HIStalk Practice Interviews Rosemarie Nelson

Rosemarie Nelson is a principal with MGMA Healthcare Consulting Group.

Tell me about yourself and your involvement with healthcare IT.

I have a great business background from having worked in a bank. In terms of healthcare IT, I started working for a vendor. We developed a practice management system and ultimately an EMR as years went on.

I worked in every area you could possibly work in. Implementation and training. I managed the programmers, the analysts, and the development team for our EMR. I helped implement about 120 practices on the system. Lots of different specialties, giving me a great background, and a tremendous background to go forward just working with groups in a consulting capacity, helping them with operations and technology.

When you implement — whether it’s practice management, scheduling, EMR — it’s all about what technology makes feasible and how you can actually change your workflow into that.

Is that EMR company still around?

They were bought out by another company. I left there in 1999 and I think the product is still around, but I don’t think they’re continuing to sell it. It was called Enhance.

What would you say are the top three bottom line financial or outcome improvements that a practice can achieve only through EMR adoption?

I have a client who has done tremendously well in a Medicare managed care environment, in terms of reaching bonus, because of the targets that were set for their patient outcomes — and I mean tremendously. They could never have done that without the EMR. They couldn’t have managed who would do for what. They couldn’t have managed which patients needed what screening. It’s an internal medicine practice and it almost mirrors what the internists are making in terms of how we’re doing with their bonus from their typical practice. That’s huge.

I have another multispecialty primary care client who was able to negotiate better reimbursement with a major player because they could demonstrate, using the data from their EMR, how effectively they care for their patients.

Then, of course, just plain old revenue; where after we get people over the hump and they get their productivity back to where it was — pretty much time-neutral — what we’ve experienced is an increase in collections because we’re capturing charges we might have missed. We’ve actually identified that. As well as providing services that we missed because we didn’t do a chart prep very well. You know, that might be tacking on a tetanus to an annual exam. Something that that patient needed that we missed had actually enhanced revenue.

What would you say are some of the biggest mistakes practices make when implementing EMRs?

They make it a technology project instead of making it an operational-type management project. They let somebody who’s pure IT lead it, rather than either partnering that person, or finding a lead that is clinical and understands what changes have to occur with nurses and physicians.

The leadership of the project — they don’t clearly identify what it is they want to achieve before they begin. They haven’t laid out what their vision is and what their objectives are. They just do it, like Nike would have them do it, and they get something that wasn’t planned for or they don’t get what they really need, but they didn’t really identify that. Not identifying objectives and having the wrong lead would be two of the major mistakes.

Does that lead to poor physician adoption?

It absolutely leads to poor physician adoption. About one-third of all my engagements in the past two years around the EHR were from groups that called and said, “Come and tell us if we picked the wrong system or if it’s us.” In every single case it was the implementation, it was not the wrong system.

You could almost make any EMR work in a physician practice setting, but it’s all about the implementation. What is it we want to do? How do we want to do it? What do we need it to do for us? Now, let’s look at how we have to change workflow. It’s poor nurse adoption as well as poor physician adoption. We don’t get nurses engaged and involved.

Many of the groups I went to help, I’ve become this kind of fixture. For many of those groups, I learned that we never even included nursing in demos. We didn’t engage nursing staff in terms of how could they let go of paper themselves. In some of the practices, nurses are still printing out lab reqs. Even though we’re sending a lab electronically, they print it out so then they can track across any lab. We don’t show them how they can use the system to just identify all open orders, or just identify lab open orders.

What do you think practices fear the most about computer hardware and networking that may also be holding them back from EMR adoption?

That’s a great question, that they make the wrong decision. I think that’s true even on the software, but that they’re like, “Well, we think that we’re going to carry around tablets, but what if we buy all those and then we want to put in thin clients in each of our exam rooms,” or, “Oh, will that really work? Am I going to have to log off and log on all the time if I use a thin client?” I think it’s the fear of making the wrong decision and buying a bunch of stuff that, then, they won’t be using.

How should they approach it?

I try and get them to go and see practices that are using: who’s using tablets; who’s using PCs in the exam rooms, their thin clients, desktops, whatever. I want them to go and visit. In fact, I encourage them.

If they’re going to be sensitive to the cost of travel, go right here in your community to see a practice using the EMR. It doesn’t have to be the one you want and it doesn’t have to be a practice that’s your specialty. Just look at how physicians and nurses have integrated into their workflow. That’s the medical model. They can relate to that. That’s the way they learn. The medical model is see one, do one, teach one. That helps them assimilate, or at least anticipate, what that’s going to be in their practice.

Let’s switch gears a bit to Regional Extension Centers. The goal of the RECs is to accelerate EMR adoption by providing financial support and offering product selection and training expertise. What will the RECs need to do to ensure success?

They’re going to have to either hire or really thoroughly train good people. People who have a background in systems; people who understand the clinical aspects. They don’t all have to be nurses or lab techs, but they better have lived in the practice setting for long enough that almost through osmosis.

A lot of people think I am a nurse. I am not a nurse. But if you’re there long enough and you’re observant enough and you pay attention and you’re interested, you’re going to figure a lot of stuff out and it’s going to become second nature to you. If we don’t understand and think the way that physicians and the nurses think, we’re not going to be able to help them change their workflow. I think there’s going to be a huge challenge trying to find the right people who can do this.

Do you think the financial support is going to be adequate to motivate physicians?

It’s pretty interesting because the stimulus has generated huge interest right now. I don’t know the numbers until every vendor that’s out there ends the quarter and says how many new contracts they’ve gotten. I certainly see an uptake anecdotally, and I think that for many it’s this idea that, “Well, I might as well take advantage of this because if I don’t, I’m going to end up having to do it anyway and I’ll lose out.” I think that there is, and I think that that’s been consistent.

I can remember in 2003, 2004, and 2005 asking physicians when I would speak, “OK, how many of you think you’ll be on an EMR in two years?” Then I’d say, “OK, now keep your hands up if think it’s going to be one year. Keep your hands up if you think it’s going to be six months.” You know, hands would go down at the same rate across three or four years. Everybody always thought it was going to be in two years. I’m like, well wait a minute, we should have been there by now. I think that this is the kind of tipping point that might get us there, but there are still a few.

Again, I’ve come across two since the whole stimulus came. They look at that and say, “You know what? This is not enough to make me want to change. I know that there’s going to be a stiff in 2015. They’re going to reduce my reimbursement for Medicare by X and I’ll have to pay attention to that, but you know, I think I can still live for the next five years after that and not have to change, or I haven’t found something that really fits me, or I just don’t see myself using it. I might even think I’m retiring in like five or 10 years, so why would I do this?”

What were the specialties of those practices?

That’s pretty interesting. One was a general surgeon and the other was ophthalmology. Yeah, we’re not talking primary care. You know, the people who look at a 1-2% hit and think, “Oh, my gosh, how can I make payroll?”

Many people have remained critical of the proposed Meaningful Use objectives, particularly, the short time to achieve many of the metrics. What’s your impression?

I think that they’re doable, but not without some pain. I certainly understand the criticism because we don’t have a lot of time. I think that one of the things we’re not focusing on enough is the fact that we have to be using a certified EHR and we still don’t know what that means. Who’s going to be the certifying body? If that’s the case, we’ve got vendors out there that are putting out guarantees that their products will be certified without really knowing what they need to go through.

The timing is going to have everybody on edge. I just got off a conference call with a client and I asked them if they were willing to give up their summer because they’re going through this whole process. They kind of laughed at me and they said, “Well, you got me until noon. I’m taking a long holiday now.” I said, “That’s exactly the problem you’re going to be faced with with all your nurses and doctors. Your timeline’s so aggressive.”

This timeline may be too aggressive, but the actual objectives are doable, I believe. There are plenty of groups that are doing many of these things already and they don’t realize, or they’re not giving themselves credit for that. I mean, everybody’s doing electronic claims. There’s lots that’s already being done.

Now we’re getting a little more concerned about some of the things that are a little deeper, like the computerized provider order entry and being able to provide patient summary. I have clients who, since year 2000, have been putting a nice little printed summary in every single patient’s hands that they see. They were using MedicaLogic at the time. We’re going to be able to do that kind of stuff electronically, or in the method that that patient requests. It’s just change, and it’s human nature to stick with the status quo.

What are some easy consumer-type technologies that doctors can use to improve their practices?

I’ve got this internal medicine practice in Nashville and 40% of their patients are Medicare. You know what? They’ve got 60% of their patients to register and use Medfusion. They get their lab results, 60% of their patients, and they’ve got a very high Medicare population.

The portals are great. Kiosks are great. I’ve got a client using one and patients swipe their credit card, then the kiosk asks them if they want to pay their co-pay with that credit card. Then it goes out and does their insurance eligibility. Patients stand in line to use it rather than go to the receptionist who’s available because they know it’s going to be done right and they get to do it themselves. This is America — we like to self-serve.

I have some folks that are trying to use some of the social media as a little marketing tool and keep patients engaged with what’s happening in their practice and that they’re sponsoring a little race in the community, or they’re going to be at a high school doing some program. Practices who are kind of thinking a little bit outside the typical Yellow Page ad or whatever, are going to reach out and recognize that their new generation of patients uses these tools, so they’re going to need to as well.

What are some suggestions you would have, or pitfalls, that practices should be aware of when a community doctor partners with a hospital to implement an EMR in their office?

When physicians call me and say, “Hey, there’s this great deal.” I’m like, “Well, would that have been a solution you would have bought yourself?” I say, “Go through the same due diligence on that product that you would if you were paying full fee. If you can honestly make that decision that, yes, I would have bought this if I was paying full fee, then that’s probably the right solution.”

Sometimes they are not the right solutions. They might be products that are second-class citizens to what the hospital IT vendor is providing to the hospital. I think it’s especially important that they go do due diligence. Cost should not be the first issue in your selection process. That’s pretty critical.

The other piece is understanding who’s going to support you. Is it just the physician liaison department? Is it just the IT department? Do they have a trainer dedicated to training an ambulatory product, or is that somebody who’s going to be pulled out of a hospital department, and when there’s a crisis in the hospital department that’s going to be their first place. Will they be providing help desk services? Where are they getting their training and then their ongoing support?

Then, of course, if it’s being hosted, they want to be sure that they’re getting the kind of backup and disaster recovery that they’ll feel comfortable with.

I read an interview you did with Evan Steele of SRS about a year ago, and one of the things you said was that, “…the voice of practicing physicians not being heard in Washington.” In light of the recent healthcare legislation, has your opinion changed?

Oh, wow. The voice of practicing physicians has probably gotten louder with all of these associations hopping on the bandwagon. What is it, 51 or 52 now that have come out and said we need to make changes? I think that their associations have collectively kind of gotten together, and I think that’s another interesting thing that’s different from a year ago. They’re starting to collaborate. Associations are working together instead of pitting each other against each other. They’re saying ‘as physicians,’ not as this specialty or that specialty. I think that is pretty powerful. I think that they need to do that.

Last question: does your own doctor use an EMR? Would you go see a new doctor who didn’t?

That’s a great question because I’m over 50, I see an internist; and the IM center doesn’t do pap smears, so I see a GYN. They both are using an EMR and they both have opportunities to use it a little bit better. They don’t take advantage of all the portal services they could.

One of them does a great job of having all lab results and the like available and sitting there talking to you about your labs is just fantastic. That’s ideal because we can both be engaged at the same time and I can take them home with me if I want to.

The other one maybe doesn’t do as great a job at conveying some of the follow-on things that an EHR can do for the patient. Primary care doctors, and really GYN is primary care world and not the OB world, and for internal medicine, I think they’re above average.

Would I change? That’s an interesting question. I’m a very healthy 54-year-old female who’s active and exercises, no medication, not overweight, nothing, and I don’t feel like that’s a critical factor for me. However, for my mother, who I’ve been following around for lots of care and lots of physicians, it’s a tremendous asset for her physician to have that EMR. That might have been a different situation if we couldn’t exchange information between collaborating physicians in different cities if they didn’t have that.

Intelligent Healthcare Information Integration 6/9/10

EHRs: It’s Business, But…

Here we go again! Over the past two years, I’ve discovered a new least favorite phrase: “So, what does this acquisition mean for my EHR?”

I started with Eclipsys’ PeakPractice back in the days of yore when it was Bond Technologies’ Clinician. In fact, I was one of their earliest adopters. I lived through the February ’08 acquisition by MediNotes and was a little less “plussed” when later that fall MediNotes itself was acquired by Eclipsys. (’08 became dubbed The Year of the Acquisitions by Clinician devotees.) Clinician was redubbed PeakPractice by Eclipsys. (I personally preferred Apollo or Solstice or some other thematically consistent, astronomically-related name, but what do I know?)

Now, about a year and a half later, just when it was really feeling as if the solar dust was settling, here we go again playing “Owner, owner, who’s now the owner?” with the Allscripts acquisition of Eclipsys announced this morning. Two to three years ago, I remember talking with some good industry folks about the coming deluge of acquisitions, mergers, and vendor disappearances coming in the EHR vendor world, but, boy, oh, boy, I never thought that lightening would hit my home so many times so often in so short a time!

Over the years, I‘ve grown quite fond of many of the folks behind this product. They have been berry, berry good to me. So don’t get me wrong: I’m not looking to bite the hands I feed. (Yes, I remember that I paid them, not vice versa.) But, despite my concerns for both my friends there and for the going forwardness of my current EHR, I’d like to offer a bit of advice to Phil Pead and Glen Tullman. (Maybe I should now alter that billing to Tullman and then Pead.)

Guys, I trust (or hope and pray) that you’re going to do right by Clinician…er…PeakPractice…er, whatever the new Allscripts tag may be. But, I listened to your webcast this morning and reviewed all the Web sites and press releases. I understand that public companies have a responsibility to their shareholders and that, even with privately held companies, business is business. Still, we are dealing here with one of the most intimate of issues: people’s healthcare and its delivery.

From the small end user’s perspective, I found the preponderance of information about the financials and the relative dearth of information about the actual, specific plans for the healthcare delivery tools somewhat disheartening. Goodness, I could barely even find a reference to PeakPractice in all of the available info. (One slide on the webcast, I think, mentioned it.) If you were selling hamburgers, I wouldn’t much care about the plans for mustard or special sauce. But, having been there before…and before…this has a huge potential impact on my practice, my patients, and what’s left of my general state of mind.

I was really glad to see the attention to the open Helios platform, very forward-thinking, I think. And, from my little viewpoint, I think this whole deal could end up as a good move all round (he said, hopefully). But, please, guys, remember this ain’t burgers and fries you’re vending.

Maybe these repeated buy-ups are an indication of Clinician’s strengths. Maybe PeakPractice will acquire some of the better parts and pieces of Allscripts products. Maybe I’m just getting acquisi-dizzy, but, I’d really just like to even out this rollercoaster EHR ride for a while!

From the dizzying trenches…

“Anxiety is the dizziness of freedom.” – Soren Kierkegaard

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.

Industry Reaction – Allscripts To Acquire Eclipsys

We are posting this on both HIStalk and HIStalk Practice due to the broad interest in today’s announcement of the proposed Allscripts acquisition of Eclipsys. We have industry reaction to today’s announcement. Let’s start with some random thoughts from Mr. H and Inga.

Some thoughts about Eclipsys

• Above are the two-year share price graphs, with Eclipsys in red and Allscripts in blue. ECLP shares are trading at about half their 1999 price.
• Phil Pead’s background is selling companies, which Eclipsys has desperately been trying to do for many years with no takers (allegedly). He’s been with Eclipsys for almost exactly one year and surely gets the credit for finally finding a buyer.
• Eclipsys started with a relatively small number of big academic medical center clients on the old TDS platform and has struggled to convince them to upgrade to Sunrise (a product it acquired) instead of choosing a new vendor.
• Despite the arguably superior CPOE and clinical documentation capabilities of Sunrise, it has competed poorly against Epic and Cerner.
• Nearly 40% of ECLP revenue supposedly comes from about 20 big customers, with one of those contributing about 10% of the company’s revenue. That one big Eclipsys customer is supposedly North Shore – Long Island Jewish, subject of a September announcement involving its $400 million effort to connect its 7,000 doctors and 13 hospitals with … wait for it … Allscripts. Surely that customer and its Eclipsys relationship had a large impact on the Allscripts acquisition interest. Obviously Allscripts needs to keep NSLIJ very, very happy.
• Eclipsys most likely paid big money for its recent acquisitions, buying the former Medinotes/Bond practice EMR products, EPSi financial management, and Premise throughput management as it desperately sought to diversify away from its at-risk Sunrise user base. Those acquisitions didn’t seem to do much for the company’s performance.
• Eclipsys ran through a long line of executives whose tenures there were unremarkable.
  
  

Some thoughts about Allscripts

• Some of the announcements referred to the deal as a “merger” and some Eclipsys communications implied that Eclipsys was the acquirer, but that’s spin: this is an outright Allscripts buy.
• The new company will have a large footprint, but that’s usually more about sales than it is product performance, integration, or customer satisfaction.
• Glen Tullman is a more competent executive than anyone who has ever run Eclipsys. As was the case with the Misys merger, he gets operational control.
• It’s late in the HITECH land grab to try to integrate companies and products in the hopes that enough hospitals are left that haven’t locked into their vendor partners to prepare for Meaningful Use. This would have been a much better deal a year ago. Companies should be focusing on execution in the heat of HITECH, not trying to bolt two companies together.
• Allscripts will have an even larger roster of competing practice EMR products. Surely they will not all be go-forward products, especially the Allscripts version of MyWay that Aprima (formerly iMedica) sold them while keeping their own rights to it, then vastly improving it to sell under their own name.
• A minimally appreciated benefit of the deal is that Misys, always a stiff and awkward US healthcare IT player that didn’t seem to have its heart in anything but UK banking software, is out of the picture. That should be greatly beneficial to Allscripts.
• We checked the registration date of the new site OneAllscriptsEclipsys.com. It was May 6, two days after Eclipsys announced results.

Thoughts about today’s conference call

• It was touted that both companies run on Microsoft platforms, but the key is whether Allscripts is good at integrating products.
• Glen Tullman says there is little product overlap, but they company will have four PM/EMR products plus Tiger, which is already being retired.
• Sunrise Ambulatory wasn’t on the slides of the combined solution set that we noticed.
• Assuming Peak Practice and MyWay are similar and PeakPractice is the sexier one, will they retire MyWay? It’s sold through the reseller channel, which will make some folks unhappy if so.
• Allscripts needs top-line growth, so the (theoretical) combined market gives it a way to (theoretically) grow.
• Dumping Misys allows Allscripts to control its own destiny, including investing in technology to a degree that Misys was unwilling to do.
• The combined company will enjoy an 8-10% growth rate, the company says, which doesn’t sound impressive if we really are starting the “single fastest transformation in HIT.”
• Helios was mentioned more than once as a go-forward product. It’s the recently announced Eclipsys capability to open up Sunrise to independent developers.
• The usual synergies were proclaimed (firing redundant managers and back-office employees, cutting the cost of running two publicly traded companies, streamlining sales and marketing).
• Allscripts shares were down nearly 10% today. Misys shares were way up on the news it was cashing out. Eclipsys shares were up around 3%. Investors don’t seem to like the deal so far.

Unanswered questions

• What will the go-forward ambulatory products be?
• How will key Sunrise customers react to having their vendor absorbed into a larger entity that has historically had less focus on hospitals?
• What’s the HIE strategy — Medicity, dbMotion, MOSS, something else?
• Will Allscripts EHR clients with IDX financials be a big target for Sunrise?
• What happens to the arguably most valuable Eclipsys executive – John Gomez?
• What’s the benefit of the acquisition to Eclipsys and its customers?
• What happens to sales of both companies now that the merger has been announced, yet won’t be consummated for months? Prospects hate uncertainty and HITECH forces them to decide somewhat quickly.

We hand-picked some of our readers with deep expertise to provide their analysis, some of which we agreed to run anonymously.

Jeffery Daigrepont, SVP, The Coker Group

It’s an interesting merger, but not a surprising development in that Eclipsys and Allscripts were the few remaining vendors without an alignment strategy to the opposite side of the coin. This announcement comes not long after NextGen acquired Opus and Cerner’s more aggressive move into ambulatory. 

Vendors are clearly getting prepared for hospitals getting back into physician employment and their desire to have a single vendor solution. Therefore the market is wanting to have “one throat to choke” when it comes to selecting a vendor for all of its integration needs. I also think Epic is dominating the inpatient space because they have been so far ahead in offering a true integrated solution for several years now. The other inpatient vendors are having to play catch up and it’s faster to merge than try to build. 

The market should expect some clunky workflow for several years while they try to blend together their platforms, although I am sure the spin machine will sell this as one patient record harmonizing seamlessly across every location of care. The press release is already indicating ONE unified record. I just wonder which of the eight EMRs will emerge as the system for housing the ONE record.

It’s also worth pointing out that both vendors have made past unsuccessful attempts in crossing over own their own. Eclipsys acquired Bond Medical a couple of years ago and has not been successful getting it off the ground. Allscripts tried the same with some inpatient technology as well. Neither could penetrate this market.

It’s also going to be interesting to see how the company operates in terms of where and how they focus their attention. For example, Meditech, Cerner, HealthLand, etc. can offer both inpatient and outpatient technology, but no one will ever accuse these of being ambulatory vendors. Vendors will generally tilt in one direction and will also focus their time and efforts accordingly.  

As for the market’s reaction, it’s going to be interesting to see how this ONE new company can manage so many overlapping products and solutions in this new age of certification and system compliance standards. The timing of this merger is interesting because it comes on the heels of Meaningful Use. Does anyone really believe they will keep all of their overlapping systems up to certification? I suspect they will start commercially discontinuing products that are not considered modern, such as all of the Misys baggage on the Allscripts side. 

After this merger, the new company will be trying to support eight EMRs systems and five practice management solutions with a sprinkling of inpatient technology. I could be wrong with this count, but it’s fair to say they have a boat load of duplication, the most of any vendor in the market. Customers buying from this new company should seek protection from their system being discontinued in the next couple of years as they move to their dream of ONE record.

Hospital CIO and Eclipsys Customer

Sounds like Glen Tullman pulled another fast one. This is the same type deal he architected with Misys. Glen controls the management suite, where all the real decisions are made, and the other company controls the board room. 

Non-Competing Vendor CEO

This is an Allscripts response to the NextGen inpatient deal. Allscripts was probably feeling pressure to have a complete solution for the bundled payment/ACO market. They were probably feeling they couldn’t live up to market expectations. This will provide enough accounting confusion for the next several quarters to hide any shortfall in organic performance.

Bill O’Toole, O’Toole Law Group

This is a great move for both companies. Allscripts has proven itself in the ambulatory world. Physicians on a selection team for an HIS at their associated hospitals will look favorably on the new combined company based on their prior experience with Allscripts. Eclipsys gets a new image, sort of like your father’s Oldsmobile being merged with the Corvette. No offense intended to Eclipsys, but in my days at Meditech I was surprised if they were up against us as a finalist. I believe the growth of the combined company will greatly exceed the individual growth expectations of the separate companies.

Investment Banker

The combined business looks great on paper with little overlap in capabilities (PeakPractice being the biggest one) and a substantially bigger platform. The challenge will be integration, of which this will be the largest attempted in this industry for a while. Even though they have a highly talented team, the challenges will be significant.

I would ask why two companies that have strong growth opportunities on their own (as they have constantly communicated to investors) would see the need to take on massive integration risk in a market that presents once in a lifetime growth opportunities.

Eclipsys Physician Practice Customer

I don’t think this’ll have a major impact on my little neck of the trenches for the foreseeable future. These acquisitions / mergers aren’t shocking given that we all know they’re going to happen in this period. I’m guessing bigger ones are in the works even as we type.

Though their press release really doesn’t address it (nor does it address the plans for the “Helios” platform which I hope continues), I know that they’ve recently sold millions of dollars of PeakPractice (originally, Bond Technologies’ “Clinician”) to some large companies and I was told the PeakPractice development team would be receiving even greater resources now. Of course, things do change, including corporate direction, but personally, I’m not worried about my software yet.

Todd Cozzens, CEO, Picis

There is an increasing trend for general practitioners to be employed by hospitals, but an opposing trend that specialist areas like emergency and anesthesia are outsourcing physician services.  So net/net, though on the surface it makes sense to combine the two areas, there is no real market force pushing for an end-to-end hospital-to-physician EHR. To the contrary, the one thing that really is taking off with lightning speed from ARRA is interoperability within and outside the hospital enterprise.

I can cite 10-15 real examples of systems already pushing CCDs among disparate EHRs, for example. Hospitals just aren’t in a position for wholesales swapouts of their IT systems across the board — it’s too disruptive and expensive. The new interoperability mandates will allow more modular approaches to building out EHRs.

With regard to the high acuity market, the merged entity will have an ED product from Allscripts, an ICU product from Eclipsys, and I assume they will acquire an OR product. So they will look like a company that’s serious about high acuity, which I think is good because it endorses our long-held belief that hospitals are becoming big high acuity care centers as the population ages and needs these services more and less acute services move out.

That’s where it stops. Our high acuity suite has been integrated and developed now for seven continuous years, has much deeper functionality, and is much more intuitive than a loose patchwork of independent applications. Our investment in analytics and interoperability with the big EHRs is starting to really pay off as well as we are the go-to, embedded high acuity enterprise suite for a growing number of IDNs. The proof? Tell me which HCIT other than us has taken on over 100 net new hospital customers in the last two years. Not even Epic has done that.

Is it too late in the HITECH game to be making a major acquisition? No, I think they’re trying to build a sort “shadow” Epic and it does make sense, as I said, on the surface. This deal definitely helps Eclipsys a ton more than Allscripts, however. And don’t forget the last time a physician-focused system company took over an in-hospital EMR vendor — IDX taking over Phamis and the subsequent sale of that mess to GE. That was a Harvard business case on how not to execute post-merger.

What happened there is that selling small ticket items to docs is totally different than mega-systems to mega IDNs — it’s kind of like Cessna buying Boeing. And then you have all these legacy technologies and systems — Allscripts with 3-4 legacy physician systems and all the legacy technology still embedded in Eclipsys. Any customer that thinks some sort of new, singular, integrated, magical, cloud-based, miracle hospital / physician solution is going to suddenly appear on the market in the next 5-7 years from this entity will be seriously misguided. Huge execution risk here. Good time to be a duct tape and bailing wire salesman, however.

All the market dynamics are in place for further consolidation. ARRA HITECH and healthcare reform — the perfect storm. I don’t subscribe to the idea that it’ll be Google or Oracle or Microsoft that will drive the consolidation. I think it’s more than just a technology convergence. I see much grayer lines between payors and providers and enabling technology providers that make the system much more transparent for the three P’s – payors, providers, and patients. 

Margin pressures are already forcing payors and providers to both to think very differently. The two things that healthcare reform were supposed to fix — cost and quality — aren’t going to improve at all for the vast majority of patients, providers, and payors. Something has got to give, or else healthcare passes 50% of our GDP by mid-century. If you look at other industries that had this pressure, it was things like supply-chain integration and other forms of co-opetition among former adversaries that drove change and finding ways for all to make money. It’s actually a time of huge opportunity. 

Intelligent Healthcare Information Integration 6/8/10

EHR Data: Privacy vs. Publicacy

Lately, there’s a whole buncha buzz about on this digital healthcare data ownership versus sharing stuff. You know the issue of which I speak: Dr. Deborah Peel, et al, reminding us that the road to healthcare data integration is strewn with personal privacy landmines galore, and then, the NHINers and other data gatherers, like Jonathan Bush’s athenahealth with their recent touting of “athenaCommunity” as one arm of their mission “to make healthcare work as it should.”

This is a tough one, no matter which knife you use to slice it. On the one hand, Dr. Peel is correct that healthcare data once released to the digital winds is “like a sex tape that lives on in perpetuity in cyberspace.” People, especially us rootin’ tootin’ ‘Mericans want our personal privacy protected at virtually any cost. I don’t think any of us want our personal health histories “Paris-ized.” (Although, Ms. Hilton seems to have parlayed her randy exposure into a personal triumph. Regardless, I doubt that’ll work for any of us if our hemorrhoidal or high colonic histories get similarly YouTubed.)

J. Bush is also on the mark, though. Our personal healthcare information needs to be shared in order to be of value. Gone are the days when you have one doctor who spanks your butt when you’re born and follows you through “till death do you part.” We move, change providers, have multiple providers, use Minute Clinics and ERs — i.e., we roam. It is impossible to fathom our healthcare histories making it in timely fashion to the many destinations we do in any version of the old, tattered, paper chart. (Lord, just try to get a faxed report from another provider during the fifteen minutes you have a patient in your office!)

If we didn’t have such cultural issues as racism, ageism, sexism, and “sicko-ism,” maybe we wouldn’t care who sees our psychological or proctological profiles. If we had fully socialized medicine or if we had complete private pay healthcare sans insurance companies, maybe it wouldn’t matter who got what gross genital germ or mental misfire malady. If you get sick, either we all pay (socialized) or you do (tough break, buddy…them’s the cards you’re dealt.)

But, we live here in the land of the free and the home of the individual. We hold our privacy sacrosanct (unless we want to see what Paris has been up to and then the paparazzi have full sway.) We hold many of our prejudices, and the fears we have about others’ bigotry, nearly as holy. Yet, we also live in the land of the insurers/CMS and the home of McDonald’s medicine. We want our healthcare delivered on demand — done right without needless repetition or avoidable error and with minimal co-pays.

I was asked to write about this issue by a friend who’s a muckety-muck at a big EHR vendor. I was really hoping I could give him some unique, big toot piece. I’ve thought and thought about it and the wow-ness I’d hoped for seems less like a grand toot and more like an SBD. The eventual solutions for healthcare data privacy versus “publicacy” will be hard-fought and counter-punched for years.

This I know: I have met both Deborah Peel and Jonathan Bush. I’ve listened to each speak on multiple occasions. I like them both and think both are brilliant. I also think both are intimately and ultimately concerned about doing what’s best for patients, providers, and all of healthcare. In this very sticky wicket of personal privacy versus grand communal good, I’m very glad to see both are engaged in this battle, guarding opposite flanks of our healthcare ranks. Our vanguard is well-manned (-womaned.)

From the trenches…

“When it comes to privacy and accountability, people always demand the former for themselves and the latter for everyone else.” – David Brin

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 6/8/10

The New York eHealth Collaborative names Greenway Medical Technologies, Sage Healthcare, Eclipsys, eClinicalWorks, and NextGen as preferred EHR vendors.

New data from MGMA shows that 65% of established physicians were placed in hospital-owned practices last year, as were almost half of physicians just out of residency or fellowship. One likely factor is higher first-year guaranteed compensation with hospital-owned practices compared to private practices. First-year guaranteed income has fallen 2% for specialists since 2006, but increased more than 17% for primary care physicians.

Steve Jobs introduces the iPhone 4, complete with a thinner profile, a 5-megapixel camera and flash, and video chat (FaceTime). Though the FaceTime feature will only work between iPhone 4s for now, I’m sure it will eventually be huge in healthcare. Time for some creative type to develop an app that translates video chat to a CPT code and passes the code to a physician’s billing system (if you steal this great idea, I’ll expect you to send me wine or shoes when you hit the big time).

UBMD (NY) selects Allscripts EHR for its 450-physician practice. Physicians in the 18-practice multi-specialty group also serve as faculty at the University of Buffalo School of Medicine and Biomedical Sciences.

Health Informatics Consulting will provide implementation assistance for ambulatory surgery centers adding SourceMedical’s Vision and Vision EHR.

Partnerships like the one mentioned above reminds me of a prediction I shared with a friend not long ago. Perhaps this isn’t terribly profound, but I believe we’re going to see a marked increase in collaborations between ambulatory EHR vendors and third-party consulting firms. As stimulus-hungry physicians demand quick but thorough implementations, look for more vendors trying to secure alternative implementation resources, at least for the next couple of years. Hospital vendors have relied on third-party consultants for years, but it’s been less common in the ambulatory world.

Spectrum Health Medical Group (MI) will spend up to $60 million on EHR technology over the next five years as part of a master plan to dramatically grow the practice. The 90-physician group anticipates growing to 700 providers by 2014, a process that may cost more than $150 million in physician recruitment and support costs. Spectrum says the goals for growth include recruiting faculty for the MSU College of Human Medicine and building its research capacity. No doubt Spectrum also believes that tighter physician alignment will help keep its four hospitals full.

Proof that security and privacy blunders are not unique to the good old US of A: an employee at a Welsh medical practice mails an unencrypted USB drive that never makes it to its final destination. Unfortunately, the memory stick contained data on 8,000 patients. Lampeter Medical Practice was called out for the incident, though not fined.

Speaking of data breaches, 3M Health Information Systems releases a breach notification tool with new versions of 3M ChartRelease and 3M DisclosureTrac software. The functionality provides a template for creating breach notifications, plus saves the details for reporting purposes.

An HHS advisory workgroup recommends that EHRs be enhanced to deal with needs of unique populations, such as children and victims of domestic abuse. The AHRQ and CMS are already working on a pediatric record template for children enrolled in Medicaid or CHIP that includes such nontraditional factors as literacy, language and cultural barriers, domestic violence, and crime.

For about $3,000, a small practice can purchase a EMR solution that includes Dell hardware and free Practice Fusion software. The Dell/Practice Fusion bundle is available through both companies. Dell has similar marketing agreements with Allscripts, Meditech, and eClinicalWorks.

athenahealth makes some changes in its executive team following the resignation of David Robinson as COO and Nancy Brown as SVP corporate development. Ed Park is promoted to COO and Derek Hughes will take over the SVP role. After talking to one athena insider, I don’t think the changes are an indication that we are  about to see big shifts in the company’s direction. Meanwhile, athenahealth stock continues to struggle, falling 13% in the last month.

E-mail Inga.