An HIT Moment with … Naomi Grobstein

An HIT Moment with ... is a quick interview with someone we find interesting. Naomi Grobstein, MD owns Family Health Center of Montclair in Montclair, NJ.

You are using several of RelayHealth’s online tools to communicate with your patients. How have your patients responded to having such tools as prescription refills or webVisits?

My patients love to be able to contact me via e-mail. It removes a lot of the frustration of phone menus, inaccurate messages, lost messages, etc. As for webVisits, it hasn’t really caught on much. I’ve only had a few patients use it. Now some insurance companies are covering it, but I’m not sure that is widely known.

How do you see medical practice evolving over the next 3-5 years, given available and potential technology?

I can’t really predict the next 3-5 years. Even what we have now is beyond what I could have imagined. I do hope to get rid of all the piles of paper that still clutter the office and get away from voice phone messages as much as possible.

How would you respond to providers or patients that view these type of online tools as a privacy risk?

That sort of thing is beyond my control. We could have a hurricane, a terrorist attack, or a major privacy breach. I hope the people working at the planning/implementation of these tools considers it carefully just as they have to consider backing up data. We’re all using our credit cards to order things online and yet we know there could be a breach.

Beyond the RelayHealth tools, does your practice use other automation tools such as EMR, practice management, or on-line connections to other data sources?

We have an EMR to do patient charting and messaging around the office, and of course we do electronic billing and banking. Through Relayhealth we do electronic prescribing, and the pharmacy or patient can request refills electronically.

How has the use of technology in your practice affected patient care and satisfaction?

Somehow the expectations rise with the ability to do more. In the old days, the patients were satisfied to get an appointment within a week and they didn’t ask questions. Still, I think my practice stands out for being accessible because of these electronic tools.

News 1/27/09

From Al Stewart: "Re: Allscripts. Didn’t athenahealth’s CEO Bush do this exact interview weeks ago? Tullman and crew must be getting a little slow on the PR front, I guess. Big surprise, he wants Congress to foot the bill upfront for EHRs. Typical big box HCIT CEO speak. Of course, maybe then Allscripts will finally make their numbers …" Link. Allscripts CEO Glen Tullman suggests that federal stimulus money first be used to help buy EMRs, then give doctors (and presumably hospitals) financial incentives to use them. Each of us could argue those points (like the commenters at the bottom of the WSJ article), but I suppose the one argument that’s already lost is whether the government should be pushing commercial products in any fashion, no matter how beneficial their use might be. I’m sadly out of fashion as a free marketer. Actually, Jonathan Bush’s platform is the opposite: don’t spend taxpayer money buying products already available that doctors are passing on for one reason or another (cost, productivity, etc.) but rather spend the money giving them performance goals and let them pick the tools. Both CEOs, naturally, advocate a position that would benefit their respective companies, which is what they’re paid to do.

From Parker Lewis: "Re: government buying EMRs. I hope to God they don’t offer to buy them, or else a bunch of second-tier businesses will stick around when otherwise the market would take them out."

From Bignurse: "Re: 77% of consumers not supporting increased healthcare IT spending. The healthcare community needs to launch a public relations campaign to inform consumers about why healthcare IT is needed and how it benefits them, i.e. PHR, patient safety, better informed physician decision-making, and hopefully, reduced waiting times. Consider the successes of past public campaigns on seatbelts and Medicare Part D, for example." I like the idea, but I’m not sure even providers agree on that (and certainly have inconsistent outcomes in trying to achieve them).

From Doris DeMarco: "Re: Baylor revenue cycle management. It’s being done by MED3OOO."

Medical Records Institutes announces the finalists for the 2009 TEPR Awards. The PHR finalists are CapMed, Doctations, and myHealtheVet. In the Hot Products category, finalists are Doctations, iChart, TapChart, and three products by Private Access.  Winners will be announced at the TEPR+ Conference next week in Palm Springs. Are we the only ones who have barely heard of most of these products? The competition is free to all the exhibitors (67 are listed on TEPR’s Website, including an assortment of magazine publishers, the Social Security Administration, etc.) If you are not exhibiting, you can still participate in the TEPR Awards for a "fee." As nice as it sounds to be in Palm Springs right now, we’ll take a pass.

The so-called HITECH Act (warning: PDF), the Health Information Technology for Economic and Clinical Health Act (man, that’s one contrived acronym) from the House Ways and Means Committee, is one angle at HIT stimulus. It claims that EMR adoption would reach 90% of doctors and 70% of hospitals within the next 10 years. It’s interesting that, despite urging that the stimulus money be used on projects that are ready to go quickly, that HITECH wouldn’t provide any immediate incentives to doctors, and in fact would require them to buy EMRs and get some level of reimbursement later. Doctors would be eligible for $40,000 to $65,000 if they can demonstrate system use through improved quality measures (different from Glen Tullman’s position above, where he thinks EMRs should be bought upfront and rewarded for use with a second round of money later). And here’s the part that every vendor (and therefore HIMSS) hates: "After standards are adopted in 2009, the National Coordinator shall make available at a nominal fee an electronic health record, unless the Secretary determines that the needs and demands of providers are being substantially and adequately met by the marketplace." In other words, unless Rob Kolodner (a VA guy) believes that existing practice and hospital systems are good enough, he can make a low-cost system available. That’s not much of a bold move since the only obvious system fitting those criteria is the VA’s VistA, already free for anyone who wants to burn a CD (but not necessarily easy to install or use).

All of the federal debate begs a question: why would you buy a system now if there’s a chance that Uncle Sam will help pay for it if you wait? If I were a vendor, I would be concerned about dramatic short-term sales dropoffs while waiting for possibly beneficial legislation to pass.

As the economy worsens, doctors are seeing the health of their patients decline as well. Providers are noting increases in headaches, stomach pains, anxiety, and depression, as well as rising blood pressure and increased obesity. Doctors believe the tougher economic conditions are elevating stress levels. Patients are also cutting corners on their diet and exercise, choosing cheaper and less nutritious fast food, and skipping refills of expensive medications.

As hospitals try to remain solvent, some resort to layoffs of employed physicians.  Consultants warn that more physician layoffs and pay cuts could still be ahead.

A Pennsylvania doctor starts a concierge practice, charging 400 patients $1,750 per year ($700K gross), which covers all visits, 24-hour telephone access, e-mail access, and online medical records. Interesting: she doesn’t have hospital privileges since she doesn’t take insurance, but she still is actively involved in the care of her patients when they are hospitalized. Some folks gripe that cherry-picking cash patients just makes the precarious healthcare system worse, but let’s be fair: if it wasn’t for the hassle of dealing with insurance companies, doctors wouldn’t do it.

Robert Gumbiner, a doctor and philanthropist who created the FHP HMO because he thought fee-for-service was immoral because doctors get paid only when patients are sick, died last week at 85.

Big healthcare reform news from China: the government will spend $120 billion to build hospitals and clinics, subsidize insurance costs to get more citizens covered, and improve rural care. The official news agency said, "The health care sector is one of the weak links in China’s social welfare system. Soaring medical fees, a lack of access to affordable medical services, poor doctor-patient relations and low medical insurance coverage compelled the government to launch the new round of reforms." It should not be forgotten, however, that China is wealthy, backward, and Communist, even though their problems are similar to ours.

The current House Ways and Means Stimulus Bill includes wording that would require federally appropriated funds only be spent on CCHIT-certified products. How is that going to fly with all those uncertified EMR vendors and their users?

Sage launches Intergy version 5.5 of its EHR/PM system. Some of the new features includes cardiac device integration, predictive orders management, encounter note wizard, and enhanced e-prescribing capabilities.
 

QxMD announces another cool iPhone application. Safe OR is based on the 19-item surgical safety checklist, A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population.

A study concludes that physicians who participate in online physician communities and social networks write about 24 more prescriptions per week. Good news if you are selling online ads for the pharma companies.

CMS posts the Measure Applicability Validation process for 2009 PQRI, which will be used to determine satisfactory PQRI reporting for participants who achieve a reporting rate at or above 80% for each measure submitted.

Odd: a college student drops by a local podiatry office after seeing an ad for a free nail trim, whirlpool, and foot massage. She finishes up 20 minutes later, fills out a medical form, and heads out. Her mother found out later that her insurance was billed for over $3,200, including charges for five surgical procedures. The doctor’s receptionist told her that anytime the doctor touches a patient’s foot, it’s considered a surgery. Cigna, which paid $616, is looking into it.

The Association of Academic Health Centers calls for a revision of the HIPAA Privacy Rule, claiming the current version has a negative impact on research. The Association cites a recent study that found researchers were having difficulty recruiting participants and that HIPAA created barriers to diversity in research studies.

Doctations and Zynx Health form a strategic alliance to incorporate Zynx’s AmbulatoryCare product with Doctations EMR.  Zynx AmbulatoryCare is a suite of clinical decision support content that includes evidence=based recommendations, order sets, performance checklists, alerts, and reminders.

The owner of a Montana billing service is convicted for mail fraud and filing false income tax returns. Kathleen Hunnewell billed insurance companies and patients on behalf of her healthcare provider clients and pocketed portions of the patient and insurance reimbursements, $225,000 worth over two years. She faces 20 years in prison and a $250,000 fine.

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Joel Diamond 1/24/09

Patient Perspectives on New Technology

I remember a few years ago when one of my mentors in Family Medicine told me that the use of computers during patient encounters would destroy effective communication. "Doctors will pay more attention to the screen than their patients." 

As we strolled down the hospital hallway, I asked him to watch several doctors who were talking to patients with their noses buried in the paper chart. "What do you call that?" I asked. "Charting," he sheepishly responded. I suggested that it was just bad doctoring. 

It reminded me of watching bad surgeons wielding a laser during my training — pure carnage. So while good technology has the potential to turn surgeons into butchers, so can it reduce bedside manner to the lowest form of social ineptitude. Pardon the mixed metaphor, but new technology is always a blade that cuts both ways.

Here’s a different take on the same subject. When I first installed my EMR many years ago, I, too, struggled at times while navigating my way through new templates and would frequently apologize to patients when I forgot to maintain eye contact. Most patients would tell me not to worry — they were delighted that I had made a commitment to improving the quality of their care and were tolerant and appreciative of the obvious struggle. I soon discovered, however, that distraction can have its advantages.

We all have been there — the lovable-but-boring patient who comes in month after month with no real problems other than a need to talk. It’s uncanny how they manage to schedule their visits on the busiest, most stressful days.

During one such encounter, I started to wonder if I could perhaps multitask a bit. My new EMR had electronic messaging. Would it be possible to take care of a few refills while my patient was droning on about the amazing coincidence of her urinary incontinence treatment and her cat’s UTI?

After completing the fifth message in my inbox, I couldn’t understand why the EMR vendors didn’t use this as the main selling feature. Talk about work flow … this was awesome! I confess to only slight guilt as I encouraged my patient to tell me more about her cat’s medical issues. I was on a roll here — maybe I could review some labs as well. 

My joy ended, though, when my patient cleared her throat. It seemed like I had been caught. "Dr. Diamond", she started, "I know that I must bore you month after month, and I realize that you are a busy man with more important things to do. But you always listen to me and never act like you’re rushed, and you make me feel like someone cares about me."   

I winced as I anticipated what I thought would come next. "You know," she said, "now that you have that fancy new computer, you seem to type a lot while I have been speaking." Imagine my shock when she said appreciatively, "I want to thank you … for taking all those detailed notes on everything that I’ve been telling you!"

This seems to me to be the perfect example of technology being a double-edged sword. We have so many tasks to complete and are often conflicted about the time we would like to spend with our patients. Work flow can mean many things. Let’s just remember that maximizing both compassion and quality during the patient encounter can be an enormous incentive to doctors if carefully coupled with return on investment.

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.

An HIT Moment with … Scott Anderson

An HIT Moment with ... is a quick interview with someone we find interesting. Scott Anderson is the president and partner of KIG Healthcare Solutions, Inc., a NextGen reseller based in St. Louis that covers Arkansas, Iowa, Kansas, Louisiana, Missouri, and Texas.

If I’m a doctor, why would I want to buy from a reseller?

We offer a local presence and flexibility as a smaller, privately-held firm. That allows us to "over-serve" our customers, by, for example, taking the time to step back and look at their practice before training begins. It makes no sense to take a bad paper process and make it electronic.

And we have a great partner in NextGen, while allows us to access their terrific corporate resources as well.

What’s the hardest thing about selling EMRs?

If we are in front of the right groups, of the right size and specialty, it is overcoming a physician’s reluctance to embark on the path to EMR. It is such a paradigm shift for them, and they are hesitant.

Thankfully, we have satisfied doctor/practice manager clients who are willing to step up and speak our praises and the praises of EMR in general. Frankly, there are some that won’t adopt an EMR until they are dragged kicking and screaming. We have learned to identify them pretty quickly and move on.

How does the market look for this year?

I feel better about our pipeline in this first quarter than any first quarter in our five-year history. We are seeing interest at most every spot of the market — small, medium and large. There are some that are stepping back and waiting to see what President Obama or their hospital might offer, but many more are realizing that there is no such thing as a free lunch. 

We have also been able to demonstrate a decent ROI if they commit to using the system as designed, although we have seen some troubling signs of the economy and how it has affected some practices.

What is your biggest challenge?

Finding good people, without a doubt. I spend 30 percent of everyday looking for talent and then nurturing the people we already have. This is a people business. 

Among the major players, the technology will continue to become more standardized and similar. It is our implementation and post-sale support that should separate us from the pack. And that begins and ends with motivated, well-trained, and happy people.

How do we keep them besides the work and the changes it can bring? Great benefits to start. We pay 100 percent of their healthcare coverage for the employee and their families. We work hard to limit the travel wherever possible so they don’t burn out on the road by making sure they are home on Thursday night and don’t leave again until Monday morning. We try very hard to convince them they have a stake in the business.

One more thing: I think we all need to do a much better job in terms of educating our audience. We need to listen more and talk less.

News 1/22/09

The number of physicians e-prescribing has more than doubled in the past year to about 12% of all office-based doctors. Between Medicare bonuses and assorted software and hardware incentives from other carriers, physicians are beginning to ease up on the use of pen and paper.

Medical malpractice provider The Doctor’s Company publishes a list of telemedicine best practices aimed at enhancing care and decreasing liability exposure. Some of the better advice includes providing patients with examples of the types of complaints that are adequately dealt with over the phone or e-mail vs. a visit to the ED. A few of the pointers make good sense for anyone e-mailing: don’t put in an e-mail something you wouldn’t say; be concise and check for spelling and grammar errors; and pick up the phone if the communication is taking more than 2-3 e-mails to explain.

Clara Maass Medical Center (NJ) provides new tools for its physicians to send and receive EMR data, selecting Axolotl to provide technology and services for its HIE. Clinicians will electronically receive clinical information via their existing EMR, Axolotl’s EMR Lite, or fax. Axolotl’s Elysium Virtual Health Record (VHR) will also compile information from disparate EMRs to provide a comprehensive view of the patient’s medical history.

Commonwealth Fund President Karen Davis calls for modernizing the country’s health information technology. "Medicare can do its share by joining with private payers in contributing funds to help those who cannot afford to purchase such technology on their own — especially safety-net clinics and hospitals serving uninsured and low-income patients. It can also create incentives for the adoption of information systems meeting approved standards, and help establish ‘health information networks’ that allow patients and the health professionals that care for them to have all relevant medical information available at their fingertips. While such a change requires upfront investment, it would begin to pay dividends after seven years and generate net savings of $88 billion over a decade."

Adena Health System (OH) rolls out a new e-prescribing initiative. The health system is sponsoring a pilot program and plans to implement the service system-wide by the middle of the year. Adena is using Pharmacy Health Information Exchange, which is operated by SureScripts.

Odd lawsuit: a retired Alabama doctor who collected $1 million from his lawsuit claiming a cemetery encroached on his 16-plot "estate lot" has the award reversed. He claimed the loss of a few square feet caused him mental anguish, although he admitted that he had not sought psychological treatment.

HIMSS, a founder of CCHIT, brags on adoption of CCHIT-certifed EMRs, coming to the oddly phrased conclusion that the market vastly prefers certified products (instead of the obvious, that pressure has cause the usual vendors to get their products certified and sales haven’t really changed). HIMSS thinks certification makes products easier to evaluate and less risky, but certified product vendors have gone out of business, sold doctors products that are completely unsuitable to their work flow, and sold products that are theoretically interoperable but definitely not interoperating. Plus, nearly every major product is certified, so certification still doesn’t provide a tie-breaker.

A survey finds that most physicians made more money in 2008 than the previous year, despite a weak economy. Specialists achieved a 4.4% salary gain and primary care doctors saw 4%  raises. Seventy-two percent of the 257 healthcare organizations surveyed reported increases in physician salaries, compared to 73% in 2007. Only ten percent of the doctors saw decline in salaries. The survey also found an increase in the use of incentive plans tied to quality measures and a decrease in plans paid per work RVUs.

In his inaugural speech, Obama promotes healthcare technology to "raise health care’s quality and lower its cost."

Crain’s New York Business/Health Pulse reports that New York University Medical Center has chosen Epic for a massive clinical systems project that includes its ambulatory sites and faculty practice office. The cost of the project was given as $186.4 million.

Revenue cycle and practice manager provider MTBC partners with healthcare collector Computer Credit to offer an ASP collection portal for healthcare practices and hospitals.

A couple of housekeeping details.  We are pleased vendors have already booked our two Founding Sponsor slots, so expect to see their banners soon. A couple of Platinum spots have also been committed. Vendors interested in one of the remaining spots should contact Inga. If you haven’t signed up for e-mail updates, take a moment to do so by putting your e-mail address in the Get Instant Updates box to your upper right. We don’t want you to miss any updates or one of the many interviews lined up for the coming weeks. And thanks for reading and sending in your comments.

A former health department billing clerk is charged with computer fraud after allegedly using an illegally obtained credit card with a patient’s name to make a $400 Wal-Mart purchase. The sheriff’s department found a handwritten list of 14 patients with names and Social Security number in the clerk’s home. The health department has warned 11,000 patients to be on the lookout for fraud.

Who knew that there was a National Medical Group Practice Week?  This is the sixth annual celebration of the MGMA-sponsored event, which is designed to promote awareness and understanding of medical group practice as the "premier form of healthcare delivery."  Next year, we’ll be more on top of it and send out "Happy Group Practice Week" cards.

A West Virginia county suspends its smoking ban less than three weeks after it went into effect after bar owners complained it was hurting business.

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