News 12/7/10

Healthcare communication provider NaviNet acquires Prematics, a developer of mobile clinical messaging and e-prescribing tools. NaviNet will integrate the Prematics mobile care management products with NaviNet’s Insurer Connect, EMR, and PM solutions.

Industry consolidation continues. The 23-doctor New Hanover Medical Group (NC) joins New Hanover Regional Medical Center’s owned physician group. The arrangement gives the New Hanover Medical Group access to the hospital group’s business support, including medical office technology, quality resources, and contract negotiations.

eDoctor and X-Med partner to integrate eDoctor’s ePrescribing into X-Med’s Linux-based PM system.

The 50-provider Ear, Nose and Throat Associates of South Florida picks PatientPoint’s RCM and self-service offerings to run with its existing PM and EMR.

The Eye Care Institute (KY, ID), completes its conversion to MedFlow EMR.

Sisters of Charity Health System (OH)  launches an IPA, designed to provide a platform to offer additional services to its independent physicians. The IPA will offer GE Centricity’s Practice Solution, billing and collection services, consulting, and managed care contracting.

In a study published in Clinical Transplantation, researchers finds that an electronic monitoring system and personalized counseling help improve medication adherence rates for kidney transplant recipients. Medication adherence jumped 40% when patients were given personalized phone counseling, along with prescription bottles that used integrated microcircuits to record when medicine was taken.

On other hand, an automated call-in system to monitor heart failure patients failed to show benefits, according to a NEJM study. Participation was apparently an issue, with 14% never using the telemonitoring system and only 55% calling in at least three times a week after six months.

The Department of State is hunting for an ambulatory EHR system to use in its medical offices across the world, including US embassies and consulates in 170 countries. Interested vendors must respond by December 15th.

I was intrigued by this press release, issued by the 800-physician member Brown & Toland (CA). Allscripts CEO Glen Tullman tells 100 Brown & Toland doctors that their organization is well positioned for success as an ACO, based on its early adoption of EHR technology. The release provides additional details of the Allscripts systems that is currently or in the process of being  implemented. I’m assuming Brown & Toland is targeting non-member physicians with this message in hopes of recruiting more providers. The San Francisco-based Brown & Toland is headquartered in a highly competitive healthcare market and likely needs plenty of troops, assuming it wants to hold its own in the ACO alignment race.

New technology alert: Mobisante is beta testing a handheld ultasound device that connects to a cellular network or Wi-Fi, allowing users to immediately send images to other providers. The company hopes the market will be drawn to the product, based on its flexible connectivity options and portability. Mobisante is waiting for FDA clearance and hopes to start commercialization in 2011.

Good news for family practice docs. Medicare allowances continue to rise for CPT codes 99213 and 99314, which represent 84% of all FP office visits by established Medicare patients. In 2006, 99213 paid $52.06; in 2011 payment is projected to be $74.85. Similarly a 99214 routine office visit earned $82.62 in 2006 and will pay $111.36 in 2011. Yes, good news, indeed, but still a lean living compared to specialists.

E-mail Inga.

News 12/2/10

Quality Systems, the parent company for NextGen, names James J. Sullivan EVP, general counsel, and secretary. Sullivan is the former SVP, general counsel, and secretary of The TriZetto Group.

Central Florida REC selects athenahealth as a preferred solution provider. Checking out the Central Florida REC’s website, I don’t see mention of any preferred vendors so I’m guessing they are finalizing details with their selected companies.

SuccessEHS makes its PM/EHR solution available for the iPad.

A new report suggests that providers implementing EHRs could see an increase in medical liability insurance, at least in the short term. While that initially sounds counter-intuitive, Conning Research and Consulting suggests that liability carriers are concerned that software failures and medical coding errors could occur more frequently in the early stages of EHR implementation. The report also predicts that the cost of defending medical liability claims could increase as more lawyers begin using data from electronic sources.

Northwest Primary Care (OR) contracts with Sage to provide the IMPAX PACS. The 25-physician practice already uses Sage Intergy PM and EHR. Sage offers IMPAX through an arrangement with Agfa Healthcare.

Most physician offices are turning to their vendor for help reaching Meaningful Use, according to our HIStalk Practice poll. That is pretty much consistent with a recent Sermo poll that concluded 45% of practices were looking for advice from their EHR vendor. A fewer number of practices will rely on RECs or their own internal resources. Meanwhile, our results indicate that consultants better focus their efforts elsewhere or increase their marketing efforts with physician practices. Our new poll to your right:  For practices: are you running an ONC-ATCB complete EHR?

I’m happy to report that traffic on HIStalk Practice increased 27% in November, compared to last year. Actually, I am more than just happy. I am ecstatic that more people keep stopping by. Dr. Gregg Alexander has pointed out to me that the site meter is about to hit 200,000 visits, and, in the next month or so I anticipate we’ll reach 1,000 e-mail subscribers. As a recovering sales rep, I love looking at numbers when they are going in the right direction. Thanks to all the readers, subscribers, and contributors (especially the prolific Dr. Alexander) who are helping ensure HIStalk Practice is trending the right way!

E-mail Inga.

Intelligent Healthcare Information Integration 11/30/10

Time for the Cheese, Please

“Thought provoking EMR comment. Don’t be sparing us the details of the cool features you’ve seen and which companies are providing the cool features you’ve found … show me the good stuff!”

That’s a compilation of a couple of quotes from John over at EMR and HIPAA after a recent post here where I mentioned I was starting to find some pretty cool pieces and parts amidst the waterfall of EMR/EHR demos I’ve been drenching myself within of late. I promised I would “stop the tease and show the cheese.” (John requested sharp, but it may be more along a Muenster.)

Four upfront caveats:

1. I am in no way receiving any remuneration from any of the vendors I will be mentioning.
2. I have really enjoyed many, if not most, of the people who have taken their time to show me their solutions. Part of me wishes I didn’t have to end up choosing but one answer / company for our office’s needs.
3. While I am certainly keeping self-interest at the fore, I try to consider the needs of my heretofore undigitized colleagues and what my understanding of their needs might include.
4. There’s only one of me and I have a day job (well, often a day and night job,) so I wouldn’t even begin to imply I’ve seen all there is to see – but I’m trying!

OK, here we go, and in no particular order of coolness…

Ultimate Usability

Unfortunately, there’s not a system in existence today that has this feature – yet — but the hands-down winner in my book goes to Medicomp’s CliniTalk and its yet-to-be-named Type / Write / Click cousin. Using their medical knowledge engine of “260,000 coded clinical concepts mapped to CPT®, DSM, ICD, LOINC®, RxNorm, SnomedCT®, and other billing codes and clinical reference terminologies,” this middleware allows truly smart data capture, integration, manipulation, and utilization. It’s coming very soon to some pretty good systems which it will help to make great.

I’m so enamored with this functionality that I’m doubtful I’ll be able to choose a new system that doesn’t have it incorporated – or at least one with plans to do so. Seriously, it does for clinical data what I’d always thought a computer should: it adds an intelligence and an level of association-making that a busy clinician really needs while helping to minimize the “Wow, I went to med school to become a data entry clerk for insurance companies” feeling. Unconfirmed, but I hear Sage Intergy will be one of the first to engage this hyper-enhancement.

Eye-Friendliness

This is one of my personal “gotta be there” criteria. It was a huge factor in my love at first site with Bond Clinician, the now life-support-plug-pulled Peak Practice. If my “blink” upon first view of an EMR isn’t one of “OK, that’s kind of pretty,” then I know the demo from there on out will likely only yield ideas for features or functions I might want to see in the other system I do eventually choose.

Prettiest faces in this category are all iPad-ian: Quest’s Care360 and ClearPractice’s Nimble. Right up there, too, is Dr. Chrono, but I admit to enjoying the warm feel of faux leather, even if only digital, which Care360 and Nimble use. This familiar view might even assuage some of the anxiety of docs who are still pen-and-paper bound. (I especially like the slightly askew desktop look-and-feel of Care360, perhaps because my desk is usually pretty askew, too.)

Desktop systems could learn a thing or three from these iPad implementations. I mean, really, isn’t there a whole science about HCI (Human-Computer Interaction) and how to make visual content appealing, productive, and efficient? My take: Many EMR vendors could use a few less chief marketing officers and a few more humanistic computer interface designers.

That said, I have seen a couple of desktop systems worth noting. SOAPware’s EMR has come miles from when I first remember its rather basic layout. athenahealth’s athenaClinicals also has evolved nicely since I joined Inga and John Smalling in a group demo about a year ago in an ill-fated jaunt into product demo reviews. (I liked it then; its look and feel is even better now.)

As this is a long, ongoing, often sleep-inducing process, I guess it’ll have to be a “to be continued.” But, before I go, here’s a few I’ll be discussing next time:

• We “get” the “App Me, Baby” idea: SRSsoft’s Hybrid EMR and Medicity’s iNexx.
• EHR vendor team who seems to have the most creative fun: Nuesoft.
• Most exciting new non-EMR EMR: Mitochon Systems mEMR.
• Best digital office preparation tool: Welch Allyn’s EHR Prep-Select.
• The value of views: DIS.
• Using exo-EMR stuff, mostly iPad apps, as really useful patient education and engagement tools: Blausen Medical’s Human Atlas, Pampers’ Hello Baby – Pregnancy Calendar, CHADIS, and Text4baby. (Pseudo exception to caveat #1 above: I also like start-up Health Nuts Media for whom I am the unpaid CMO). Heavy prejudice toward pediatrics, I know, but remember the source here.
• Vendor web sites: what attracts and what repels.
• “The Good, The Bad, and The Ugly” of demos and vendor/client connections.

So, while not meaning to continue the tease as I’m really trying to dole out the requested cheese, I’ll close here with the promise to grate some more fresh Parmesan soon.

From the trenches…

“The early bird may get the worm, but it’s the second mouse that gets the cheese.” – Jeremy Paxman

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 11/30/10

From Telepathic: “Re: Your post. Your readers are thankful for you! Your post made this dry overcooked piece of turkey feel better knowing she isn’t the only one ‘done’ after burning out in sales in this exhausting and unrelenting (and oddly unfulfilling) world of HIT. Funny how the universe works!” Thanks to Telepathic and others who took the time to send equally affirming notes. Heck, I’m just thankful to anyone who took the time to read HIStalk Practice over the extended weekend.

University Radiology Group (NJ) says its MedInfomatix RIS, along with ZirMed’s RCM solutions, have allowed the practice to reduce its A/R staff from five employees to three. The practice can perform insurance eligibility searches in 15 seconds using ZirMed’s online tools.

Hartford Healthcare (CT) is negotiating a $28 million purchase of the 30-physician Constitution Eye Center. Practice co-founder Kris Mineau says the deal will give Constitution Eye access to a deeper resource pool for new technology, including electronic medical records.

The Burlington, VT newspaper highlights the charity works of John Canning, the president of Physicians Computer Company. Canning and the practice management software company donate $30,000 to $50,000 a year to charitable causes, most of which support musicians and the arts in Vermont. I’d bet he’s not your typical HIT leader. The reporter notes that he was wearing sandals during the interview despite sleet outside. I also noticed an older posting on the company’s web site where Canning mentioned he just completed a class in conversational Japanese. I’m thinking this industry could use a few more non-traditional leaders.

The House approves a one month delay for the planned 23% Medicare pay cut. The Senate approved the postponement a couple of weeks ago, so the legislation goes to the President for signature. It’s anyone’s guess as to how long it will take Congress figure out a permanent fix.

Indiana Hand to Shoulder Center selects SRS Unifed Desktop for its 35 providers.

A few housekeeping items: despite my never-empty inbox, I love getting e-mail, so send any rumors, story ideas, interview suggestions, or haikus my way. Our terrific sponsors allow us to keep HIStalk Practice rolling, so please visit their sites and check out their offerings. You can also friend me or like HIStalk on Facebook, or, follow me on Twitter. If you aren’t getting an e-mail notification for new HIStalk Practice posts, it will take just two seconds to sign up at the top right-hand corner of the page. And, thanks to everyone for reading.

Policies that require insurance pre-authorization before treatment can negatively impact patient care, according to a new AMA survey. Physicians complain that pre-authorizations take too long to obtain and that approval is often difficult for many of the required tests, procedures, or drugs. The AMA says such oversight programs are costly and can delay patient access to medically necessary care.

Black Book releases the results of its Top EMR Vendor survey, which includes the top 20 EMR vendors in 10 different categories. The results are based on responses from over 4,000 users and each ranked vendor had to have at least 10 unique clients in order to be ranked. Black Box allows you to see the top 20 vendors in each category for no charge, but if you want details (including rankings), you must purchase the report (for about $3,000). That seems a bit pricey, especially since KLAS will give providers similar data at no charge.

eClinicalWorks takes silver honors in the Team Massachusetts Economic Impact Awards, given to businesses for their outstanding contributions to the state’s economy.

ProHealth Physicians (CT) selects CoActiv EXAM-PACS for the management of medical images across its 250-provider, 75-location practice.

The National Labor Relations Board files suit against an ambulance company that fired an employee for criticizing her supervisor on Facebook. The action prompts labor attorneys to remind physician practices of the need for social media policies that are not too broad. Practices have the right to establish social media policies, but guidelines should include specifics, including the requirement that employees not post anything that would harm the practice’s reputation, violate HIPAA regulations , or disclose patient information.

E-mail Inga.

Overcooked Turkey and Thankfulness

I am thankful that I was laid off. No, not from HIStalk, but from the last job I had before I begged Mr. H to hire me.

I spent several years in the HIT vendor world. Most of the time I was in sales, spending many hours a week in physician offices trying to convince providers and their staff that my offering would help them achieve the doctor’s office version of nirvana.

I loved sales. My co-workers were my closest friends. I generally enjoyed office managers and administrators, most of whom I found to be smart and dedicated. I loved most of the physicians (particularly those in primary care), though I thought some of them were … well, jerks.

Despite all the good stuff over the years, towards the end, I was more than done, kind of like the Thanksgiving turkey I once cooked about two hours too long. I had known for weeks that my position might be eliminated during company-wide efforts to trim costs. In the end, I was just another crossed-through line item on a bloated spreadsheet.

Happily, my parting gift included a healthy severance package, It gave me time to figure out what I did and did not want to do with the rest of my life.

Rather than immediately securing a job, I had the freedom to tell headhunters that I wasn’t interested in interviewing for another high-stress job with 70% travel. Instead, I invested time and a few dollars with a career coach, who encouraged me to think beyond the world of HIT vendors. All the while, I had a chance to work out daily, go to the grocery store in the middle of the day, read a pile of books, and catch up on lost sleep.

Of course I kept up with the HIT world, reading various online publications. HIStalk really was my favorite since it kept me up to speed with all the highs and lows over at my former company. One day Mr. H made a tiny mention that he needed “some help” and wanted to hire someone “who might work a few hours a week to handle routine stuff.”

It took me about 10 seconds to ponder the comment. I sent over an e-mail … and the rest is HIStalk history.

Of course, I am leaving out a lot of details, like the fact that I never meant for this to be a long-term gig. However, I got lucky: HIStalk has grown tremendously, we’ve added HIStalk Practice and HIStalk Mobile, companies keep sponsoring, and readers keep stopping by. And you couldn’t ask for a better boss than Mr. H, who has become a combination coach, mentor, and friend. He’s the only one I can always count on to laugh at my one-liner e-mails.

So, I’m thankful that I’ve been lucky. What if I had missed Mr. H’s tiny mention that day? What if Mr. H had been a jerk? What if, what if, what if …

In addition, I’m thankful that some companies write stupid press releases so Mr. H and I can make fun of them.

I’m thankful that I have over 1,000 Twitter followers, because it makes me feel important in a most pathetic sort of way.

I’m thankful that readers send me links to good online shopping sites. And, how can any real shoe lover not be thankful for Zappos.com?

For these things and so much more, I am thankful.

HIStalk is far more than the original “few hours a week” that Mr. H and I thought it would be. I’m thankful that I was freed from my previous career, because it allowed me to toss that overcooked turkey part of life and replace it with a big ole slice of homemade pecan pie.

E-mail Inga.