News 06/30/09

The AMA and over 80 other physician organizations send David Blumenthal a letter expressing concern over the proposed timeline to demonstrate meaningful use. Some of the challenges noted are the lack of certifiable EHRs for certain specialties and the length of time it requires to fully implement EHR. Also at issue is the migration to HIPAA 5010 transactions and ICD-10.

Rep. Kathy Dahlkemper, chairman of the House Small Business subcommittee on health care proposes a bill to create a new SBA loan program to help doctors in small or solo practices to buy and maintain EMRs. The program would rely on private sector loans of up to $350,000 and $2 million for groups and be 90% backed by the SBA.

The local paper highlights Walla Walla (WA) Clinic’s conversion to Allscripts’ EHR. The 39 physicians paid more than $1 million in start-up costs but believe it is “the right thing to do.” The clinic CIO admits the EHR transition is difficult, saying, “It’s like changing the motor on the car while its driving down the road … and keeping it running good.”

A former business manager is sentenced to 40 months in prison for stealing almost $1 million from her ophthalmologist employers. The Pennsylvania woman submitted bogus payroll information, including claims of working 22 to 32 hours a day, seven days a week. She spent the proceeds on a $1.6 million home, luxury cars, and private college tuition for her children.

Small medical practices provide almost three quarters of the the ambulatory care in the US, according to a recent NCQA report. Smaller groups are more likely to lack the resources to improve quality of care, implement EMRs, and serve an increasingly diverse population.

EHR provider Sevocity announces the the availability of a no-charge interface to Austin Radiological Association’s (TX) radiology reports. In what appears to be a creative strategy to gain market share, Sevocity is offering the free interface to any of its clients. Austin Radiological operates 14 outpatient radiology clinics in central Texas.

The Wall Street Journal highlights the growing use of online communication between patients and physicians. RelayHealth and Medfusion are mentioned as companies offering interactive questionnaires that automatically generate follow-up queries based on the patient’s symptoms.

Two doctors and the former owner of two medical billing companies plead guilty to a money laundering, tax evasion, and fraudulent medical billing scheme to defraud no-fault insurance companies that provide medical benefits to motorists involved in collisions. Among other charges, the group pled guilty to concealing $1 million in income from the IRS.

Diagnostic Center of Medicine (NV) selects Allscripts PM as a replacement for its Misys practice management system. The 16-provider, three-location practice is also adding the Allscripts EHR.

The AHRQ considers the development of an electronic toolkit to assist small and medium sized practices change their workflow when adopting HIT. The AHRQ just issed an RFI to gather information on how clinics and physician groups redesign their workflow when adopting technology.

HIStalkPractice readership continues to climb, so thanks for tuning in. Make sure that you sign up for e-mail updates so you don’t miss a thing. And, if you have an interesting EMR story to share or know of a physician using technology in a creative way, let us know.

E-mail Inga.

Intelligent Healthcare Information Integration 6/27/09

A Willing Suspension of Magical Thought

Actors and playwrights know that “a willing suspension of disbelief” is essential for the successful acceptance of any fiction. Such faith allows us to enjoy the greatest of entertainment, be it Samuel Beckett’s “Waiting for Godot” or Matt Groening’s “The Simpsons.” Without a willingness to forego our skepticism and socially inculcated, rules-based orientation, we would forever be ingrained in a world of columns and rows and formulaic drudgery.

This is the essence of “magical thinking.” It allows us escape from our cubbyholed, preconceived mindsets. It enables flights of fancy, free association, and the perception of the possible. It is enabled from birth (genetically programmed?) as evidenced by watching any child at play. It allows us some of our greatest kidhood fantasies and fears. (Think: Santa, Tooth Fairy, Easter Bunny, Boogey Man, and all those monsters under your bed.) Magical thought allows magicians to amaze us and artists to enthrall us.

Unfortunately, that same ready power of mental delusion is what also allows us to believe that politicians really do mean what they say this time, that bankers really can self-regulate themselves adequately, that insurance companies are there for our protection, that technology can solve our healthcare crisis. It permits the fantasy that ARRA money will wind up helping heal healthcare and not just bulking the bankrolls of EHRco bigwigs and bolstering Insco bottom lines.

I love my fantasies as much as anyone. I would absolutely love to believe that information technology will put a period to my pen-and-paper-based problems, end my seemingly ineluctable non-electronic errors, provide instant access to the information I need as I need it, give me gobs of great evidence-based new brain power, and stop the shrinkage of my already skinny sliver of practice profit. However, I am unable to relinquish the disappointing deduction that the current rush toward IT as the “end all, be all, cure all” for healthcare is poorly planned at best and an impending catastrophe at worst.

For those who live and work in highly technical worlds, where the people you see daily are digitally oriented and adept, it is probably not an unreasonable reach to assume all things digital are possible. But, when I drive around my little corner of middle America, I see loads of folk whose electronic skill sets are likely limited to TV remotes and ATMs…at best. Where I work, I encounter colleagues who would love the aforementioned techno-advantages, but who barely have enough time to unravel the mysteries of CPTs and ICD-9s, no less the quandaries of an entirely new EHR-demanded workflow. Where I practice, I live the daily dilemmas of bringing the non-techno-literate along as we endeavor to navigate our way across the digital divide.

In considering this piece, I Googled “magical thinking” which brought me immediately to a great article by Gilles Frydman with comments and links to related pieces by such HIT notables as David C. Kibbe, Sarah Greene, John Halamka, and e-Patient Dave. Agree or not, all are worth a read, though perhaps the best, from the view of a grunt in the trenches, was a shorty by e-Patient Dave where he highlights the neglect of the everyman in this HIT stampede. 

I want this brave, new, digital world for healthcare as much as anyone, but authentic and concrete, with real value for everyone, not just the fat cats and CEOs. Let’s suspend the magical thought and deliver truly “meaningful use” to my neighbors, Joe and Josephina Sixpack, not just the technorati.

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 06/25/09

From: Al Borges “Re: New CCHIT certification options. CCHIT is simply trying to defuse the argument that certification costs too much. The only thing is that: the cost of earning the certification can be overwhelming; most folks that have non-CCHIT certified EMRs don’t care about CCHIT nor do they care about HITECH; and, they still shut out commercial non-c-EMRs out there in the market. Other countries are way ahead of us, and none of them rely on CCHIT, even though Canada, Europe, and SE Asia did try to do certification schemes like CCHIT.”

Epocrates claims its mobile clinical reference software is the most helpful safety technology for physicians. Sixty percent of the 2,000 physicians they surveyed reported avoiding at least one adverse drug event per week using the Epocrates software. About one-third of US physicians use the application.

Physician compensation did not keep up with inflation last year, according to an MGMA survey. Primary care doctors reported a two percent increase in compensation (or –1.73 percent adjusted for inflation.) Specialists saw an adjusted decline of 1.59%, with internal medicine faring the worst with a 3.37% adjusted decline. Gastroenterology and pulmonary medicine were among the few specialties posting moderate compensation gains.

On the rise: the use of signing bonuses to attract new physicians. Eighty-five percent of searches offer a signing bonus, which average $25,850.

Signing bonuses may be the key to replacing older family practice physicians practicing in rural communities. Eighty-one year Dr. Kenneth Spady says he can’t find anyone willing to take over the rural Washington health clinic he’s run for the last 52 years. The suggested reason is no surprise: a shortage for primary care providers as more doctors opt for the higher paying specialties.

Doctors fail to tell patients about abnormal test results seven percent of the time, or a rate of one out of every 14 tests. Practices using EMR had lower failure rates than those using paper. However, offices using a combination of paper and computer records had the worst overall failure rates.

Bridges to Excellence launches five new reward programs to assess improvements in the diagnosis and management of chronic diseases. The programs provide incentives that reward physicians and practices for adopting better systems of care, including the adoption of HIT.  Bridges to Excellence also announced it will utilize IPRO’s Clinical Data Portal to accept chart data directly, or, via an EMR and score data against clinical measures.

For $3,000, ophthalmologists and optometrists can purchase an EHR that incorporates electronic prescribing. Compulink Business Systems is offering the Eyecare Advantage Essentials and E-Rx products, which sounds like an “out-of-the-box” application that does not allow for customization. Compulink also offers an ophthalmology-specific PM plus a more robust and customizable EHR.

HealthCare Partners Affiliates Medical Group (CA) acquires Northridge Medical Group, an IPA serving 24,000 patients in Southern California. With the transaction, Healthcare Partners Affiliates Medical Group will include 1,200 employed and affiliated physicians and server over 680,000 patients.

Massachusetts takes top honors at Surescripts’ Safe-Rx Awards, which recognize the top e-prescribing states. Massachusetts providers send 20% of prescriptions electronically, followed by Rhode Island at 17%. Vermont was named the most-improved state. Surescripts also recognized the top individual e-prescribing physicians, include three using stand-alone e-prescribing software and three using EMRs. Interestingly, 44% of Vermont’s e-prescriptions were generated by Allscripts users, as were three of the six top prescribers. A fourth provider utilizes Eclipsys Practice Solutions.

The high rate of EMR de-installations in the Phoenix area leads analysts to conclude that small physician groups need solutions that are more simple and affordable. Though the Phoenix market at one time was adopting faster than other regions, de-installations are now rising as physicians complain of training, functionality, and cost issues. Is this a trend unique to Phoenix or something we will see repeated across the country? I predict the latter.

Does technology create a new etiquette for physician-patient interactions? Those of us in HIT focus on how technology changes the way physicians practice medicine. This article points to some of the ways patient behavior is and will evolve as technology seeps into the clinical world. Patients must be increasingly assertive, especially if their doctor has his/her back turned entering information into a computer: patients must be sure to communicate any visual cues their physician might miss. Patients are now armed with more clinical data, thanks to the Internet. Physicians should be prepared to address questions from more educated patients. And, as patients have more access to their own records, they will bear more responsibility for monitoring the accuracy and completeness of their information.  Just ask e-Patient Dave.

E-mail Inga.

News 6/23/09

From Evan Steele: “Re: new CCHIT proposal. Finally, people are listening to the voice of the physician. The recognition that the original CCHIT certification may be overkill for many practices, particularly specialists, and unreachable for others is a positive step. Gayle Harrell made some very salient points at the HIT Policy Committee meeting last week. She cautioned against placing such an extensive burden on physicians that they simply do not adopt an EHR at all, warned that the definition of ‘meaningful use’ must be achievable, and reminded the Committee that specialists should not be left out. We know from the comments on blogs like yours that there is a silent majority out there who are starting to speak up.” Evan is referring to the new recent CCHIT announcement that it is considering three certification approaches to replace its current single one. The options would include EHR-C, a rigorous certification for comprehensive EHR systems; EHR-M, a module certification program for e-rx, PHR, and other technologies; and, a simplified, low-cost option for providers who self-develop or assemble EHRs from non-certified sources.

Beth Israel Deaconess Medical Center embarks on an “open notes” project that will permit patients to read the charts of about 100 doctors. The $1.5 million project aims to understand if having patient notes available online proves to be more useful than objectionable to those patients. I’d definitely read my notes online, though I’d mostly be looking for any suggestions the doctor thought I was fat/stupid/unattractive, etc. Or, perhaps paranoid.

Practice management consultants recommend that physician offices accept credit cards, despite their 3-5% transaction fees. More practices are refusing to accept them, but consultants say they’re worth it compared to the expense and hassles of issuing paper statements and collecting bounced checks.

CMS announces that additional physicians may qualify for 2007 PQRI bonuses, following an investigation of the feedback reports and incentive payments. CMS identified some technical issues that could be corrected. Revised reports will be available to eligible physicians by the fall.

Three Cleveland community health centers are preparing for EMR in advance of pending stimulus funds. The three clinics will receive a combined $2.7 million for EMR and other capital projects. One clinic has already selected NextGen; the other two have narrowed their choices to NextGen and EpicCare.

According to this RWJF study, personal health records provide clinicians and patients insights into daily life that aren’t available solely through clinical encounters.

RelayHealth announces a strategic partnership with Lighthouse1 to help providers automate payments for patients with healthcare spending accounts and consumer driven healthcare plans. RelayHealth will integrate its EasyCDH solution with Lighthouse1’s OnDemand  platform to create the SAS OneCard solution.

CMS names NextGen a qualified PQRI patient registry for 2009, meaning their solution will help eligible physicians submit data based on PQRI quality measures direct to CMS.

Louisiana passes a bill that will set aside $5 million to provide EMR loans to providers (or more accurately, to give the state access to stimulus money).

Document imaging vendor Scantronix and eClinicalWorks sign a partnership deal. Meanwhile, ECW founder and CEO Girish Kumar Navani takes home an E&Y Entrepreneur of the Year Award in New England’s healthcare technology category.

Here is a shocker: patients are at a greater risk of obesity when there are more fast-food restaurants than grocery stores close by. I am thankful that this study is courtesy of the Canadians because I would have been miffed to see my tax dollars spent confirming something so intuitive.

The AMA provides a great list of the the most common and avoidable mistakes for physicians buying an EMR. The single biggest error: doctors not listening to other doctors and learning from their mistakes. Some of the best tips include taking a site visit, checking with practices other than the references provided by the vendor, and allowing for plenty of training.

MGMA reports that the starting salaries for physicians in many specialties are on the rise. Neurologists saw the biggest gain, from $200,000 to $230,000 a year, which is a 15% jump. Neurosurgeons earned the highest salary at $605,000 while pediatricians earned the lowest at $132,500.

Dr. Jay Parkinson is busy developing Facebook-style software for his start-up company Hello Health, a national franchise of clinics he is building that allows patients to e-mail, text, or video chat with doctors over a secure website. His Hello Health website debuts this summer. Mr. H interviewed Dr. Parkinson in 2007, back while he was still practicing and making house calls. Meanwhile, the company’s three-doctor demonstration clinic has treated 700 patients in the last year and 400 have become regular patients. Member patients pay $35 a month, which covers simple e-mail questions, and $100-$200 per office visit (and patients file their own insurance). Time will tell whether or not the model is financially sustainable and if it will attract enough patients and doctors.

E-mail Inga.

Intelligent Healthcare Information Integration 6/20/09

Pool Pumps and EHRs

Never having owned a swimming pool before — kiddie blow-up pools notwithstanding –I had no clue about anything pool when we moved to a home with our first “cement (pronounced “see-ment”) pond.” Being in Smalltown, Ohio, where ‘pool guys’ are something we only hear about on Nip/Tuck, I had no options other than to learn my way around pool care, including chemistry, biologicals, skimmers, hoses, filters, jets, and pumps.

Turns out the pool pump we inherited, besides being old and inefficient, had been wired poorly and was using far too much juice. When our summer electric bills pushed us toward bankruptcy, I studied up on newer pools pumps and decided to purchase a “smart” pump which promised “up to 90% savings” on our electricity tab.

Savvy enough to have a certified-smart, real electrician convert my wiring run and circuit breakers from 120 volt to the required 240V, I chose to do the actual pump installation and final wiring to the outdoor switch on my own. (No, this isn’t leading to a tale of emergency squads and defibrillations!) With a broad smattering of electrical and electronic training and a general understanding of electrical codes, hots, grounds, and safe wiring habits, the job was not the greatest of challenges but was still not the simplest or least nerve-wracking of installations. Fortunately, it powered up without a spark and seemed to work.

Afterwards, I relaxed in the hammock listening with some small sense of self-accomplishment to the much more muted hum of our new, high tech, energy-saving, self-adjusting, computerized pool pump. But, now, with the new, high end tool online and operational, I still had to figure out just how to decipher and adjust all of those new pump-puter settings and codes to optimize my chances of achieving the 90% savings advertised.

The manual seemed complete, all 60 pages of it. Predictably, though, the typically poor tech writer-to-lay person interpretation skills were in full swing, so I found myself looking online for deeper insights and better explanations. This did help, but I’m still not sure if I am using, or even understanding, all of the available digital tweaks and tools this of fancy new gizmo.

You see, I’m sure, where this is heading. With something as relatively simple as a pool pump and with someone who has a generally workable background in electronics and computers, the challenges of digitization and the learning curve for its incorporation are not irrelevant, not even minor. Why, then, is it such a surprise that medical providers, who typically boast minimal-to-no I.T. background, have such trouble adopting, no less understanding, VASTLY more complex electronic healthcare tools?

How are healthcare providers ever going to achieve HIT competency and EHR satisfaction … two weeks of on-site training, hard-to-reach support call centers, and a written-by-techies manual? These are the typical answers which most EHRcos have concluded are sufficient to bring healthcare workers across the digital divide. That’s about what most of us could use to competently install and utilize one of these fancy-schmancy, cement pond pumps. I’m thinking a better training, support, and ongoing education plan might be required for the complexities of HIT.

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.