Intelligent Healthcare Information Integration 11/14/10

Oh…So, That’s Cool…

After my last set of whines and gripes, I have been gifted with a wonderful slew of wake-up slaps to the face. There are — thank you, Jesus — some pretty cool new developments in the world of EHRs. I feel as if I have been given a Moses-ian view of the EHR Promised Land and the view up here is pretty pleasant, much brighter than my first assessment may have perceived.

I’ve gotten demos and descriptions of some EHR 2.0- to 4.0-ness that are flat-out encouraging. CEOs and development VPs and idea men and sales folks have all shared some very cool new approaches and system enhancements which have me feeling almost giddy with possibility.

I said I wanted to see apps: apps there are a’poppin’. I mentioned my new iPad love (even though as a PC guy from way back it feels almost illicit): there’s more iPad approaches a’brewin’ than I a’knew. I noted WebOS moves so smartly: some EHRs are now a’hoppin’. And, though my desire for EHR “beauty” may still be more a part of the “Promised” than the current “Land,” the scenery is showing some springtime buds a’bloomin’.

So, now that my bipolar swinging is apparent, I have to admit that my prior gripes may have been somewhat stilted, probably secondary to my exogenously-induced IEDD: Impending-EHR-Death Depression. (By the way, if it isn’t yet, I hereby suggest a new DSM-IV entry of just such a disorder; I am certain we’ll see many more such cases in the coming years. Successful treatment of IEDD – for which Xanax helps, I should add – is primarily dependent upon a fast bolus of Innovation and Value: an “IV bolus.” I am blatantly pilfering this term for the new IEDD rehab center I’m founding.)

As I move higher into my mania, I’m almost moved to a mental meltdown by the mention of a not-so-minor bit of minutia: the dreadful awareness of “you can’t have it all.”

Smart pieces and parts from here or there all swim within my mental imagery of the world of EHR possibilities which are upon us. They dance and dodge about in my mind as the number of demos mounts and the differences among them melt into one gigantic “what could be” mélange. I can see the future, the EHR Promised Land, but as many a pioneer’s dissuaders have portended, “You can’t get there from here.” I can see little snippets of the path to the land of EHR Shangri-la, but I can’t see how to tie them together into one consistent path. The road to HIT nirvana is still hit AND miss.

I didn’t want to have to change systems, but now that I’ve been blessed with a deeper view of what’s been cooking on EHR stoves all about – much of it still percolating under boiling pan lids – I’m starting to get a little bit excited about what functionalities and innovations my next system might provide. In fact, I’d place my order right now, if I could P.F. Chang it – you know: one from column A, two from column B, one from column C…

From the curiously intrigued trenches…

“We want the world and we want it now.” – Joey Ramone

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 hisblog, practice web site or directly from doc@madisonpediatric.com.

News 11/11/10

Practice Fusion contends it now serves 50,000 medical professionals and five million patients, making it the third largest EMR community behind the VA and Kaiser. Wow. I’d love to see an audit of those numbers. Or perhaps just a definition of “serves.”

NextGen says its partnership with 25 RECs has allowed it to add more small practices to its client base. More details on NextGen’s REC initiatives here.

The five-provider Forest Hill Family Health Associates (NJ) selects RCM technology from PatientPort to provide real-times claims adjudication and calculate patient-responsible monies at the time of service.

HealthPoint Medical Group (FL) will implement McKesson’s Practice Partner EHR for its 118 employed physicians. HealthPoint, which is part of the BayCare Health System, will also offer Practice Partner to affiliated physicians.

No surprise here: medical practices aren’t as sophisticated as hospitals when it comes to data security, according to a HIMSS security survey. Practices are less like to conduct formal risk analysis, less likely to have security tools in place, and less likely to analyze data from audit logs. One logical explanation is that practices lack the internal IT staff to handle security issues.

Epocrates launches a mobile and online CME platform in partnership with RealCME. The CME courses are free for providers who use Epocrates.

Fairview Health Services contracts with Accretive Health to provide Fairview physicians access to clinical care coordination tools.

Ophthalmic Imaging Systems issues its third quarter financial results: net revenue of $4.9 million, up 25% from 2009; net loss of $466,788 (.02/share) compared to last year’s net income of $85,656 ($.00/share.) The company offers an EHR/PM solution as well as digital imaging systems. I have to wonder how long unprofitable niche vendors like Ophthalmic will be able to compete with the bigger EHR players.

EHRtv has added several interviews from MGMA, including ones with Scott Decker (NextGen), Dan Michelson (Allscripts), Robert Tennant (MGMA), and Jonathan Bush (athenahealth). All are fast paced and fun with good questions. Worth a peek.

Almost half of hospitals report having very good or outstanding relationships with employed physicians, though only 26% say the same about relationships with independent physicians. Almost all of the 193 organizations surveyed in a Modern Healthcare / Press Ganey survey believe physician employment by hospitals will increase in the future.

After eliminating $28 million in unnecessary tests during a year-long pilot program, the Institute for Clinical Systems Improvements (ICSI) licenses Nuance’s RadPort decision support solution for use across Minnesota. RadPort helps clinicians verify at the point of care if particular imaging exams are medically appropriate. ICSI members include 60 medical groups representing 9,000 physicians.

Trivia for your next cocktail party: the incoming Congress will include 16 doctors in the House and three in the Senate. That’s a 64% increase over current numbers.

Sage Healthcare announces the addition of six new practices running its PM and EHR applications. The healthcare facilities represent over 150 providers.

E-mail Inga.

News 11/9/10

From Zuckerberg: “Re: ONC ACTB EMR certification. Several EMR vendors are making a big deal out of partial certification and deserve some grief. Partial certification is meaningless – you think physician practices are going to buy multiple products and integrate them? I can understand partial certification for hospitals, but for physicians, this is crazy. Novice physician buyers are going to see that a vendor is ‘certified’ and assume that they are good to go. They’ll only find out after a lot of effort that what they’ve implemented isn’t going to deliver the goods.” I agree the “modular” versus “complete EHR” certification will cause confusion for some unsophisticated buyers. I’d suggest novice physicians refer to the ONC’s list of certified products, which includes designations for modular versus complete EHR certifications. You can also drill down to see what specific modules have been certified. More importantly, ONC indicates which modules within a particular product are not certified. If an EHR has only modular certification, providers will need additional applications in order to meet meaningful use requirements. Unlike Zuckerberg, I assume vendors are being up front and forthcoming about potential product gaps, but perhaps I am too optimistic. The winners here are consultants, who have the opportunity to help providers wade through the quagmire.

From Jack Dempsey: “Forbes article. HIT wouldn’t be as much fun without Bush.”  Forbes’ Zina Moukheiber likens the “sniping” between athenahealth’s Jonathan Bush and eClinicalWorks Girish Navani to a Bill Gates-versus-Steve Jobs type debates. I’m not sure I’d characterize Bush or Navani as snipers, though both leaders are definitely passionate about their companies and their business models. Bush, however, is the only CEO I’ve ever met who’s willing to sit in on a panel discussion wearing a suit jacket and red shorts.

Mercy Memorial Hospital System (MI) contracts with Allscripts for several clinical solutions, including EHR and PM for Mercy’s employed and affiliated physicians. Mercy is also adding Sunrise Enterprise 5.5 and Allscripts Care Management.

Speaking of Allscripts, Sales President Jeffrey A. Surges is leaving to take over as CEO of Merge Healthcare.

A Kaiser Permanente study finds that targeted alerts sent to physicians through EHRs can help decrease unnecessary tests and help physicians pay closer attention to the messages they receive. In Kaiser’s study, physicians who ordered specific blood tests for elderly patients were immediately alerted when typical results for that age group were unreliable. Kaiser found unnecessary tests were dramatically reduced. To reduce alert fatigue and promote adherence to clinical practice guidelines, researchers recommend implementing alerts for specific types of orders.

Forty-six percent of readers say their practice is paying between $500 and $999 a month for their vendor or hospital-hosted EHR. Another 28% say they pay less than $500 and the rest claim the cost is over $1,000 a month.

Allscripts releases its third quarter numbers: net income falls to $1.4 million from $12.9 million last year. Revenue rose 47% to $242.4 million. Excluding one-time items, earning were $.19/share; analysts were expecting $.17/share. Allscripts blames the income drop on higher expenses, including selling, general, and administrative expenses of $103.8 million compared to last year’s $53.0 million.

MedLink acquires the assets of EHR provider MedAppz, maker of the iSuite EHR.  Both MedLink and MedAppz have products that are 2008 CCHIT certified and neither appears to have earned ONC ACTB certification, at least to date. I’ll go out on a limb and say that I bet MedLink would like to find a way to certify just one EHR and move the combined client base to it.

Epocrates and Covisint team up to help physicians receive PQRI reimbursements from CMS. The partnership allows the 300,000 physicians in the Epocrates network to report on quality measures through Covisint’s DocSite PQRI registry.

A local paper reports that Troy, MI-based gloStream has added 50 new employees in the last year. The five-year-old company has 130 employees plus 15 independent contractors.

Trend alert: the number of physicians signing up to provide concierge medicine continues to grow. Concierge Choice Physicians says it has added over 50 practices since the start of the year and now includes 172 practices. MDVIP, which has 430 practices, has signed on 100 practices in the last year.

E-mail Inga.

Intelligent Healthcare Information Integration 11/5/10

But What Do I Know?

I’ve been looking at a whole lot of EHRs and their web sites lately, looking for my "next great system." Maybe they’re just starting to blur together in my brain, but it looks as if every single EHR out there will improve my workflow, decrease my errors, increase my productivity, improve my bottom line, get me home earlier, make my life easier, and guarantee my MU bucks. Somehow the redundancy of hype doesn’t increase my interest…but what do I know?

Back in 2004, I remember thinking that the majority of EHRs looked a whole lot like Windows 95. Not much has changed. I used to think that most EHR developers would soon learn the value of style, of "eye friendliness" for meeting the wide variety of end user tastes, or that at least they’d develop "skinning" for their systems to help solve the problem of ugly EHR user interfaces. I remember thinking how much better they’d all look within the next five years…but what do I know?

I remember when you moved from one medical practice to another, from one type of paper chart to another, and it took all of about thirty seconds to figure out what went where and how to find the info you needed. Seems that the multitude of "modern" electronic charting systems could stand to be reminded of that…but what do I know?

Seems as if every report I receive via fax or hard copy from (fill in the blank) EHR is either way too long and filled with mostly irrelevant "filler" data or way too short and lacking essential, clinically valuable elements. Seems as if very little effort is being spent, at any level, on truly defining what clinicians actually "need" and how to make that information apparent, easily visualized, and perhaps even somewhat standardized when it comes to knowing where to look for any given piece of info…but what do I know?

Doctors used to be paid for their knowledge, for their experience, for their clinical skills, and their wisdom. Nowadays, it seems we’re paid mostly for data capture. I think patients still want good “doctoring”…but what do I know?

It may just be me, but there appears to be an increasing similarity between how insurance companies deal with clinicians and how more and more EHR vendors are starting to treat us…but what do I know?

I read that independent providers aren’t flocking to EHRs quite as much or as fast as hoped despite the ARRA/HITECH incentives. I’m thinking it might be because of some of the above concerns and just how difficult it is to actually change virtually everything about how you work while you’re busy actually trying to do the work…but what do I know?

For myself, I’m also hesitant to make another EHR choice. Having lived through three EHR company acquisition-mergers which eventually led to the Kevorkianization of a really smart, sexy system that was just reaching a respectable maturity, I’m pretty sure more this same digital tragi-drama will happen to many other decent systems over the next few years…but what do I know?

Don’t get me wrong; I see systems which do some things very well and I know a whole lot of EHR vendor folks who I think are just plain wonderful. Good people and good intentions are important, but I’m still thinking I want a beautiful system that works as easily as my iPad and as intelligently as WebOS, one that I can start using as simply as I need and which can then be "apped" silly at my discretion, one that is actually as good and as smart as all the hype…but what do I know?

From the trenches…

“Committee – a group of men who keep minutes and waste hours." – Milton Berle

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 hisblog, practice web site or directly from doc@madisonpediatric.com.

News 11/4/10

Radiation Therapy Services, dba 21st Century Oncology, selects Sage Intergy for its 90 radiation therapy centers across 16 states.

The University of Wisconsin-Madison’s Center for Quality and Productivity Improvement takes a look at the effects of HIT tools on physician workflow in the outpatient setting, noting that previous studies have shown varied results. It’s a long read but here are a few conclusions worth noting:

• There is growing awareness that the analysis of workflow is necessary to ensure successful HIT implementation and to effect process improvement.
• When there’s a lack of integration of HIT into clinical workflow, quality and safety improvements suffer. HIT integration needs to support the cognitive work of the clinician and the workflows among organizations (e.g., between a clinic and community pharmacy), within a clinic, and within a visit.
• If HIT is to provide optimum performance, it must be designed to fit the specific context in which it will be used, specifically practice and patient types.

Core Solutions, which specializes in behavioral health software solutions, wins a contract to implement an EHR for 60 substance abuse providers affiliated with the Arkansas Office of Alcohol and Drug Abuse Prevention.

I’m glad the elections are over, along with the annoying political commercials and even more annoying phone calls. Over the next few weeks look for the lame-duck Congress to patch pending Medicare cuts before the 30% payment reductions kick in.

From the International Journal of Medical Engineering and Informatics: self-management of chronic disease can improve patient health and reduce hospital visits, and, PHRs and the use of the Internet have the potential to help patients better manage their diseases. Too bad no one wants to use PHRs.

Start-up company Avvo announces it will expand its free online ranking services to include rankings of physicians. Avvo debuts with listings for over 800,000 doctors, drawn from public records and company research into doctors’ backgrounds and experience. Any predictions as to whether or not they’ll be able to filter out the retired/deceased/imprisoned physicians?

I happened upon this commentary by a couple of attorneys who specialize in negotiating HIT contracts between practices and vendors. They point out that one of the key services that RECs can provide is educating providers on HIT contracts, including some of the important provisions to minimize risk and to improve chances of achieving meaningful use:

RECs have the potential to serve as a valuable resource, especially for remote and underserved paper-based primary practices. However, RECs could be doing a disservice to physicians by failing to advise or provide them with essential EMR contract negotiation skills.

I was surfing YouTube today and noticed a recently posted series of videos highlighting a presentation by McKesson Sales National Sales VP Tammy Eden of the Physician Practice Solutions division. Each of the 10 clips are three to four minutes each and overview the final rules of the HITECH Act, the requirements for qualifying for Meaningful Use, and how to actually apply for reimbursement. The information is generic enough to be a great tool for anyone needing summary information, regardless of your EHR, and definitely worth a peek.

E-mail Inga.