Intelligent Healthcare Information Integration 5/16/10

The Complexities of Stupid Simple

Trying to follow, no less actually wrap your brain around, what’s happening in US healthcare these days is somewhat akin to trying to follow the rope through the Gordian Knot. Just think about some of the currently running debates, most hotly contested and all fueled by the NOS of the Internet:

• Privacy versus data sharing
• HIT best-of-breed versus enterprise systems
• Payers versus players
• Institutions versus individuals
• McDonald’s medicine versus medical homes
• Evidence-based versus medical art
• Security versus usability
• Etc., etc., etc.

Goodness golly, Nurse Molly, if you have half a handle on even one of these momentous mental jigsaw-like messes, you’ve got more moxie than most. This stuff is just massive…and that doesn’t even touch upon the multitude of subtopics and permutations thereof!

The fact of the matter is, for most of us, whether big brain pan or small, such giant complexities are only conceivable via analogy, simile, allegory, metaphor, or imagery. Trying to follow and make useful sense of all the threads and nuances and twisty-turns will lead to mental meltdowns and the turning on of American Idol.

The difficulty arises when trying to take the pictures within one person’s head and make them similarly visible within another’s. Vulcan Mind Probes may one day yield such seamless data transfer, but until then we’re stuck with words and numbers, pictures and symbols, ones and zeroes. We typically gain and share knowledge linearly, but our minds process it conceptually.

We humans have processed images and concepts long before “communication” via symbols, and even pictograms, came about. A single “picture paints a thousand words” because it transfers information in an easier to process format for our brains, a format for which our brains have been wired for millennia.

Accepting our limitations is by no means accepting defeat. We just need to work within the constraints of our current design criteria. Malcolm Gladwell’s “Blink” is a wonderful explanation of the power within our conceptual capacities belied by our limited communication facilities and meager attempts at linear thought processing.

Thus, I am a firm believer in the power of Stupid Simple.

Stupid Simple is not a simplistic or light-minded concept. Rather, it is the acceptance of the reality of our actual mental processing powers. Stupid Simple is what brings “light bulb” moments. It says, “We are smarter than our communicational clarity capabilities. We can understand far more deeply than the extent of our dictionaries.” Thinking clearly, communicating clearly, is typically an outcome of Stupid Simple.

Look for the Stupid Simple solution and, more often than not, you’ll find answers. Whether it’s how to portray medical info on a computer screen so that it is at its most useful or how to pay for healthcare: the higher the complexity of the explanation, more often, the less the value. Our problems may be deeply intertwined and complex; our best answers most often come from Stupid Simple address.

According to legend, Alexander of Macedonian was confronted by the classic such knotted mess at Gordium in Phyrigia, then a province of Persia. The legend contends that when incapable of finding the Knot’s ends in order to untie it, he sliced through with a stroke of his sword. Historical debate argues he may have pulled the Knot from the pole pin to which it was tied, exposing the ends, thus enabling an actual untying of the knotty problem. Regardless of the exact method of solution, Alexander got one thing right: Stupid Simple rules.

From my stupid simple trench…

“I am dying from the treatment of too many physicians.” – Alexander the Great

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 5/13/10

California Forensic Medical Group, a healthcare provider for correctional facilities, selects eClinicalWorks for EMR.

Alaska’s largest orthopedic clinic contracts with SRS for its hybrid EMR solution. Anchorage Fracture & Orthopedic Clinic includes 12 physicians.

Ophthalmic Imaging Systems reports Q1 earnings: revenue up 72% from last year to $4.1 million; net loss of $857,000 compared to the previous year’s loss of $1.1 million.

GEMMS selects Medfusion’s patient portal solution to interface with the GEMMS practice management system.

Speaking of Medfusion, Intuit announces plans to purchase the company for $91 million in cash. Intuit is the maker of Quickbooks, TurboTax, and Quicken Health. Inuit says it will use Mefusion’s technology to enable patients to communicate with providers, review health information and track healthcare expenses. Allscripts happens to be a reseller for Medfusion’s portal and Quicken Health, so they’ll likely be happy to see further integration between the product. Medfusion founder/CEO Stephen Malik with become an Inuit SVP and GM.

Aunt Martha’s Youth Service Center (IL) selects NextGen’s EHR and PM solution, plus QSI’s electronic dental records program. I was curious who this  “Aunt Martha” was so I checked out the website. Turns out Aunt Martha is really just a “concept,” or the embodiment of a caring relative a youth can turn to for help. Cool. The organization includes 17 community health centers.

Hunterdon Healthcare System (NJ) is using InterSystems Ensemble to connect its 15 affiliated physician groups running NextGen EHR/PM to the medical center’s QuadraMed Affinity HIS.

The 780-physician Marshfield Clinic (WI) joins Premier healthcare alliance, giving it access to Premier’s clinical, financial, and outcome data, as well as its purchasing network.

The Health IT Policy Committee endorses a permanent certification plan that includes provisions to monitor EHRs after they are purchased to ensure providers are installing the proper technology. The committee also wants EHRs to be checked regularly to see if they are labeled with the same meaningful use stage that they have been certified. In addition, they recommend giving the ONC authority to de-certify EHRs in “egregious situations.”  While all that sounds great in theory, wouldn’t it be pricey to oversee, not to mention complicated for providers (will they understand what year certification they need and/or will they needlessly shy away from products that are pending certification for future years?)

In case you missed it, we released the results of our HIStalk Practice reader survey. My favorite stat: 85% of readers say HIStalk Practice helps them perform their job better. And, my favorite recommendation: talk about men’s shoes once in a while.

The Boston Globe publishes an editorial in support of EMRs and chastising providers who “feel little or no responsibility for symptoms that get misdiagnosed because of inadequate information about a patient’s past medical care, let alone the tests that get repeated because no one has a record of the previous results.”  As proof that the providers are wrong to avoid technology, The Globe cites the oft-referenced IOM study that suggests thousands of deaths a year could be prevented with computerized records. As a final dig at providers, the editors suggest doctors and hospitals are “putting their own habits ahead of the clearly demonstrated needs of patients.” Interestingly, readers seem to be agree with The Globe at about a  2:1 ratio. Even more interesting, to me anyway, is that the only ones getting blamed for the situation are the providers. Hmm.

South Miami Criticare selects McKesson to provide ED billing, coding, and reporting services. Here’s something I didn’t know: McKesson’s Revenue Management Solutions group has 4,000 employees and does billing for over 1,000 physician clients. I am sure it’s a relatively small segment for McKesson (they employ 32,000 and have $106 billion in annual revenue,) but they clearly have a good chunk of the physician medical office billing market.

An Institute for e-Health Policy panel says that healthcare reimbursement needs to be changed in order to spur more physicians usage of mobile health and tele-health technology. Currently CMS pays just $2 million of its $400 billion Medicare spending on tele-health reimbursement.

E-mail Inga.

HIStalk Practice 2010 Reader Survey Results

In the interest of transparency, I like to share what readers have told me. Here are some tidbits from the 2010 survey.

• The most common age range for readers is 41-50, followed by 51-60. Those groups summed up to 64% of readers.
• HIStalk Practice’s readership has a lot of industry experience, with 44% having at 20 or more years and 72% having at least 10.
• Provider employees with IT purchasing influence make up 48% of readers.
• Readers are on the site often, with 49% saying they read whenever the e-mail comes, 26% daily or more often, and 99% more often than weekly. 93% say the frequency of new posts is about right.
• While 74% of respondents get the e-mail blast when I write something new, 26% don’t. I’m a little surprised that folks read without getting the blast since that’s a sure way to be the first to know.
• For the question of the degree to which HIStalk Practice influences reader perception of companies and products, 78% said some and 17% said a lot. Five percent said none at all.
• The most valued HIStalk Practice features are (in order) news, rumors, and humor. Also popular were our Vendor Exec Questions and editorial opinions.
• I asked whether readers have a higher interest in companies mentioned in HIStalk Practice. A whopping 77% said yes.
• When asked whether readers were more interested in companies that sponsor HIStalk Practice, 37% said yes.
• I asked about HIStalk Practice’s influence on the industry. 10% said not much, 61% said some, 22% said a good bit, and 6% said a lot. If I were a vendor, I’d spin this to say that an amazing 99% of readers say HIStalk Practice influences the industry.
• Here’s a humbling statistic. To the question of whether HIStalk Practice helps you perform your job better, 85% of readers said yes.

I asked what topics I should be covering more of. Some of the themes:

• Implementation stories and case studies of practices that have implemented EMRs and other healthcare technology
• HIT beyond EMR, including business intelligence tools, revenue cycle billing, and personal health records
• ARRA, P4P, and other government incentive programs

I asked what one thing I should change. Some comments that represent major themes:

• Less opinion, more HIT information, and be more opinionated. Ah, hard to find the perfect balance of opinion versus news. Personally I think I need to express my opinion more.
• More practice IT & vendor success stories. Agreed. We are always looking for practices willing and able to share their story. Send over recommendations any time.
• Less interviews with blowhard and/or finely polished EMR company execs. From here on out we will only interview unpolished execs (satire alert). If you read an interview and believe it’s full of marketing-speak without substance, I encourage you to post a comment to let exec know. And, again, we are always looking for good candidates to interview.
• Love the vendor interview concept, but could use some more consistency. Some of them sound like ads, some only push what they want, some sounds more honest. Use your charm/skills/wiles to make them REALLY answer the questions instead of give marketing babble-talk. Maybe make them answer yes/no type of questions. You give my charm skills too much credit. Again, share those comments with the folks we interview and that situation will correct itself.
• Nothing. Ah. I need to marry this person.
• Cut down on the Flash ads. Sponsors take note.
• Redesign the Web site. A few readers mentioned this, as well as improved search capabilities. The new search engine has been installed on the site. It will scour HIStalk, HIStalk Practice, and HIStalk Mobile. At some point Mr. H and I will chat about updating the Web sites, though that sounds like a mighty big task requiring energies that we part-timers might better use on the content and not the presentation.
• None- good insights.
• Drop the rumors. The people who report them are desperate for attention and the information has little value (other than gossip) until confirmed. Clearly readers do not agree with this sentiment given that rumors are the second most popular feature of HIStalk Practice.
• I would like to put a face with the name (Inga). You might be disappointed.
• Explore complimentary vendors to EHR (Nuance, Welch Allen…) that optimize use. Great suggestion.
  Provide more discussion on who (if) practices will achieve MU $$$. I think in the next few months this will become a hotter topic.
• Nothing, Keep up the GREAT work!
• Combine HIStalk and HIStalk Practice. I think your intent was good, but I think it’s too much to keep up both and there is a lot of overlap. When we first started HIStalk Practice, we worried about the overlap issue. In reality, there are rarely more than one or two news bites each post that run on both sites, so the “informed” reader needs to peruse both sites. The advantage of splitting the information between both sites is many hospital providers have little interest in the ambulatory world and visa versus. The reader stats bear that out – HIStalk Practice has more practice-based readers, while HIStalk has more from hospitals.
• Post applicants and positions and put events on the home page. I’ll ask Mr. H if we can link to our new HIStalk Sponsor job site, as well as the events calendar.
• Shorter. OK to pack in lots of info, and I know how hard it is to be concise, but it takes too long to read some days.
• I’m a relatively new reader (have subscribed for about one year now) and sense an editorial slant toward the same HIT vendors. While your witticism and snarky comments are part of what make this blog worth reading, it would be nice to see it applied universally. If it were applied universally, then we wouldn’t be adding much value. Selective snark based on vendor performance is that we strive for.
• A little less news and a little more focus on a large issue once a week
• Love it the way it is, no changes
• You’re doing great! Don’t change a thing. Thanks for all the nice comments. It helps me get past my massive insecurities.

I then opened it up for any general comments. Here are a few representative ones:

• Kick ass, I appreciate all your effort. I write a blog and know what a PITA it is. Keep it up.
• Keep up the good healthcare reporting efforts.
• Great resource, enjoy regular updates
• Quit your day jobs. You are both really good at this.
• Stay cutting edge. Print the rumors. Give time to the naysayers as well as the PR mongers. Stay focused on patient care, employee respect, and straight forward, no BS mgmt !
• My lunch reading. I alternate between you and Mr. HIStalk. Excellent product – thank you for doing it.
• You do a great job and I appreciate your updates. They’re well-written and help me stay abreast of the industry.
• I have shared information with my team that I’ve read on HIStalk Practice and appreciate the timeliness of the information. I many times wonder how you can fit it all in with a full-time gig and have a (hopefully meaningful) relationship and balance of life.
• Uncover more about ambulatory HIT vendor revenue reporting practices.
• Thanks for your work. I truly enjoy reading your information and feel like I am better informed each day. I often send out your information to my departments to keep them informed.
• I don’t routinely read any other healthcare IT blog.
• I really like the rumors and your opinions and humor!
• I would love more detail on trends you see in the market in software and healthcare reform (not just meaningful use but outside of the normal stuff).
• Nothing more — keep up the good work.
• Nice tool for those in the industry and market, I believe it misses the MGMA-type audience that should keep tabs on much of this. I’d recommend reaching-out to them and maybe offer a weekly digest edition that they syndicate to their members.
• More firsthand accounts from private practice EHR users.
• I just absolutely adore Inga.
• Talk about men’s shoes once in a while 🙂

Thanks to everyone who took the time to respond.

Intelligent Healthcare Information Integration 5/8/10

EHRs and Molecular Gastronomy

I like cooking, though I’m no chef. Something has always fascinated me about chemistry, though I’m certainly no chemist. I’ve been a gadgety, geek freak who loves his PCs pretty much since birth, but I’m definitely no computer engineering or programming guru. But, watching Chef José Andrés whirl his amazing gastronomical wand on 60 Minutes recently led me to realize that my somewhat diverse fascinations have a heretofore unrecognized common, sort of covalent, bond.

In cooking, one of the most important features is the presentation. The Gestalt beauty, the interplay of colors, the mingling of aromas, and the artist’s eye for movement in the interplay of textures all combine to build an experiential expectation for the taste sensation which is to come.

Molecular gastronomy throws an understanding of chemistry into sauce pan, examining the “transformation of ingredients, as well as the social, artistic and technical components of culinary and gastronomic phenomena in general,” per Wikipedia. In the hands of Chef Andrés, it turns eating into romance.

As I droolingly watched Anderson Cooper prepare to delight in a “bagel with lox” which appeared more like a mini-ice cream cone made of a crêpe “bagel,” cream cheese “ice cream,” and (my personal all-time favorite sushi ingredient) salmon roe “lox,” it occurred to me that the next big thing for HIT might just be an incorporation of a similar approach for EHR development, sort of an EHR molecular gastronomy.

I mean, good Lord, it’s been decades now since folks started to apply technology to the art of healthcare information management. If you look around at the hundreds of EMR and EHR solutions out there, you’ll see oodles of great ideas and clever ways to address certain elements of the HIT dilemma. The “molecular” underpinnings of EMRs are becoming clear. The problem remains that these ingenious solutions exist in disparate products. None of them have the all-in-one, melt-in-your-mouth, taste explosion phenomenon of a José Andrés creation. I think I now know why.

Pretty much across the board, EMRs and EHRs have all taken the TV dinner approach: you got your meat, your potatoes, your veggie, your sliver of cornbread all plastic-wrapped into one “complete meal,” if you want to call it such. It’s edible, but…

I’m starting to think the trend toward all-inclusive, “integrated” solutions may have been as deceptively misleading as the “amazing convenience” of the TV dinner.

How about we start creating José Andrés-style culinary laboratory mini-bars (development centers) where those creative “chefs” (HIT developers and programmers) can concoct their clever individual bitefuls of component EHR “dishes” (molecular apps) and let the provider “gourmets and gourmands” (end users) pick and choose the “taste sensations” (tools) which best enthrall our “taste buds” (practice needs)?

The new Helios platform by Eclipsys is a step toward this molecular EMR diner. Personally, I’d like to see the trend continue. I’m anxious to taste more molecular EHR gastronomics.

From the trenches…

“Anybody can make you enjoy the first bite of a dish, but only a real chef can make you enjoy the last.” – François de la Rochefoucauld

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 5/6/10

The administrator at Gulf Coast Orthopedic Specialists (FL) claims his practice’s full utilization of MedInformatix EMR and practice management system has allowed it to meet or exceed nearly every MGMA best practices index. In the last three years the five physician group has dramatically improved its A/R, grown the practice, and reduced billing staff from nine to five. In reading the short case study, it sounds like the administrator should also get some credit for recognizing the practice’s lack of full system utilization and for pushing the staff take advantage of the software’s capabilities. When the administrator joined the practice, MedInformatix had been installed for two years. He brought in more training and led the charge for better system deployment. Successful implementations require a champion (or three.)

ClearPractice, a SaaS-based solution for smaller practices, names Dr. Gary Ferguson CEO and president. Ferguson is the former president and CEO of NotifyMD. ClearPractice, by the way, is the former GenesysMD, so even though the name is fairly new, the company has about 4,000 provider clients. In addition to Ferguson, the company is hiring additional sales talent.

Over their career, cardiologists earn an average of more than $5 million, compared to $2.5 million for primary care specialists. While that’s quite a gap, even the primary care docs might feel some consolation knowing they still earn more than the average business school grad ($1.7 million) or PAs ($847,000) or regular old college grads ($341,000.)  Meanwhile, policy-woks need to figure out how to lessen the gap between specialists and primary care to make primary care a more attractive option for medical students.

Not only are primary care physicians not compensated as well as their specialist counterparts, their workloads are expected to increase 30% over the next 15 years. More for the policy-woks to ponder. Undoubtedly technology will be an underlying component of many of the proposed solutions.

Twenty-four Sadler Clinic (TX) physicians resign, forcing management to lay off 38 clinical and clerical staff members. The resignations, representing a quarter of the practice’s doctors, come after Sadler changed its policy for compensating physicians (to supposedly make payments more equitable between general practitioners and specialists, by the way.)  Messing with peoples’ money (in Texas or anywhere else) rarely ends well.

The athenahealth folks have a new blog that will be multi-authored, and include posts from Jonathan Bush. Bush’s first piece is entitled, “Ceci n’est pas un Blog.” Now who is not going to want to take a peek at a musing with such a catchy title?

Emdeon buys an minority stake in Enclarity, forming a new strategic alliance to develop tools that help payers identify provider data errors at the claim level.

Massachusetts internist Dr. Robert LeBow says he may forgo potential stimulus money because he’s not interested in adding an EMR, claiming they are too complex and controversial.  Other doctors worry that even if they purchase an EMR, promised savings from efficiencies will never materialize, or, computer incompatibilities will keep them from sharing records with other physicians. It will be interesting to discover just how many other Dr. LeBows are out there, choosing to accept Medicare penalties and lower reimbursements  over going digital.

merdianEMR launches a new patient check-in system that uses the iPad.

P4P studies could increase medical disparities experienced by racial and ethnic minorities and people of  low economic status. A new RAND study suggests that typical P4P payments are lower for practices serving vulnerable communities, creating an incentive for providers to deselect patients with poor outcome measures. In other words, P4P may have the unintended effect of diverting medical resources away from the communities that need these resources the most.

E-mail Inga.