News 8/26/10

PerfectServe introduces PerfectServe Clinician, a free iPhone application that works with PerfectServe’s hospital communication system. Mr. H chatted with PerfectServe CEO Terry Edwards a couple of months ago. It’s an interesting read about a unique product.

Culbert Healthcare Solutions earns a spot on Inc. Magazine’s Top 5000 Fastest-Growing Private Companies. Culbert says that strong growth from physician practice management services and IT implementation services have helped propel the company to #988 in its first year of eligibility.

Meanwhile, Allscripts earns a #22 spot on the Fortune’s 100 Fastest Growing Companies. Allscripts ranked sixth among healthcare companies and was the only HIT company among that group.

MGMA sends CMS a letter regarding the proposed 2011 fee schedule. A few notable HIT points:

• MGMA urges CMS to revise its proposal to impose 2012 e-prescribing penalties to reflect 2012 e-prescribing activity versus the first six months of 2011.
• MGMA says CMS should exercise additional flexibility in assigning e-prescribing penalties. For example, CMS should give consideration to higher-volume prescribers who practice in geographic areas where local pharmacies do not have eRx capabilities, or to prescribers in specialties that require a high volume of controlled substance prescriptions that can’t be sent electronically.
• MGMA believes CMS should not assign any e-prescribing penalties to providers who meet Meaningful Use objectives. CMS will administer the 2011 EHR incentive program separately from its 2011 e-prescribing program and the criteria varies between the two.

For $10 a month, patients can sign up for GreatCall, a prescription reminder service available through Jitterbug cell phones. The Web site says patients get a “friendly” reminder call for up to 16 medications and consumers can indicate when they’ve taken their meds for compliance tracking. It’s unclear if the “friendly” reminder comes from real person or a computer, but I’m guessing computer.

Feeling the need to learn more about achieving EHR Meaningful Use goals? I noticed on the Industry Events link on HIStalk we have a number of webinar and conference options available. Click over and check them out.

Good read: California physician Rahul K. Parikh writes about his use of Google and the Internet for medical research. He points out it can be a great tool, but warns of potential pitfalls. Parikh recommends that providers become search savvy before relying too heavily on online research tools. “Unless you’re Internet savvy enough and have time to scan pages and pages of websites, skip Googling for diagnoses and just call your nearest specialist for help.”

Novo Nordisk introduces a new iPhone app for physicians. The NovoDose applications gives providers the ability to look up insulin dosing guidelines and blood glucose goals for their diabetic patients.

Ingenix Consulting launches a Strategic Technology Solutions practice, targeting large practices and hospitals. Scott Kolesar, formerly of  Wellspring Partners and EDS, will lead the group.

ISALUS Healthcare jumps into the mobile app craze, with the introduction of a new EMR-EHR app. ISALUS’s mobile app will give physician users the ability to access patient charts via their iPhones.

E-mail Inga.

News 8/24/10

From Ronnie James Dio: “Re: AAFP comment. What exactly does Waldren mean when he says, ‘Eligible professionals in the Medicare program must bear a heavier burden of full meaningful use compliance in their first payment year to receive the incentive payments’?”  Dio is referring to Steven Waldren’s comments on the final Meaningful Use rules. Dr. Waldren graciously agreed to clarify and I have attached his response to the original HIStalk Practice post.

From Not Clueless: “Accountable Care Organizations. I saw that you were going to be talking about Accountable Care Organizations with someone. To prep for your meeting, you may want to watch this video. Actually, it probably won’t help with your meeting, but it is pretty funny, although in a sad reality kind of way.”  Very funny! The clip features a health system CEO asking a help desk how to form one of those Accountable Care Organizations he read about in Modern Healthcare magazine. Last week I did have an opportunity to talk with Chet Speed, VP of  Public Policy for AMGA, and hopefully the interview will post later this week. Meanwhile, I’ll just say there’s probably more confusion than clarity surrounding the whole ACO concept.

Speaking of ACOs, critics are already speaking out against such networks, claiming they would create monopolies and thus would be more expensive than today’s models. Case in point: an ophthalmologist raises concerns over organizations that bring together large numbers of physicians in a single community to provide “total patient care.” He charges that such set-ups actually reduce or eliminate local competition. “The only way to decrease costs that truly works is increasing competition, but for some reason in health care, we’re supposed to believe that competition drives up costs.’’ I must say I am concerned he could be right.

New York Epilepsy and Neurology connects to NYU Langone Medical Center’s Epic system, the first private practice to do so. NYU Langone is offering subsidized access to the Epic system for the 700 affiliated private physicians.

Researchers with the Boston University School of Medicine find that their use of an EMR tracking system reduced diagnostic resolution times for abnormal Pap tests. After controlling for certain abnormalities, resolution times decreased from 108 days prior to implementing an EHR tracking system to 86 days after implementation.

I’d like to welcome Ingenix aboard as our newest HIStalk Practice sponsor. Ingenix has been a long-time supporter of HIStalk and we appreciate their spilling the love over to HIStalk Practice. Ingenix has made HIT headlines as of late for its purchase of Picis and Axolotl. However, the company has a host of other healthcare IT solutions for hospitals, pharma, payers, and physicians. CareTracker is the company’s integrated financial and clinical solution for physician practices. Other ambulatory care offerings from Ingenix include an RCM solution, EDI services, coding compliance tools, and consulting services. Thanks to Ingenix for supporting HIStalk Practice and our readers.

Preferred Health Partners (NY) and Staten Island Physician Practice each receive $100,000 in incentive payments from the Primary Care Information Project. Both practices leveraged their NextGen Health Quality Measures Reporting Modules and Ambulatory EHRs to document improvements in core quality health measures.

DrChrono.com releases a new version of its iPad EMR Platform, which now includes electronic prescribing and the ability to store and display scanned documents and lab reports.

Health care attorney J. Ryan Williams cautions physicians not to jump on the first hospital-subsidized EHR option that comes their way. Instead providers should develop their own Meaningful Use plans and consider hiring a consultant to test the various systems being offered by affiliated hospitals.

Several receptionists at a busy “surgery” in Brighton, England quit after suffering months for verbal abuse from irate patients. Apparently the doctor’s office is understaffed and patients are irate over not being able to get appointments. From one receptionist: “We get sworn at, get called jumped-up receptionists, and even threatened that someone will come down to the centre and sort us out.” Sad, of course, but why do things always sound so much cooler when the Brits say it?

E-mail Inga.

Intelligent Healthcare Information Integration 8/23/10

EHR Data Sharing – No Manhattan Transfer

A recent change in working arrangements led to the need to look into the exchange of a few hundred patients’ records, from one well-known EHR system to another very prominent company’s system. To say such an exchange is easy or, especially to say it is cheap, would be the understatement of the month.

Don’t get me wrong, it is possible — in some format or another. Demographics only via .CSV or full CCR/CCD transfer of medical data are possible. But for small practices who want to share large chunks of data from one well-built system to another, it is certainly cost-prohibitive and not a simple “have your peeps call my peeps and set it up” type of deal. You’d think that by this time we might have had enough such transfers that the cost would be decreasing and the intercourse would be, well, more satisfying.

You may not be a fan of vocal jazz as put forth by “The Manhattan Transfer,” but they have been putting out some pretty silky songs for some 40 years. Their sustainability is founded upon their ability to incorporate and appropriate from many diverse styles and formats. They bring in elements from many great musical genres and meld them into their own particular musical system.

EHRs must be able to share amongst the many, many digital “genres” now fairly entrenched throughout the country and do so in a way that isn’t another bloodletting point for small practices. If not, the whole NHIN (or whatever version or flavor or name du jour it is) concept might as well be called the Big Organization EHR Information Network. Add “Group” at the end and it’s BOEING. (Hmmmm… Big government contracts, mega-corporate mindset and attitude…there’s some association there.)

Us little guys don’t have the overhead room to afford playing in the big digital sandbox if simplicity and small guy costs aren’t a part of the plan. I know, I know — healthcare data is complicated and these multi-siloed, often incompatible systems and system architectures argue against simplicity and inexpensive costs. But, you know, we let it get built that way. There’s no rule that says we can’t reengineer.

I hope so. The more I use our EHR, the more value I see within it. It has its problems, sure, but they’re far more acceptable than the hassles associated with pen and paper. It just shouldn’t make such off-key squawks when all I want is syncopation.

From the trenches…

“Beauty of style and harmony and grace and good rhythm depend on simplicity.” – Plato

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 8/19/10

Steven Waldren, MD, the director of AAFP’s Center for Health IT, says the the final ruling on Meaningful Use includes some good changes. But, he cautions, meeting Meaningful Use objectives will still require significant effort. Specific concerns include a) the Medicare program places a heavier burden of Meaningful Use compliance in the first year compared to Medicaid’s;  b) the aggressive timeline for implementation; c) the absence of certified EHR technology in the market; and, d) the complexity of Meaningful Use rules. Waldren also notes that RECs and vendors lack adequate skilled personnel to meet the market’s implementation and support demands. [Update 8/23/10: A few readers asked for clarification about Waldren’s comment that Medicare places a heavier burden for MU compliance than Medicaid.  Thanks to Steven Waldren for the following:

The burden difference for the first year of participation between Medicare and Medicaid is that one does not have to report/achieve the measures of meaningful use under Medicaid to receive the incentive.

From the final rule:

“The HITECH Act allows Medicaid EPs and eligible hospitals to receive an incentive for the adoption, implementation, or upgrade of certified EHR technology in their first participation year. In subsequent years, these EPs and eligible hospitals must demonstrate that they are meaningful users. There are no parallel provisions under the Medicare EHR incentive program that would authorize us to make payments to Medicare EPs, eligible hospitals, and CAHs for the adoption, implementation or upgrade of certified EHR technology. Rather, in accordance with sections 1848(o)(2), 1886(n)(3)(A), and 1814(l)(3)(A) of the Act, Medicare incentive payments are only made to EPs, eligible hospitals, and CAHs for the demonstration of meaningful use of certified EHR technology.”]

In a profile of the 176-physician Baptist Memorial Medical Group (TN), the group’s CEO says the hospital takes care of all the business concerns for their physicians, including leasing space and hiring and training staff for the billing and EMR systems. MGMA weighs in, noting that the main reason doctors are becoming part of hospital groups is the money. In fact, MGMA says that in 2009, first-year primary care and specialist physicians in hospital owned groups averaged higher compensation than those in other type practices.

Speaking of MGMA, the organization reports that compensation for practice management professionals has remained static over the last year. Interestingly, MGMA members are earning more than their non-member counterparts: office managers average $13K more per year and finance directors earn almost $1,000 per year more. ACMPE members achieve an ever bigger delta, earning at least 21% more working in practices of seven or more physicians. And, ACMPE-affiliated CFOs average $59K more than their non-affiliated peers. Note that you can join both organizations for a mere $585 per year.

A big welcome and thank you to AdvancedMD, our newest HIStalk Practice Platinum sponsor (and sponsoring HIStalk at the Platinum level as well). A few weeks ago, I had a chance to chat with AdvancedMD’s CEO, Eric Morgan, who is quite upbeat about the recent successes and rapid growth of his 10-year-old company. AdvancedMD started out with a SaaS-delivered practice management solution and acquired EHR vendor PracticeOne late last year. The Draper, UT-based AdvancedMD has over 10,000 connected providers, plus over 300 billing service providers participating in their AdvancedBiller program. We are pleased to have AdvancedMD on board!

Patients are more concerned about ready access to their medical records than they are potential record inaccuracies, according to Practice Fusion-sponsored survey. Their other top concerns include the theft or loss of medical record data and inaccessible data when in an ER.

I noticed that e-MDs posted some Facebook pictures from its sold out User Conference & Symposium in Austin, TX last month. This happy bunch were either Casino Night winners or members of e-MDs Advisory Board.

The seven-provider Good Neighbor Community Health Center (NE) selects Sage Intergy CHC as its EHR system.

E-mail Inga.

News 8/17/10

Ingenix announces plans to acquire HIE vendor Axolotl. Ingenix offers a number of HIT products and services, including PM, RCM, and EHR solutions for physician practices. About 3 1/2 years ago, Ingenix introduced its own suite of HIE products, but Axolotl has been more successful in that market.

The 2,000-member Indianapolis  Medical Society announces discounted subscription pricing for iSALUS EMR and PM software.

Practice Fusion announces ChartShare, which enables physicians to electronically refer patients to other providers. The press release stresses that access to data within Practice Fusion is “controlled by well-defined provider roles and access levels, the enforcement of strong login passwords, stringent user authentication and user inactivity locks” and only NP- and MD-level users can access the referral system. However, a provider sharing patient information with the ChartShare module apparently uses a template to create the letter, which is then forwarded via fax. I suppose technically that is an “electronic” referral and I suppose faxes are “secure.”  Why nitpick about a free product?

Speaking of Practice Fusion, the Las Vegas-based Ecco Healthcare is named a Practice Fusion Premier Certified Consultant.

Medical Informatics Engineering (MIE) names Bruce Lisanti CEO and president. He takes over for founder Doug Horner, who will remain board chair and CTO. MIE, by the way, is the EHR company that Google selected for its onsite employee health clinics. Lisanti spent time at EDS and GE before working working with several high tech startups.

Culbert Healthcare Solutions appoints Brian McCartie regional VP of its Midwest division. He’s a former VP of business development for Cejka Solutions.

Now that the Allscripts and Eclipsys boards have approved their merger, Allscripts initiates a public offering of 25 million shares of common stock. The shares are actually being sold by Misys to reduce its equity stake in Allscripts, just the next step in a complicated transaction.

AHRQ talks to a small group of clinicians (27) and evaluates the use of technology to assess patient health within specific practices. Findings: (a) practices with EHRs perform more practice-based population heath (PBPH) functions, such as identifying patients for clinical trials or disease management programs; (b) even practices with EHRs don’t fully utilize the functionality they have; and (c) barriers to adopting PBPH include lack of technological innovation, practice workflow, and lack of usable data. Hey, those are some of the same reasons practices don’t embrace EHRs!

Whether or not to adopt EHR is an especially tough decision if you are a facing retirement. Healthcare consultant Joseph Mack discusses the pros and cons in amanews.com, but here’s the bottom line: a physician less than three years away from retirement may have a hard time justifying the expense. Those who are 8-10 years away should probably find a way to make the investment so they can avoid penalties and earn incentive pay.

I am rooting for this guy. Greg Waldstreicher is co-founded of DoseSpot, a 2009 e-prescribing start-up company mentioned on HIStalk early this month. I can’t say his company’s offering is better or worse than other e-prescribing companies, though the product is Surescripts certified. Waldstreicher, however, is just a senior in college (at the Maryland Technology Enterprise Institute) and one of five finalists for Entrepreneur magazine’s Entrepreneur of 2010 Awards in the college entrepreneur category. I am sure I have shoes older than him. Nonetheless, I’m all about helping our HIT brethren out, so feel free to give him a vote here. Voting ends September 10th.

I’m chatting with an accountable care organization (ACO) guru tomorrow, which is a great thing, since I don’t have a good grasp on the whole ACO concept. A couple of the biggest question marks in my mind is how payment works for individual providers and is there adequate funding to make provider participation worthwhile. MGMA offers some good background in one of their recent blog post, which is helpful for newbies like me, as well as anyone contemplating participation in an ACO.

E-mail Inga.