News 9/28/10

Virtual Radiologic announces plans to pay $170 million cash for its top competitor, NightHawk Radiology. Both companies offer remote radiology services for radiology groups and hospitals. Nighthawk holds 22% of the market and Virtual 15%; the combined entity will have 325 radiologists serving 2,700 healthcare facilities.

ONC publishes a list of 20 FAQs to help providers and vendors understand and meet Meaningful Use requirements. Most of the questions address the certification process.

Meanwhile, CMS says it will correct a few inconsistencies in the Meaningful Use final rules and publish more detailed guidance for providers on how to meet quality measures.

Here’s a clinic I’d like to check out. When the Imed Center of Danbury (CT) opens its doors this week, there will be no chart room. Patients will check in and input their medical histories using kiosks in the waiting room. The practice will issue each patient a USB drive that includes his/her personalized information on prescriptions, allergies, and other clinical data. If a patient needs to talk to a doctor after hours, texting or Skype will be among the communication options. And, each exam room includes a flat screen TV so physicians can view scans and other images.

I can’t figure out if this is a good deal or not. ClickFreeMD introduces an “unlimited use, all-inclusive” billing, PM, and EHR software (Ingenix) service and support for a flat monthly fee. Most billing services bill based on a percentage of collections, which definitely motivates the billing company to bring in as much money as possible. However, ClickFreeMD claims their model is simpler and less expensive. I guess I am of the mindset that less expensive is not always “better.”

In case you missed it, we’ve set up HIStalkTV, which features HIT-related videos. We’re still figuring out where to go with the site, but if you have any content that you think readers might enjoy, send it my way.

I had an interesting conversation with a CIO type today. He contends that the only enterprise HIS vendors with solid ambulatory solutions are Epic and Allscripts/Eclipsys. Anyone care to counter his claim? Certainly those two have more ambulatory practice installations than any of the other enterprise vendors.

Practice managers’ salaries are on the rise, at least in the UK. The average income is now about $50,000, or about $55,000 in greater London. Still not quite as good as earnings for US practice managers, where in a small group practice, the median salary is $56,000 and in practices over six physicians, the average is $77,000.

The use of new personal technologies such as cell phones and BlackBerrys is forcing doctors to ask patients new questions about their technology habits. I suppose physicians now have fields in their EMRs for BlackBerry thumb, cell phone elbow, and computer vision syndrome. Here’s a new ailment I had not heard of before: Facebook depression, which results when people replace face-to-face interaction with online friends.

To cure any blogger depression I might have, I’m heading to New Orleans for the MGMA conference next month. Today I took a quick peek at the agenda and noted a few familiar names on the featured speakers list: Malcolm Gladwell, Microsoft’s Bill Crounse, David Blumenthal, and AMA President James Rohack. MGMA has quite a few sessions on information management (where you’ll likely find me), as well as tracks covering practice revenue and cost issues, practice performance, and government affairs. I’m also scheduling time for some of that great New Orleans grub.

E-mail Inga.

Intelligent Healthcare Information Integration 9/25/10

POF, POOF, POTF — It’s All Geek to Me

Just days after last year’s American Academy of Pediatrics National Conference and Exhibition (AAP-NCE) in Washington, DC, we began to work on this year’s “Pediatric Office of the Future” exhibit. Trying to showcase technology capabilities for pediatricians in an educational, yet exhibit hall-style show has become a year-round challenge. (I’d call it a “job” instead of a “challenge” except that would imply at least a modicum of pay.)

It’s really a labor of love — though some have said it’s more of “insanity” — trying to engage medically-oriented ,tech-savvy companies of all sorts and sizes into donating time, people, resources, money, and prizes. It becomes exceptionally tricky when you need them to understand that while we appreciate their desire and need to generate sales leads — they are in business to sell products and/or services, for sure — in our exhibit, we need them to keep the educational focus at the fore. We want our sponsors to find value for their generosity, but our booth is all about the attendees getting an education regarding currently available “future” technologies. (Yeah, I know, but “Pediatric Office of the Nowadays” just doesn’t sound as zippy.)

Speaking of names, I get a whole heap of variations on the acronym, or the assumptions thereof — POF, POOF, POTF, etc. We have always used the shortest, POF, but take your pick. “Call us what you will, as long as you call us!”

The team has really put together an impressive “show” for 2010. (Be warned: blatant POF promo approaching!) Our 30’ X 30’ booth now has displays and sponsors on every inside and outside wall…and beyond! We have some of the biggest names in EHRs and HIE, some really great tools for practices, “green” tech, non-brick-and-mortar office ideas, cool health literacy tools, and even an international “tech head” from eastern Africa bringing MIT Sloan along for the ride. Plus, we have been successful in organizing a side bar to the POF: the “Future Faces Family Fun & Fitness Zone.” We have grown way beyond our four walls and now have the second largest footprint in the exhibit hall!

The AAP has shown us lots of love, both in onsite as well as pre-show marketing. We have even been given our own Web presence, something rather unusual for such an event, at http://aapexperience.org/future. Details of all our generous sponsors and their educational foci as well as links for more of their details are there. Also, you can read more about the “Future Faces” fun stuff (i.e., games, “Eye Screen for Ice Cream,” enjoyable distractions for kids of all ages, etc.) Not the least important, you can also see a list of the over $40,000 in prizes we have been generously provided which we’ll be giving away over the three days of the exhibit. From an EHR to a hippopotamus to 500 thumb drives and more, attendees who stop by and get their badge scanned are all automatically entered.

Am I trying to sell the POF? You betcha! I love selling it because it doesn’t cost anything for attendees. It’s a “value add.” So, if you’ll be in or around San Francisco October 2-4, come by the Moscone Center and see why I’ve become such an unabashed pitchman. I’m pretty sure you’ll enjoy the “show.”

Oh…one last pitch: we’ve already gotten some huge conversations with some even more gigundo companies interested in sponsorship for the 2011 POF. It’s looking truly legen…wait for it…dary!!!

Back from the future trenches…

“A lie is just a story ruined by the truth.” – Barney Stinson

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 9/23/10

From InfoGard: “Re: ONC-ATCB. InfoGard Laboratories will complete the mandatory ATCB training conducted by ONC this week (week of 9/20). We are required to make any changes to our testing procedures and process for EHR testing after completing the mandatory ONC training.  We expect to be able to start the testing process the week of October 4. We will begin providing testing process information and taking applications the week of September 27.” No word yet on pricing.

Carilion Clinic (VA) and The Everett Clinic (WA) deploy Humedica’s clinical analytic and benchmarking tool to compare care delivery among its physicians and across other medical groups. Sounds great for prepping for ACO participation.

A third of office-based providers are now e-prescribing, according to Surescripts. However, only 12% of all prescriptions were written electronically last year. The number of providers using electronic prescribing grew significantly from 2008 to 2009, from 74,000 to 200,000, while the total number of e-prescriptions jumped from 68 million to 190 million. Massachusetts had the highest e-prescribing rate at 57%, followed by Rhode Island and Delaware.

The Association of Northern California Oncologists selects Via Oncology Pathways as the preferred cancer treatment protocol option for its 400 members. The Pathways Portal application is Web-based and enables oncologists to apply the pathways at the point of care.

Practice Fusion announces its first-ever user conference, to be held November 5th in San Francisco. Just like their EHR software, there’s no charge for the one-day Practice Fusion Connect 2010 event.

HCA-owned Ocala Health System (FL) buys Family Care Specialists, a 27-provider practice with seven locations. As part of the deal, HCA will provide the practice with resources to implement an EHR.

CapSite releases a new analysis of the ambulatory EHR and practice management market, based on insight from over 2,000 practices. Key findings include:

• 2010 EHR sales are expected to double 2009’s results.
• Over the next 24 months, the projected EHR/PM market opportunity will exceed $3 billion.
• Allscripts and Epic each hold 13% of the ambulatory EHR market, followed by eClinicalWorks, NextGen, and GE.
• Allscripts, eClinicalWorks, NextGen, and McKesson are the most-considered EHR vendors.
• GE has 9% of the practice management market, followed by McKesson, Cerner, Allscripts, and Meditech.
• Epic, eClinicalWorks, NextGen, Allscripts, and McKesson are the most-considered PM vendors.
• Most practices don’t plan to purchase a new EHR or PM solution for another 12-24 months.
• Despite the increased popularity of hosted models, 44% of practices prefer the traditional software license purchase option.

The AMA introduces a set of self-auditing tools for developing and evaluating fee schedules and billing safeguards in preparation for billing and payment audits. The Practice Analysis Tools for Healthcare includes tools to develop a practice-specific fee schedule and compare it against national average billed charge amounts. Physicians can also analyze their coding and billing patterns and compare them against national averages by specialty.

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A malpractice insurer finds that 35% of physicians aren’t aware that by 2015 the government plans to penalize practices that haven’t implemented EHRs. However, more than half of those who were unaware say the penalties won’t cause them to implement EHRs. As usual, cost was the top concern for physicians, followed closely by staff training.

E-mail Inga.

News 9/21/10

CHRISTUS Health selects athenahealth’s EHR, Collector, and Communication for its 150 providers and 40 clinics. They’ve been an athenahealth client for several years, having run athenaCollector at several sites. Interestingly CHRISTUS owns and operates multiple clinics within Walmarts, which at one time required its in-store clinics to run eClinicalWorks.

A janitor makes $40 selling 14 boxes of patient records to a recycling center. Unfortunately, he apparently stole them from the ambulatory care center where he worked and now faces felony commercial burglary charges. Officials say the records contained no personal medical information.

HHS approves a third ONC-ATCB: InfoGard Laboratories, which has extensive certification experience in a number of areas. InfoGard will compete with CCHIT and Drummond Group in the race to certify EHRs. No word yet on the company’s pricing or procedures.

Speaking of certification, Addison Health Systems, Inc., developers of the EHR WritePad, says it has applied for accreditation with The Drummond Group. The company points out that its e-prescribing partner will be CCHIT-certified, so WritePad will have certification from both Drummond and CCHIT. While technically I’m sure it’s true, I hope the company doesn’t spin the certification story in such a way as to confuse the average buyer.

Meanwhile, CCHIT opens its ONC-ATCB application process. The cost for complete EHR certification and testing: $34,300 for eligible provider products and $32,500 for inpatient software. I think it would be fun to compare the pricing model for all three of the selected ONC-ATCBs; I’ve reached out to them for details. Stay tuned.

Here’s a new dictation tool for the iPhone. MD-IT releases iConnect, an app that allows physicians to select patients from an appointment scheduling list and dictate directly into their iPhone. Recordings are electronically uploaded to the MD-IT platform for transcription.

Covisint acquires DocSite, a developer of clinical decision support and quality performance management tools. The acquisition will strengthen Covisint’s offerings for ACOs and HIEs.

Speaking of ACOs, as doctors wait for the government to clarify particulars on this new model of care, ACO experts recommend that physicians consider which providers with which they would prefer to align and begin tracking their own utilization and quality of care. An EMR helps in this area, but may not provide enough details to assess costs and quality or track patient ER visits and hospitalizations. At a minimum, practices should consider tracking some of this information in a spreadsheet and to monitor quality metrics.

TriageLogic introduces Office Triage Solution, a Web-based application to help practices manage incoming calls using decision-tree support tools.

Despite an overall decline in patient visits, physician offices continue to add more jobs. The Bureau of Labor Statistics says 5,300 jobs were added in August. For the summer, 9,300 new positions became available. Some theories for the counter-intuitive trend: practices are ramping up for potential increases in patient volumes as a result of health reform; they are betting that additional clinical staff will attract more patients and thus generate more revenue; and, as the threat of Medicare cuts loom, physician offices are hiring now in anticipation of spending freezes later in the year.

Deloitte Center for Health Solutions provides a comprehensive overview of several medical home pilots and offers insights into the future of the model. Researchers conclude that health IT plays a big role in the medical homes model and say it’s an essential front-end investment. Overall physician adoption will be a challenge, in part due to physician resistance to the use of health information technology in diagnostics, treatment planning, and routine patient interaction.

E-mail Inga.

News 9/16/10

From Spice Surfer: “Re: Mark Young. I noticed that Mark Young, Sage’s SVP of IT and CIO is no longer on the Sage website. Is he gone?” The folks at Sage sent over confirmation: “Mark Young left Sage to pursue other opportunities. Though his experience and insight will be greatly missed, we wish him the best in future endeavors.”

The New Jersey HIT Extension Center (NJ-HITEC) selects PatientPoint to provide health IT consulting to practices deploying EHRs and trying to qualify for Meaningful Use.

Hillside Avenue Family and Community Medicine (RI) says its use of McKesson’s Practice Partner EHR enabled them to reduce patient ED visits by 10%, decrease the average glucose levels of diabetics by 5%, and increase rates of screening for depression and smoking. The practice attributes the improved outcome to Practice Partner’s tracking tools and the ability to keep patient health information updated. By the way, the charming artwork above is direct from Hillside’s Web site.

Here’s another argument in favor of EHRs: the Federation of State Medical Boards (FSMB) says that EHRs could help state medical boards assess a physician’s clinical competence, which could one day be required for license renewal. The FSMB’s “Maintenance of Licensure” (MOL) framework says that physicians should continually engage three types of activities: reflective self-assessment, the assessment of knowledge and skills, and the demonstration of performance in practice.The FSMB believes the use of IT and EHRs in particular will be “of value” to doctors as they fulfill professional obligations and demonstrate their ongoing clinical competence.

Physician rating sites take note: few publically available characteristics of individual physicians make good indicators of physician performance or clinical quality measures. The only factors found associated with higher overall performance were gender (females did 1.4% better than males), board certification (3.3% better than non-certified,) and graduation from a domestic medical school (1% better than international). Malpractice claims were not significantly associated with performance. This study, published in The Archives of Internal Medicine, looked at 124 quality measures for 10,408 Massachusetts doctors.

Medical billing provider AdvantEdge Healthcare Solutions appoints Lahey Clinic (MA) CEO David M. Barrett, MD.

The Physicians Foundation is handing out 15 HIT-related grants, worth almost $2 million, to promote the use of HIT to improve physicians’ practice environment and quality patient care. Projects winning support include a Meaningful Use Achievement Toolkit, an HIT in Practice program to support EHR implementation in small practices, and grants to help physicians implement EHRs. The Physicians Foundation, by the way, was founded in 2003 through the settlement of a class-action lawsuit brought by physicians and medical associations against private third-party payers.

Dell continues its efforts to be a player in healthcare, announcing plans to integrate healthcare applications with its new Streak 5-inch Android-based mobile device. Dell says physicians will be able to buy the Streak as an integrated component of its EMR technology bundle, which I assume means its software partners (Practice Fusion, Allscripts, eClinicalWorks, and Meditech/JJWild) will soon announce Streak-compatible options. Dell is emphasizing the device’s size and weight, which they say make it easy for a physician to carry in a lab coat pocket. To me, that sounds as if Dell is positioning the Streak as an alternative to a tablet PC rather than a smart phone.

However, I was curious how the Streak compared to the iPhone. Here’s one recent review:

The iPhone has an advanced 3.5” screen with a resolution of 960 x 640 pixels, the Dell Streak has a larger 5” screen with a lower resolution of 800 x 480. The Apple excels in resolution, the Dell in size.  However, if you actually have to read something you generally have to expand it on the iPhone, that happens less often on the Dell, because the screen is so much larger. Whether it is using the screen keyboard, reading from the Kindle application that both now have, watching a movie or sharing a picture, or just browsing the web, the bigger screen is better. In terms of portability and phone use, both devices are substantially larger than the cell phones we used to carry and the Streak likely hits the upper limit. Both also look a bit dorky when held up to your head so both should have headsets.

NaviNet hires Shari L. Zedeck as VP of product management. She has served in similar roles with other software vendors, including Chordiant Software and Mindreef. NaviNet also mentions plans to roll out a unified patient information management system that integrates PM and EMR capabilities.

E-mail Inga.