News 2/12/09

US physicians utilize EMRs at lower rates than several other advanced nations, including the Netherlands, New Zealand, the UK, Australia, and Germany. As of 2006, 28% of US physicians used EMRs and 15% received alerts from them to provide patients with test results. The Netherlands had 98% utilization.

Greenwood Pediatrics (CO) chooses Eclipsys PeakPractice as its new PM/EHR solution. The 10-doctor group opted for the former MediNotes product over a hospital-subsidized Epic solution.

A new KLAS research report claims that more hospitals are looking for aggregation solutions that provide a more complete view of medical records and documentation. Such solutions would help clinicians improve patient safety. The report names six vendors that account for 85% of contracted deployments, with MEDSEEK owning the largest installed base. KLAS concludes the solutions from Microsoft and dbMotion are the most functional. The other top vendors include Medicity, PatientKeeper and CareFx.

Clinicians override more than 90% of drug interaction alerts and 77% of drug allergy alerts, according to a study that concludes electronic alerts as deployed today are more of an annoyance than a valuable tool.

A Princeton economics professor calculates that Americans age 15 and older spent an average of 1.1 hours a week obtaining healthcare in 2007. The figure includes travel time to see the doctor, waiting to see the doctor, the examination, taking medication, obtaining care for others, and paying medical bills. He concludes national healthcare costs are underestimated by 11% by not counting waiting time.

A study finds that found most Medicare programs designed to improve the care of chronically ill patients failed to reduce hospitalizations and save costs. Thirteen of the 15 CMS demonstration programs that included patient education, monitoring, and tracking wellness measures failed to influence hospital stays, while none of the 15 reduced Medicare cost.

Lawson Software announces that MedicalEdge Healthcare Group has licensed Lawson QuickStep Healthcare, HR Management, and BI suites. The Dallas-based practice management group supports over 1,000 providers.

Think all that economic stimulus talk is sincere and well-intentioned? This lobbyist isn’t satisfied that compromise rollbacks reduced the HIT portion of the kitty from $23.9 billion to "only" $21 billion. "Sometimes you have to lose the battle to win the war. We want to see the Senate pass this agreement and we will work during the negotiations this week to restore some of these savings." His lobbying firm lists no healthcare IT-specific vendor clients, just big hitters like Cisco, HP, IBM, Microsoft, etc. so they must be planning to get themselves stimulated.

Regional Cardiology Associates Medical Group (CA) selects the SRS hybrid EMR for its six-office, 22-provider practice.

The AMA joins other doctor and consumer groups in suing Aetna and Cigna, claiming the insurance companies intentionally rigged the data they contributed to the Ingenix "usual and customary" out-of-network rate calculator, thereby lowering physician payments. The insurance companies pout: "We’re disappointed the medical community has chosen to litigate on top of already pending consumer litigation on the same topic," said an Aetna spokesperson.

When Good Doctors Go Bad, Episode 1: the orthopedic surgeon of baseball star Barry Bonds and an upcoming witness in Bonds’ steroid trial is the subject of a restraining order filed by Dr. Michael Eiffert in a spat that took place in California hospital. Eiffert told a reporter that the surgeon exhibited "roid rage" behavior consistent with steroid-induced anger, but later clarified that he had no way to know whether the surgeon was juiced. The surgeon made a comment to Eiffert by telephone, prompting Eiffert to call him a "ding dong who was giving alcohol to a patient," referring to an incident in which the surgeon was accused of making in-hospital cocktails for a patient Eiffert was treating for alcoholism. According to Eiffert’s statement, the surgeon held him to a wall by the neck, threatening, "I’ll kill you. I’ll crush you. You don’t know who I am. I’ll kick your ass. And don’t ever call me a ding dong again." I can’t say for sure it’s the same one, but Michael Eiffert, MD is president of Palo Alto-based MyHealth Inc., and holder of a 2003 patent (warning: PDF) on computer-based patient treatment and monitoring plan.

A former office manager in Maryland faces charges for allegedly stealing over $100,000 from her OB/GYN employer via unauthorized credit card charges and outright theft of cash.

Now that the Senate has passed their version of the economic stimulus package, lawmakers must resolve differences between the House and Senate versions. Within the healthcare IT portion, some of the major differences include:

• The Senate bill would provide about $21 billion for health IT, while the House bill would provide about $20 billion;
• The Senate bill includes less stringent patient privacy provisions and directs HHS to issue rules addressing the disclosure of patient information, while the House bill includes provisions limiting the sale of patient data and the sending of fundraising solicitations without patient consent; and
• The Senate bill allocates about $3 billion for the Office of the National Coordinator for Health IT, while the House version includes $2 billion for ONC.

The Allscripts-Misys Healthcare board of directors approves the repurchase of up to $150 million in common stock over the next two years. Under the buy-back plan, Misys PLC has agreed to sell Allscripts the number of shares required to maintain its current stake in the company. Allscripts also announced it plans to sell its Medication Services business.

Unity Physicians Group (IN) lays off 38 people and closes its call center. Unity provides staffing at several emergency departments in Bloomington, owns and runs six urgent care centers, provides billing services for physicians, and hosts software applications. A company news release says the restructuring was undertaken to “make it more efficient and lower its operating expenses.”

A man accused of stealing a University of Utah backup tape from a courier’s car receives a one year jail sentence.

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Joel Diamond 2/11/09

You know that you’re getting old when your kids laugh at your original iPod, calling it an antique. It’s only six years old. My original EMR is a little older than that.

Now that I’m merging practices, I’ll be transitioning to a new EMR. Although it’s probably just the natural progression of being an early adopter, moving to my second EMR adds to my angst about aging in a modern world.  

Learning a new system has been a bit humbling. I can recall the days of my first implementation and the frustration of being out of my groove while caring for sick patients. We are after all, creatures of habit, and transitioning EMRs is not that dissimilar to moving from paper to computer. It also reminds me of the inefficient work-arounds that one accepts over the years.

Sometimes the effort needed to make change seems greater than, what in reality, is merely a minor adjustment in workflow. Designing templates again from this fresh perspective is great, and for those of you who haven’t tried this, I can assure you that the creative process is invigorating. 

Overall, I would report that the good news when learning a new system is that the learning curve is much more manageable. This is mostly due to the fact that, aside from some minor differences in the user interface and some new bells and whistles, the overall user experience has not changed much in all these years. I guess, though, that this is also the bad news.

Contrast the change in the iPod user’s experience over a shorter period of time. In 2004, the first iPod Mini came out, soon followed by the iPod photo (in color!). The tiny IPOD shuffle came out just a year later, which was soon followed by the iPod Nano. The current iPod  Touch was announced in September, 2007.

The popularity of the iPod is clearly due to its continuing emphasis on aesthetics, while making sure that it fits into users’ varied activities and changing lifestyles. Basically, a cool interface, with an ability to easily download endless new apps, has tremendous appeal. Furthermore, the ITunes software lets users seamlessly transfer data between systems.

Now without carrying the analogy too far, can you say the same about  your EMR?

The truth is that as far as gadgets go, EMRs are still geeky and haven’t attained the coolness factor associated with BlackBerries and iPhones. When EMR vendors can reflect the same consumerist mentality, we’ll need far fewer incentives to promote adoption.

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh Medical Center, and a practicing physician at UPMC.

News 2/10/09

A reader forwarded a letter supposedly sent by PNC Bank in Pittsburgh that indicates that it will shut down its Xpack electronic claims and transaction management system this summer.

Dr. Trent Pierce, chairman of the Arkansas State Medical Board and apparent car bomb victim, appears to be on the mend, although still in critical condition. Authorities don’t yet have a motive or suspects.

If you are interested in what you may have missed at last week’s TEPR meeting, check out Nick van Terheyden’s post on HIStalk. Though attendance was down over previous years, Nick did find a few bright spots, including the opening session:  "The opening sessions were great, and like or not Adam Bosworth’s views on where to spend the $50 billion stimulus, he had a compelling story that was not about technology investment (surprising for an acknowledged pioneer of XML) but centered on incenting behavioral change in the US population to stop the epidemic increase in American waists. But it was the Illness in the Age of “e” hosted by Danny Sands from Cisco and his patient Dave deBronkart that stole the show."

Greenway Medical Technologies and Navicure announce that both are expanding their offerings to include more integrated solutions and services. Sounds like a solid match, given that both are "Best in KLAS" award winners in their respective areas.

A bookkeeper being paid $100K a year by a six-doctor ophthalmology group and left alone to manage their payroll pleads guilty to stealing $783,000 from them by paying herself for 165 worked hours per week. According to court records, "the doctors did not get deeply involved in the financial aspects of the practice."

Penn School of Medicine researchers find that patient information stored in electronic medical records can have new analytical formulas applied that allows generalizing drug efficacy studies to a generalized population, not just those who participate in clinical trials. The study was performed using a UK research database, the extent of which won’t be available in the US for several years.

EMR vendor Bizmatics partners with PhyLogic, a national billing service and revenue cycle management company. The collaboration allows both Bizmatics and PhyLogic to offer and integrated EMR and PM solution.

The Detroit paper details the growth of eVisits and other online medical tools in Michigan. Henry Ford Health System reportedly conducted an impressive 30,000 eVisits last year. Insurance companies are reimbursing doctors between $20 and $30 a visit.

Outer Cape Health Services (located on the tip of Cape Cod) lays off eight employees in a cost-cutting measure. The laid off workers include both full and part-time clinical employees managers,  and support service personnel.  The medical group employs more than 100 people.

Marshfield Clinic (WI) selects SAP Business Objects XI intelligence system. Marshfield plans to use the BI tool to improve patient care and to analyze internal business operations.

iTMP Technology introduces new technology that will allow an iPhone or iPod to double as a heart monitor.  The $150 SMHEART LINK is a wireless bridge that collects data from sensors, such as heart rate monitors, and sends it to the smartphone via Wi-Fi. It appears they are targeting the fitness world, but it will interesting to see if it is accurate enough for clinical use.

Nuance Communications, makers of Dragon Naturally Speaking and dictation/transcription systms, announces Q1 results: revenue up 11%, EPS -$0.10 vs. -$0.08.

Lawyers are getting electronic medical records before many doctors. We’ve written about them before: a company’s new site that allows personal injury lawyers to obtain medical records directly from participating doctors.

What will be the effect of IBM’s announcement that it’s launching new technology to automatically import data from medical devices into PHRs and EHRs?  It definitely indicates that IBM is wanted to grow its healthcare footprint. It also provides more proof that the tele-health and remote monitoring market is growing.

A patient who failed to pay Carle Clinic’s six-figure medical bills by filing bankruptcy and then incurring another $30,000 unpaid bill for defibrillator implantation is upset that he’s not welcome back, calling the private practice "money-hungry" for declining to treat his other conditions. The nonprofit Carle Foundation Hospital wrote off what he owed it, so he offered the clinic $50 a month toward the $30,000 with no interest charges, which would require 50 years to pay off (he’d be in his early 100s by then). He says that’s all he can afford out of the $36,000 a year he and his wife make. So what do you do?

This Computerworld article highlights some of the struggles of rolling out an electronic health record. No surprise here, but younger doctors prefer using technology and older docs prefer doing things manually.  A bit more surprising was the admission from the director of IS at Midland Memorial Hospital that they paid doctors $1,000 each to participate in EHR training. Midland uses Medsphere’s OpenVista system, so I guess when you go with free software you can afford to pay doctors to use it.

Here is an interesting practice model discussed at last week’s TEPR meeting. Greenfield Health (OR) has designed its practice to be patient-centered, both physically and operationally. The practice has invested heavily in IT (EMR, PHR, e-mail) and patients can walk right in and see a physician or staff member without sitting in a waiting room. The practice takes Medicare and most commercial insurance. And, Greenfield Health charges a retainer fee of $250-$650 a year per patient to ensure the practice remains small. The practice also has a consulting service on the side.

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Intelligent Healthcare Information Integration 2/6/09

Go Big by Thinking Small

I don’t know about you, but this whole economic meltdown has me worried. I’m worried for my family, for my little local hospital, for my little rural community, for my practice and the families we serve, for the future of healthcare …

OK, ‘nuff said about my anxieties. On to a solution or two.

(I hate whining. That’s for depressing, “poor me” chats over a beer or three. As the testosterone-laden male that I am, I want to know the problem, sure, but mostly I want to know how we go about fixing it. So, now, where’s my toolbox?)

Speaking of my tools, history is one of my greatest wrenches. Utilizing the lessons hard won from days gone by, I believe you avoid silly missteps and can tighten up many a loose nut which you might otherwise miss. (Please hold your “loose nuts” comments until the end.) I also believe many “advanced” minds often overlook the power of historical context and reference.

Currently, I am praying daily that the new Obama administration folks don’t neglect their history lessons as they approach the absolutely monumental challenges before them. Recent HIT efforts/failures and the Great Depression can provide clues to some serious answers for our current healthcare, environmental, and even economic woes, if we heed their warnings. With this in mind, I’d like to offer them an absolutely brilliant solution designed to:

1. Deliver the 70% of the population currently being ignored by most HIT projects;
2. Enable the NHIN goal for all Americans, utilizing a tool we already have;
3. Minimize the impact of more technology upon the already strained electrical power grid;
4. Provide jobs and lower healthcare costs;
5. Stimulate PHR participation while providing a tax break to all, and;
6. Eliminate all forms of STDs from the entire planet.

Yes, just stretching it a bit on that last one, but drop dead serious about the rest. Kidding? Nope. Not even a little. While the naysayers out there will poo-poo such grandiose proclamations, if the rest of you will willingly suspend disbelief for a moment, I will explain, very succinctly, after two short points.

First, small communities and their associated community hospitals provide care for some 70% or so of the U.S. population. They have been virtually ignored by the past 25 years of HIT development. They’ve been awaiting the trickle down from big medical center/large regional/big money projects. It has been a long, boring wait with no brass ring in sight. And now, the global economic crisis threatens them even more.

Second, the big boys and their big-money mindsets are notoriously neglectful of the little people. Their big projects often don’t provide down-scalable answers that work well for smaller markets. However, as many a grassroots phenomena illustrates (recent evidence: Obama campaign), starting with an answer from the little folks can absolutely engender big, even huge results for everyone.

Consider this:

1. Begin to build the national health information database using a system we already have. If they’re already planning to provide a tax break, build in an incentive for extra bucks for those who opt in and provide some basic demographics and maybe allergy history to a national healthcare database. Why not use the IRS? Who has more info on everyone already? (OK, CIA aside). They already have a national electronic input form; all you’d need is something similar to the check box they use for donating a dollar to the presidential campaign.
2. Develop a small community HIT mindset. Start with a system designed for the end user, a basic EHR/PHR combo that provides end user satisfaction and doesn’t try to compete with the big boys doing everything for everybody. Push this inward toward the hospital and outward toward the community at the same time allowing everyone in the community to go through the growing pains together. People are empowered by, and engaged with, their communities; use this to provide mass motivation to all of a given community’s doctors, hospitals, and individuals — all together, all at once. Patient-centered, but community-driven.
3. Use open source as much as possible. Save taxpayer dollars. (Sorry, all my HIT vendor friends).
4. Associate green technology with HIT deployment. Every new computer component in every doc’s office, home, or hospital is going to add to the already overburdened power grid, not to mention add to electric bills we all have trouble paying. Offer incentives to add a solar panel or micro wind turbine for each new system, residential or commercial. It may not lower your heating costs, but it could offset any increase in power consumption.
5. Use small business incentives to develop small community employment to deploy, train, and service these new technologies. Provide jobs for people to help us ‘technologize’ healthcare, contain our energy demand, and create the real NHIN from the grasses’ roots up.

Large problems need gigantic answers. But that doesn’t mean it has to be from or for the giants. Little guys, in little communities, eventually all working together can generate an unstoppable force.

Don’t just throw money at the big boys. Go big by thinking small.

Dr. Gregg Alexander is a grunt-in-the-trenches physician and admitted geek. He runs an innovative, high-tech, rural pediatric practice in London, OH, and can be reached at doc@madisonpediatric.com.

News 2/5/09

West Memphis, AR police call Wednesday’s car bombing of the chair of the state’s medical board a terrorist attack. A bomb was placed in or near the Lexus SUV of family practice physician Trent Pierce MD, which exploded in his driveway. He’s in critical condition.

The VA’s MyHealtheVet PHR wins the best PHR ward at TEPRs. The top "Hot Product" award went to the Private Access suite of solutions.

RelayHealth launches a new insurance payment reconciliation service for healthcare providers. RelayReconcile Payment Services converts paper EOBs into electronic remittance advice (ERA) files, and then reconciles the ERAs with bank deposits. Providers are able to automatically post payments to their patient accounting system.

A Reno federal judge rules that state laws and the federal privacy act do not prevent the questioning of a doctor of someone involved in a lawsuit. The case involves a wrongful death suit against a pharmaceutical company. The pharma lawyer calls the ruling a "dangerous precedent" that violates Nevada’s privacy rules. The ruling might end up in appeals court.

A group planning to rate doctors using their individual Medicare data is thwarted when an appeals court overturns an earlier warning that required the federal government to turn the data over.

Henry Backe, MD tells the Senate Banking Committee that his practice’s retirement fund lost $11.6 million as a result of the alleged Ponzi scheme run by Bernard Madoff.  Fifteen physicians and 125 staff members from the Orthopaedic Specialty Group (CT) will likely recover a mere $500,000 of their total investment.

iPhone now offers 745 different applications in its healthcare and fitness categories. Inga’s kind of geeky about variety of applications available, which include calorie counters, pedometers, and blood pressure trackers.  For $49.99 you can also purchase My Life Record PHR.  It looks cool, but when we decide to actually use a PHR, we’ll probably go with one of the freebies.

A Kansas doctor accused in 59 overdose deaths is found to be connected to Cephalon, makers of the Actiq fentanyl lollipop. The company was charged with over-marketing the highly addictive drug for routine conditions such as headaches and paid $425 million in settlements and fines. One of the doctor’s patients died of fentanyl intoxication; the family is suing the doctor and the drug company.

And, speaking of PHRs: User Centric releases the results of  an independent study comparing the usability of Google Health and Microsoft Health Vault. The 30 participants preferred Google Health, finding its navigation and data entry was easier and utilized more familiar medical terminology.

Humana becomes the first insurance company to support MGMA’s Project SwipeIT, a standard, rigid, machine-readable insurance card that could save up to $1 billion per year.

An osteopathic surgeon who generated 125 medical malpractice lawsuits over a seven-month period files a $50 million lawsuit against his lawyer. John A. King, DO claims his attorney is guilty of negligence, legal malpractice, and breach of contract.  King apparently has an extensive history of suing hospitals who terminated his privileges, medical boards who took away his licenses, and lawyers he hired to represent him. Wow. How did he have time to practice medicine?

Both the American Academy of Family Physicians and the American College of Physicians are encouraging lawmakers to support healthcare in any economic stimulus package. Among other projects, the organizations are recommending support for HIT initiatives.

An Allscripts survey finds that physician groups are overwhelmingly happy to take federal stimulus money to use toward EHR adoption. Less consensus was found in what form the payments should take — being paid to buy EHRs or being paid to use them. Two-third of doctors said they would participate in a pay-for-purchase program, and not surprisingly, practices that already have EHRs think Uncle Sam should reimburse them retroactively. Survey flaws: only 15% of the respondents were actual providers; the rest were administrative staff. EHR users made up 60% of those surveyed, far outpacing overall adoption. And, the response rate was less than four percent. That’s not a criticism of the survey, just the usual cautions about drawing conclusions from it.

A new Institute of Medicine study concludes that the existing HIPAA privacy rule does not protect privacy as well as it should.  Also, as currently implemented, HIPAA impedes health research.

Cielo MedSolutions announces a 300% year-on-year increase in revenues in 2008 and a 400% increase in its client base. Cielo, started in 2005, provides clinical management systems to help ambulatory care providers improve, document, and report on clinical care initiatives.

Now that Daschle is out as HHS secretary candidate, will HIMSS withdraw its formal (as opposed to informal?) letter of support?

An AHRQ report finds that patients who clearly understand after-hospital care instructions are 30% less likely to be re-admitted or visit the ER. Also, costs for hospitalization and outpatient expenses are, on average, $412 lower for patients who receive complete information.

The Texas State Attorney General charges a  now-defunct imaging center for failing to retain mammogram results and copies of patient records for the required minimum for five years (or 10 years if no additional mammograms are performed at the facility). Central Imaging Center in Brownsville sold a large number of old screening films to a silver refinery business. The imaging center’s owner is now faced with penalties of up to $25,000 for each violation. (Inga is obsessing over the possibility that her silver jewelry may have once been a breast x-ray.)

Our HIStalkPractice readership continues to climb higher every week, so thanks for reading.  Feel free to sign up for e-mail updates if you haven’t already – just put your e-mail address in the Get Instant Updates box to your upper right. We already have several sponsor commitments (thanks!) and will continue offering introductory rates through the end of February. Contact Inga to learn more.

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