News 8/13/09

As many as 45,000 office-based physicians who participate in Medicaid and use EHRs could collect as much as $63,750 through the ARRA stimulus plan, according to a new report. The researchers recommend that if you can qualify for the Medicaid funds, you are probably better off. You must have at least 30% of your patients enrolled in Medicaid and use your “certified” EHR in a “meaningful” way. The Medicaid program allows physicians to collect $21,250 in 2011 at the program’s start, then earn an additional $8,500 annually for the next five years. That’s a better deal than Medicare, which rewards early adopters, then pays smaller incentives in subsequent years.

MGMA members say their top concerns and struggles are dealing with operating costs rising faster than revenue, maintaining physician compensation despite reimbursement declines, and selecting and implementing an EHR. Interestingly, medical practice managers ranked these same three issues at the top of last year’s survey. Other big concerns centered around patient collections, uncertain Medicare reimbursement rates, recruiting physicians, and negotiating payer contracts.

Health Care Partners, an FQHC in South Carolina, adopts Visionary Healthware for its EHR, PM, and LIS solutions. Health Care Partners is a 12-provider practice with four locations.

RelayHealth partners with Identity Force to help clients comply with the FTC’s upcoming Red Flags rule. Identity Force’s software identifies suspicious activity involving Social Security numbers and other identifying information.

If you are a  community health center, Happy National Health Center Week. Who knew that such a thing existing? Sage Healthcare obviously did as they are offering volunteer assistance at community health centers throughout the country. Sage employees are lending a hand at six different health centers this week.

Family physicians now have their own social networking site, thanks to the AAFP and their subsidiary TransforMED. Delta-Exchange is a virtual, online learning community that is available to primary care doctors for $30 a month. The site includes online discussions, interactive Webinars, practice improvement articles, and customizable policy and procedure forms.

What to do if a you are a doctor and your patient wants you as a friend on Facebook? What is ethical? What follows HIPAA guidelines? Information Week discusses the dilemmas healthcare providers face as social media become more mainstream. Here is an insightful comment: “We had these same conversations 10 or 15 years ago about the Internet. As the Internet became ubiquitous, people wrote articles about whether medical groups should have Web sites, and whether doctors should have e-mail. Now, it’s taken for granted, as they should.”

A Minnesota chiropractor is sued by the state attorney general for fraudulently pushing high-cost credit cards onto patients, then pre-billing them for thousands of dollars in treatment. The clinic may have obtained high interest credit cards for as many as 150 patients, a good number without patient consent. The clinic is also accused of inflating patient income figures in order for them to qualify for the cards.

The medical profession is not recession-proof, at least according to this Ohio State Medical Association study. The report found that 70% of the 559 medical professionals surveyed claim their practice had seen either a decrease in business, or, an increase in the number of cancellations. A whopping 92% said they seen an increase in patients having lost their health insurance from the period of October 2008 and June 2009. Most practices also noted that more patients are having trouble paying their bills.

Suncoast Medical Clinic (FL) selects Learn.com to deliver online courseware and managed training services to its employees and customers. Suncoast is comprised of over 50 physicians serving six locations.

Individual and family health savings account balances increased in the first quarter of 2009, which is the first time since Q2 2008. Employer and employee contributions to HSAs nearly doubled quarter-over-quarter. Individual and family account holders age 51+ hold the highest average account values.

Get ready for the deluge. The pharmaceutical industry authorizes lobbyists to spend about $150 million on TV ads supporting healthcare reform. To give you an idea of what $150 million will buy, consider that the Obama campaign spent $236 million on TV advertising during the election, and McCain spent about $126 million. Obviously the drug makers stand to gain millions of new customers and millions more dollars if healthcare coverage is expanded.

E-mail Inga.

News 8/11/09

Patients with cardiac disease  who kept in touch with their doctors via electronic health records were able to maintain healthy blood pressure and cholesterol two years after being discharged from a risk reduction. This Kaiser Permanente study concluded that electronic reminders and direct physician counseling were equally effective in maintaining healthy cardiac risk factors.

Last week we ran an excerpt of a letter from a physician frustrated with his EMR implementation. Since that time, we’ve heard from the EMR vendor, who was thankful we filled them in on the situation. Here is what the vendor shared with us: “We have been in contact with the customer and have been told that the project as a whole is doing well. In fact, 80 percent of the implementations are complete. We are committed to our customers and we work closely with them  to make sure they can optimally utilize the system.” Kudos to the vendor for trying to address the issue quickly. As to the critics who suggested we were siding with the vendor and blaming the victim, let me re-iterate my comment that just about any vendors’ name could be inserted into the letter and, sadly, the story would be similar. There is not one EMR on the market today that addresses workflow issues to the satisfaction of all uses. Almost all practices suffer productivity losses for several weeks after going live. Salespeople, of course, don’t like to highlight the negatives. If there were a vendor who had figured out all the issues, that company would surely dominate the market. Instead we have hundreds of vendors and just a handful at the top.

Noteworthy Medical Systems adds Louisville, KY-based MedX12 as a sales and service partner.

Digital consults are on the rise, especially as insurers like Cigna and Aetna agree to cover their costs. About 20,000 physicians now use RelayHealth’s webVisit and typically receive $25 to $35 per online visit; patients also pay a co-pay of about $10. Patients with no insurance usually $25 to $45 for the service.

Mr. H recommends checking out this interview in the Journal of New England Technology. eClinicalWorks president Girish Kumar Navani predicts his company will see a 20-25% impact from the economic stimulus, and that it will take 5-6 years to evidence itself. Great answer to the question of whether he wants to take the company public: “No. There is no question about it. There’s no way I would kill my freedom to be shackled by reporting to Wall Street every quarter … I think going public is like the hangover after a night out. You really feel good about it the day you go public, and then after that it feels like a hangover — and it never stops.”

Healthcare employment grew by 20,000 in July, including 9,600 new jobs in the ambulatory care sector. The national unemployment rate, by the way, is a dismal 9.4%. Over the last past year, the number of health care jobs rose from 13.3 million to 13.6 million.

EHR Scope explores why EMR adoption is still slow, despite the HITECH Stimulus Act. The primary issue seems to be that doctors are taking their time researching vendors because they don’t want to risk purchasing a system that won’t qualify for stimulus money. Of course it doesn’t help that we likely won’t know until January 2010 the final definitions for “certified EMR” and “meaningful use.” The author of the article suggests physicians purchase a simple, flexible, and inexpensive EMR that fulfills their needs and conforms to meaningful use requirements, and to avoid unnecessary features. Perhaps. Then again, I wonder if physicians who are on their second or third EMR would agree that this is the best strategy.

Interestingly, this study finds that EMR adoption is ramping up as a result of the stimulus plan. Providers are increasing their focus on implementing systems in time to qualify for funding.

Nuance Communications, the maker of Dragon Medically Speaking and other speech technology products, beat analysts’ expectations for its fiscal third quarter. The company posted a quarterly net loss of $1 million, compared to a  $9.9 million during the same time period last year. Total revenue grew 11% over last year, led by a 27% increase in Nuance’s healthcare and dictation revenues.

E-mail Inga.

Intelligent Healthcare Information Integration 8/10/09

Drink To Me Only With Thine Eye(s)
or The Window to the EHR Soul

I’ll betcha Ben Johnson, back in 1616, never dreamed his sweet, though somewhat melancholic “To Celia” would ever become the basis for the musings about a relationship with a machine. Yet, here it is almost 500 years later and as I stare into the giant baby blue of the EHR with whom I have become so enamored (or at least familiar), that is the love song I hear swimming betwixt my ears.

It isn’t just the soulless machine or LCD whom I find myself adoring in virtual and intellectual romance; it is the essence within which drives my love and from which her true beauty derives. It is her spirit, her life force, her anima, her élan vital. It is her software GUI, from her EHR underpinnings, which inspires my adoration and supplies the muse to my mental poetry – for she, her eye, is beautiful.

The first thing that attracted me to her was her eye. Beautiful blue with gorgeous splashes of color, clear whites with few lines, and an aura of serene simplicity which almost belied the wonderful depth of her inner complexities. She was stunning. Still is.

She is still the only eye I want to look into every working day. She still fulfills most of my manly medical needs. The soul I see within as I am constantly drawn to her never-wavering gaze each day is still one of passionate concern trying to be my all, to meet my every desire. Her countenance still pleases my gaze, her eye still beauteous to mine.

But, just as with every great love, time and familiarity reveal undeniable cracks in the veneer of loveliness which first bedazzled completely. Not that she isn’t still beautiful and not that there is another out there who has caused my eyes to wander; it’s just that all of the promise, both implied and assumed, never quite matches fully with time-revealed reality. The talents presumed and the best-foot-forward finesse of the early infatuation days yield to the actuality of the true.

Will this beautiful eye, this rectangular optical window to the true soul of my EHR machine, ever fulfill all of my desires? Will she grow with the refinement of age and experience into the dream with which my mind’s eye beheld her when infatuation first flowered?

Or, will I join the ranks of the unfaithful, becoming enamored by the sultry lines and sinuous curves of a younger, newer beauty? Will one with the flexibility of youth and the promise of new love distract my eye from my first, now aging, love?

Frankly, I don’t know. Our cohabitation, after all, is solely at my discretion. I do know that it was love at first sight with my first EHR love. The beautiful GUI, her “eye,” drew me in helplessly. Her understanding of my needs was deep, but her visual splendor captured my soul. This was an eye I knew I could gladly gaze into daily for many, many years to come. (Others before – and most, so far, since – appear lifeless and cold and uncaring of my visual happiness.)

While many are perhaps far more pragmatically oriented, I believe beauty engages us all. If you’re going to spend years, perhaps a professional lifetime, gazing upon a quadrangular “eye” to your EHR machine’s soul, it should be a gaze returning pleasure and visual “vavoom.” Superior EHR GUI design can lead to love.

Talent hits a target no one else can hit; genius hits a target no one else can see. – Arthur Schopenhauer

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.

News 8/5/09

Salinas Valley Memorial Healthcare System (CA) selects e-MDs to provide PM/EHR systems for its 200 affiliated physicians. The healthcare system will supplement a portion of the costs of the software, training, and support expenses for its community physicians.

RealMed is named exclusive clearinghouse provider for Adventist Health System’s physicians.

The State of Mississippi contracts with Shared Health to implement and operation an EHR and e-prescribing solution for the state’s 600,000 Medicaid beneficiaries. The free, Web-based EHR will be automatically populated with Medicaid data, including lab results, medications, immunizations, and allergies.

TrialX will release an iPhone application that gives doctors and patients the ability to search for various clinical trials.

Salesforce.com takes a minority stake in PracticeFusion. PracticeFusion also announces plans to offer a new PHR offering using Salesforce.com cloud computing platform. PracticeFusion’s EHR software is Web-based and offered free of charge to physicians, as long as they are willing to put up with advertising on their systems.

Consumer Reports, the granddaddy of rating services, is now supplying patient satisfaction ratings to hospitals and physicians. The Consumer Reports Health Ratings Center rates the overall patient experience, including doctor and nurse communication, room cleanliness, and hospital staff attentiveness.

Cuban-trained physicians are fleeing their country in record  numbers and settling in the Miami area. By some estimates, as many as 6,000 medically trained professionals have moved to the South Florida area in the last six years.

More physicians are asking patients to pay out-of-pocket costs at the point of care, versus weeks later after insurance pays. Physician offices are taking advantage of various software tools that calculate the patient-responsible portion based on deductibles and insurance plans. While many patients appreciate the convenience of point of care payment, this article cautions patients to compare their payment amount to the actual EOB in order to catch any inaccuracies.

Welch Allyn introduces an online tool to educate doctors on the benefits of device connectivity. New site here.

SRS announces that the 12-provider Chestnut Hill Cardiology (PA) has selected the SRS hybrid EMR for its practice.

We were forwarded a letter penned by a doctor who is frustrated with the transition to his new EMR. To summarize, the physician has been live for six weeks and is still seeing fewer patients; they don’t have time to enter all the past history information required; he and the other doctors are spending numerous hours working with the vendor to figure out glitches. He feels the vendor misled him about the system and its capabilities. He questions whether his experience is unique or if other practices feel the same way. We didn’t see the need to mention the vendor because frankly you could insert just about any vendor’s name and it very well could be applicable. Perhaps an enthusiastic salesperson skipped over some of the details — it’s been known to happen. On the other hand, moving to EHR is an overwhelming process and many of the smaller details are incomprehensible until you are actually in the midst of a go-live. It’s easy for assumptions to be made on the front end. It’s easy for buyer’s remorse to set in when things don’t seem to be working the way you envisioned. No one has created the “perfect” EHR and every vendor has room for improvement. However, I would tell this doctor to give the transition more time. Six weeks is not enough time to feel comfortable with an upheaval as huge as a move from a paper to digital office.

athenahealth reports its second quarter results, which included a 9% increase in profit compared to a year ago. The company reported $3 million in profit ($.03/share) and revenue of $46.7 million (a 42% increase.) athenahealth attributes the positive results to better sales, including an increase of athenaClinicals EMR users from 498 to 1,034 active providers. Results were in line with analyst expectations.

Featherstone Informatics Group is named the exclusive vendor for the American College of Cardiology’s practice-based quality improvement program, IC3 (Improving Continuous Cardiac Care.) Featherstone will coordinate the program’s EHR interfacing and data extraction process for practices across the country. Data will then be analyzed in order to report logarithms for benchmarking physicians and practice clinical performance.

Durham, NC internist Esther E. Poza, MD joins TSI Healthcare as the company’s chief medical officer, tasked with leading the company’s efforts help physicians adopt EHRs.

Proteus Biomedical Inc. is testing a miniature digestible chip that can be attached to conventional medication, sending a signal that confirms whether patients are taking their prescribed pills. A sensing device worn on the skin uses wireless technology to relay that information to doctors, along with readings about patients’ vital signs. Sounds way too big brother-ish to me.

E-mail Inga.

Intelligent Healthcare Information Integration 8/4/09

The Elegant Palm Pre Cereal Box Top EHR

Yep. Pretty happy with the new Palm Pre. Simple, nonetheless powerful. Stylish, yet practical. Hip, though perhaps not iHip. Zen, and so much so, that I quit maintaining my motorcycle.

But, regardless of the number of contemplatory eggs gracing Palm developer desks, it isn’t perfect. Battery life is abysmal unless you keep all the apps closed. This kind of diminishes the glamour of being able to keep a bunch of ‘em open and switch in and out at will. Of course, if you have a bunch of chargers scattered around, you can keep up and the new magnetic grab-n-go charger helps this. (Thank you, yet again, Mr. Tesla.) Still, I’m used to having my digital six-shooter on my hip and jumping about at will. Remembering to grab the little beauty when I run off to an emergency or bathroom break proves challenging.

Also, the Palm Data Transfer Assistant could use some work. You’ll find lotsa online tales of woe about Palm Desktop or Outlook data migration. (Thank you, Chapura PocketMirror.) Another noticeable weakness is Sprint’s cellular coverage, at least here in my little burg. Verizon had me covered and I could always hear you now. Sprint doesn’t want me getting calls in the surgery center or even sitting at my office desk. (I won’t bore you with why Sprint doesn’t want new business customers to have AIRAVEs to enhance their signal, but will freely give them to established customers – I have to endure crap coverage until them deem me worthy, I guess.)

Still, challenges and foibles aside, I realized the other day that I could pretty much do every common little computer thing I need from wherever I happen to be (within cell tower range.) This is phenomenal! The integrative nature of the Pre and the beyond-iPhone-friendliness of my new pocket-sized phone-calendar-contact database-camera-GPS locator-weather center-web browser-videocam-pager-planner-game system-younameit tool made me realize the future had hit. This was a, “Wow, I can actually do what I’ve always wanted to do,” light bulb moment.

Then, this morning, I was putting my Raisin Nut Bran cereal box away when I noticed the box top. Remember how cereal boxes always had that little semi-cut-out slit you had to punch open to stick the opposing flap’s tab into? Remember how it invariably would not be well cut and your attempt to pop it apart would, also invariably, lead to the little connector piece tearing such that the tab would never hold the flaps closed as intended? Well, some cardboard engineering whiz kid has figured how to cut the tab and its opposing flap indentation such that the punch is eliminated and my little box top stays untorn and closes right every time. Genius, though it took decades to discover.

So, a two-and-two flash strikes. That’s what I want from my EHR. I like my system well enough; it has lots of the gadgets and gizmos I need. The problem is it isn’t Pre slick yet. Close. Kind of like the difference between the Palm Treo and the Pre. Functional, but kludgy. Close, but still not quite brass ring worthy. Missing the box top simple solutions for functionality. I’m guessing many EHR users feel similarly. We know what we need, but no one has the truly elegant answer yet.

I would like to know if anyone out there knows the “Geniuses of the Box Top” and a couple of Palm Pre developers who might be interested in constructing the new Palm Pre Cereal Box Top EHR? To make the next generation EHRs, the ones we really need, it’ll take these types of Zen master geniuses, those who can make all the work underneath appear simple and elegant. Maybe I should ask Fred Astaire.

Where all think alike, no one thinks very much.   – Walter Lippmann

Postscript : Since submitting this piece, I came across a tremendous article, The EHR ‘killer app’, by Jeff Marion on EHRWatch.com. If you haven’t seen it, it is well worth a read.

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.