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.

News 9/14/10

Affinity Health System chooses GE Centricity EMR for its 22 multi-specialty clinics. GE will host the software for Affinity’s 220 doctors.

MPM selects PracticeSuite EMR as the EMR option for its MPMsoft billing software. PracticeSuite EMR is a “free” EMR for providers, though the company charges $35/month for each non-provider. MPMsoft is also a lower-priced alternative (their Web site says a “complete billing system” is $2,998). From MPM’s owner Jim Muschetti: “Our practices don’t have millions to spend on EMR systems like Allscripts or eClinicalWorks; our clients are small and they watch their pennies. They’re reluctant to spend a dime frivolously even in the best of times.” I have no doubt there is a demand for less-expensive alternatives (although “millions” is hardly typical even on the upper end), but, I wonder how many will have the financial means to certify products.

Speaking of the cost of EMRs, we didn’t have too many participants in our poll (to the right) indicating the monthly fee for a hosted solution. However, the small sampling indicates $500 to $999 is the most popular price point.

RCM provider PracticeMax acquires eClinicalWorks reseller Medinomics. PracticeMax already offers implementation and training for NextGen and SequelMed.

Medical billing software provider Kareo says it has raised $9.5 million, which it will use to enhance customer service, expand its product offerings, and add sales, marketing, and management personnel. Kareo targets small practices and offers its software via a hosted, monthly subscription model.

Here is a legal case to watch. The California Medical Association sues Blue Shield of California, saying its online rating system is inaccurate and misleading. The site recognizes providers who meet national standards for quality care. However, the medical association alleges the ratings are based only on claims data and do not consider details from medical records.

When it comes to EMR adoption, the most likely indicator of doctors’ interest and use in EMRs is whether their friends (and not just peers) use them. That’s the conclusion of a study published in the Journal of American Informatics Association. Researchers recommend that practices train the more popular doctors to be physician champions rather than doctors who are simply techies.

The government predicts that community health centers will double their capacity by 2014 and treat 20 million additional patients.

In the retail clinic world, Target increases the capacity of its in-store clinics, adding eight new locations in Chicago and the Palm Beach, FL area.

Aprima Medical Software announces DEVsource is its newest reseller.

RadNet announces its intention to acquire Image Medical Corporation, the parent of eRAD, for $10.7 million in cash and promissory notes.

SRS partners with Medstrat to integrate its PACS system with the SRS Hybrid EMR. SRS will implement and support the new “SRS PACS, powered by Medstrat” product.

The Gulf Coast REC at the University of Texas Health Science Center at Houston opens its enrollment for eligible providers, with a goal of 2,855 primary care providers in the first year.

Drummond Group, the organization that is CCHIT’s only official certification competition, says they’ve been hit with such a high volume of questions from vendors that they’ve set up a FAQ on their site.

Amednews.com chats with a few consultants about IT and the need for regular “checkups.” Recommendations include working with a vendor that has a proven track record and having hardware and software monitored twice a year. Especially important: a working backup, up-to-date security, and current software. As one consultant points out, “Information technology is no longer just a little component of somebody’s business, that a little nerd comes by and fixes your problem and moves on.”

I am all about spicing up life with a little humor. Kronos, a developer workforce management solutions, apparently likes mixing wit with work and  introduces a new weekly cartoon called “Time Well Spent.”  The above reminds me of just how much of a challenge this whole EMR thing might be for the industry.

E-mail Inga.

Intelligent Healthcare Information Integration 9/10/10

EHR Mountains and Molehills

Way back in days of yore, when I was but a naïve EHR pup looking into systems which might be suited for me and my one-doc practice, I clearly remember thinking how I wanted to be certain that whichever system I ended up choosing, I wouldn’t end up as a corporate afterthought. Once the big boys (or girls) had my money, I worried I might become but a faint, far-off voice, more of a gnat when I had a problem than a lion whose roar could not be ignored.

Not only had I read and heard tales of just such woes, I had experienced the uppitiness of some of the bigger vendors’ sales reps first hand. I had many a demo in my office or at various events where the “show” had a constant underpinning of “see how wonderful we are” followed by a slightly upturned nose as they sat back in their chairs with a smug sense of “there’s no way a little, one-horse doc like you won’t be hyper-impressed by our magnificence.”

Not that I was, or am, any great shakes EHR reviewer, but I knew just as much then as I do now about what looks good to my eyes and about what made medical workflow sense. Frankly, most of the big systems weren’t very small-user-friendly, plus, they looked kind of ugly. (And, to top it off, I detest smugness.)

I was on a quest; I wanted to find a good-looking system (at least one that suited my eyes) and I wanted to find a company which I felt would value me as much after I had paid the price of admission as they did before. I finally settled on a system and a company which I thought fit that bill to a proverbial “T.” The system was very high tech, very customizable, very attractive, and very workflow-centric. The company was small, but the people were phenomenal, the kind of people I’d want my children to emulate. They promised to keep me, and pediatrics as a whole, as primary considerations. And they did.

I believe our partnership was mutually beneficial. I helped their company grow and helped them flesh out some important elements of their system’s design. They kept my concerns addressed just as if I were their only client. I felt well-matched and well-considered.

But, then … then came the mergers/acquisitions. Up one step, up another step, and now, up into the Himalayas (or, at least, the high Sierra Madres). What I worried about with each step was whether I would continue to have the feeling that I was still a valuable client despite my Nowhere, Ohio, address. I was fortunate that along each step up, my little guy concerns continued to be considered. Up step one, up step two, each seemed to value little trench grunts (or at least they made me feel that they did).

Getting noticed when you have an issue among molehills is one thing; it concerns me that no one will hear my screams if I fall in the midst of the mountains. So, Glen, while I doubt you’ll have the time to be reading my measly blog submission, I sure hope someone on your (our) new team still notices us little guys and realizes that, en masse, we have a lot to offer that is distinct from all the large groups and institutional players with their colossal checks. (Ours will also be colossal; you just have to cash a whole bunch of them to attain colossal-ality. Sort of like Seinfeld with all of his twelve-cent royalty checks from a Japanese TV show appearance.)

From the molehills…er, mountains…er, still in the trenches…

“It’s the sides of the mountain that sustain life, not the top.” – Robert M. Pirsig

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 9/9/10

The Association of Alexandria Radiologists (VA) chooses McKesson’s Revenue Management Solutions for radiology billing and practice management for its 26-physician practice.

MedLink International collaborates with HIE vendor Thrasys to market a cloud-based HIE platform to RHIOs and hospital groups. This is the same MedLink that was originally formed in 1997 as an answering service for doctors. A few years later, MedLink expanded its offerings to include VPN services to medical communities, as well as an EHR and PM solution for physicians. Management appears to be paying attention to market trends.

meridianEMR and PM vendor MedEvolve announce plans to share technical resources and integrate their products.

Greenway Medical Technologies says it had a record 1,300 attendees at last week’s customer conference in Atlanta.

The Massachusetts eHealth Institute (MeHI) REC releases a list of certified EHR vendors and Implementation and Optimization Organizations. Ten companies make the EHR vendor list, which pretty much encompasses all the major players. Eighteen vendors are named certified implementers.

Meanwhile, I could not find a list of any certified vendors for the South Florida REC, though Mitochon Systems says they’re now an Approved EMR Provider. Mitochon offers a free HIE/EMR/PHR system.

Nuance Communications introduces Dragon Medical Enterprise Network Edition for  large practices and hospitals. The new release includes a centralized management console and enhanced support for Citrix-based EHRs.

The American Society for Gastrointestinal Endoscopy will offer Welch Allyn’s EHR Prep-Select service to its 11,000 members.

Three in ten Americans say they would use their cell phone to track and monitor their health and 40% claim they would pay to use a remote monitoring device that would send health details to their doctor. Most physicians support remote patient monitoring as long as there’s an option for exception reporting, rather than just supplying raw data. Forty percent of physicians believe that a combination of e-mail, text messaging, and mobile health technologies could reduce office visits by as much as 30%.

Hill Physicians Medical Group (CA) brags that its IPA now has over 1,000 private physicians in the San Francisco area, plus another 1,200 practitioners that are part-time, faculty, or provide services through hospital-based positions. Across northern California, Hill has more than 3,500 physicians.

US Oncology selects PatientPoint as its patient portal solution.

A public radio station in Tampa looks at EMR adoption in the region, finding at least two physicians who aren’t big fans. A family practice doctor complains that consult letters from specialists with EMRs run four pages long, compared to one-page notes from non-EMR docs: “You’ve got this mass of uncoordinated data. Even though it’s all there it’s agonizing to try and go through this information, so you become inefficient.” A second doctor who’s had an EMR for four years says, “It really cut down the number of patients we were able to see as we were learning to use this. It probably took about a year for us to get comfortable with the system.” Ouch.

MedPlus and the eHealth Initiative release results from a benchmark survey on the role of RECs in EHR adoption. Some key findings:

• Of the 46 RECs responding to the survey, 30 said price and total cost of ownership will be the most important criteria for selecting a preferred EHR vendor, with other factors being Meaningful Use guarantees, local implementation presence, and availability of system hosting.
• Only 14 RECs said they had signed contracts with primary care providers.
• 30 RECs intend to change their fee structure in order to sustain themselves once stimulus funding ends.
• 28 RECs will conduct an RFP process to select recommended vendors, with 13 planning to choose five or more vendors.

Compulink Business Systems announces it is providing an unrestricted educational grant to the Joint Commission on Allied Health Personnel in Ophthalmology to develop online courses on EHRs for ophthalmic medical personnel.

A professional magician-turned doctor finds that a bit of magic helps put patients at ease and builds rapport. Magic has worked so well for Dr. Lalit Chawla that he’s written a manual (which includes 20 tricks) to help other health professionals incorporate magic into their professional work.

E-mail Inga.

HIStalk Practice Interviews Lisa Martinez, Applications Manager, Staten Island Physician Practice

Lisa Martinez is a applications manager at Staten Island Physician Practice of Staten Island, NY.

Give me some background on your practice and the technology you are using.

We are a two-location, multi-specialty group of about 90 to100 physicians.We’ve been using NextGen since 2006. It was our first experience using an electronic medical record. We also use their practice management system, so we’ve use both ever since then.

In the sense of using the system for the pay-for-performance enrollments, we enrolled with NextGen due to their HQM, their Health Quality Measures, that they set up. We moved forward with NextGen. We were not previously reporting until NextGen created the HQM.

Which was how long ago?

This was last year that we enrolled.

So that’s essentially how you got into the ehearts program?

Exactly.

What made you decide to participate?

It was actually brought to us as a NextGen client. Obviously we were interested in the pay-for-performance initiatives. At that point, especially knowing that it was just on the reporting end that we were enrolling as a beta site for their new application or utility, we enrolled.

Since we are a New York-based group, we enrolled in the eHearts and we also enrolled in PQRI. We reported for both of those for 2009.

How did you do on the PQRI? Have you gotten those results yet?

We have not heard back from PQRI yet.

What type of data are you capturing?

That was one of the great things with the HQM is that the physicians were already documenting into the electronic medical record. Say it be specific information for the patient while they’re doing their documentation for the day, or it can be information that’s coming through an interface. For example, lab results.

Through all the different measures, they’re actually going into the back end of our database and pulling those fields for the patient. The physicians don’t have to change their way of documenting. They continue to document the same way. We brought it to their attention, obviously, that we were reporting off of specific fields, but they were already using those fields, so it worked out well for them.

What sort of data are they looking for?

It depends on the measures. For example, in the measures that we do with eHearts, they’re looking at their medications, their blood pressure control, cholesterol control, and their smoking cessation.

All that type of data was already in your templates?

Exactly, yes. It could be even a drop-down field. It could be coming from an interface from their vital signs that they’re taking. For example, their blood pressure check on a daily basis, and their cholesterol also, would be from a result.

Did the physicians have to make changes in workflow? For example, were they necessarily testing cholesterol levels on a regular basis or did you they have to add those protocols?

No, luckily we actually already had it in place through our case management where they are following up with those patients before we even enrolled in eHearts or PQRI. The providers were already being informed of their patients, their high-risk patients, or any other case management that they were following. So luckily, this is a very popular scenario with the eHearts. We were already doing that for our patients.

How long was the reporting period?

It was for a year.

Did you do monitoring during the year to make sure everybody was capturing what they were supposed to be capturing?

We did, internally on our end. We pulled reports. NextGen didn’t have the capability to do that. I know that they’re working to do that, but they gave us a yearly report on the information.

We also can pull a breakdown, through NextGen, of exactly where our physicians stood that year, and where the patients that were missing the information were. We provided that to our physicians, but we also have our own internal reports that we pull.

What was involved in creating the reports?

That was all taken care of on NextGen’s end. They set up the utility. It was just in a sense, an afternoon of programming where they connected to our database. They informed of us the fields that they were going to be pulling, and at that point, we just did some basic data structure to make sure that the fields that we have are the same as what the reporting was of, and the fields’ names are the same so they’re not missing anything.

We went through that a few times back and forth until we made sure that we had everything 100%. I would say a couple of weeks to have everything set up and completed.

Where’s the practice in terms of meeting Meaningful Use objectives?

At this point, we are not enrolling with the Meaningful Use objectives until we go to the next version that’s offered by NextGen. That’s probably in 2011.

Any particular reason for that?

I’m sure there is. I just don’t know.

Anything else you can add to clarify what you are doing and how the physicians have embraced this? I guess they’re probably pleased as punch to get $100,000 not having to do any additional work.

Exactly, that’s the key piece. They didn’t have to do anything additional because asking anything additional is always an issue as it is.

But with that said, and seeing that there was a true payment that was given … because that was another piece, that we were in the thoughts of, “Oh, well they’re saying this is going to happen, but it’s probably not going to happen.” Once we said that, it did happen.

It’s great for the physicians to actually see that their follow-through with their patients is also giving them a benefit through NextGen, through using the electronic medical record, because it was a great investment — a very big investment on their end — for the group.