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.

News 12/9/10

The 20-physician South Carolina Oncology Associates integrates its GE Centricity PM system with Kryptiq’s Online Bill Pay.

HealthPartners (MN) expands its online clinic services to Wisconsin. For $40 or less, patients in either Wisconsin or Minnesota have access to online consults with nurse practitioners using HealthPartners virtuwell.com program.

Berkshire Health Systems (MA) deploys Allscripts EHR and PM for its 108 providers and will offer a hosted and support option for 300 affiliated physicians.

Across the pond, a UK-based supermarket chain plans to add about 200 in-store medical practices. Sainsbury supermarkets will offer the space at no charge, though some GPs are critical. The chairman of the Royal College of Practitioners is quoted as saying, “Supermarkets should stick to selling fruits and vegetables.”

The Rhode Island RECs adds Ingenix CareTracker as a qualified EHR for doctors in its state. Ingenix, by the way, just  announced that its ClaimsManager software is available in a cloud-based version, targeting small and mid-sized physicians offices with fewer than 50 doctors.

Clark & Daughtrey Medical Group (FL) and Central Florida Gastroenterology contract with PatientPoint to automate registration through self-service check-in kiosks.

Just one month after announcing its pending purchased by McKesson, US Oncology tries to raise awareness for its iKnowMed practice management system with this recent press release. US Oncology stresses that iKnowMed is a customized version of Henry Schein’s MicroMD product, perhaps to emphasize it’s not offering an untested product. I find it mildly curious there’s no mention of the McKesson deal.

The great folks at Hayes Management Consulting sent me a virtual holiday greeting, saying they are making chartable donations this year in lieu of cards. I am sure Hayes’ contributions are much appreciated by the Toys for Tots Foundation, Massachusetts General Hospital Charlestown Health Center’s Pediatric Patients, and Susan G. Komen for the Cure.

Physician practice consulting firm Equation acquires competitor HealthCare Business Consulting of Baton Rouge, LA. The purchase expands the marketing reach of the Salt Lake City-based Equation.

McKesson says Practice Partner, Medisoft Clinical, Lytec MD, and Horizon Clinicals are all now ONC-ATCB certified. McKesson has its share of detractors, but I find it commendable that they seem to be trying to take care of their client base, even if that means maintaining multiple legacy systems.

Looks like the pending 25% pay cut from Medicare may be pushed back at least another year. Lawmakers are leaning towards a 12-month reprieve, giving the incoming Congress time to  come up with a new payment policy based on care quality.

The administrator at Birmingham Heart Clinic (AL) says its use of Greenway’s PrimeSUITE EHR helped the clinic earn a $70,000 PQRS bonus from CMS.

Adding  interactive forums to online health programs reduces member attrition while also saving program costs compared to face-to-face coaching. In other words, we’ve become a society that loves our social media and need our online world to motivate us, regardless if we are trying to improve our health, find a spouse, or raise chickens.

Physicians don’t really trust hospitals, even though they view hospital alignment as a way to relieve their administrative and financial burdens. Two-thirds of cardiologists and 48% of primary care physicians are interested in being employed by hospitals, citing an improved work-life balance as the primary draw.

E-mail Inga.