Intelligent Healthcare Information Integration 4/24/10

Intelligent EHR Help

Many if not most of you reading these pages are already EHR savvy. You have either struggled through the process of swapping your trusty old pen and paper for some version of digital data collection or else you’re on the side of the suppliers of the necessary paraphernalia for HIT. While I hope you’ll enjoy this post, I really hope you’ll consider sharing it with one of your friends or colleagues who aren’t yet on the electronic bandwagon.

For those providers out there who’ve made the switch, remember back to the Days of Decision? (Maybe that should be Days of Indecision). Remember all the hours of frustration spent just trying to find out what information you needed in order to even begin to figure out what sort of system might best suit your needs? Remember when “you didn’t know what you didn’t know” about EMRs?

For the vendor folks out there, how much more valuable would a potential new client be if they were fully prepared to make the switch to an EMR? Wouldn’t a medical practice that had all its ducks rowed up be much more likely to have a successful install, one that doesn’t revert to the dreaded “Failed and De-installed” file?

If we’re honest with ourselves, there’s no such beast, yet, as a perfect EMR. They all have issues and areas of weakness. But, it isn’t the “not ready for prime time” phenomenon that derails many installations. The main circuit breaker to blow, preventing many, if not most, successful transitions from pen and paper to digital seems to me to be lack of adequate preparation and support.

So much emphasis has traditionally been placed upon EMR/EHR selection. If more practices were adequately prepared for the gigantic operational switch that is to come with an EMR, then failure rates would fall and purchased systems sitting on shelves collecting dust would be less frequent.

Of course, larger centers and institutions have IT departments, educational staff, and committees ad nauseam to assist in the preparatory process. (Some still don’t prep up very well.) But, smaller practices, where the vast majority of healthcare in our country is delivered, have no such support teams to task with these time-consuming chores. A doc or two, perhaps an office manager, is saddled with taking on the tremendous task of trying to determine what their little organization needs to get “digified” and then must sift through scores, hundreds even, of available products.

Consultants are available and can provide the help needed, but they are often somewhat beyond the means of smaller practices. This is especially true if a practice needs “full service” planning, selection, and negotiation assistance.

EHR selection tools are available, and I personally like several of them, but their roll is more limited, their focus being upon the actual selection of an EMR or EHR.

But, as many of us can attest, the planning portion is often the key element in successful EMR adoption. Poorly done, it can sink the most enthusiastic advocate’s plans. Taking the time before implementation to define the practice’s current situation, determine how key workflow and staffing issues will be altered, delineate technology needs, and calculate capital requirements can dramatically enhance the opportunities for successful EMR implementation.

This, however, is very tough to do when you’re busy taking care of patients and meeting the day-to-day demands of a small business. That’s why I got very excited when I discovered a new tool designed to fill this need, one that is both affordable and considerate of the needs of a small practice.

Having already implemented our EHR, I can’t bear first hand witness to this tool’s full prowess. I did convince the developers to allow me access to their web portal, a key component of the product, which gave me a deeper view than just a demo or white page. From this access, from my personal past experiences, and from the innumerable conversations I’ve had with colleagues seeking to demystify this digital dilemma, I can say that it appears to fit the old bill of “just what the doctor ordered.”

They have consolidated a ton of information, organized it into guided steps and phases, and built, essentially, a correspondence course for EHR preparation and eventual selection. It is a “hand holding,” but in the very best sense. Getting started with figuring out what you need is a huge hurdle; having an affordable tool to assist you in starting the race on the correct foot is huge. This product provides guidance, helps you find and organize the information you’ll need, and know what work within your own practice is necessary.

Not insignificantly, this particular instrument also includes real, live consultants, vetted by the MGMA, to assist with the inevitable questions and unique practice issues. Their time is used more efficiently as much of the legwork is done via the guided “homework” laid out in the online program. Additional consultant time is available, for an additional fee, if required. There’s even a higher end version where you can have the consultant act as the complete project manager.

The developer of this “homeschooler tool” is has their eye upon profit, to be sure. However, at the proffered price, they obviously aren’t going to ring any big bells at the NYSE from this product alone. The motive, which isn’t hidden or obtuse, comes from enhanced connectivity: the more digitally connected a practice is, the more likely they are to seek digitally-connected tools. Thus, Welch Allyn – you know, the folks whose name is probably on the otoscope you or your doctor uses every day – saw fit to try and assist practices with EMR adoption by developing their “EHR Prep-Select Program” as they now have a passel of products which you’ll only want if you’re down with things digital.

In preparing this piece, I Googled and Binged about a bit. There may be other such tools available, but I wasn’t able to easily find anything similar. Actually, the landscape doesn’t appear all that different from when I first began my EMR search earlier this decade. There’s lots of information to be found, but sorting through what is necessary and valuable for me and mine versus what is salesmanship and schlock appears just about as daunting as ever.

Having a full-time, industry-savvy consultant help walk you through this morass would, obviously, be preferable. Larger groups and institutions are well-served by such professional guidance. Even I used one for my final contract negotiations and was very satisfied with both the cost and the service. But, as a solo doc, I would never have been able to afford the five figures it would have run to engage a consultant for full preparatory planning. Such a tool as this, though, appears to be a “next best” option at a fraction of the price.

I have absolutely no desire begin the process again myself – believe me! – but I can say with unequivocated assuredness that, if I were, I would absolutely consider such a helpmate. The time savings alone would be well worth the investment.

By the way, if anyone knows of similar tools or services, I’d really appreciate hearing about them.

From the trenches…

“The rule is perfect: in all matters of opinion our adversaries are insane.”  – Mark Twain

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 4/22/10

Martin Children’s Clinic (TN)  selects Waiting Room Solutions’ EMR/PM software.

Passport Health Communications will use TransEngen’s HealthEgen solution to determine patient eligibility for charity care assistance.

Quality Systems, the parent company of NextGen, announces several changes to its executive leadership team. Tim Eggena moves from his role as executive VP of NextGen Practice Solutions to the newly created role of executive VP of R&D for NextGen’s ambulatory products. Monte Sandler takes over as EVP of Practice Solutions after serving as NextGen’s VP of account management. Finally, Donn Neufeld takes over as EVP of EDI for NextGen and QSI and keeps his current role as SVP and GM of QSI’s Dental unit.

Stanly Family Care Clinic (NC), Dr. David H. Franzus (TN), and Medical Associates of Southwest VA all pick Benchmark Systems as their EMR and PM vendor.

Clearinghouse vendor RealMed will use TIBCO business process management and enterprise messaging server solutions to increase transaction volumes and accelerate processing and payment transactions.

The CIO of The Little Clinic (TN) wins Boston Software Systems’ User Excellence Award for using Boston Workstation to automate the patient registration process. CIO Mat Waites developed a kiosk system for his organization that interfaces with the practice’s eClinicalWorks software.

Speaking of eClinicalWorks, the company points out numerous clients that have been recognized by the NCQA for achieving Patient-Centered Medical Home (PCMH) status. Requirements include the automation of business and clinical processes, as well as using clinical support tools.

Medical billing company MTBC acquires competitor Medical Accounting and Billing.

The University of Toledo Medical Center takes its first clinic live on McKesson’s Horizon Ambulatory Care EMR. The rest of the system’s 33 clinics will go live over the next 12 months.

Emdeon reports that the electronic medical claims adoption rate is now 85%. Electronic remittance adoption stands at 46%.

If Meaningful Use still has you befuddled, you might want to check out CSC’s “Meaningful Use for Eligible Professionals: The Top Ten Challenges.” In addition to about three pages of MU background data, the authors list what they believe will be the biggest roadblocks for physicians. Topping the list: capturing data, establishing effective workflow to reinforce data entry, and driving provider involvement in the adoption of EMR. The overriding theme seems to be that practices will be challenged to get physicians involved and actually using the EMR tools provided. Sounds reminiscent of the old days, before Meaningful Use became an overused buzzword.

Clinics of North Texas selects Allscripts EHR and PM for its 35-physician group.

GEMMS, an EMR vendor for cardiology practices, announces plans to invest $2.1 million to expand its headquarters and add 69 new jobs by 2015. The company has 40 employees.

About every week or so, readers send us notes suggesting one vendor is acquiring another or some company is looking for a buyer. Many of the rumors prove true, though more often then not they are nothing more than speculation. If you like speculation, this article about Sage Healthcare is a fun read.The author suggests a few separate incidents may be more than coincidental (the retirement of CEO Paul Walker, an upgraded rating from Citibank, and an increase in holdings on the part of financial management firm BlackRock). Throw in a few theories about why Sage would or would not want to divest healthcare or its North American division and you have a captivating topic to ponder at your next HIT happy hour.

E-mail Inga.

News 4/20/10

From Grizzled Veteran: “Re: EMR for neuro. Most vendors can easily handle the needs of a neurologist. It isn’t that complex.” I have to agree with Grizzled Veteran here. Unless you are planning to use extensive neurology-specific templates for charting at the point of care, a good number of vendors should be able to accommodate your needs. Obviously you’d want to avoid the niche vendors that focus on specific and unrelated specialties, e.g, pediatrics, oncology, urology.

Physicians working in hospital-owned outpatient facilities will be eligible for stimulus incentive payments, assuming they demonstrate meaningful use of EHRs. Congress passed a new bill which gives more physicians the ability to quality for funds, including an additional 13-17% of family physicians. Physicians working primarily in the ER and in inpatient settings are still excluded.

Congressmen Patrick Kennedy and Tim Murphy introduce legislation allowing behavioral, mental health, and substance abuse treatment provides to qualify for meaningful use of EHRs. If the intent of HITECH was to improve the quality of care through the use of HIT, why would you want to exclude the mental health providers?

mPay Gateway says more than 800 physicians signed up for its patient payment system during the first quarter of 2010.

eClinicalWorks makes the annual Boston Business Journal Pacesetters list of the 50 fastest growing private companies in Massachusetts. eCW ranked number nine, based on revenue growth.

In addition to revenue growth, eClinicalWorks has grown its staff and is in need of space to expand its headquarters. The company tentatively plans to stay in Westborough, MA with a move to another in-town site.

Microwize Technology earns honors as the best Value Added Reseller for Lytec in 2009.

EBM IPA (NY) selects MedAZ EHR, PM, and billing services for its 100 physician members. EBM IPA will also deploy the MedAZ PRH portal.

Managed care insurance provider AmeriHealth Mercy Family of Companies wants to help connect RECs with small physician practices. AmeriHealth, which covers Medicaid patients in several states, believes that providing these practices with extra support, including education on technology adoption, will ensure more practices remain in the AmeriHealth network.

Danville Polyclinic (IL) selects Sage Intergy EHR for its 40-provider practice. The clinic already employs Sage Practice Management and Practice Analytics.

Immediate Care at Stanford Medical Park, North Garrard Family Medical Center, and Ephraim McDowell Lancaster (KY) go live on the the Medical and Practice Management Suite by LSS Data Systems. The practices will share clinical data with Ephraim McDowell hospital, which runs MEDITECH.

ELLKAY takes advantage of what’s sure to become one of HIT’s fastest-growing segments: EMR conversions. ELLKAY announces a new conversion division focused on EMR-to-EMR data extraction and conversion services.

CMS takes steps to expand its current Medicare provider enrollment system and make it easier for physicians to register for meaningful use incentives. CMS awarded a $1.6 million contract to CGI Federal to make updates to the Provider Enrollment Chain Ownership System.

Here’s an interesting thought: could providers be liable if they fail to take into account information patients provide vis-à-vis a personal health record or an e-mail?  Is it too much to expect doctors to dissect every bit of of digital information coming their way, especially as we connect provider/lab/hospital in a community? One of the many questions pondered in this article about the future of medical data.

GE announces Q1 results, which included overall EPS of $.16 and first quarter revenue of $36.6 billion. Healthcare had a “strong quarter” with orders of $3.8 billion, up 5% from the previous year. US orders were flat.

The children of a deceased patient drop their lawsuit against an ER doctor they claim allowed their father to die in order to steal his Rolex watch. A jury also found the doctor not guilty of grand theft. The California Medical Board is still investigating the doctor, however, to determine if he illegally prescribed himself a stimulant two days before the watch incident.

A data security expert warns that practices need to address system security issues each time an employee leaves. Practices should not only block access for former employees, but also consider if the ex-employee shared passwords with remaining employees. Excellent point here:

"You wouldn’t let [departing employees] leave with the keys to the clinic. You shouldn’t let them leave with the keys to the data."

A New York plastic surgeon now holds the world-record for Donkey Kong. He sounds a wee bit obsessed with the game: he has a full-size arcade machine in his Manhattan apartment and spends hours playing each evening. To prove he won fair and square, he had to videotape the inside of the machine before the game, video the actual game, and video 29 other things. Incidentally, researchers have found a correlation between gaming and a proficiency in laparoscopic surgery. Regular gamers are apparently 27% faster than non-gamers and commit 37% fewer errors. Guess I am New York-bound for my next nip and tuck.

E-mail Inga.

Intelligent Healthcare Information Integration 4/17/10

AAs for EHRs

No, this isn’t an offering from Bill W, nor is it a Serenity Prayer for EHRs. (Though I could use one of those some days!) This is about the two main players acting upon providers when it comes to EMRs: aversion and attraction. It’s about what can draw doctors toward, and what will repel them from, digital healthcare data use and adoption.

Attraction:

· Ease of use

· Ease of use

· Ease of use

Think “apps.” There’s not one non-geekified physician out there who wants anything to do with learning about dropdown boxes, navigation panes, or data input modalities, no less any who care one whit about programming language limitations or whether it’s MySQL or yours.

Docs want to see patients. It’s that simple.

We never wanted to become data collection devices assisting insurance company profit margins nor defensive documenters dodging ambulance-chasing lawyers looking to capitalize upon the imperfections inherent in being human.

So, give us easier ways to practice medicine. Period. Do that and docs will literally flock, in mass migratory waves, to your door.

Aversion:

· Clicks

· Clocks

· Clacks

Clicks, also known as “clicky-clicks,” is shorthand for all the monstrously difficult ways we’ve thus far devised for interacting with computers. Compared with pen and paper, few information input methods can be called anything but regressive. (OK, voice recognition has gotten good, but it’s still tough to do in a noisy, busy office.)

Clocks are the continually ticking timepieces running doctors’ professional lives. Lower reimbursement leads to the need to see more patients, but more regulations require more data collection which takes more time per patient. More times more times more equals less: less time available, less fun, less happy providers, mathematically proven here: 

A clack is defined as both “thoughtless, prolonged talk” and “a simple valve allowing one-way flow.” Both definitions fit many of the tasks associated with EMR use and adoption. Think about it.

Minimize the clicks, enable slower clocks, cut out the clacks and, again, physician flocking will occur.

This isn’t about the incentive dollars which will be gone before we know it. If vendors and governments want docs to adopt, understand and address the AAs of EHRs and help us get flocked.

From the flocking trenches…

“A word to the wise ain’t necessary – it’s the stupid ones that need the advice.” – Bill Cosby

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 4/15/10

From John “Re: EMR for neurology. I am looking for a practice management solution, to include EMR/EHR for a neurology clinic … ideas please.” If you have suggestions, please forward them directly to me. I will compile comments into a single post.

Physicians from more than 860 practices in remote and underserved areas of California will soon be able to connect virtually with specialists in larger hospitals. The University of California, which is overseeing the initiative, just awarded AT&T a $27 million contract for the telecommunications infrastructure that will serve as the backbone for the California Telehealth Network.

Speaking of telehealth, American Well launches Online Care Team Edition, which brings live, on-demand specialist care consults into primary care physician exam rooms. Hawaii Medical Service Association will be the first health plan to deploy the technology.

Greenway Medical Technologies announces a meaningful use guarantee which has a slightly different twist from others we’ve seen to date. Greenway guarantees that its PrimeSuite EHR meets the reporting functionality and requirements necessary for providers to achieve meaningful use and qualify for stimulus funds. If providers fail to qualify for stimulus dollars, based on concerns with PrimeSuite’s certification or reporting standards capability, Greenway will fix the problem and in the interim pay customers an amount equal to any stimulus funds lost.  Different twist, but the onus is still on the physician to use the EMR in a meaningful way.

e-MDs announces it has increased its employee count by 36% over the last year. The company has also grown organic sales 36.5% since the beginning of the year.

Only 7% of US residents use personal health records, but that’s up from 2.7% last year. Younger individuals with more education and higher incomes are more likely to use PHRs. About 40% of PHR users are more likely to ask their their doctors new questions, and, about the same number say that PHRs made them feel closer to their doctor (the sweetness of that finding makes me smile.)

SourceMedical launches SourceTherapy Billing, a billing service specializing in outsourced revenue cycle and consulting services for physical therapy. The billing service is enabled by SourceMedical’s acquisition of Advanced Patient Financial Solutions.

Medical billing company HealthPac Computer Systems partners with AssistMed to integrate AssistMed’s data capture technology with HealthPac’s patient accounting and control system. The integration supports the use of a digital pen and custom forms and will automate charge capture and billing.

MDeverywhere releases a Web-based practice management offering for all its mobile hand-held devices, giving physicians the option to captures and view schedules via any smart phone or other Web-enabled hand-held device.

The Florida Medical Association selects Galen Advisors as its sole supplier of revenue cycle management services. Association members will be eligible for one month of free billing services for each 24 months of service.

Revenues from remote patient monitoring using mobile network will rise to $1.9 billion globally by 2014, with heart-related monitoring applications driving the initial growth in the sector. Also predicted to be big: healthcare smartphone apps that link to sensors worn on the body. Time to buy some stock, perhaps.

E-mail Inga.