DOCtalk by Dr. Gregg 5/22/11

A Confident Nobody

Most all of you who read what is written anywhere within the HIStalk realm know that our world, the world which straddles healthcare and technology, is rife with egos galore. (Actually, I should probably write that “EGOS”.)

Doctors are notorious for their inflated senses of self. Heck, even many a nurse or med tech gets in on the medical godhead fun.

Tech-heads aren’t far behind. In fact, sometimes when I listen to two technophiles go at it as to who has the superior program design or some such, the haughty disregard each expresses for the potential validity of the other’s opinion often exceeds that evidenced amongst medicos.

Confidence in our abilities and our decisions is vital to achieving anything. Sadly, its evil cohort, arrogance — which is really just a Girls Gone Wild version of confidence — often takes an otherwise fun time and turns it into a “whose is bigger / better” contest.

This seems particularly counterproductive to our current HIT drive. I say this because of many recent conversations where I see chest-flashing bravado circumvent honest progress. Whether it’s among HIT industry types or between medical folks discussing HIT or medicos taking on HIT-men (or HIT-women), all too often I see chest pounding (or, in keeping with the theme, chest flashing) prevent real potential progress.

Sure, we all like to think we know stuff. But, when “knowing stuff” turns to “showing off,” ears tends to close as pumped out chests start to grow. One knower stops hearing the other knowers. Even though all knowers know they don’t know it all, their know-it-all-manship takes a hold and makes unknown knowing unknowable because the knower thinks they now know no one knows as well as they know. Ya’ know?

I’m seeing more and more really good partial solutions coming down the HIT trail. Some are standalones, some are within larger products. The problem is that virtually none of them do as well on their own as they might if they were hooking up with some of the others. Yet, despite all the chest-flashing going on, few are moving on to the hookup. So many are so mired in the showing off that they forget that the flash is only a part of the fun; the hookup is where the real pay off happens.

With everyone thinking that they have the best answer(s), few are truly open to hearing how the other answers out there might sweeten a mutually satisfying association. Our endless egos, which are probably a large part of the reason for healthcare’s late arrival to the technological party, are also likely a prime source for its continuing negative inertia despite all the beads being thrown about these days. The bountiful beads, it seems, are making it pretty hard for most of the HIT “somebodies” to keep their shirts down. Everybody wants to show what they have; few are really looking at the bigger picture (i.e., it’s the hookup, not the flash, that is the goal.)

I worry about this for myself, too. I’m probably far worse than most since I have both geek and doc genes. I’m probably doubly inclined to start unbuttoning. But, honest, I try to keep an open ear and a closed shirt. I try to keep my brain engaged and my chest hairs covered. I try to think “listen,” not “talk,” because most of the time odds are pretty darn good that I’ll hear something I don’t know. When I’m not in the “gone wild” mode, goodness knows that I know just how little I really know.

So, if you ever catch me writing or talking as anything other than a “confident nobody,” please tell me to button my shirt. And, please, be you on the “H” or the “IT” side, keep your top down, too. There are some really good answers out there and they don’t just come from you or me. Remember: tops down, ears open, and we’ll all get to the hookup.

From the buttoned down trenches…

“In heaven, an angel is nobody in particular.” – George Bernard Shaw

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 5/19/11

CMS announces that the first Medicare EHR incentive payments will be issued this week. Eligible Professionals, who can receive a maximum of $18,000 during the first year, will be paid via electronic funds transfer or by check.

Massachusetts governor Deval Patrick helps eClinicalWorks CEO Girish Navani and COO Mahesh Navani cut the ceremonial ribbon on eClinicalWorks’ new Westborough headquarters. Patrick then took some time to meet and greet eClinicalWorks staff members.

Carmel Foot Specialists (NC) partners with TSI Healthcare to deploy NextGen’s PM/EMR/Patient Portal.

Patient check-in company Phreesia wins the Triple Tree I Award for Operational Effectiveness at the recent Wireless-Life Sciences Alliance Convergence Summit.

Billing service provider MedData introduces an online patient portal option.

Florida’s Center for the Advancement of Health IT says over 700 physicians have signed up for assistance. The REC has funding for 2,000 providers and is waiving membership enrollment fees for eligible participants. I wonder if the waived fees are a result of too few providers enrolled for services?

ADP AdvancedMD earns ONC-ATCB certification from CCHIT for its 2011 Summer release.

CCHIT announces plans to certify ambulatory EHRs in obstetrics, oncology, and clinical research. CCHIT’s specialty-specific certifications are separate from its ONC-ATCB certification program.

Capario says it is now processing inbound 5010 claims (Errata version) and providing 5010 ERAs with submitters.

Sage Healthcare Division President Betty Otter-Nickerson is featured in the May issue of Imaging Economics discussing the need for industry leaders to bring technology tools and connectivity to patients and physicians.

I realize today’s post is a bit short. I am blaming it on a slow news day, though it could be a hot date or a need to catch a shoe sale.

Fill Inga’s inbox.

Practice Wise 5/18/11

Since I didn’t formally introduce myself in my initial posting last month, Inga asked me to take a brief moment to do so now. I’m the founder of a practice management consulting firm. Although we do soup to nuts practice management consulting, we have focused on filling the information gap between the ambulatory medical practice and their technology solution providers. We consult on some software, sell a few products, but mostly consult on practice management and performance as a whole.

This is not a platform for me to sell my products or services, but to do more of what I do every day: share information and opinions. I’m not banking that everyone will agree with what I have to say, nor does it matter.

What I know is that most technology vendors have a disadvantage communicating with their clients – the medical care providers. I come from both a hospital and ambulatory clinic background. My perspective in this blog is to give voice to the needs of the medical staff and providers as they wind their way through this crazy technology landscape.

Where the Workers Are

We keep hearing that with the great rush towards EHR adoption, there is going to be a serious shortage of HIT people to handle all the implementations and support roles. I was recently invited by our local community college (Portland Community College) to speak to a group of students completing their HIT program. A consortium of five Oregon community colleges have joined the nationwide effort to train and find employment for workers to help fill the projected HIT worker gap.

The consortium is targeting unemployed individuals with health care or information technology backgrounds as well as currently employed workers in both fields who are ready to take advantage of the opportunity to expand their professional portfolio. The colleges will use their connections with local employers to help place newly-trained HIT workers in jobs that will promote the adoption and meaningful use of EHR systems in Oregon.

The program received seed money through an ONC 2 year grant. The Health Informatics Concentration of Study Award is a short-term training program, created to meet the needs of two types of professionals:

• The healthcare professional with high computer literacy who is interested in acquiring programming, networking, and database development skills in order to enter the health informatics industry.
• The IT professional who is interested in acquiring knowledge of medical terminology, medical records, and health information management in order to enter the health informatics industry.

Going into it, I knew that this was a program to retrain adult students who were looking to change up their careers. What I didn’t know was that this program is a treasure trove of amazing talent. Although I was there to share my industry experience and an employer’s perspective of the industry to these students, I ended up getting an education about the caliber of students these programs are producing.

If you are an EHR vendor, a hospital HIT manager, an ambulatory medical practice, or a consulting firm, you can’t afford to overlook this deep pool of talented individuals. I stayed after the presentations were done to meet with the students. I found myself talking with a computer programmer with dual degrees, an RN with practical clinic experience in EMR implementation, a SQL programmer/DBA, and a bevy of IT folks who had some health care experience or none at all, but many years of IT experience and a deep desire to break into this industry.

Every one of these folks had a well-crafted resume, an excellent elevator presentation of themselves, and a passion to find a job that offers them some level of security for the near future. As an employer, I’m really excited about the value of the potential employees coming out of this program.

You, too can tap into this gold mine. This program curriculum is currently being used in 82 community colleges that received grants from ONC, but the curriculum is going to be available for free to the 1200-1400 community colleges nationwide this summer.

There was a dual grant for this program, the second part being a curriculum development grant awarded to top universities such as Oregon Health & Science University, Duke, U of Alabama, Columbia, and Johns Hopkins. This ensures a robust and content rich program that guarantees that the students are getting course work that is readily applicable in our industry.

Did I mention that I’m excited about this program for my own business, the industry, and my clients as well? There is a talent pool waiting for us to dive into and show them where the jobs are. I’ve already started interviewing several of these folks for both positions with my company and with clients of ours who are starting EHR implementations. I’ve forwarded a few resumes to local healthcare IT support vendors. Check it out in your community.

Julie McGovern is CEO of Practice Wise, LLC.

News 5/17/11

The City of Philadelphia selects eClinicalWorks to provide its EHR/PM solution for the Department of Public Health, which includes 230 providers and 20 primary care and correctional clinics. The eCW folks reminded me that they are also working with the San Francisco Department of Health and the NYC Department of Health and Mental Hygiene.

Dunes Family Health Care (OR) notifies over 16,000 current and former patients of a potential data breach following the the theft of a hard drive. The clinic says the drive was “stored in a locked, fire-protected building with limited access” and contained medical record information. The practice also indicates that they’ve now encrypted their data, so presumably that wasn’t the case with the information on the missing drive.

McKesson medical director David K. Nace, MD is named first vice chairman of the board of directors for the Patient-Centered Primary Care Collaborative.

Thirty-four percent of all office-based prescribers were using e-prescribing by the end of 2010. Cardiologists had the highest adoption rates (49%) followed by family physicians (47%.) Providers created 326 million e-prescriptions in 2010, up from 190 million in 2009. Still, that’s only about 25% of all eligible prescriptions.

meridianEMR  names CDW Healthcare as its preferred provider of IT infrastructure and services for its meridianEMR solutions.

eClinicalWorks negotiates a Tax Increment Financing plan with the city of Westborough, MA. The city will extend more than $190,000 in tax breaks to eCW in exchange for the company’s decision to keep its headquarters in Westborough. Last year the company purchased a new facility for $4.6 million; eCW is investing over $14 million in the property.

The AMA Board of Trustees argues that any attempts to standardize EMRs would stifle product innovation. Two years ago, the AMA announced it was in favor of standardized user interfaces, but now admits there’s a “lack of evidence about what constitutes an ideal user interface in a health care environment.” The AMA provides an opinion of what characteristics should be considered in the development of an effective user interface, including simplicity, an organized structure, easily visible options, easy-to-interpret user feedback, and a flexible and tolerant structure that helps prevent errors.

Trend alert: demand for workplace health clinics is on the rise as companies attempt to reduce costs and increase worker productivity.

The Association of Black Cardiologists partners with DrFirst to offer its members DrFirst’s clinical solutions. The Association hopes to drive HIT adoption rates among African American cardiologists and close the “digital divide” that separates minority providers from other physicians.

The 10 hospital and physician groups that participated in ACO demonstration projects contend that CMS’s proposed ACO framework holds too much financial risk. Participants in the Physician Group Practice Demonstration said in a letter to CMS that  the proposed structure would cost more than it would save and would penalize physicians who treat the sickest patients. Last week, AMGA and CHIME also raised objections to the preliminary ACO model.

Mr. H is forever giving me a hard time because I love news that involves lots of stats (must be that economics/MBA background.) Someone at Nuesoft must be a number lover, too because the company’s latest newsletter includes all these fun facts. If you prefer visual stimulation over number-crunching, check out NueTube for Nuesoft’s library of well-done training on demand videos. The ABCs of RECs is also a good read.

E-mail Inga.

Joel Diamond 5/14/11

A Few Minutes With Joel Diamond

Can you believe that Andy Rooney still appears on 60 Minutes?  You know who he is — the curmudgeonly commentator who closes the Sunday broadcast with supposed homespun and witty observations. 

Unfortunately, I often think of them as the bizarre rants of a crazy old reporter with cognitive dysfunction. For those of you who have never seen him, it goes something like this:

• Computers make it easier to do a lot of things, but most of the things they make it easier to do don’t need to be done.
• The average dog is a nicer person than the average person.

I never found this to be particularly insightful or funny. In fact, I’m always waiting for him to say something like:

• Did you ever wonder where the phrase ‘too big for your britches’ comes from? It generally refers to men with very large testicles.
• Did you ever wonder what color Papa Smurf changes to when you choke him?
• Why am I wearing Depends brand adult diapers right now? I suppose it ‘depends’ if I am incontinent of urine or feces.

Here’s what I think it would be like if HIStalk closed with some quaint Andy Rooney observations.

• Why do HIT venders always think it’s cute to demo their products with silly made-up names like Dr. Billy Rubin, or Vi Agra? I always found this distracting. If you insist on doing this, please go all the way — have a patient named Mia Butreeks being taken care of by Dr. Wilma Fingerdu.
• Am I the only grown-up who still giggles every time he hears someone mention the company Siemens?
• Why do EMRs have an hourglass to remind us of how slow they are going? An hourglass?! They should be consistent with the antiquities theme by showing an animated apothecary compounding drugs while looking up formulary data, or leeches sucking blood while searching for a CPT code.
• I swear I didn’t make this up. The Episcopal Sisters of Charity’s Web site said that they were looking for used Siemens units.
• Why didn’t anyone notice that the acronym for the National Coordinator’s office is the widely used medical prefix for malignant cancer? As in ONCology. This can’t be good.
• If the Enterprise Master Patient Index (EMPI) and patient identity issue so hard to get right, why could Navy SEALs do it with so quickly with Osama bin Laden … while getting shot at!
• Are they running out of pharmaceutical names? There’s a new cholesterol drug called Livalo. That just sounds wrong.  I suppose it’s not as bad as the stomach med, Aciphex (it’s seriously pronounced ‘ass effects.’)
• Speaking of drug names, shouldn’t they all just give us a hint at what they do? Anusol for hemorrhoids is a great example.
• CIO can also stand for Chief Investment Officer, and CMO can also be Chief Marketing Officer. In texting they, mean ‘Check It Out’ and ‘Count Me Out,’ respectively. Some of you may find this very insightful. I have actually have no idea if this is relevant to anything.
• I never really liked the term COWS for Computers on Wheels. The imagery is disturbing for some reason. I suppose it’s better that Computers on Carts, though.
• Is it possible that Andy Rooney suffers from Typus Degenerativus Amstelodamensis? This is a condition characterized by bushy eyebrows, low-set ears, a webbed neck, and a low-pitched cry. Think about it

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.