But one of my favorite young Abe descriptors is, "he was young and gregarious, and he liked to pull pranks, spin a ribald yarn…, and talk politics."

I love that Abe was quite the antithetical and even anachronistic man for his time, that "growing up in a land of hunters, he spurned hunting; in a land of overt religiosity, he was a skeptic and kept his beliefs private; in a frontier society preoccupied with physical labor, he disdained it; in and environment indifferent to education, he had a passion for learning; … surrounded by slavery sympathizers, he opposed it."

This delightful article left me considering why I have always found inspiration in the outsiders, in those who don’t necessarily agree with the "way we’ve always done things" (a phrase I personally find one of the most abhorrent and counterproductive of all time), and in those who aren’t afraid to call it as it is (and maybe even tell a "ribald joke" on occasion.)

Such folks, those who are truly original and unencumbered by the considerations of popular consent, are few and far between. But, I just love when I encounter one of them or the efforts which spring from their free and generative minds. 

"Free and generative" doesn’t mean "free spirited." In fact, some of the most creative and original thinkers I know are mired in obsessive-compulsive ways or are such workaholics that they might seem more lockstep than free-flowing. (Consider the hours and hours spent alone by the light of the monitor of a certain someone doling out irreverent, slightly cynical, but almost always insightful HIT commentary for a certain "News & Opinion" Web site.)

Yet, it is this same internal contrarianism which seems to spark the tinder of originality to ignition. These are the people who are the originators, who bring us all up a level, who allow us to see beyond our unquestioning “that’s how it’s done because that’s how it’s done” mindsets.

HIStalk is running an Innovator Showcase series which helps bring to the fore some of these types: the people who can see things a little differently, who can combine previously unassociated things or ideas to create novel advances, the folks who are unafraid to go against the norm.

I’m tickled to see these upstart start-ups (and I’m happily involved with one of them!) I love seeing how they challenge the accepted standard approaches and try to bring useful variants to life. Their irreverence for "what is" and their eagerness to combine the heretofore uncombined is, for me, invigorating. It is, after all, what Abe did. And, if it’s good enough for Abe … 

For a little fun and in keeping with this theme, I’d like to highly recommend this little video entitled I’m a VC: Be Smarter than Your Lawyer and Venture Capitalist. It combines the irreverent spirit of Abe and the comedic hip hop stylings of a bunch of VC white boys. How unconventional can you get? I thought of it as I was thinking about those startup innovators and thought that they — and hopefully all of you — might be able to both appreciate it and get a good chuckle from it, too.

From the respectfully irreverent trenches …

“If I were two-faced, would I be wearing this one?” – Abraham Lincoln

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 9/22/11

Sage Group PLC will sell its Sage Software Healthcare unit to private equity firm Vista Equity Partners for $320 million in cash. Sage says it will take a loss up to $108 million on the sale of the former Emdeon Practice Services, which it acquired for $565 million in August, 2007. A November close is expected.

Asking patients their race is apparently offensive to many patients, according to an article in a Florida newspaper. The health reform law mandates that physicians ask patients about their ethnicity, as well as language and other demographic questions,  for inclusion in the patients’ EMRs.

Alpine Urology becomes the first physician practice in Colorado to receive test results and other patient data through CORHIO’s HIE, using their Greenway Medical PrimeSUITE EHR.

The Rothman Institute  (PA/NJ) selects SRS EHR for its 100 provider, 14 location practice. Rothman will also leverage Universal Research Solutions’ Outcome Based Electronic Research Database to automate the collection of clinical outcomes and provide decision support tools.

Premier HealthNet (OH)  completes its four-year launch of Epic EMR at 44 practices that employ 124 physicians.

athenahealth updates its MU dashboard, which it plans to publish bi-weekly.  Highlights through September 10^th:

• 17% of Medicare providers have attested, compared to 11% as of August 27^th
• 52% of Medicare providers are satisfying the clinical summary measure, up from 32%
• 75% are satisfying five of 10 menu measures, versus 64% two weeks earlier.

To make it easier for staff and providers to fulfill the clinical summary measure, athena tweaked workflows in the athenaclinical product and added a secure electronic delivery option.

Meanwhile, meridianEMR updates its Meaningful Use Tracking Board. A month ago, meridian reported 36 attestations and $648,000 in practice dollars. At that time meridian pointed out that only about 50 total urologists had  attested, with the largest percentage meridian EMR clients.

athenahealth and meridian are the only ambulatory vendors that I am aware of that are publishing this type data. If anyone knows of any other vendors posting MU dashboards, please share.

Medical practices cut operating expenses 2.2% in 2010, though general operating costs have increased 53% since 2001 and revenues have grown only 46%.

An Australian study concludes that despite the growing use of financial incentives to reward physicians for quality care, there is insufficient evidence to support that such programs actually improve care.

E-mail Inga.

News 9/20/11

From Jiminy Cricket: “Re: dueling free EHRs. I thought this press release was funny, not to mention horribly written. But like a street fighter swinging wildly and skillessly against a pro boxer, sometimes a punch lands, and I’d say this one might have connected with the Practice Fusion jaw a couple of times.” Mitochon Systems issues a press release to “debunk” the “hyperbole, myths and over-reaching claims” on the part of fellow free EHR provider Practice Fusion. Among Mitochon assertions: Mitochon — not Practice Fusion – offered the first free, complete ONC-ATCB certified EHR; Practice Fusion probably doesn’t have the largest MU physician community since its MU product was just released last week; and if 5,000 Practice Fusion customers attest for MU this year, it would only represent 5% of the Practice Fusion client base. Maybe some of the punches have connected and maybe it’s really a whole lot of bunk about nothing. Regardless, Practice Fusion clearly seems to have struck a nerve with its competition.

Southern Illinois Hand Center announces plans to upgrade from Sage Medical Manager to Sage Intergy Meaningful Use edition and add Sage’s patient portal.

These numbers surprised me: almost 90% of physicians use at least one social media site for personal use and over 65% have at least one site to support their professional practice. Most physicians also see potential for physician-patient online interactions, including the sharing of educational materials and for monitoring patients’ health. Liability, privacy, and compensation remain big concerns for providers.

SuccessEHS expands into the electronic dental record market with the purchase of MediaDent. The acquisition strengthens the SuccessEHS offerings for community health centers.

Quixote partners with ZirMed to offer ZirMed’s RCM services to Quixote’s practice management customers.

The 230-physician Hattiesburg Clinic moves to Epic’s EMR.

McKesson integrates its iKnowMed EHR and Lynx Mobile drug inventory management system, giving oncology practices a single chemotherapy orders workflow management system.

Thirteen thousand additional physicians and hospitals signed up for the MU incentive program in August, bringing the total number of registrants to 90,000. CMS paid Medicare incentives to 1,000 EPs in August, with 1,300 receiving checks under the Medicaid incentive program. YTD payments: $652 million.

Meanwhile, the Office of the Inspector General estimates that Medicare contractors have overpaid physicians $28.8 million for incorrectly coded services provided during 2008 and 2009. OIG recommends the recovery of at least $7 million of the identified overpayments.

CMS issues an ICD-10 transition guide for Medicare providers that includes information on how to handle claims for services during the ICD-9 and ICD-10 transition.

E-mail Inga.

Practice Wise 9/17/11

Compassionate Expectations

Boy, I never thought I’d have such a love-hate relationship with a word as I do this one: expectations.

It’s been a long, hard summer in my world. We’ve been buried in Meaningful Use software upgrades and a rush of new practices starting up.

Who said all the small practices are selling to the hospital systems? Not in my neck of the woods! We usually start up one or two practices a year. We’re on #6 this year and they keep calling, and they all want to be open in three months. But I digress …

I started this summer with great anticipation of MU product releases. Although I knew that the upgrades would be arduous, what I didn’t anticipate fully was the varying degrees of expectations — met and unmet — around these upgrades.

My greatest expectation was that our clients would be thrilled with over 450 new features and functionality in their software. So thrilled, in fact, that they would embrace all the free training we offered and be enthusiastic at upgrade. We delivered a fully certified MU product in time for them to attest for Phase 1 this year if they desired. I was confident we met their expectations, in spades!

Suffice it to say that we met our own expectations of what we thought they wanted. But in the end, everyone had different expectations and perceptions of how this would play out.

In our experience, doctors expected us to provide an amazing product and it would just work. They wouldn’t have to learn anything new, even though it did a gazillion new things. Practice administrators expected their staff to participate in the training we provided and sign off when they actually did it. What we found is many signed off and never really did the work. When we showed up post-upgrade, they were lost and expected us to do training on the spot while we were troubleshooting technical issues.

Everybody in the practice had differing expectations and it was our challenge to meet them all.

Our own expectations of how our software vendor would handle their product release and ensuing support was the surprise of the summer. I have been doing medical practice software support and consulting for 11 years now and it hasn’t all been wine and roses. We expected reduced response for our support cases since our vendor was as overwhelmed as we were, but they didn’t leave us hanging.

They even pulled off a few miracle saves. A big was bug found at our favorite client’s office, a show-stopper that brought them to their knees. The developers fixed it in 48 hours.

Of course, the doctor’s expectation was that the code should haven been rewritten before end of business the same day it was found. I was praising the 48-hour miracle and she was complaining that it took so long. Our expectations were clearly out of alignment.

Just when I realized the toll this was taking on my staff and our clients, I was moved by the HIStalk post by Ed Marx on 8/17/11 titled Connect. This article motivated me to take action — first with myself and my staff, then with our customers.

It was posted the day before our quarterly user group, an informal meeting with all of our customers to check in, share ideas, and work together towards solutions. We were all feeling a little ragged from the first round of upgrades. Customers still waiting to be upgraded were anxious.

I started the meeting by sharing Ed’s discussion of compassion. It really touched a nerve (I still had a few left). It helped me refocus on what our intentions are. We are here to help providers and their staffs provide excellent patient care. We are not purely consultants with solutions. We are partners in the patient care they provide.

With this as the theme, I started our meeting on a different tact.  I did a level-set of expectations for all of us. It was a gamble, but I spoke from the heart to my customers about the challenges we were facing, the stress of the upgrades and their reactions to the changes, and the challenges within their own practices. I showed compassion for myself, my staff, and most of all, for our customers. How the interruptions of software changes often take their focus off caring for their patients while they battle data entry in their EHR.

They shared the same. It was transformative. We found commonality in purpose and compassion for each other.

We have continued to soldier on through the remaining upgrades. We continue to remind ourselves that compassion for the role and position of everyone involved is the key to getting through stressful encounters when they arise.

Did I mention that my Outlook crashed this summer during all this stress? I guess my expectation that this awesome piece of software can hold an unlimited amount of data (48,385 messages in fact) in a .pst file was unrealistic. Luckily, I have a compassionate engineer on board who took pity on me and didn’t berate me (too much) for not deleting more than three emails a day for the past nine years, and not launching our mail server years ago! We are currently planning a migration and setting appropriate expectations, because you never know how these things will go.

It’s been a great summer. I’ve learned to set clear expectations and practice doing so with compassion, every day. Thanks, Ed!

Julie McGovern is CEO of Practice Wise, LLC.

News 9/15/11

From Cleve Van Valen: “Re: Jonathan Bush. Hate to say it, but Jonathan Bush makes my CEO look like he is driving a horse and buggy.” I assume Cleve is referring to our recent interview with JB and athena’s MU transparency initiative. The transportation reference reminded me of this cartoon produced for the 2008 HISsie awards, which features Jonathan Bush in a DoLorean sports car, a la’ Back to the Future. It still makes me laugh.

McKesson introduces McKesson Practice Choice, a Meaningful Use-certified, Web-based integrated EHR/PM solution for small, independent primary care practices.  The company also announces McKesson Practice Care, a service line that offers patient-centered medical home consulting in conjunction with AAFP’s TransforMed and available exclusively for practices running Practice Partner, Medisoft Clinical, Lytec MD, and Practice Choice.

Practice Management Associates (VA) selects the ADP AdvancedMD PM for RCM services.

The 14 physicians of Sandhills Pediatrics (SC) receive $184,000 in government incentives for their Meaningful Use of the SRS EHR.

The Physician Services technology division of Inland Northwest Health Services (WA) announces plans to offer implementation and hosting services for Greenway’s PrimeSUITE EHR/PM solution.  INHS serves and connects 38 hospitals and over 4,000 physicians on its HIE.

Practice Fusion forecasts that 5,000 of its eligible provider customers will qualify for 2011 Meaningful Use incentives worth up to $90 million. That’s a big number, especially considering that through July only 4,491 EPs, regardless of EHR, have received MU checks. On the other hand, HHS Secretary Kathleen Sebelius reports that 80,000 providers have applied for funds, so perhaps the 5,000 EP estimate is on target.

Medicaid managed care provider AmeriHealth Mercy launches a program to offer its network providers free mobile technology. Physicians will have access to care alerts and e-prescribing at the point of care using the NaviNet Mobile Connect platform.

Phreesia introduces an electronic Medicare Annual Wellness Visit form, which can be presented to patients during check-in.

Integrating telehealth tools with care management for chronically ill patients may result in significant savings ($312 to $542 savings per patient per quarter.) The coordinated approach may also improve health outcomes.

Speaking of telehealth, Mount St. Mary’s Hospital and Health Center launches a telehealth practice to address acute health issues and follow-up care, as well as provide chronic care virtual visits. Mount St. Mary’s says its Online Care practice, which uses American Well technology, is the first medical group in the country to be formed as a telehealth practice.

E-mail Inga.