Intelligent Healthcare Information Integration 7/13/09

You Have To Let It All Go, Neo

Just for fun, let’s say you have 19 billion dollars and a tremendously philanthropic heart. Let’s say you decide to devote your vast fortune to solving the healthcare crisis in America. As you also have a geeky soul, you settle upon healthcare information technology enhancement as the vehicle you deem most likely to have give you that big bang for your many, many bucks.

You look around the HIT realm and see many, many players providing many, many digital solutions, but realize that the vast majority of them are siloed, they don’t work and play well with others. There are some really wonderful systems, many of which have the potential to provide the electronic underpinning to your truly national health care project; however, very few, if any, have all of the tools with all of the interoperability you seek. Virtually none have the diversity of user interface that end users’ widely divergent personal preferences demand. (People do want their own style.)

It appears to you that no current system can provide the be-all-end-all tool that works for everyone, no system yet has the easy and highly individualized personal customization required to entice everyone into adoption with a tool that works for their unique needs and their unique eyes. Thus, you begin to ponder, “I wonder what kind of a broadly attractive system I could build from scratch for my 19 billion dollars?”

Pursuing this thought train, you muse:

• How many top notch developers could I hire? (2,000 X $150K = $300 million)
• How many designers could I employ to make user interfaces that are easy with thousands of skins so everyone can look at whatever suits their eyes? (2,000 X $150K = $300 million)
• How many educators could I deploy throughout the country to make sure “no child is left behind” – or any adult? (10,000 X $150K = $1.5 billion)
• How much of my money pile could I afford to give to individual smaller communities across the nation to help them step across the digital healthcare divide? (Micropolitan areas: 577 X $3M = $1.73 billion)
• How much could I give to schools to help educate the young so that, going forward, this digital healthcare stuff becomes second nature? (94,000 X $100K = $9.4 billion)
• How many really great support personnel could I hire and deploy to every corner of the land in an effort to insure uptime? (10,000 X $250K = $2.5 billion)
• How large a chunk would be left over for various loose nuts and bolts, including quality CEOs, COOs, CIOs, and all the little “o”s? ($3.27 billion)

2,000 developers; 2,000 designers; 10,000 support personnel; 10,000 educators; big, no huge, chunks of money to help small communities join the party and teach our children how to be digital healthcare thinkers using existing Web and cell phone technologies which already reach every knook and most every cranny? “Hmmmmmm…,” you further muse, “I bet this money could really do some good.”

“You have to let it all go, Neo…fear, doubt, and disbelief. Free your mind.” – Morpheus

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 7/9/09

RealMed earned the top spot in a recent KLAS survey of ambulatory electronic claims clearinghouses. Navicure and ZirMed tied for second place in the study that compared 15 industry solutions. Getting paid correctly the first time was an important factor in overall satisfaction, though customer service was also a crtical variable. Interestingly, price had little correlation to customer satisfaction.

For $.99, you can purchase a new mobile iPhone application that screens for depression. The physician-created Sad Scale ranks symptoms and emotions, comes up with a score, and gives the patient the option to forward results to his primary care physician. I am pretty much convinced I could develop a hot-selling new application called Do You Need to Get a Life? Sample questions: do you spend more time Twittering than talking? Do you have 1000 Facebook friends but still unable to find anyone to go out with on a Friday night? Do you hyperventilate if you can’t check your texts or e-mails for more than an hour? Feel free to send additional questions my way (though I may not share any of the royalties.)

Considering a remotely-hosted EHR solution? Information Management magazine presents a comprehensive overview of the pros and cons of using an application service provider versus an in-house server solution. In terms of cost, their take is that the ASP service is less money up-front, but likely costs about the same as the local server option over the long haul.

SRSsoft bags another customer willing to drop their CCHIT-certified EMR in favor of the SRS hybrid EMR. Southeastern Orthopedic Center thought they were good to go with regard to HITECH, but says, “The CCHIT EMR we had purchased would have placed overwhelming demands on our physicians and resulted in a significant loss of productivity, even if we had overcome the initial implementation hurdles.”

A study in the Annals of Internal Medicine finds that time pressures, chaotic environments, low work control, and an unfavorable organizational culture were strongly associated with low physician satisfaction, high stress, burnout, and intent to leave. Really? Would anyone be content working in such an environment? The report also found some correlation between work conditions and quality of care and errors, though stress and burnout were not found to affect care.

Physicians using Allscripts Clinical Quality Solution (CQS) earned more than $4.5 million in pay-for-performance bonuses last year. The CQS solution is powered by TeamPraxis, a Hawaii-based MSO that developed the clinical data extraction tool. Currently 24 medical organizations across 16 states have implemented the CQS product.

St. Rita’s Medical Center (OH) selects Retasure’s retinal risk assessment solution for its 75 primary care physicians. Digital Healthcare, the developers of Retasure, say deployment of their product is up 50% over last year.

Eclipsys names Chris E. Perkins executive VP and CFO. Perkins previously served in similar roles at Per-Se and Emageon. Perkins takes over from interim CFO David Morgan, who stepped in after the January resignation of Robert Colletti. Colletti left the company after Eclipsys announced it would miss its Q4 earnings projections.

Advanced Data Systems (ADS) announces a partnership with Medflow, allowing them to offer Medflow’s ophthalmology-specific EHR. ADS is a provider of the MedicsPremier PM solution, as well as MedicsElite EHR.

The CDC launches an environmental public-health tracking network to explore potential links between environmental contaminants and chronic diseases. The new network brings together data on air quality, drinking water, and other environmental information and will allow the public and researchers to compare it against disease data.

E-mail Inga.

Intelligent Healthcare Information Integration 7/8/09

KISS, Please

Simplicity. As complex as healthcare is, if we try to add the density of technology to it, perhaps it is counter-intuitive to think of ‘simplicity’ as a key operating principle of the NHIN construct. However, I believe this is the must have nuclear core for the successful initiation of the broad masses of both consumers and providers to the adoption of healthcare information technology. It is also key to their subsequent and sustainable utilization of these tools.

Everyone who has been listening to the widely broadcast cachet attributed to HIT has at least some appreciation for the extensive list of advantages we all envision for our future digitally-enabled healthcare provision. Seeing what tech has done for shopping, banking, communications, social networking, political campaigns, and general information sharing, it is virtually impossible to imagine that such benefits would not also transcribe well into the realm of healthcare. Indeed, it is the very complexity of healthcare that makes it seem such a likely candidate for technology enhancement.

Therein lies the rub: We know what technology can achieve, yet we are seemingly overwhelmed by its application to so complex an arena as healthcare. We want all the benefits which we know it can provide, yet we are stymied by the vastness of healthcare as well as the currently available information technology solutions, most of which have trouble working and playing together.

I propose we let the big players continue to duke it out over who shares what with whom and how they’re going to solve their big center issues. I mean, while they have helped to push HIT along the past quarter century or so, they’re also the ones who have enabled the ‘silo-ization’ with which we are now hamstrung. They have oodles of money and should be the ones to fix the dilemmas they’ve enabled.

In the mean time, for the rest of us (consumers, small providers, ancillary healthcare delivery providers,) let’s do simple. Already familiar tools. Real, immediate value. Attractive, intuitive user interfaces. Internet as the backbone, no silos. Easy-to-use cell and smart phone push-pull data collection and dissemination apps. Work with the individual end user in mind, both consumer and provider – together, not separate. Important pieces first, add complexities as mastery grows. Small sips to start; avoid the overwhelming drink-from-a fire-hose phenomenon.

As John Gaule said, “A complex system that works is invariably found to have evolved from a simple system that works.” Couldn’t agree more.

Keep it simple, stupid? No…Keep it stupid simple.

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 7/7/09

From: Handy Man “Re: Should CCHIT-certification be required for EMRs? Perhaps the analogy ought to be that when I hire a contractor to build a house, I don’t mandate what tools they use…. Do I really care whether they use Craftsman hammers or 10 oz or 16 oz hammers? Or, do I care that the house stands up straight and level? I.E, let’s focus on goals of medical care, not just having technology to say we have technology.”

Executive Solutions for Healthcare, a developer and manager of ambulatory surgery centers, selects ProVation MD and EHR solutions for two of its facilities. Trinity Plaza Surgery Center and The Endoscopy Center of Lodi (CA) will utilize the ProVation solutions from Wolters Kluwer Health.

JL Software announces the release of The Handbook of High-Risk Obstetrics for use on Phones and iPod Touches. The $49.99 application covers all aspects of perinatal practice.

The Tennessee Medical Association sues a collection agency, alleging the company is fraudulently trying to take back reimbursements paid to doctors. Health Research Insights is demanding repayment from physicians, on behalf of its insurance company clients. The collection agency is demanding repayment for claims that in some case date back several years. The company accuses the physicians of coding visits at too high a level, a charge based on claims data and not actual medical records.

Metropolitan Health Networks (FL) selects eClinicalWorks for its nine internal medicine clinics.

A New Hampshire nurse files a class-action lawsuit against three Obama administration officials, claiming that the health IT provisions in the ARRA violate patients’ rights to privacy and violates HIPAA privacy rules. The suit seeks an injunction to prevent the distribution of the $22 billion earmarked for HIT.

The 12 providers at North Oaks Obstetrics and Gynecology (LA) select Sevocity EHR.

David Brailer says that the government’s lack of specificity about how stimulus money will be paid out to providers is hurting EMR adoption as potential customers wait and see. He also predicts that meaningful use criteria will be loose even if that dilutes the whole point of having them. “They’ll go for the big tent as opposed to a narrow solution. That’s not good policy, but that’s the politics of the matter.” The CNN article mentions EMR licensing expense and the potential use of VistA, quoting Medsphere CEO Mike Doyle in comparing the $9 million the State of West Virginia paid it for eight hospitals vs. the $90 million West Virginia University (which he incorrectly called the University of West Virginia) paid Epic. “If Obama is serious about this, he won’t be able to do it $90 million at a time.”

The AMA offers some strategies for practices wanting to reduce their carbon footprint. For example, turning off computers when not in use, offering follow-up consults via phone to reduce driving, and replacing film x-rays with digital.

Omega Medical Solutions (SC), a medical billing and consulting agency, selects Allscripts Practice Management and Payerpath solutions for its physician practice clients.

A St. Louis-area practice launches a program aimed at helping the uninsured and stimulating the local economy. The seven employees of Baker Medical Group were given $300 work of $2 bills they could spend on anything. Employees can also give a $2 bill to an uninsured or unemployed patient, who can then redeem it for a free office visit. By the end of June, 20 patients had taken advantage of the program.

E-mail Inga.

News 7/02/09

The State of Texas will spend $7 million over the next two years to establish 30 telemedicine sites that will give Medicaid patients access to pediatricians.

About 6,000 patients of the Buffalo Medical Group have signed up for online access of their medical information in the past year. Epic MyChart costs the practice twenty cents per patient per month. Administrators are fans because they believe it provides patients better control over their health.

The folks at InteGreat let us know their EHR version 6.3 just received CCHIT 2008 ambulatory EHR certification. CCHIT bestowed 2008 certification to 14 products in June, bringing the total number to almost 70. Just suppose that the ONC does not make CCHIT certification a requirement to secure stimulus funds. Will there be as many products seeking certification for 2010?

Pentucket Medical Associates (MA) rolls out GE Centricity EMR in a remotely-hosted environment utilizing virtualization applications. Global Data Systems is hosting the Centricty software using InstallFree Bridge virtualization technology. Pentucket is a 400-provider, five-location multi-specialty group.

The AMA notes that more and more doctors are Tweeting, typically to extend their Web presence, enhance patient communication, expand their marketing efforts, and/or to communicate with their colleagues. Like most users, physicians tend to stop regular Tweeting within 30 days of creating an account. Will Twitter become a standard aspect of practicing medicine in the 21st century, or is it just a fad? The jury is still out.

A week-long computer glitch at Ohio’s state medical board kept 5,000 physicians from renewing their licenses online by the June 30 due date, forcing them to drive to Columbus to avoid having their licenses lapse. The medical board has extended the deadline by a week for those who weren’t able to renew.

I had my own computer glitch Tuesday. We are working on several new interviews with interesting HIT folks for HIStalk Practice and HIStalk. My recording software failed me in a very compelling interview with a physician who offered some excellent insights on using technology to improve quality of care. I’m hoping he’ll forgive me and give me a chance for a “do-over” so readers can learn his views on software usability, making better use of practice management software tools, and CCHIT certification (hint: he thinks it is irrelevant and unnecessary).

Three western NY health insurers hire HEATHeLINK to implement a program to get 500 physicians on EMR within the next three years. HEALTHeLINK will help select the vendor software packages that physicians can choose from and guide them through implementation.

In New York City, over 1,100 physicians are now participating in the city’s Primary Care Information Project (PCIP). Over $20 million in city, state, and federal monies have already been spent to subsidize eClinicalWorks systems for doctors serving Medicaid patients and the uninsured. Several hundred providers more are in the pipeline awaiting implementation.

Here’s a new service that leverages the growing telemedicine trend. DoctorsonDemand.com allows patients to connect with available doctors for short virtual visits via phone or the Internet. Patients are required to have an initial in-person visit with a participating doctor before being eligible for a Tele-Consult. Patients are billed $35 for each virtual visit.

The Children’s Hospital of Denver names Navicure the exclusive clearinghouse program for its PedsConnect program. PedsConnect is an integrated EHR/PM solution offered by Epic for use by pediatric providers in Colorado.

An overnight security guard at a Dallas orthopedic clinic is arrested for hacking into one of the practice’s computer and downloading malicious code in hopes of launching a massive computer attack by July 4, which the guard calls “Devil’s Day”. He goes by the nick “GhostExodus" when presiding over his hacker group, “Electronik Tribulation Army”.

The hacker actually seems pretty sane compared to this guy. I’m all for DIY projects, but the obvious question here is, “why?”

E-mail Inga.