Intelligent Healthcare Information Integration 7/16/10

Musings on EHR Usings

By now, most of you know I’m a small-town pediatrician in private practice, with an IT department consisting of me. (Not to take anything away from the great job my wonderful EHR VAR support people do, but their 1,000-mile reach has its limitations.)

As the chief cook and bottle recycler, it sometimes amuses me just how challenging this EHR/EMR proposition is, especially when I think of others trying to pull this off who may not be so tech star-struck. I mean, really, how many doctors really care if they’re using pen and paper or mouse and keyboard? From what I see, most of my colleagues just want to provide healthcare help. All that charting stuff is more often seen as a way to get paid than as a real necessity for patient well-being and ongoing care.

I know: in bigger institutions and large practices where patients may see multiple providers, thereby necessitating better legibility and patient care communication, and when you consider data usefulness and sharing, I think most physicians understand that digitization is the way to go. However, I’ll bet that outside of CMIO and geekoids such as me/we, very few really want to be bothered with the technicalities of .NET or MUMPS or SQL or even CCD/CCR. They just want to be docs. And get paid reasonably. And get home sometimes.

We had a recent episode where our EHR kept slowing to a crawl just before freezing completely, again and again and again, over several days. A server reboot would fix it, but it would come back within hours, maybe minutes. My VAR support team finally figured out that a driver needed updating, but we really struggled for a couple of days there.

Then we had one of our touchscreen registration desk kiosks act up. Actually, it turned out to be the flexible, spill- and child-proof keyboard, but there wasn’t much my 1,000-mile VAR could help with on that one. It seems simple now, but the strange effects of the partially-working keyboard caused a diagnostic dilemma for weeks.

The other day I realized I had been using a poorly finished template for many months which necessitated my rewriting pieces of each note that should have been auto-populated. I wasted many seconds every time I had to do that, but during a busy day, who has time to stop and edit a template? Then, by the time the day has beat you into submission, you don’t even remember the little template nuisance when it is overshadowed by the many, much larger issues of the day. You just want to get home. Thus the template remains a constant reminder of the inadequate allotment of 24 hours within which to scramble.

As you can glean, the “Musings” title is befitting, as I’m really not too focused here on any particular issue. Within some of the other roles I juggle, be they doctor-y or HIT-ish, I have very little time for wistful reflection. Maybe that’s part of the point. Maybe that’s what I hope more of the vendor-programmer-developer folks out there will hear.

Being a physician these days isn’t about HIT. It’s still about being a doctor and it is harder than ever. When you sit inside your protected, usually air-conditioned HIT worlds and talk tech-ese with other technophiles, please remember — the people you’re trying to serve, for the most part, couldn’t care less about scripting, unless you’re talking prescripting. Keep it stupid simple … and easy to fix.

From the trenches…

“The most potent muse of all is our own inner child.” – Stephen Nachmonovitch

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 7/15/10

If you are in the ambulatory world and still not clear on all the just announced final ruling on Meaningful Use, here’s a quick and dirty summary:

• For Stage 1, eligible providers (EPs) must meet a total of 15 “core” requirements in order to qualify for Meaningful Use funds
• For Stage 1, EPs also have to to achieve an additional 5 objectives based on a list of 10 possible criteria

Here is the list (click to enlarge) of the core set of requirements (all 15 must be met):

Here is the menu set (click to enlarge) of requirements (must meet at least 5 objectives):

Also note that Stage 1 will not require practices (or hospitals) to submit claims electronically or verify insurance electronically. If you have been somewhat followed the discussions around Meaningful Use for the last few months, you are likely not surprised by any of the final requirements. Actually, the biggest surprise is that bar has been lowered a bit, giving providers a bit more flexibility  fewer Stage 1 requirements. Also, several of the measurement thresholds have been reduced, including the percentage of meds that must be entered electronically and e-prescribing requirements.  With these rules finalized, those providers who have been procrastinating on their EMR implementation are now just about of out of excuses.

If finding the right EMR is still an issue, you’ll want to check out a new website launched by AmericanEHR Partners. Multiple professional medical societies are participating in the organization, whose stated goal is to help practices evaluate EHRs, view user ratings, and compare functionalities. It doesn’t endorse any products, though 16 EHR vendors are currently part of the project (and prominently displayed on the site’s homepage.)

The 20-physician Northwest Georgia Oncology Centers joins US Oncology. The president of the NW Georgia groups says the arrangement will give his group the ability to expand its clinical informatics and research offerings.

Need an iPad? DrChrono.com is giving away free iPads when users sign up for its iPad EMR app. Don’t know how much it costs to sign up but the software apparently includes SOAP notes, e-prescribing, and billing.

New Jersey-based Physicians Resource Network )PRN) achieves “AdvancedBiller” status from AdvancedMD after adding 17 new providers over the last four months. PRN is a billing partner for AdvancedMD.

RCM solution provider Galen Advisors says its client base has grown over 50% in the last six months. Lest we forget amidst all this EMR buzz, practices need to control their collections more than ever.

Capella Healthcare (TN) selects athenaClinicals for its own physician network of over 130 providers. Capella’s physician network currently uses athenaCollector.

The Minnesota state Board of Medicine fails to discipline a physician at the University of Minnesota, despite a dozen privacy violations. The still-employed physician was estranged from his family and used his position at the university to peek into his wife and daughters’ medical records. Now the feds are investigating to determine if privacy laws were violated. Is it possible the good doctor received a bit of preferential treatment from his employer and local medical board?

ZocDoc completes $15 million in Series B funding round to expand its network of practitioners. ZocDoc uses online technology to help consumers and medical and dental offices book appointments.

HP introduces EHReady, a program aimed at helping hospitals work with affiliated doctors to deploy EHRs. HP says it will provide hospitals with marketing support services to educate physicians about getting EHR into their offices and extend financing options for physicians wanting HP products. Sounds like an underwhelming and late-in-the-game attempt to penetrate the small physician world. On the other hand, there are plenty of hospitals out their with strong HP ties so maybe health systems will be interested.

E-mail Inga.

Final Meaningful Use Regulations

The full text of the Meaningful Use final document is posted on HIStalk. We are updating the comments at the end of the article with interesting points we are finding in the revised document.

Rather than reposting here, we suggest that you start by reading our comments to the HIStalk posting, then take a crack at the 864-page document if you are so inclined. Feel free to add your comments to the posting – that will help everyone get a quick handle on what it means.

News 7/13/10

Henry Schein’s Dentrix Enterprise Dental PM software earns national certification from the US Indian Health Service, meaning all federal and tribal sites can deploy its electronic dental record.

A writer for the LA Times recommends a few of his favorite healthcare apps, which include a how-to CPR program and a calorie tracker tool. However, the one I’m looking forward to seeing is HEARTifacts, which will help people locate the closet automatic external defibrillator.

A Northwestern University School of Medicine professor develops a talking touch screen computer kiosk program that’s now being tested at three Chicago-area cancer clinics. The professor believes the multimedia touch screen tools will improve satisfaction and care for patients with diverse language, literacy, and computer skills.

In what may be the first documented iPhone 4 medical video consultation, an Arizona surgeon connects with a colleague in California to check out a foot reconstruction. One of the physicians called the real-time consult a “game-changing tool” with the potential to change how doctors work with patients and each other.

Kodak and MedCo Data introduce a new patient chart-scanning solution for physician offices. It uses Kodak Capture Pro Software and scanners to capture data from patient charts and into the MedCo Data Vault.

E-mail messaging between patients and providers improves the quality of care provided, according to a Kaiser Permanente study. Patients with diabetes and/or hypertension were found to have statistically significant improvements in HEDIS scores when patients and physicians communicated via e-mail and were 7-10% less likely to schedule an office visit.

The National EyePA Coalition extends a preferred provider endorsement of the Eclipsys PeakPractice EMR. FoxFire Systems Group, a PeakPractice VAR, was named the preferred EMR provider for the 4,900-member IPA.

A couple of big organizations announce intentions to implement Allscripts products. The 120-provider Physicians Alliance (PA) plans to implement Allscripts EHR, which will connect to the Alliance’s existing Allscripts Vision PM system. Christ Hospital (NJ) will work with Allscripts reseller ITelagen to provide EHR and PM for the hospital’s affiliated medical practice.

Speaking of Allscripts, I am thrilled to welcome them as the latest HIStalk Practice Platinum sponsor. Allscripts has been a HIStalk supporter for quite some time and CEO Glen Tullman has always been accommodating any time we’ve asked him to share his impressions of the industry. Allscripts is a leader in the ambulatory care market and serves more than 160,000 physicians. The company also has a presence in 800 hospitals and provides solutions for post-acute care facilities and homecare agencies. Of course, since Allscripts’ traditional sweet spot has been the physician market, I think it is appropriate to welcome them “home” to HIStalk Practice. Thanks, Allscripts!

Medical billing service provider Medical Management, LLC (MD) selects Kareo as its software billing solution.

Set your alarm: CMS and ONC are hosting a press briefing Tuesday, July 13th at 10:00 a.m. EDT to announce the final rules on meaningful use, standards, and certifications. An all-star cast will be presenting, including Secretary Sebelius, new CMS head Donald Berwick, ONC chief David Blumenthal, and Surgeon General Regina Benjamin. A live webinar webcast is available.

The CEO for clinical analytics vendor Anvita Health believes that as more providers adopt EMRs, demand will rise for better reporting and analytics tools. Providers will soon realize the value of clinical data and look for better ways to use the information to evaluate patients and populations. Good news if you are in the data scrubbing business like Anvita.

CaroMount Health (NC) converts the first of 44 physician practices to NextGen’s EMR. The health system’s IS director expects it will take about two years to move over all the sites.

Maternal fetal medicine specialists at Regional Obstetric Consultants of Chattanooga and Knoxville create a seemingly successful telemedicine model that allows physicians to provide perinatal consults to high-risk women in rural Tennessee. The practice and the Community Health Network created Solutions to Obstetrics in Rural Counties (STORC) to improve specialist access through the use of videoconferencing technology. The BCBS of Tennessee Health Foundation provided $1.8 million to fund the three-year pilot project.

E-mail Inga.

News 7/8/10

From Green Mountainer: “Re: Vermont demo. I was sitting in on an eCW public demo for Vermonters, watching Girish show off the patient portal. However, mid-stream, he jumps to his browser and searches for ‘Baumel HIStalk’ and pulls up your interview with Andrew Baumel, referring to you as ‘a highly respected IT resource.’” Ah … love Girish!

From Donald B: “Re: CCHIT certification. Assuming CCHIT becomes an an accredited testing and certification body, will vendors with previously certified products need to go through additional testing and certification? And is there a charge?” Great question. I checked with CCHIT and Sue Reber, CCHIT’s marketing director, shared this:

If vendors participate in the CCHIT Certified® 2011 or our Preliminary ARRA certification programs, there will be no additional charge for final ARRA testing and certification done by CCHIT. If they were certified in a CCHIT program prior to the CCHIT Certified® 2011 program, they will need to be tested and certified in the final ARRA program by an accredited certification body. There will be fees for that separate testing.

Speaking of certification, I see that CCHIT has extended 2011 certification to three new ambulatory EHRs: Eclipsys Sunrise Ambulatory Care 2011 Suite 5.5, Integritas’ Agility EHR 10, and Universal EMR Solutions’ Physician’s Solution 5.0.

VHA signs an agreement with athenahealth to provide special pricing for VHA members. VHA providers will be eligible for discounts on athenaCollector, athenaClinicals, and athenaCommunicator. athenahealth also names Dev Ittycheria, most recently president of the Enterprise Service Management division of BMC Software, to its board.

The American College of Physicians appoints Steven E. Weinberger, MD as EVP and CEO of the American College of Physicians. He takes over for John Tooker, MD, who announced his intention to step down last October.

Iowa’s HIT Regional Extension Center selects eClinicalWorks as a preferred ambulatory vendor for primary care providers.

Here’s a reminder of some cool reader stuff. 1) The search box to your right covers HIStalk, HIStalk Practice, and HIStalk Mobile and will dig through the archives to find the exactly what you are hunting for.  2) Sign up on each site to get updates when we run something new. 3) Friend or Like us on Facebook because you can never have too many friends or likes. 4) Send us your guest article, interview idea, or rumor, and 5) Support our sponsors so they will keep supporting us.

A new survey to ponder: half of physicians say they’re keeping their patient records in an electronic format, which is up about 10% from 2008. In addition, results from this Knowledge Network survey indicate that 62% of specialists and 55% of primary case doctors have smart phones, with as many as 90% of those using them for Internet and e-mail.

The American Academy of Pediatrics introduces a new iPhone application that helps parents figure out when their children’s symptoms require medical attention, calculate medication dosages, and identify rashes and insect bites.

The latest issue of JAMA (subscription required) features commentary from a physician who favors the meaningful use of EHRs. The internal medicine doctor believes too many of his peers look at EHR as simply a way to generate progress notes for payment justification. However, he argues, using an EHR fully can help providers better manage patient data and thus improve patient care and safety.

Wichita Clinic (KS) plans to implement GE Centricity EMR across its 12 locations. The 160-doctor practice has been a Centricity Business PM clients since 1999.

An ambulatory surgery center sues staffing agency Robert Half International, claiming the agency failed to check references for a twice-convicted embezzler they recommended to the ASC. The ASC hired the accountant, who had previously served time for stealing about $650,000 from two previous employers. A year and a half after she was hired, ASC auditors discovered accounting irregularities and determined the accountant had embezzled about $300,000. The accountant, who used the money to support her gambling habit, is now serving 57 months in prison. Meanwhile, the ASC is hoping to recoup $415,000 plus legal fees.

E-mail Inga.