News 12/21/10

Top issues influencing the health industry next year include: increased demand for HIT professionals as providers spend more on HIT; new risks and opportunities resulting from new payment models, such as accountable care organizations; and, more mergers and acquisitions as providers look for ways to share administrative and IT costs. Those predictions courtesy of PwC’s Health Research Institute.

eClinicalWorks CEO Girish Navani chats with a local paper about company’s upcoming move, eCW’s history, and recent financial performance. Here are a few tidbits:

• eCW is spending $18 million for the new site, which includes the purchase of a 100,000 square foot building, renovations, and furniture. The move is scheduled for early next year.
• The company anticipates its 2010 revenues will hit $130 to $150 million, up from $100 million in 2009.
• Over the next 12 months, eCW plans to hire an additional 100 to 200 more employees to its existing 1,300 person workforce.

Wills Eye Health System (PA) contracts with NextGen for its EHR and PM products.

athenahealth tells investors its FY2011 earnings won’t meet expectations with predicted earnings of $0.68 to $.78/share versus expectations of $.85. Shares slipped on the news Thursday but were moving back up by Monday.

Employment in doctor offices fell by 500 employees in November but grew by 8,000 in hospitals, according to the Bureau of Labor Statistics.

This won’t help employment statistics: Gulfcoast Oncology Associates of St. Petersburg (FL) plans to lay off 197 employees by February. The 70-physician group was recently purchased by Florida Cancer Specialists.

Geolocation technology will likely play an increasingly larger role in healthcare, despite HIPAA privacy concerns. Geolocation services, such as Foursquare and Facebook Places, allow patients to voluntarily check in various locations, including their doctor offices. Possible benefits for provider: attracting new patients or for promoting certain services, such as flu clinics.

The one-size-fits-all design for EHRs does not address workflow demands of all physicians, according to a new UC Davis study. Physicians who have invested time using various EMRs would likely draw the same conclusion. After implementing an EMR, physician productivity dips a painful 25 to 33%, though some specialties eventually return to better than original productivity. Other specialties (in this case FP and pediatrics) didn’t return to original productivity levels. The conclusion: there is a  “mismatch between technology design and the work-flow requirements and health administration expectations” for different specialties.

Slow week in the HIT world, but since Mr. H is still slaving away, I figured I better show moral support and dig deep for industry news. Feel free to send me an email with your juicy news, holiday greetings, or last minute shopping tips.

E-mail Inga.

Intelligent Healthcare Information Integration 12/19/10

Look Out, Pretty Mama, I’m On the EMR Road Again

(Prizes go to the first to name the two bands most relevant to the bastardized title above. No Googling.)

Reminder to self: Don’t promise what you’re going to be blogging about “next time” ever again. It stifles the few creative juices you have left and disrupts those last couple of remaining neurons.

Please pardon the short redirect from my previously stated next blog topics, because as I continue the hunt on down The Next EMR Road, I keep coming across cool features and, sometimes, even cooler people. That occurred today when I had a really enjoyable, refreshingly honest conversation with Physician’s Computer Company’s (PCC’s) Chip Hart. I know them a bit from their generous sponsorship and well-done exhibit presentation at the Pediatric Office of the Future.

I haven’t done a deeper dive with them – yet – but I sure will, as much due to Chip’s forthright attitude as anything. To wit: he told me he assumes I won’t end up choosing their EHR, but he says they have some really cool features and he is just as excited to share them despite his conjecture. He also gives props to Office Practicum, who is the standard for doing pediatrics EMR stuff, says he.

Chip had a lot more wonderful insights as he and PCC have been at this since 1990 and 1982, respectively. But, what really struck me were those two statements, certainly not comments any upstanding sales, marketing, or PR team leader would condone. How can you not appreciate a company so self-satisfied in a niche market like pediatrics? I read an interview where he’s quoted saying the pediatric software market is “not a pond you would fish in. Pediatricians are poorly paid compared to other medical specialists.” (Amen, brother!) And, yet, here they are, pole in hand, strolling the banks of our poor, little pediatric puddle, and even willing to point out where the fish may be biting better to another fisherman. I like that kind of straight shooting.

Now, back on track down EMR Road. I don’t know about you, but this HIT world gets about as dry and tasteless sometimes as a salt-free Saltine. That’s why I just adore those spicy little folks and jokes that pop up every now and then along the trail. (You read Mr. H and Inga’s stuff; you must enjoy some HIT humor, too!) One of the masters at this entertainment value add is, hands down, Jonathan Bush. (No surprise there to anyone who reads HIStalk or hits their Reception at HIMSS.) Agree with him or not, he adds a whole heap of color to this sometimes dreary, sales-pitch heavy road. Keep on keepin’ it real, JB.

A new challenger to the HIT comedy throne, though, has got to be the happy staff over at Nuesoft. If you’ve seen their Lady Gaga’s Pokerface parody over on HIStalkTV, you know what I mean. If you’d have seen them in their Star Trek garb and 1970s leisure suits during a recent exhibition hall outing, you’d agree that they’re definitely in the running for a “Most Fun HIT Vendor” award at next year’s HISsies. (I don’t think such an award category now exists, but I’m hereby suggesting it and placing a nomination!) I was lucky enough to spend an evening dining with a bunch of Nuesoftians at the aforementioned conference/exhibition. They are, without question, one of the happiest gaggles of gleeful, goofy geeks with whom a guy could gulp, gobble, and gossip a night away. (Thanks, again for the laughs, y’all.)

One exciting relative newcomer system with which I recently became acquainted is Mitochon Systems and their “Virtual Medical Community.” Their founder, Dr. Andre Vovan, is a practicing critical care specialist who is as sharp as they come and wonderfully impassioned, as any great entrepreneur should be! To say their EMR is “free” is misleading. They are developing a way to have the right people pay for it, the people who derive the most monetary value from the healthcare industry – pharma, medical suppliers, inscos, etc. The docs get their great new connectivity between providers, patients, and hospitals without charge; sponsors, who reap financial value by targeting relevant markets, bring the money to drive the ship.

They are very focused upon simplicity, the preeminence of the physician-patient relationship, and the integration of EHR, PHR, and HIE – which is where we’re all heading one day anyway, right? (He said, hopefully.) Mitochon’s COO, Chris Riley, came out of an early, self-imposed retirement because of his enthusiasm for their model. Even though a well-funded early retirement sounds pretty good to me some days, I can see why he’s so enthused. Mitochon is young and needs maturation, but they have some tremendous connectivity and information sharing, as well as some pretty cool interface concepts that I find very exciting.

OK, I didn’t finish what I started last time, so next time…oops…almost forgot. (See first full paragraph.)

From the trenches…

“I had nothing to offer anybody except my own confusion.” – Jack Kerouac

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

News 12/16/10

KLAS releases its 2010 Best in KLAS awards. Winners in the ambulatory care categories include:

• Ambulatory EMR (Over 100 Physicians) – Epic EpicCare Ambulatory EMR
• Ambulatory EMR (26-100 Physicians) – eClinicalWorks EMR
• Ambulatory EMR (6-25 Physicians) – Greenway Medical PrimeSuite Chart
• Ambulatory EMR (2-5 Physicians) – e-MDs Chart
• Practice Management (Over 100 Physicians) – Epic Resolute/Prelude/Cadence
• Practice Management (26-100 Physicians) – McKesson Horizon Practice Plus
• Practice Management (6-25 Physicians) – Greenway Medical PrimeSuite Practice
• Practice Management (2-5 Physicians) – e-MDs Bill
• Claims and Clearinghouse Services – Navicure

I’m also told that Praxis EMR took the top stop for solo physician EMR and athenacollector for solo physician practice management. The Best in KLAS ambulatory winners are almost a repeat of 2009’s, except in the 2-5 physician space and in claims and clearinghouse services. Last year Greenway led the pack for 2-5 physician EMR and athenacollector for 2-5 physician practice management; RealMed was the top clearinghouse. This year e-MDs displaced both Greenway and athena and Navicure earned top clearinghouse honors.

RediClinic announces plans to open 20 new clinics in HEB supermarkets in Texas. The clinics will be affiliated with Methodist Health System in San Antonio, Memorial Hermann Healthcare in Houston, and St. David’s Healthcare in Austin.

Wellington Radiology Clinic (IL) picks McKesson’s Revenue Management Solutions for radiology billing and PM services.

WebPT, a startup company providing EMR solutions for physician therapy practices, receives a $1 million investment from private equity firm Canal Partners.

Hoag Memorial Hospital Presbyterian (CA) has connected 250 community physicians to its HIE, giving practices online access to lab, radiology, and pathology reports, as well as transcribed reports and face sheets. Hoag is using Medicity’s Novo Grid solution to facilitate information exchange.

Everyday Health acquires online medical news service MedPage Today. MedPage Today’s portfolio includes a website, mobile applications, and partner site blog KevinMD.

Nashville-based EMR company iPractice Group will hire 30 employees in January. The company promotes a $74,500 contract that includes “all services” for doctors moving from paper to EMR. The founder says the company plans to start sales in January and will add 100 more staff by the end of 2011. Pretty darned aggressive strategy for a startup entering a competitive and crowded market.

A former University of Michigan physician pleads no contest to counts of unauthorized access of computers and using a computer to commit a crime after it was discovered he altered computer files to boost his performance evaluations. Eric Batterson installed keystroke recording software on computers to obtain colleagues’ passwords and access their e-mail accounts. He then went into different systems, made improvements to his evaluations, and also lowered evaluations of his colleagues. To avoid prison, he must pay $9,400 in restitution.

Tucson Orthopaedic Institute rolls out an online learning solution for Allscripts Enterprise EHR. It was developed by the consulting firm ImplementHIT. Interestingly, ImplementHIT’s CEO Dr. Andres Jimenez is the former clinical director of content and online training for Allscripts.

Coming to a cell phone near you: diagnostic testing. GENTAG develops a disposable wireless diagnostic test platform that enables consumers to use cell phones to diagnose pregnancy, fertility, pathogens, AIDS, drugs, allergens, and certain types of cancers. The technology is based on immunoassays and is being marketed primarily to the OTC consumer market.

E-mail Inga.

News 12/14/10

The cost to adopt an EMR may be as much as $120,000 per physician, though it can reduce overall costs with full implementation and accelerated workflow. This report suggests that during the first year of adoption, physicians may manage 10% fewer encounters. As a result, lost revenue is a bigger drain on a practice than the actual EHR software and hardware costs. The methodology for this study is a bit questionable (findings were largely based on a survey of 200 practices that had not yet adopted EMRs), but, I agree with the bottom line assessment: the sooner the implementation is completed, the sooner the returns will be be realized.

I’m guessing this doctor might concur with the above findings. Dr. Paul Meriwether, a small-town family practice doctor, shares with the local paper his struggles implementing a new EMR. Dr. Paul Meriwether says he and his partner added 2.5 FTEs and still had to reduce their patient load by 30-50%. Though he considers the EMR “a natural evolution of the nature of healthcare,” the road hasn’t been easy:

As we get used to the system, the adjustments are limiting us – limiting the number of new patients, because they take longer to enter into the system. Everything has to manually be put in to the computer. We’re hoping six months from now, we will be back up functioning like before… I believe once we get it into the computer and it’s in the system, it’s going to get better. We were told this, but it is very frustrating. It’s something, I’m sure, like, 30 years ago, things were implemented that doctors hated to do, but that now is second nature for them.

Marshfield Clinic (WI) will receive a $16.5 million performance payment based on achieving 100% of benchmark performance measures in CMS’s Physician Group Practice Demonstration. Marshfield calculates it has saved over $83 million in its first four years participating in the national demonstration project designed to incent practices to improve quality of care. Dr. Theodore Praxel, the clinic’s medical director for quality improvement and care management, says that initiatives such as a 24-hour nurse line, anticoagulation program, heart failure care management program, and EMR were integral to the cost savings. Four other group practices will also receive bonuses as part of the demonstration project, for a total of $31.7 million. A similar demonstration project for solo and small practices will pay $9.5 million to more than 500 practices.

The AMA and 103 state and specialty medical societies urge HHS to revise the Medicare e-prescribing penalty policy and better align it with complete EHR incentives programs. The policy penalizes physicians in 2012 and 2013 if they don’t e-prescribe in the first six months of 2011. The AMA says this policy will hurt practices that are implementing complete EHR systems. To participate in the 2011 e-prescribing program, some  physicians may have to spend additional resources on an e-prescribing program that may be discarded once the physician moves to a complete EHR.

Healthcare Partners Medical Group, a 1,200-physician primary care group in California,  goes live on Unity RIS/PACS from DR Systems.

ICSA Labs and SLI Global Solutions join CCHIT, Drummond, and InfoGard as the latest ONC-ACTBs. Neither of the new companies mention the EHR certification program on their websites (yet).

RCM provider ZirMed raises an undisclosed amount of venture backing from Sequoia Capital.

McKesson names Professional Data Services its Practice Partner Value-Added Reseller of the Year for the fifth straight year.

WellDoc announces integration of its DiabetesManager solution into a “leading” EHR solution, which I am told is Allscripts.

Consulting firm Surrex EHR Solutions partners with gloStream to provide sales and implementation of the gloStream platform.

Clinical messaging provider Kryptiq ranks number five on Portland Business Journal’s list of Oregon’s Most Admired Technology companies, based on the votes of 1,800 Oregon CEOs.

A CDC survey finds that around half of physician practices use EMRs, but only 25% of practices use a system that meets “basic system” functionality, with just 10% using a “fully functional” EMR that includes medical history, drug interaction checking, e-prescribing, electronic ordering of lab and radiology tests, and viewing electronic images. Still, the use “fully functional” EMRs has gone from 3.1% to 10% since 2006. Laggard states include Kentucky, Louisiana, and Florida, in which more than 60% of physicians in practice do not use any form of EMR. Leading the pack is Utah, with 51.5% of office-based doctors having access to a basic EMR.

Meanwhile, a 2011 Black Book Ranking’s user survey suggests that 90% of providers that have purchased EMRs aren’t ready to meet Meaningful Use implementation goals. The top reasons users cite for delayed implementations included lack of support from vendors, cost for additional vendor or consultant support, and lack of properly trained staff. Another noted problem that sounds like a great catch-all excuse to blame “others”: a hurried selection of an EHR vendor that resulted in negative consequences.

E-mail Inga.

Intelligent Healthcare Information Integration 12/9/10

EMR Hunting: 20 Questions (well…5, plus)

Q) Why is hunting for an EMR like looking for a new smart phone?

A) Because there are a ton of them from which to choose, most of them look and feel pretty much the same, they can all do a lot of the basics, there are some pretty cool features even in some of the less-developed ones, and even the best ones don’t do everything you might want.

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Q) Why is vendor EMR enhancement sometimes akin to moving from a pig pen to a mud puddle?

A) Because when a vendor gives their old users a new feature or a slightly better interface, the users will rave and crow about how cool the new feature(s) is/are, not realizing their lot in life has only minimally improved.

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Q) Why aren’t all vendors offering free online demo tool access where users can “test drive” an EMR?

A) Not sure. I only know that if I’m buying something to “drive” for the foreseeable future which may make or break my bottom line, I sure as heck am not going to pony up after a spin around the block with the salesperson doing the driving. Plus, I’m much more prone to appreciate a vendor who provides such access.

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Q) What makes for a great EMR demo experience?

A) Vendor reps who really know their product, who don’t assume that they know more than their customer, who take the time to try to deliver a personalized experience and not just a rote spiel, and who TRULY understand the value of time to a busy physician.

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Q) What can providers do to enhance their EMR product compatibility?

A) Look for a system “look and feel” that suits you, yes, but also look for a corporate philosophy and history that is compatible with your values. Glitz and sham abound; don’t be blinded by pseudo-science, salesmanship, or “the show.”

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Q) What about those products mentioned in the post of November 30th?

A) Not forgotten. (And by the way, I really appreciate the Comments and emails I’ve received suggesting products and features I may not mention or even be aware of – thanks, and please keep ‘em coming!)

SRSsoft’s Hybrid EMR – One of the things I like best about SRSsoft isn’t just their new “app store” which allows users to add new parts and pieces in the user-friendly fashion of iPhones and Droids (which I truly, dearly love!) No, perhaps the best thing about them is straight-shooter Evan Steele, company CEO and all-round good guy. Evan actually took the time to personally show me around the SRSsoft block and describe their tool, their new app store, and their pending new version features (very cool!) What really makes him unique in my book, though, is his honest, no BS approach. Case in point: Evan has been rather outspoken in his opinion of Meaningful Use certification and its lack of value to specialists (one of his special foci.) He has maintained a clear vision about wanting to provide physician-friendly tools which are “workflow-driven.” However, as this ever-evolving process has unfolded, he has re-evaluated their corporate stance and will now get on about obtaining an ONC-certified diploma. The value to his clients of such has changed and he is open and frank about seeing the need for providing this and changing his approach. As he gave me a explanation of his changed views, I sensed no sales guy schmooze, just a plain-spoken “I’ve reconsidered.” I like his lack of guile and straight up manner.

Medicity’s iNexx – Well, I’m not sure what to say now about Medicity and iNexx. I have gotten to know several of their corporate bigwigs and really enjoy and respect them. I like their primary product a lot and am very intrigued by their approach with the open source, app-able iNexx (though it’s really still in alpha and not yet ready for prime time.) The recently announced buyout by Aetna is something that makes the physician in me cringe. Nothing particularly personal to Aetna, but after years of aggravating experience after aggravating experience, my overall insurance company Gestalt is, well, probably pretty commonplace amongst providers and not all that wonderful. I do try to maintain the bigger picture view I espouse, but whether it’s Aetna or UnitedHealth Group or MomsAndPops Hometown Insurance, most physicians don’t really feel too good about having more insco involvement in between their patients and them. It’s a “once bitten, twice shy” thing. I read on HIStalk that Medicity would stay as a separate biz unit “under the company’s current management.” I hope so. I really like those folks – and their tools.

So many products, so little blog space. Next up: Fun folks (expanded,) excitement, a true helpmate, the power of views, plus.

To be continued, from the trenches…

“Dreams are today’s answers to tomorrow’s questions.” – Edgar Cayce

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.