DOCtalk by Dr. Gregg 12/24/11

The Year’s Biggest HIT Event May Be a Sneaker

Over on granddaddy HIStalk, you’ll see Part One of the annual query of HIT C-suiters and other head honcho types, “What was the biggest HIT-related news or event in 2011 and why?” Some pretty expectable answers about ICD-10, ACOs, the Stage 2 Meaningful Use delay, mergers/acquisitions, and mobile health – often with some also expectable vendor-centric skew on the take – dominate these execs’ considered replies.

I can’t really say that I disagree much with any of these folks’ points of view, but I’ve been watching the land of HIT from a slightly different perspective of late and I think there may be an even more powerful portent percolating in the periphery of our health tech world. It’s sneaking up on us and it has the potential to change virtually anything and everything we do in healthcare. At least when history looks back, I’m thinking it may just be the true lead story for 2011 … and beyond.

Just as in the Middle East where, via the connectivity they can now muster via the Internets [sic], common folks have inflamed the fires of revolution and toppled longstanding authoritarian rule, I think the growing “militia” that is the so-called “e-patient” (“e” for electronic, empowered, engaged, enlightened, etc.) may just be the as yet unsung “biggest HIT-related” development in 2011. This movement is growing by leaps and bounds, yet most of the HIT world has it only on the periphery of their radars.

You all may be familiar with e-Patient Dave DeBronkhart. Dave is a leader in the budding Society for Participatory Medicine which builds upon the foundations laid by the late Dr. Tom Ferguson and his e-Patients Scholars Working Group using the guiding principle, “When the people are well-informed, they can be trusted to govern themselves.” (This, from the genius Thomas Jefferson, famous figure of a previous toppling of authoritarian rule.)

Founded in 2009, their byline is “Bringing together e-patients and healthcare professionals.” I joined SPM a little earlier this year and though I’ve so far just been listening in, getting a feel for the folks and the forum, I gotta tell you, this now fast-rising rabble has one of the most active and spirited multi-thread e-mail conversations going that I have ever seen. With voices from all over the land of healthcare, be they people/patients or medicos, and all over at least three continents, they are very busily debating just what the direction for consumer-centric healthcare delivery should be and just what people/patients should allow.

Recently, the folks at SPM were going back and forth about the value and/or ulterior motives of corporate involvement with the patient engagement realm (e.g., Merck’s MerckEngage.) Regardless of whether we can always trust the big pharma to always do the right thing or to be driven by high-moral motives, their recognition that healthcare is heading toward a consumer-driven model just adds more fuel to the SPM fires. (Personally, I really enjoyed several great little videos which Merck has on their site of Dr. Marie Savard, an advocate for patient rights and former director for the Center for Women’s Health at the Medical College of Pennsylvania, where she discusses how to start down the e-patient path.)

I lean toward a preference for inclusivity and transparency. I think this whole empowered patient movement will perhaps do more to change the course of our traditionally paternalistic medical world (providers and HIT vendors, included) than any governmentally-driven initiatives or any latest and greatest techno-marvel. Engaged folks have skin in the game and understand that their participation matters. Enlightened consumers have the potential to help drive change, both in how we deliver care and how successful the care outcomes will be. (Isn’t that what ACOs want?)

It will be a little scary for providers (and for HIT vendors) to allow access to our somewhat hidden world. Allowing the general public to see what we write, to have the obligation to explain in real “people-speak”, to invite patients into our so dearly regarded ivory towers, and to elevate consumers onto our pedestals (or to just get rid of those silly pedestals altogether) will greatly challenge some long held credos and egos.

Whether you call them “patients”, “consumers”, or just plain “people”, eventually “they is all us.” We all have a stake in this game. We’re all healthcare consumers at some point. I suggest it is long overdue that we open the doors of the hallowed (and somewhat musty) halls of medicine (and HIT) to let a little sunshine in, some e-patient powered sunshine.

From the trenches (and wishing you all great holidays)…

“There’s a war out there, old friend. A world war. And it’s not about who’s got the most bullets. It’s about who controls the information. What we see and hear, how we work, what we think… it’s all about the information!” – Cosmo, from the movie “Sneakers”

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 12/22/11

Toronto-based EMR provider Nightingale Informatix Corp. pays $1.75 million cash to buy Medrium, a US-based a practice management company that serves about 1,500 physicians. Nightingale’s CEO believes the acquisition, which includes Medrium’s development and customer support teams, will strengthen the company’s foothold in the US market.

Emdeon’s ePrescribing entity is named a certified Health Data Intermediary by the Minnesota Department of Health.

The seven-physician Elko Clinic (NV) claims that since moving to MedInformatix’s PM/EMR program, it has cut its percentage of over-120-day AR accounts from 30 to one percent while eliminating 10 FTEs.

HealtheConnections, the RHIO for central New York, says over 100 area physicians have attested for Meaningful Use.

CBSMedTech joins MD-IT as a Medical Transcription Service Organization associate and will market the MD-IT platform to its physician clients.

Practice Fusion releases an infographic outlining its 2011 accomplishments and record growth.

MDInteractive introduces a mobile app that allows providers to create patient records and submit PQRS quality measures.

The New York eHealth Collaborative reaches its enrollment goal of 5,107 eligible providers. To date, 7% of NYeC enrollees have achieved Meaningful Use. Keep in mind as of the end of November, CMS reported that only 2.5% of all EPs who had registered for the Meaningful Use program had been paid.

DocBookMD reports that over 80 medical societies in 20 states now offer its HIPAA-compliant smart phone platform to send text messages and photos to patients and other providers.

Saying that the industry is not yet ready to comply, MGMA calls for HHS to immediately issue an expanded six-month contingency plan for the Version 5010 transaction standards. MGMA recommends that for the next six months, health plans continue accepting 4010 standards and adjudicate 5010 claims, even if the 5010 claims lack all the required data. In a recent MGMA member survey, the organization found that less than one third of practices have completed all the upgrades and testing required for the 5010 transition.

Am I the only one troubled by the use of the words “urologists” and “flow” in the same headline?

Ho! Ho! Ho!

News 12/20/11

From CIO on a Mission: “Re: EHRs for surgeons. I’m trying to be helpful to some surgeons who practice at our hospital. They asked me for recommendations of practice-based EHR systems that are more surgeon focused, i.e., manage the episodic care of surgical patients rather than the chronological data of a family practice or internal medicine focused system. I’ve done the usual Google/Bing searches and came up with a few, but wondered if you or your HIStalk Practice readers can help? Thanks.” I passed on a couple of names, but also defer to our expert readers for more suggestions.

Orthopaedic Center of Southern Illinois selects SRS EHR for its nine providers.

The American Telemedicine Association develops a legislative proposal that would expand Medicaid coverage for telemedicine services treating patients with high-risk pregnancy conditions.

Vermont IT Leaders, Inc., the state’s REC and HIE organization, subscribes to CapSite’s online service, giving providers access to CapSite’s  database of HIT vendor pricing and contract terms.

Allscripts partners with clinical decision support and analytics company DiagnosisOne to offer DiagnosisOne’s smartPath platform to its Allscripts’ Professional EHR clients. DiagnosisOne will also provide real-time PQRS patient alerts and reporting to CMS on PQRS measures for Professional clients participating in the PQRS incentive program.

The Arizona REC selects PatientClick EHR as a Tier 3 participant in its Vendor Alliance Program. Tier 1 participants include Allscripts, athenahealth, e-MDs, GE, Greenway, NextGen, and Office Ally.

AHRQ introduces an online guide for reducing unintended consequences of EHRs. The guide, which was developed by RAND, is designed for all types of healthcare organizations from solo physicians to large hospital systems and addresses problems that can occur when implementing and using an EHR.

The New York Times highlights Micky Tripathi and his organization’s data breach tale. Tripathi, who is CEO of Massachusetts eHealth Collaborative, provided the full low-down on the data breach earlier this month on HIStalk Practice. On MAEHC’s blog, Tripathi posted a few follow-up comments about the Times piece, including his opinion that electronic systems are actually more secure than paper and fax. The photo above accompanied the Times story — check out his computer screen.

We mentioned the new KLAS ratings on HIStalk last week, but here is a summary of which vendors took the top three spots in the ambulatory EHR and practice management categories:

• EHR >75 Physicians: EpicCare Ambulatory, eClinicalWorks, GE Centricity
• EHR 11-75 Physicians: athenaClinicals, Greenway PrimeSuite, Allscripts Professional
• EHR 1-10 Physicians: Amazing Charts Greenway PrimeSuite, athenaClinicals
• PM >75 Physicians: Epic, McKesson Practice Plus, eClinicalWorks
• PM 11-75 Physicians: Greenway PrimeSuite, athenaCollector, McKesson Practice Plus
• PM 1-10 Physicians: Greenway PrimeSuite, athenaCollector, OptumInsight Ingenix CareTracker

In the Claims and Clearinghouse Services category, ZirMed, Office Ally, and Navicure were the highest ranked vendors.

Naughty or nice? Tell Inga.

News 12/15/11

The Orthopaedic Group, a 36-provider group in Mobile, AL, replaces its legacy EHR with SRS EHR.

Emdeon and HHS announce a program through which Emdeon will donate Emdeon Clinician EHR licenses to 100 New Jersey healthcare providers practices in medically underserved areas. License fees will be waived for one year from the date a qualified provider contracts with Emdeon. I found this demo of Clinician from this year’s HIMSS conference.

athenahealth CEO Jonathan Bush speaks out in The Hill’s Congress Blog, calling for greater transparency and accountability in the Meaningful Use incentive program. Bush points out that the current program includes no verification process to prove physicians are actually using HIT in a meaningful way. He argues that the lack of verification could potentially lead to billions of wasted taxpayer dollars and “enormous disparities between what physicians and hospitals are able to do with the EHRs and their actual ability to improve care.”

The Maine REC (MEREC) reaches its enrollment target of 1,000 primary care providers. MEREC, by the way, does not charge for its services, and, the statewide HIE will not charge small practices a connection fee for the first year.

The New England Chapter of HIMSS names practicing physician Daniel J. Nigrin, MD (Children’s Hospital, Boston) Clinician of the Year. Nigrin is also CIO at Children’s and a faithful HIStalk/HIStalk Practice reader.

The White House announces that more than $2.9 billion in healthcare fraud has been recovered in 2011, which represents a 167% increase over 2008.

In article highlighting HIPAA privacy, The Boston Globe profiles Leon Rodriguez, director of the Office of Civil Rights. Also getting a mention: Massachusetts eHealth Collaborative CEO Micky Tripathi and his recent HIStalk Practice post, which details his organization’s handling of a patient security breach earlier this year.

E-mail Inga holiday greetings.

News 12/13/11

AthletiCo Physical and Occupational Therapy (WI/IN) selects NextGen Ambulatory EHR/PM for its 50 physical and occupational therapy facilities.

HHS’ Office of Inspector General releases an advisory opinion regarding the exchange of EHR data for patient referrals. At issue: whether a vendor can facilitate a (presumably nominal) charge from a referring doctor to a specialist for a patient’s clinical record, without violating the anti-kickback statute. In reading the advisory opinion, it appears the vendor will not only facilitate the charge, but also keep a portion of the fee. OIG’s verdict: the proposed“coordination” service would not violate the anti-kickback statute. At the vendor’s request, the OIG does not name the vendor, although it sounds a lot like athenahealth to me (unverified.)

Danbury Radiological Associates (CT) selects ADVOCATE to provide billing services for its 20 physicians.

Quest’s Care360 EHR is named the top standalone e-prescribing platform by Black Book Rankings. Practice Fusion earned top scores for its EHR-based e-prescribing module.

e-MDs clients Drs. Mark Woodruff and William Weeks of Southwest Family Physicians are among the first providers in Nebraska to attest and receive Medicare payments for their meaningful EHR use.

The Chicago Health Information Technology REC says it’s on target to reach its enrollment goal of 1,486 primary care providers by the end of the year.

Altos Solutions will extend preferred access to its OncoEMR and OncoBilling platforms to members of the Innovatix non-acute care purchasing organization.

The California Health Information Partnership Services Organization (CalHIPSO) partners with CDW Healthcare to provide technology services and solutions to practices implementing EHRs.

DrFirst embeds technology from Atlas Medical into its Rcopia e-prescribing solutions, allowing Rcopia users to order tests and receive reports from any diagnostic testing facility on the Atlas iOn Interoperability Network.

Dermatology-specific EMR Encite, Inc. integrates NetHealth’s Quality Report System into its product to automate PQRS reporting.

An employee hired to purchase and maintain the IT systems at Wasatch Internal Medicine (UT) faces second-degree felony theft charges for stealing nearly $350,000 from the clinic. Over a 2-1/2 year period, the clinic paid Eric David Christensen almost $400,000 to purchase 51 PCs, warranties, and servers. Results of an audit uncovered that only three computers had been supplied to the office and none had warranties. When confronted, Christensen admitted he had been overcharging the clinic and had falsified records to cover up his actions.

A former physician with Fletcher Allen Health Care pleads guilty in US Court to unlawfully obtaining the private medical information of another person. Apparently Joshua Welch was having a sexual relationship with a woman who was not his patient and wanted to ascertain if she carried a sexually transmitted disease. He faces up to one year in prison and a $50,000 fine.

Overlake Imaging Associates (WA) selects Zotec Partners as its outsourced billing provider.

CMS posts the PQRS measures for 2012, including detailed specifications and release notes on the individual quality measures and measures groups. I found the release notes gave a pretty quick summary of what measures have changed and how.

On EHRtv, Medicomp CEO David Lareau talks Quippe with EHRtv’s Eric Fishman. He discusses the multiple way different EHR vendors are incorporating Quippe into their platforms.

Adirondack Region Medical Home Pilot Program, with implementation support services the Massachusetts eHealth Collaborative, earns Level 3 NCQA recognition for 29 of its 31 primary care practices.

E-mail Inga.