News 3/17/11

Main Line Health (PA) is implementing eClinicalWorks for its affiliated physicians.

WebPT EMR announces a certified billing partner program that includes integration with Kareo’s medical billing software, as well as with BMS.

National Billing partners with Practice Fusion to offer an EHR solution for its physician billing clients. National Billing uses Kareo’s practice management system.

RCM consulting services company TrustHCS partners with RemitDATA. TrustHCS will utilize RemitDATA’s business analytics and post-adjudication claims tools in its physician services practice.

Document management solution provider Accentus expands it ambulatory care service offerings through the acquisition of Mrecord, a speech recognition and medical transcription services company.

Doximity raises $10.8 million Series A venture capital to accelerate development of Doximity’s free communication platform for healthcare providers. Doximity, which is led by Epocrates co-founder Jeff Tangney, allows physicians to use their iPhone, iPad, Android device, or computer to connect with other providers to collaborate on patient treatment.

A big thank you to Dr. Jayne for pitch hitting on HIStalk Practice earlier this week while I was taking a few days off. I’m hoping to convince her to drop in more regularly and share more of her wisdom on ambulatory EHR and related topics. Meanwhile, I am guessing I am was not the only one Spring Breaking this week, given the slow trickle of news in the HIT world.

Academic faculty physicians in primary and specialty care reported slight increases in compensation from 2009 to 2010. Median compensation for primary care faculty physicians was $163,704 (up 3%) and specialists was $241,969 (up 2.7%.)

MED3OOO CEO Patrick Hampson will serve as a 2011 Ernest & Young Entrepreneur of the Year judge for Western Pennsylvania/West Virginia.

Allscripts opens two offshore development centers in Pune and Bangalore, India that will provide customer support and other services.

Housekeeping note: please show your support for HIStalk Practice by visiting our sponsors (a mere click is all it takes to learn the myriad of ways that each can make your HIT world better.) You can never have too many friends or connections so friend me on Facebook and give HIStalk a like, connect with me on LinkedIn, and follow me on Twitter.

A private investigator who specializes in preventing and detecting fraud against dentists shares a scary story of how a practice manager stole over half a million dollars from her employer. Most of the theft involved cash and over the years the practice manager developed a “duffle bag full of tricks,” including:

• Non-legitimate write-offs
• Not entering cash receipts into the computer
• Excess overtime pay, since the practice manager also handled payroll
• Tampering with check ledgers for cash disbursements

Since  the practice manager was a 20-year, trusted employee, her employers ignored plenty of warning signs, that included refusing to take vacation and often working in the office alone at odd hours. Plenty of good lessons here for any medical practice.

E-mail Inga.

Curbside Consult with Dr. Jayne 3/14/11

It’s my honor and privilege to appear this week on HIStalk Practice while Inga and Mr. H are out enjoying spring break. I’m happy to help keep the home fires burning. Frankly, after some of the things I saw while providing emergency department coverage for Mardi Gras, I’m content to sit happily at home with my laptop and a cup of cocoa.

I did venture out this weekend to have dinner with a good friend, someone with whom I shared the wonder and agony that is Residency Training. For you non-clinicians, residency is the multi-year period after one has graduated from medical school and has a degree, but continues to train under supervision. It’s a high-stress time when you learn how to run a hospital-based practice as efficiently as possible. Unfortunately, except for a handful of programs, they don’t teach you much of anything about how to run an office-based practice.

My friend finished residency and joined a small private specialty practice. The scattered topics we hit during dinner and drinks reminded me how widely varied physicians’ experiences are with regards to healthcare IT and the various state and federal rules and regulations, let alone Meaningful Use. There were some random things I mentioned about liking or not liking in the EHR, such as logging samples, and we discovered that her practice is blissfully unaware of some of the things that are looming.

She’ll be deploying an EHR in the coming months, trying to get her piece of the federal pie, and I’m sure I’ll be hit for many curbside consults in the future. As long as she pays the bar bill, that’s OK. I’ll share the tales of woe (and wonder) as they come. But in the meantime, I decided to write some tips and tricks for all of you on the practice side to help prepare for Meaningful Use.

Meaningful Use: 15 Things Your Practice Can (and Should) Do Now

Note: This assumes that the practice and physicians have already decided to try to demonstrate Meaningful Use and have chosen the Medicare path. Most of the folks who are going for the Medicaid path have already figured out they have a much easier road and are laughing all the way to the bank in many states.

1. Get thee to a certified EHR. If you are already on EHR, make sure that you are on a version that the vendor has certified with one of the Meaningful Use certification bodies. Beware of phrases like “certification compliant,” as that is similar to “board eligible.” The Feds require that you be on a certified version — end of story. Pending or compliant doesn’t cut it. If you are not on the certified version, immediately schedule a consultation with your vendor / reseller / technology partners to determine what it will take to get you on a certified version. If you are not already on an HER, are in the search process and achieving Meaningful Use is a significant consideration, you might want to use certification as a litmus test to make your search easier.

2. Make sure you understand your vendor’s reporting strategy. Are they providing “out of the box” reports that you just have to deploy to see how you are doing? Or do you have to hire a report writer or consultant to get the reports you need? Ideally, you want the reports in hand so you can run them throughout the year and see how you stack up prior to submitting your data.

3. Make sure you understand the HITECH program. Providers need to be intimately familiar with the objectives and measures, whether they think they do or not. They should be able to articulate what is expected of them if they plan to be successful. Failure to show up to meetings where this is discussed or to participate in discussions about changing office workflow are not favorable signs.

4. Register with CMS. If you have never been to the CMS overview page, bookmark it now and visit it often.

5. Determine exactly where and how in the EHR measures need to be documented. I’ve seen several vendors put together MU slide presentations that outline this. For those providers that don’t always pay attention, I recommend printing this, highlighting it, and hanging it at various places throughout the office, preferably where the providers habitually document their visits. There should be no question on where the data should be entered.

6. Understand that MU is not graded on a sliding scale. It’s pass-fail. You either pass all the elements or you do not get your money. There is no partial credit.

7. Ensure the EHR is configured properly for MU. Some systems require certain settings be enabled to support MU documentation. Ensure that your allergy and drug interaction checking is enabled and that providers cannot turn it off. This sounds like a no-brainer, but you’d be surprised at some practices’ system configuration.

8. Read Evan Steele’s HIStalk article, Meaningful Use Does Not Have to Burden Physicians. This should be required reading for practice managers. The vast majority of MU objectives and measures can be achieved by leveraging support staff. Physicians should not be asked to serve as data entry clerks. It’s unfortunate that, all too often, poor workflow design and failure to adequately train staff puts them in this role.

9. Ensure providers are enrolled in electronic prescribing and know how to use it (and when it’s legal to do so). Providers need to be sending more than 40% of permissible prescriptions electronically unless there are certain hardships, like being in a rural area without Internet or having insufficient pharmacy participation. Look carefully at your workflow to make sure that processes, like allowing nurses and other staff to refill medications in some situations, are not going to drive your percentage down.

10. Analyze offices process for collecting demographic information. You need a sensitive plan to collect language, race, and ethnicity data without having to explain to every patient through the front window. I personally like the approach of using a patient data collection form (or use a kiosk if you have one) so the patient can complete this privately. If the patient doesn’t complete it, have a members of the nursing staff ask about it in the exam room. Be sure the system is configured to include the appropriate descriptions and codes – eliminate home-grown or customized descriptions from pick lists NOW.

11. Whether you’re still on paper or fully electronic, update problem lists NOW. Since you are already asking the patient to fill out a demographic update sheet, why not use the opportunity to gather pertinent medical information as well? Too many practices simply ask the patient, “Has anything changed since your last visit?” The yield from that question is not very good. Consider mailing an update to patients prior to an upcoming visit or having them complete a questionnaire via a patient portal or kiosk. When I started doing this annually in my practice, I was shocked at what patients had forgotten to tell me.

12. Update medication and allergy lists NOW. See above. Really, for good patient care you should be doing this every visit. But now, when the patients complain that you are asking them to validate their medication list (and I do hate arguing with the sweet geriatric ladies who say, “But Doctor, I know you know what I’m taking”) you can thank your friends at Medicare for making you do it and make sure the patients know who is behind all the fun their having updating their information.

13. Clean up (or create) office policy and procedure documents regarding patient care elements included in Meaningful Use. Make sure all staff understand (physicians too!) and sign to indicate their understanding. This will be very helpful down the road when folks argue with the IT and management teams about why their data doesn’t show them meeting the criteria. Don’t forget to include vitals, smoking status, quality measures, etc.

14. Determine your strategy for providing patients with electronic copies of their health information. Are you going to use a Web portal? Burn it to CD? Interface with a personal health record? Give them a jump drive?

15. Prepare to meet technical requirements for data exchange and security. Make sure staff understand what they need to protect patient information and deal with deficiencies promptly.

16. If your office does not have a CMHO, identify one immediately. OK, I couldn’t resist adding one more item. What is a CMHO, you ask? Chief Medical Humor Officer. Because once the practice fully embraces Meaningful Use, there’s going to be a need for humor STAT.

If you’re savvy enough about Meaningful Use to understand most of the items above, you’re probably in a reasonable position to prepare to demonstrate MU. On the other hand, if you feel like you’ve just tried to read a novel in a foreign language, you’re going to need some help. You may want to consider contacting your state’s Regional Extension Center (REC) for assistance. Other good sources include your state Medical Society or various medical specialty organizations.

Have a question about Meaningful Use or the best suppliers for nitrous oxide (laughing gas?) E-mail me.

Intelligent Healthcare Information Integration 3/11/11

Clever Tech, HIPAA, and You

There’s a new cloud-based service now in beta that immediately brought to mind HIPAA and how we might adapt such a service to help advance the safety and security we need in healthcare communications.

Called babble.ly, this new service allows you to enter a phone number into a box on their Google-simple home page. It then generates a link you can post online when you need to make your phone number available. (If you’ve ever used Bit.ly to shorten a URL for Tweeting, you’ll get the idea.)

They create a free, disposable link to the phone number you entered. You can then copy that link and post it online: on Facebook, in Tweets, in forums, in e-mails, or on your web site. When the link is clicked, babble.ly connects to your number. Your number remains private and you can revoke the link whenever you want. (Would be very useful with smart phones, VoIP, Skype, etc.)

Besides the obvious telemarketer and phone surveyor avoidance benefits, this tool suggests the as-yet-undeveloped software possibilities which could enhance patient privacy and address cloud-based HIPAA concerns. For instance, if I can post my cell phone number in an e-mail to a patient without worry that access to that number might get scattered across the global e-mail winds, I can more comfortably allow access to folks who I know really need it.

Once that access is no longer relevant, the link gets revoked. Even if the e-mail goes YouTube viral, my phone isn’t hammered with superfluous pranksters, conspiracists, and nothing-better-to-do-ers.

OK, that’s one new answer to some small portion of privacy concerns, though it isn’t enough for HIPAA. Maybe there’s some similar approach we can use for healthcare, maybe on the possible nationwide web that is just for healthcare. (I’ve heard this is being discussed.) 

HIPAA regulatory entities could control the inputted data – and access thereto – be it phone numbers or other health data. We wouldn’t have to entrust babble.ly or Google or any private company without public oversight to watch guard the info. Maybe health record banks could be the guard dogs and provide the de-identifying access and connection enablement.

There are bound to be more and more of these creative ways to enhance digital security coming down the pike, whether designed for healthcare specifically or otherwise adaptable to our needs. I’m thinking that these best-of-breed answers, as they crop up, need to be engaged and supported by us grunts. (I’d really love to see them integrated into the Extormities of the healthcare world – in a non-proprietary fashion – so that we can all move into a secure digital future, not just those of us with the right exclusivity contract.)

We as providers need to start thinking of how we can reach out to our digitally-adept clients, securely. As their desire to connect with us electronically expands, along with their capabilities for doing so, we don’t want find ourselves technically behind the curve.

If they reach out to us in non-secure ways, we really need to understand the privacy and security issues sufficiently so that we don’t follow them into unsecure paths and fall prey to the HIPAA Violations Police from our own digital ignorance.

From the trenches…

“Publication is a self-invasion of privacy.” – Marshall McLuhan

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).

E-mail Dr. Gregg.

News 3/10/11

Grace Community Health Center (KY) secures $150,000 as part of Kentucky’s Medicaid EHR Program. Grace CHC has yet to implement EHR, but at this stage, providers only need to demonstrate the selection of an EHR to qualify for the Medicaid incentive programs. Grace CHC is implementing NextGen’s ambulatory EHR and PM products. If I were selling an ambulatory EHR, I would find every willing provider who qualifies for the Medicaid EHR incentive program and share with them just how easy it is to buy my EHR and have the government to cut them a check for $21,500. It’s a great country.

HIT benefits both small and large practices, according to a review of 154 peer-reviewed articles published from 2007 to 2010. Outgoing ONC leader David Blumenthal co-authored the analysis, which noted that 92% of the studies found the use of HIT produced overall positive effects.

Patient check-in provider Phreesia hires former Allscripts director Will Rideout as VP of sales. He was previously with Misys before its merger with Allscripts and also worked with MDeverywhere, PriCare, and Wellpath Community Health Plans.

The total first-year cost of an EMR implementation for a five-physician practice is $233,927, according to a researcher at the Institute for Healthcare Research and Improvement at Baylor HealthCare System (TX). That figure is based on the actual costs to implement GE Centricity EMR at 26 primary care practices affiliated with Baylor. The $233,927 figure averages to $46,659 per physician and includes maintenance expenses, implementation and training, and hardware. On average, end users required 134 hours per physician to prepare for the use of the system. In other words, the $44,000 maximum EHR incentive per provider from Medicare doesn’t even cover the first year of costs.

Vermont Information Technology Leaders (VITL), the REC for Vermont, adds Sage and McKesson to its list of preferred EHR partners. Other vendors include Allscripts, Fletcher Allen, athenahealth, and Greenway.

The Alabama REC picks SuccessEHS as a preferred EHR provider. In checking out the REC’s website, I don’t see mention of other vendors at this point.

The four-physician Muskogee Bone and Joint Sports Medicine Clinic (OK) selects ChartLogic’s EHR suite.

Space City Pain Specialists (TX) picks SRS EHR for its six-provider, two-location practice.

If you read HIStalk, you may have noticed we are experimenting with a new format. We are not as bleeding edge here on HIStalk Practice, so the “classic” format will remain until Mr. H completes the QA process.

St. Louis-based Curas is named the top reseller for eClinicalWorks. Curas posted 2010 revenues of $2.3 million, which represents a  55% increase over 2009.

Emdeon announces its Q4 numbers: earnings of $9.7 million on revenue of $275.7 million, compared to 2009 earnings of $3.1 million on revenue of $238.6 million. Analysts predicted revenue of $273.6 million for the quarter. Emdeon  expects 2011 adjusted net income of $1.00 to $1.06/share and revenue between $1.1 billion and $1.3 billion. Despite a strong performance, the stock slipped 2.5% Wednesday to $15.62.

Physician offices added 1,500 new jobs in February, according to the Bureau of Labor Statistics. The healthcare sector as a whole added a total of 34,000 workers.

Health Affairs reports on findings from the National Demonstration Project on patient-centered medical homes. The report is generally optimistic about the new model, but my impression is that smaller practices will have a difficult time making the migration. Some of the key findings:

• Two years isn’t long enough to implement the entire model and transfer work processes, even in highly motivated practices.
• To succeed as medical homes, practices need to be nimble; capable of continuous learning; and adept at self-assessment, reflection, and improvisation.
• Implementing new technology, even for practices that have adopted EHR components, is not “plug and play” and can be challenging because of a lack integrated and interoperable systems in primary care practices.

Meanwhile, the AAFP, American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association release 13 new guidelines for PCMH recognition and accreditation. It’s all about establishing standards.

A  GfK Roper phone survey indicates that 78% of patients whose doctors use an EHR believe they get better care as a result. Over 1,000 people participated in the survey, leading me to ponder if I am the only person who never answers her home phone when I suspect surveys or telemarketers.  I mean, who exactly does participate in phone surveys?

E-mail Inga.

News 3/8/11

From Grey Fox: “Re: Dr. Jan Lee. NextGen’s former VP of KBM and content has left to join the Delaware Health Information Network as executive director.” The DHIN website says it “unanimously approved” the hiring of Dr. Lee, as well as Mark Jacobs as DHIN’s first CIO. Jacobs is the former director of technology services for WellSpan. Both will start in mid-March.

REC HITArkansas names ABEL Medical Software and eClinicalWorks as preferred EHR vendors, offering a pre-negotiated, vetted contracts and a negotiated base price. HIT Arkansas is in final negotiations with 10 other vendors including Allscripts, e-MDs, Ingenix, McKesson, and Sage.

Aprima reseller Doctors Administrative Solutions appoints Jennifer Shimek as COO. She is the former director of clinical services and managed care at HealthPoint Medical Group and former COO of the Florida Orthopaedic Institute.

A hopeful sign of the times: Practice Velocity, a provider of EMR and PM software for urgent care and and occupational medicine, is hiring 30 new employees across multiple departments. The company is headquartered in Belvidere, IL.

Please join me in welcoming Healthwise as the newest HIStalk Practice Platinum sponsor. Healthwise is a 41-year-old company that develops health content and patient education solutions. Its products integrate with EMRs to provide patient education tools that relate to specific clinical encounters. The Healthwise solution can also be linked with PHRs and patient portals to provide patient education content. The Boise, ID-headquartered Healthwise is a non-profit, which I thought was pretty interesting. Show them how much you appreciate their support of HIStalk Practice by clicking on their ad and investigating their offerings. Mr. H and I thank Healthwise for their support!

I had a doctor’s appointment today and like I always do, I asked the staff what computer system they were using:

Me: What software do you run?

Girl at the front desk: e-MDs.

Me: Do you like it?

GATFD: It’s fine. It’s all I really know, actually.

Me: Do you have EMR, too?

GATFD: What’s that?

Me: Electronic medical records. Do the doctors put their charts into the computer?

GATFD: I don’t know.

Me: Do you have paper charts?

GATFD: No. Oh, I guess we do use electronic charts.

I was obviously amused that the EMR was so much of the practice’s workflow that GATFD didn’t even know what an EMR or “electronic medical records” were. She was fairly young ,so I bet she’s never even seen a mobile shelving cabinet.

Most Americans say they would use online tools to get lab results, request appointments, pay medical bills, and communicate with their doctor’s office. The same office I mention above did offer the ability to request appointments online. That choice sounded great to me until I read the disclaimer on their site that I might not get a response for 48 hours. I ended up picking up the phone and wading through the practice’s voicemail system until I talked to a live person. Moral of the story: patients will take advantage of all the cool technology that practices put in place, but only if it’s more efficient than the old fashioned way of doing things.

As physicians look for additional revenue opportunities, some practices are considering the sites such as Groupon, Living Social , or similar “one-day deal” programs to offer discounted prices for services that are normally not covered by insurance and are typically paid for in cash. An attorney cautions that the promos are not suitable for all services, particularly those covered by traditional or federally funded insurance. Attorney David Harlow warns that if a patient is covered by a federal payer and pays out of pocket for a service the payer might traditionally pay, the practice could be violating anti-kickback laws. In addition, private insurers always want to get the best possible deal and it’s possible that a physician’s agreement with an insurer requires that the doctor extend its “best price” to the carrier. In a worst-case scenario, the carrier could force the physician to accept the “deal” price for all the insurance company’s patients.

Doctors Express of Woodbridge (VA) partners with Healthagen to provide consumers the iTriage smartphone app to search for medical information and local healthcare services. In looking at the Healthagen website, it appears that providers like Doctor Express pay to have their practice listed in the local healthcare services section. It’s the new yellow pages, I suppose.

ONC begins recruiting physician champions to help peers who might be struggling to implement EHR. Meaningful Use Vanguard participants work with their area RECs to assist fellow providers become meaningful EHR users. Delaware already has 221 MUV champions taking part in the initiative.

The Westborough (MA) Board of Selectmen vote to approve a tax increment financing plan that would reduce the real estate tax burden for eClinicalWorks. In 2009, eCW agreed to stay in Westborough and expand its operations rather than move out of the area. eCW spent $4.6 million on the purchase of a 100,000 square foot building that is being renovated. The tax exemptions will decrease eCW’s real estate taxes between 10 and 50% over the next five years for a projected savings of almost $200,000. The article in the local paper also notes that prior to committing to the new Westborough location, eCW was considering a move to Atlanta or Tampa.

ASC management company APAC Partners selects SourceMedical’s Vision Enterprise and Vision EHR products for its ASC and physician practice clients.

I’d like to welcome MED3OOO to HIStalk Practice as a Platinum sponsor. MED3OOO has been a longtime HIStalk sponsor, and I am thrilled they have decided to spread their love to HIStalk Practice. The company provides medical billing and EHR software for physician groups, provider networks, and EMS organizations. In addition to selling their own InteGreat EHR and a couple of Allscripts EHR solutions, MED3OOO offers billing and RCM services, ASP hosting, coding and compliance, data warehousing, decision support, and more. MED3OOO is one of a handful of companies that has already incorporated Medicomp’s new Quippe technology (into InteGreat) and I had a chance to ooh and ah over it at HIMSS (great technology.)Thanks, MED3OOO, for your support of HIStalk Practice!

CCHIT weighs in on proposed Stage 2 and 3 Meaningful Use objectives and measures and reports findings from a survey of stakeholders (36% providers, 29% EHR vendors, and 29% “others.”) One-third of respondents say the nine proposed measures for Stage Two are too aggressive. More than 50% of the providers and 40% of the rest express concern for the proposed requirement for electronic reporting of syndromic surveillance to public health agencies, since public health agencies lack sufficient infrastructure to analyze the data. Other areas of concern include drug formulary, HIE, and medication reconciliation. Despite objections, most of the respondents think the proposed Stage 2 objectives could be accomplished by 2012.

E-mail Inga.