Report: Bush vs. Navani on Healthcare IT, Boston

Jonathan Bush (president, CEO, and chairman of athenahealth) and Girish Kumar Navani (CEO of eClinicalWorks) met at Xconomy Xchange: Jonathan Bush and Girish Navani Face Off on the Future of Health IT in Boston on September 29. Andrew Baumel, MD, a pediatrician with Framingham Pediatrics and HIStalk Practice reader, attended the event and provided this overview.

Today at the offices of WilmerHale, Girish Kumar Navani, CEO of eClinicalWorks, and Jonathan Bush, CEO of athenahealth discussed their views of the healthcare IT environment and how their own companies are navigating the changing waters. The discussion was in front of a packed room of over 200 people. It was moderated by Pamela McNamara, president of Cambridge Consultants.

The CEOs first discussed heathcare reform and ARRA. They agreed that both companies were on high trajectories prior to the stimulus and will both have smaller market shares over the next five years as older, less nimble companies are able to survive with this temporary injection of stimulus funds. Girish mentioned that one of their new strategies to come out of the stimulus will be in five years when practices decide to replace the systems they rushed to buy to take advantage of ARRA.

When asked to compare and contrast their strategies, Bush highlighted the fact that every user was on the same iteration of the same application, which allows athena to gather valuable data that they can use to improve payment remittance and work out bugs quickly. He also highlighted the cloud nature of his software. 

Girish highlighted the very large (nearly 100,000,000 patients) penetration of eClinicalWorks and the fact that users can customize the product on their own without IT specialist and that many customers demand different customizations or versions that athena, on one application, cannot provide.

Bush then highlighted athena’s Community software which attempts to move patient PHI seamlessly between providers and institutions, cutting down on cost of registering patients, and his view of a Facebook-like interface in which clinical information could be shared between providers if they "friend" each other and that Athena would collect a modest $5-$8 fee per transaction.

Girish spoke about a project at Children’s National Medical Center in which they determined the basal metabolic rates of children, entered the data into eClinicalWorks, and then were able to give custom medication to their patient based on the metabolic data in each electronic chart. He used this story to illustrate one of the many ways clients can innovate with eCW to help them improve patient care.

In the Q&A period, one questioner challenged both CEOs, implying that their products were weaker than Epic’s and Cerner’s as those products can aggregate data from 12 clinical departments in a large hospital. Girish took on the questioner and stated in these hospital systems, one would likely find the outpatient doctors using eClinicalWorks and that his company cares just as much about the solo practitioner as the large health care systems.

Another questioner who was starting a company supplying EHRs to mental health providers asked the leaders for their advice on size of sales force. Bush stated that he had 100 sales people and Girish said he always put more employees in post-sales positions and let satisfied customers be his sales force.

For their final words, Bush stated that he wants to be a backbone of HIT. Girish said that eCW will not be distracted by the stimulus funds and will focus on the long term to be able to change with the times.

Both leaders were very forthcoming with their views and strategies for the future of their companies. Those hoping for fireworks would have been disappointed, as the two CEOs displayed much cordiality towards each other, saving their barbs for their mutual competitors. While Girish was unwilling to name names, Jonathan showed no hesitation in calling out Allscripts, GE/IDX, and a few others as ones that would remain relegated to prehistory when the story of HIT is written.

Unlike politicians in a debate, both CEOs answered the questions that were posed by the moderator and did so in the time allotted. Both exuded confidence in their business plans (private vs. public funding) and the ability of their products to thrive in what both agreed would be a rapid and unpredictably changing playing field.

News 9/30/10

From: Matt “Re: imedcenter. I noticed that you picked up the article about our clinic. What we are doing is extremely time consuming to invent from the ground u/p, especially for primary care type offices like ours. We really feel that the systems we put in place allow the patient to feel the personality of the old days of the home visit, while allow the physician to survive in the brutal primary care market.” When imedcenter of Danbury opens its doors this week, it will be totally paperless. I checked out their website and noticed that their HIT setup is not the only thing differentiates them from the masses: imedcenter providers are a unique combination of traditional MDs, naturopathic physicians, chiropractors, therapeutic massage therapists, and nutritionists.

From: NoKlass “Re: KLAS and ambulatory solutions. What’s being ignored is the difference between enterprise systems that work in hospitals, and EMRs that work in ambulatory medical practices. Also missing is a distinction between EMRs that cater to specialists versus primary care.” Well said. On the other hand, if there are too many categories I can envision a whole other set of issues, not to mention plenty of criticism from vendors who are benefiting from the status quo.

The big Xconomy Exchange with eClinicalWorks’ Girish Navani and athenahealth’s Jonathan Bush is/was Wednesday. A reader sent in this stealth picture with promise of more details to follow.

Daily text messages reminding dermatology patients to take their medication significantly improve patient adherence, self-care behaviors, and quality of life, according to a Center for Connected Health study.

Also dermatology-related: dermatology-specific certification, such as the one CCHIT offers, will likely not sway EHR-resistant dermatologists to invest in a system. I’m sure one reason many dermatologists avoid adopting EHRs is because of their high patient volume: they don’t believe there’s time to document electronically and still see 40+ patients a day. In addition, ARRA won’t incent too many physicians to adopt EHR since the meaningful use measures are less relevant in dermatology.

A whopping 70% of medical students say that having an EHR is a very important factor in deciding where they will practice medicine (could the rest be considering dermatology?) Additionally, medical students love smartphone devices, particularly iPhones or iPod touches: 70% are Apple fans, followed by BlackBerry and Android devices.

Phreesia completes a $20 million Series D round of funding. Just this week, someone suggested I check out Phreesia, a company that has developed a patient check-in system that also verifies insurance eligibility, calculates the patient-responsible amount, and collects the money with a credit card swipe. Patients are handed a “PhreesiaPad” tablet device, take a seat in the waiting room, and complete all the check-up and payment tasks before being seen. The product is timely since more practices are attempting to collect the full patient-responsible money up front, rather than wait until insurance pays. What differentiates Phreesia from similar products is that the “collection” task is performed by the tablet and not the office staff, most of whom rather ask Mrs. Smith about her new grandbaby than break the news about a new payment procedure.

RCM-provider ZirMed achieves Phase I certification from the CAQH CORE, which means the company has proven its ability to provide real-time access to key eligibility and benefits data.

Western Maryland Health Systems selects Dell and eClinicalWorks as the hosted subscription-based EMR/PM solution for its 150 affiliated and 26 employed physicians.  Dell will provide both the hardware and software support through its ProSupport EMR helpdesk.

ClearPractice announces the release of Nimble, an EHR designed specifically for the iPad.  I’m kind of wondering why, if you are going to run your software on a device with amazing graphical capabilities like the iPad, would you develop your software with a brown background.  Anyway, the first 500 physicians to subscribe to ClearPractice’s Practice Edition EMR get a free iPad.

Blue Shield of California commits $24.8 million in 2010 payments to reward medical groups and IPAs that meet pay-for-performance objectives for clinical care, patient experience, and HIT adoption.

Coming to a mobile device near you: mobilePDR. Physicians Interactive Holdings and PDR Network are offering a mobile, digital version of the Physician’s Desk Reference. mobilePDR is available for free for full-time practicing physicians via PHI’s Skyscape mobile channel. Details here.

E-mail Inga.

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.