News 1/8/09

Doctors in Hawaii will soon be making virtual house calls to patients via America Well’s Web service. Hawaii Medical Service Association, the state’s BCBS provider, will make the service available to everyone in the state. Members pay $10; non-members $45. That’s a good deal for the uninsured, impatient, or busy patient. Not so helpful for the poor and/or elderly who don’t have ready access to a computer and Internet access.

Alabama Medicaid tests a Web-based EMR that gives physicians access to a patient’s prescription information and past doctor visits. So far, 59 sites are using the free service that is part of a $7.6 million project funded with federal dollars.

A California doctor finds a profitable business niche by helping immigrants from India and China give birth to sons, which are culturally preferred over daughters. Instead of the female infanticide sometimes used in those countries, the doctor employs "pre-implantation genetic diagnosis," identifying the sex of fertilized embryos before implanting them. Couples pay up to $18,000 to make sure their child isn’t a girl, which the doctor says is ethical since Canadians prefer girls.

INTEGRIS Health extends its deployment of Allscripts Care Management from two hospitals and 74 physicians to all 13 of its Oklahoma facilities. Allscripts also announces the sale of its Enterprise EHR to the 85 physicians at Medical Specialists of Palm Beaches. Medical Specialists is a longtime user of the Misys Tiger program, which will be integrated with the EHR.

Healthcare IT stocks fell Tuesday after a stock analyst’s prediction that any vendor benefit from the proposed Obama economic stimulus plan won’t show up on their bottom lines for at least 12-18 months. He downgraded shares of Cerner, athenahealth, Allscripts, and Quality Systems. The analyst believes that healthcare IT funding will not exceed $10 billion and much of that will be used for non-EMR purposes, such as infrastructure and a national health network.

Robert Sexton MD, a neonatologist and Vietnam veteran in his 50s, rejoins the Army and heads off to Iraq after a 38-year break, following his sons into the military as a major. "I figured we have less than 1 percent of the American people in the service, and some of those people are going to need a break sometime – and that’s what I aim to do. I’m still physically fit. I thought I could make a contribution."

Children’s National Medical Center (DC) selects eClinicalWorks EMR/PM solution to connect its employed pediatricians to the medical center. Children’s is also implementing eClinicalWorks Electronic Health eXchange to create a community health record. The eCW software will interface with the hospital’s Cerner applications, as well as the Sage Intergy EMR application used at other sites.

The 12 physicians at Horizon Gynecology & Obstetric Associates (GA) choose Sage Intergy PM/EHR. The group has been a Sage client for more than 20 years.

Summa Health Network (OH) offers free software to help physicians participate in P4P programs. Using MDdatacor’s CareInformatix technology, physicians will have access to Web-based software to collect clinical data from various information systems. Clinical data will then be compared with claims-based data. The clinical data will be used to support P4P initiatives.

Whitney M. Young Jr. Health Services (NY) commits to the purchase of a Cerner system following the receipt of a NY Department of Health grant. The community health center is receiving $897,000 from the state.

PracticeOne hires Scott Lentz as CFO. He was previously CFO of Picis.

Physicians at Landstuhl Regional Medical Center (Germany) military hospital master Dragon Medical speech recognition software to document patient medical records. The champion physicians claim the software is faster, more detailed, and more accurate than transcribing. Because of the success, the surgeon general’s office has purchased 10,000 copies of the Dragon Medical software and is distributing it across 42 facilities worldwide.

A Stanford attending physician pushes students and residents to spend less time in front of the monitor charting and examining test results and more time refining their beside, hands-on patient skills. "In short, bedside skills have plummeted in inverse proportion to the available technology," claims Dr. Abraham Verghese.

Physicians are adopting smartphones at a faster rate than the general public, according to a Manhattan Research study. Doctors are incorporating smartphones into their care routines to access drug information, medical calendars, and EMRs. Currently 54% of physicians own a PDA or smartphone, compared to about 20% of physicians using EMRs. Mr. H uses a BlackBerry Bold and Inga an iPhone. As smartphone experts (ahem), we predict the EMR market will boom when applications work as easily as the ones on our phones.

The University of Kentucky’s faculty practice plan implements a charge capture solution from MedAptus.

The Australian Medical Association opposes a physician code of conduct that would prohibit having sex with patients, writing phony sick notes for patients, and turning in incompetent peers, saying it would be a "lawyers’ picnic."

Inga has been a fan of Dr. Sanjay Gupta for awhile, so she is happy to see he is getting a promotion to U.S. surgeon general. Who else recalls that he was once featured as one of People magazine’s “Sexiest Men Alive”?

Is this a sign of the times? A 13-physician cardiology group sells its practice to Concord Hospital (NH,) making it the fifth practice to sell to the hospital in the last two years. The practice’s managing partner said the practice needed to buy an EMR to stay current and the hospital is covering the $250,000 cost. Economic pressures also influenced the transaction.

Earlier this week we published an "HIT Moment" with Mark Anderson, HIT futurist and CEO of AC Group, Inc. If you have suggestions for future interviews, drop us a note. Self-nominations will be accepted.

A retired Washington physician publishes a new book entitled, “The Best of Wits End: Medical Humor at its Brainiest.” The 81-year old Dr. Harold Ellner compiled 450 pages’ worth of jokes that he collected over the years wile writing a medical humor column for a national physician magazine. Available at Amazon.

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An HIT Moment with … Mark Anderson

An HIT Moment with ... is a quick interview with someone we find interesting. Mark Anderson is CEO and healthcare IT futurist with AC Group, Inc.

We saw a number of HIT companies consolidate last year. Do you think the trend will continue?

Yes. With over 370 vendors in the marketplace selling EHR products, the consolidation trend will continue. However, we believe more companies will just close their doors rather than being consolidated. If an EHR vendor does not have at least 2,500 physicians using their product by the end of 2009, we do not believe that can afford to stay in business. Therefore, physicians risk losing their money if they select a vendor with a small EHR footprint. 

Additionally, vendors that are not CCHIT 2008-certified by March 2009 will have a very hard time selling their EHR product. Not that physicians are really requiring CCHIT, but from a marketing campaign standpoint, competitors will scare physicians from purchasing non-CCHIT 2008-certified products.

As the EMR market matures, products seem increasingly similar in terms of features and functions. What should physicians selecting an EMR evaluate beyond features and functions?

Functionality is important, but it should not be the only consideration. When evaluating products, we rank each vendor from a scale of 1 (low) to 5 (high) in each of the following characteristics:

1. EHR product functionality
2. PMS product functionality
3. PHR product functionality
4. Company viability
5. Management
6. Long-term support
7. End user satisfaction
8. Initial pricing
9. Second-year pricing
10. Contracting terms
11. Negotiated contracting terms
12. Performance guarantees
13. Community hub pricing
14. Community hub functionality
15. Initial installation, training, and configuration
16. Overall rating

In the past,your company has been accused of bias when compiling your annual AC Group rankings. How do you respond?

The best way to answer this question is to ask our clients if they think we are biased. What you will get is that we are extremely hard on all of the vendors. 

I have to agree with many of the vendors that our reports back in 2004-2006 were not totally fair since we only provided rankings based on functionality. Vendors receiving high ranking were those with the best functionality, not necessarily the best solution for any one physician.

We listen to the critics and, starting in 2008, we revised our rankings based on the 16 categories listed above. Now functionality only counts 18% of the total vendor ranking.

Starting in 2009, we are ranking vendors based on five levels of sophistication. This means that a physician can use our reports to determine the top nine vendors based on what "type" of EHR product they are looking for. This means that vendors with low cost, ease of use, and maybe not as many functions (level 2 EHR) can be ranked in the top 10 and will not be compared to products that might cost the average provider over $35,000 during the first three years.

Of course, there are always vendors that do not like the ranking system and the ranking that we provide them. Like the BCS college football ranking system, our ranking is partially based on real data and based on our perceptions and the perceptions of our clients.

The toughest part of any evaluation is determining the EHR vendor’s company viability and end user satisfaction of clients. Since 92% of the EHR vendors are private, they do not have to report any data on clients, revenues, and financial viability. This makes it very hard for a practice to evaluate a vendor.  

When it comes to end user satisfaction, if you believe vendor market data, every practice loves their product and they have no issues. When it comes to end user satisfaction, we believe that KLAS has the best data.  Even there, vendors always complain to use that we should not be using a third party study, but that we should only believe what the vendor tells us. Sorry, I am not interested in beach front property in Arizona.

You were an early supporter of RHIO efforts, yet most have struggled financially.  What will it take to make a RHIO or HIE successful long term?

We believe that the RHIOs will be as effective as the CHINs of the 1990s. Very few will create any benefit to the community.  

However, the concept still makes sense. A community of physicians and hospitals must come together to create a community-based EHR that will allow clinically pertinent data to be exchanged within a local community, not a region. Before we can have a region (RHIO), we need local communities. 

Additionally, the community needs to provide multiple EHRs based on provider needs along with an "EHR Lite" for the majority of the providers who want to start slow. 

Finally, the community EHR needs to provide one consolidated PHR for all of the patients who would like to opt in to a community data exchange. Patient demographics and selected clinical information (lab results, eRX, etc) need to flow between treating physicians following the government’s CCD/CDA data exchange standards.

Do you have any predictions for 2009 in terms of industry trends or technology innovations?

The number of EHR failures will continue to increase. Just look at the numbers so far. According to multiple studies, only around 17% of providers have installed an EHR and less than 5% of the providers nationwide are using EHRs for full documentation, clinical orders, clinical decision support, and for outcomes measurements. Additionally, the majority of the EHR vendors provide inadequate training and support when it comes to changing business and clinical processes. The vendors are teaching physicians how to use the software, but most are unaware of the clinical and operational transformation that must occur before true adoption will occur for the masses.

CCHIT will continue to drive EHR purchases. However based on our studies, 67% of providers do not want all of the functionally and the costs and they are not willing to adopt the operational changes required to fully utilize a fully functional CCHIT EHR. The main reason is not the cost, but the operational change that providers perceive the CCHIT product will require. For example, the average provider spends an average of 33 seconds handwriting or dictating their note on a returning patient visit. Since every patient is new the first time they are seen using the EHR, the amount of time required to enter the information averages 295 seconds, an increase of  over 800%. Over the average clinic day, the EHR would require an additional three hours of charting time, basically eliminating all of the benefits that are promised by EHR vendors. However, the problem can be minimized if we change our approach towards pre-populating the EHR with patient data before the provider starts using the EHR.

The next generation EHRs will enter the marketplace — "DRT-enabled EHRs". DRT stands for Discrete Reportable Transcription. A DRT-enabled EHR allows the physician to continue to dictate clinical notes for a specific period of time. The difference is that the DRT-enabled EHR populates discrete data via the transcription, reducing data entry time by 87%. In most cases, dictation is eliminated within the first nine months once the majority of the patients have been seen using a DRT-enabled EHR. Using multiple methods, a DRT-enabled EHR populates up to 95% of clinical data required for the creation of a clinical note, for orders, and for clinical outcome reporting.

Along with DRT technologies, physicians will learn that a majority of clinically pertinent data can be enter without touching the keyboard. We have determined that up to two years of patient lab results can be obtained electronically along with patient medications, diagnostic codes, and numerous other data via upfront data conversions. If we can pre-populate patient data, the transition period can be eased. Additionally, through community data exchanges and PHRs, we estimate that 72% of patient information can be captured without the keyboard.

EHR purchasers will switch from individual practices to community purchasers. From our research, 87% of EHR licenses were sold to individual physicians/practices in 2007. By the end of 2009, we estimate that 43% of EHR licenses will be sold to community-based initiatives including hospital-sponsored community EHR, IPA-sponsored EHRs, and not-for-profit EHR communities. These types of community EHR initiatives  can help reduce upfront costs by 45% and, via a community data exchange, can help reduce data entry time by 68%.

Monday Morning Update 1/5/09

NYC offers $60 million in subsidies for eClinicalworks EMR, with doctors in the poorest neighborhoods receiving the most assistance. One doctor notes how their program may vary from other initiatives around the country: “We know that at these fancy schmancy systems, they can do these things, but here in New York, we’re trying to do this for the storefront in Harlem.”

In another not so “fancy schmancy” part of the world, the Maine Health Access Foundation announces new low-interest loans to promote EMR adoption in primary care medical practices.

"Free EMR" vendor PracticeFusion has always been questionable to us because their announcements seem to invite more "confusion" than "fusion" (i.e. misleading claims of a Google partnership, announcements of rapid growth that didn’t seem all that rapid, the company’s business model of selling de-identified patient data and pushing ads, how to get the records back out if the honeymoon sours) but the company seems to be playing seriously, bringing on management talent and releasing a good-looking 2.0 product (click above to enlarge). I’m starting to feel more convinced, although it’s hard to know how deeply doctors are actually "using" the product instead of just signing up for it because it’s free. That’s true of all vendors, though — the real question is what functions are being used, by whom, and with what result? We’ve yet to run across a real, live PracticeFusion user, so if you know one, let us know. Surely if it’s anything but terrible someone must be using it — it’s free and online.

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The New York Times overviews the Marshfield Clinic’s (WI) use of technology and an EMR. The article discusses the potential EMRs have for improving healthcare, especially as patient data is mined to find patterns (e.g. outcomes) to manage chronic diseases. Marshfield leaders emphasize that measurable ROI is not the key to assessing the EMR’s success. I wonder if the Harlem and Mainer docs agree.

Outgoing HHS Secretary Mike Leavitt’s editorial in the Washington Post that we mentioned last week urges that any government "investments" in healthcare IT be limited to systems that are CCHIT-certified as interoperable. One might argue that the government should not be intervening in the EMR market by trying to pressure vendors to make them interoperable (a theoretical capability) than to pressure providers to actually share information in whatever way the government has in mind and then let them pressure vendors themselves. Just because you own an "interoperable" EMR doesn’t mean that you’ll ever actually exchange data, either because you as a practitioner don’t want to or because there’s no organization technically prepared to accept your information in the first place.

The local paper highlights Tucson physicians who are moving to EMRs. A former EMR resister believes the transition is “hands-down better for the patent because there are much fewer things you miss." He also notes that his productivity dropped from 25 to 10 patients a day during the changeover to NextGen, but has presumably improved since. The administrator admits the ROI is not immediate, though there is immediate improvement in patient quality care.

Forbes quotes a Congressional Budget Office study that says EMRs will save $7 billion over five years. So given the thousands of EMR-using practices out there, doesn’t that constitute a pilot study group that should already be saving those dollars? The problem, of course, is that it isn’t the practices that are saving the money, most likely, so poring over their books would probably show nothing but additional EMR expense since the savings accrue to insurance companies, patients, and employers. The article cites several self-proclaimed experts, none of whom appear to actually practice medicine and, in fact, all of whom make money selling EMRs and related services. The reporters who write these articles always seem to marginalize the concerns and observations of real, practicing doctors, writing them off as irrelevant Luddites when there are fast-talking sales types available who, not surprisingly, sing the praises of whatever they’re selling at the moment.

GE Healthcare releases Centricity Business 4.3. I assume Centricity “Business” is the old IDX software since it is geared to academic medical centers and large practices.

Sermo introduces a new infectious disease monitoring tool called Sermo FluMonitor that allows physicians to report geographically based clinical observations in real time. I’d love to see how the reliability compares to Google’s flu trend tool.

A new report notes the shift from a provider-owned medical record to a record shared and controlled by both the provider and patient. It predicts the EMR market will grow by 14.1% annually through 2012. Of course I remember the days when everyone predicted 30% per year growth, a rate the market never quite achieved.

A UMass study says that medication errors occur in 7% of adult chemotherapy visits and 19% of those of children. The biggest question that lay people and even clinicians often forget to ask is whether the "errors" actually had the potential to cause patient harm without being caught down the line. The authors of this study did ask and found that about half had that potential, with most of them involving failed reconciliation between initial chemo orders and those adjusted for a specific visit. Many of the errors were cause by people in the home preparing and giving doses, not medical professionals. The clinic with the lowest rate of errors, one per 500 visits, used an EMR system with physician order entry.

Financial conditions are hitting physicians: more of them want hospitals to pay them for on-call cover or to hire them outright and fewer of them will attend conferences that involve overnight travel in 2009. Another example: a practice management company for plastic surgeons is laying employees off this week, which might logically be interpreted as meaning that fewer people are willing or able to shell out for cosmetic surgery.

Here’s a significant but tiny news item that the usual healthcare media will probably miss (unless they read it here, of course). A primary care office in Maryland cancels its plan to move to a boutique practice model when the Maryland Insurance Administration, worried about losing more primary care doctors, held hearings to decide whether retainer-based medicine is a form of health insurance that requires additional state regulation. Is it insurance to charge patients a flat yearly fee rather than fee-for-service? My first reaction was an emphatic no, but I can see how there is some gray area that would need to be carefully spelled out in whatever agreement the patient and practice sign. Other than that, it’s still an emphatic no in my book, but I’m not a state insurance bureaucrat. My suspicion is that the state wouldn’t have cared if it was a small group doing it.

Medical bills that have been turned over to a collection agency are keeping many people from qualifying for a mortgage, a mortgage company says, calling it a "huge injustice" that credit scores are hurt even when the debt is fully paid. I’ll go out on a limb to speculate that those mortgage companies who can’t get the money owned to them without turning it over to a collection agency (or who even experience only ‘slow pay’ from debtors) feel it’s entirely right and good that their deadbeats take a credit score hit.

I’ve always found the Zagat restaurant surveys to be pretty reliable. As Zagat expands into healthcare, we’ll see if the results will be as solid. The new Zagat Health Survey tool, offered in partnership with BCBS North Carolina, allows patients to evaluate their physicians on a set of distinct criteria. I wonder if consumers are as willing to rate their doctors as they are a good meal.

This is Inga’s kind of doctor. An Irvine plastic surgeon sets his Botox rates based on the rise and fall of the Dow Jones industrial average ($1/Botox unit for every 1,000 points on the Dow.) On those days his patients open their 401K statements and become depressed by all those losses, they can now find consolation from a little cosmetic refresh.

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News 12/23/08

A Tennessee physician receives disciplinary action for allowing staff to examine patients without supervision while he spent a month in the hospital. Unlicensed staff continued to provide care for 115 patients and also billed for nurse visits despite having no nurses on staff.

East Tennessee Medical Group receives the 2008 TECHMED Award for its outstanding use of patient care technology and its innovative use of electronic medical records (EMR) in its practice. The multi-specialty clinic includes over 50 physicians.

If you are looking to implement electronic lab results, Physicians Practice offers some tips for integrating the functionality into your existing EMR.

Put your e-mail address in the "Get Instant Updates" box to your upper right and you’ll get an e-mail blast notification every time we write something new here.

Despite being preoccupied with other matters, Illinois governor Rod Blagojevich signs a law that extends the Medical Practice Act until 2010. The bill continues the regulation of physicians and ensures that no licenses for practice doctors expire at the end of the year.

I’d love to know what, if any, practice management system this cardiologist has in place. A Kansas office manager pleads guilty to embezzling over $300,000 from the physician who employed her for 12 years. Frances E. Holt’s duties included keeping payroll records, entering patient charges, creating financial reports, and printing checks and paying bills for her physicians. At some point, Holt obtained a credit card in his name, used it herself, and had the doctor pay for it.

We made some minor adjustments to the format of HIStalkPractice to provide a visual cue that you’re here instead of HIStalk (since we also hope you’re reading both sites).

What do you think is the primary barrier for small practices looking to adopt EHR systems?

Cost

76.92%

Implementation

15.38%

Participant buy-in

5.77%

A recent eHealth Smartbrief survey concludes the primary barrier for small practices looking to adopt EHR is cost, according to 77% of respondents. Fifteen percent claim implementation is the main issue.

Holland Hospital (MI) forms a physician clinic subsidiary, claiming doctors want a new model that allows them to practice medicine without worrying about administrative issues. The hospital CEO says that one of the heaviest financial burdens for physicians is the high cost of IT for an EMR deployment.

The Minnesota Department of Health issues a 13-page complaint against the Mayo Clinic, charging that the practice failed to obtain federally mandated written permission from patients undergoing major surgical procedures, including organ transplants. Mayo physicians instead obtained oral consent and noted it in the patient record.

A researcher at Worcester Polytechnic Institute (MA) is awarded a $750K National Science Foundation grant for a three-year study on whether a "single best way" exists for implementing and using electronic medical records.

Outgoing HHS Secretary Mike Leavitt writes an op-ed piece for The Washington Post, insisting that any federal stimulus money earmarked for healthcare IT should be used only for CCHIT-certified, interoperable systems. "If stimulus money supports a proliferation of systems that can’t exchange information, we will only be replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful."

An Archives of Internal Medicine article suggests that physicians using EMRs are less likely to have paid malpractice claims (10.8% of paper-based physicians vs. 6.1% of those using electronic records). The authors hope that similar studies will encourage insurance companies to lower malpractice rates for EMR-using doctors.

A Congressional Budget Office review of the Obama administration’s healthcare proposals finds that most of them would be expensive and wouldn’t save much money, but the biggest potential winner is the requirement for doctors and hospitals to use electronic systems. CBO estimates savings of $34 billion over 10 years in addition to lower malpractice insurance. Another financial winner is allowing generic equivalents of biotechnology drugs, estimated to save $12 billion over 10 years beyond the individual savings for consumers and employers.

HHS affirms the right of health care providers to refuse to participate in services to which they object, such as abortion.

CCHIT says it will use the recently released HHS privacy framework into its certification for personal health records when that program starts in 2009. It includes a draft policy notice for PHRs that lets consumers compare the privacy practices of PHR vendors.

UC Physicians (OH) combines 16 practices into one company in an attempt to save more than $1 million next year. Leaders expect that more negotiating power with insurers and consolidated back-office departments could lead help the group to double annual revenue of $180 million within five years. The group includes 649 doctors and 2,200 employees.

Good news for all good girls and boys, big and small. Baylor University Medical Center clears Santa for takeoff after physical exam. Mr. Claus was warned to lay off the milk and cookies, however. (is telling you that a HIPAA violation?)

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News 12/18/08

From Ad Guy: “Re: PracticeFusion. The way they are able to offer the software for free is that it is run through an ASP and is supported by ‘discreet’ advertising. A hundred bucks a month gets you an ad-free version.” Something about their press releases announcing a single new user here and there makes me suspect it’s been a struggle for them, free or not. And, they were a bit shifty about throwing Google’s name all over their early announcements when it turned out the only Google connection was that they planned to use AdSense ads like any other Web site can do. I would be interested in seeing a review of the software, not just its price, from a real user.

From Bubble Burster: “Re: new site. I am struggling with its intent compared to the original HIStalk. Who is the target audience? You might want to make it look a little different with a font change or something." Thanks to everyone who has already provided us feedback on our new venture (even though we’ve done it in stealth mode with no announcements). Most of it was very encouraging. HIStalkPractice is definitely a work in progress and reader input will help us fine tune things. So, to back up a bit, our annual HIStalk reader surveys indicate that the majority of our visitors come from the hospital side of healthcare. Our goal with HIStalkPractice is to offer information and commentary of particular benefit to physicians and their office staff, some of it from experts who can inform and educate folks in that ambulatory setting. We absolutely intend to include vendor news. And of course we love rumors. We recognize there is overlap between the hospital and physician world, so you might occasionally see an item mentioned more than once if you read both sites (and we certainly don’t recommend that you stop reading HIStalk since it won’t all be duped here). We’re also tweaking things a bit so the site looks more unique. Stay tuned and keep providing your feedback.

Community Care Physicians selects Allscripts’ Practice Management for its 190+ provider group. The practice already uses Allscripts’ Enterprise EHR.

Pediatrix Medical Group acquires Florida Perinatal Associates. Pediatrix paid cash for the seven-doctor group. I see that Pediatrix now employs over 1,200 physician specialists and 400 nurse practitioners in 32 states.

AdvancedMD names Christopher J. Bijou executive VP of sales. He had similar roles with UCN and Oracle before that.

Good news for medical billers: demand for medical billing experts remains steady.

AAFP Board Chair Jim King, MD tells the CMS to fix PQRI or doctors may not want to participate. The biggest complaint stems around the fact that thousands of physicians participating in the PQRI did not receive promised Medicare bonuses. CMS had coding problems and other technical issues, so less than half of the participating physicians received their 1.5% Medicare bonus.

Eclipsys wins a Frost & Sullivan award for Healthcare Innovation in the North American Clinical IS market. The honored product is the former MediNotes physician practice solution. Nothing against Eclipsys or its products, but I’ve never quite understood why a company would go to the time and expense to “win” one of these awards. I could be wrong, but my impression of how easy it is to win an F&S award is on par with the soccer trophies handed out to every player in the league (at least if soccer players paid big bucks just to take the field).

The North Carolina Medical Society endorses Web portal software developer Medfusion (also of North Carolina). Medical society members will be eligible for discounts on Medfusion’s patient portal products.

Sevocity launches a new secure web portal that facilitates communication between Sevocity EHR users and their patients. It’s free to customers in the latest software release.

Physicians in 15 states and DC can now manage their Medicare enrollment online. The new service is named Provider Enrollment, Chain, and Ownership System or (PECOS) and will be rolled out to all states over the next couple of months. I’m surprised that CMS is just automating this function.

If you are an iPhone/iTouch user who’d like to maximize its use, check out this posting from a Tulane medical student. He names the top 10 medical resources available, including Eponyms, Mediquations, and Epocrates RX.

HIMSS issues its "recommendations" for the Obama administration, wrapped around a suggested healthcare IT industry donation of $25 billion (does every handout-seeking industry always ask for $25 billion?) to encourage adoption of electronic medical records. HIMSS wants higher government visibility of healthcare IT and insists that no government money be paid out to encourage use of any software that is not certified by CCHIT. Also interesting (and out of left field, but a good idea) is to bar payments to providers by check – the funds would have to be electronically transferred. It should be noted, however, that HIMSS has had marked lack of success in pushing any of its special interest recommendation, so there’s no guarantee that anything in the laundry list will be approved.

Some Best in KLAS winners in the ambulatory market: Epic, Allscripts, and Greenway (EMRs); Epic, athenahealth, and Greenway (practice management).

Highmark Blue Cross Blue Shield (PA) opens up its database of physician quality measures to members. Ratings are based on preventive screenings, office visits, and recommended tests and procedures for diabetes, pediatrics, and women’s health. Only PCPs are scored, getting one, two, or three stars based on how often they provide services to Highmark’s members compared to the average (how well Highmark pays them to do so is another story).

A new survey finds that about 40% of doctors use electronic medical records, but many of them say their systems aren’t very good. Only 4% said their systems do the job to their satisfaction. While the results aren’t encouraging that vendors are selling the products that doctors need, the survey did ask the right questions — not just whether the physicians had access to ‘electronic medical records,’ but exactly what functions they are using them for, which is really the important fact. It would be highly interesting to see those stats broken out by system vendors, of course, but that’s another survey (say, since vendors would never sponsor something like that for fear of bad results, maybe we should run one).

And speaking of EMRs, it would be interesting to find out what customer relationship management capabilities are built in. Can you enter a few notes to help you chat personably with the patient next time, like that they were headed off to Greece for the summer or changing jobs? Some of the early systems focused on that, helping doctors and office staff build relationships with customers, but you don’t hear too much about it these days.

Something too few people worry about: that little footnote in the medical insurance documents that says everybody gets a lifetime dollar cap, and then they’re on their own. This patient is an example: a surprise attack of AML led to a 48-day hospital say, followed by chemo, BMT, and another five months as an inpatient. Because of high costs, she hit her $2 million lifetime cap and her insurance had run out. Employers are accepting all kinds of compromises (high deductibles, high copays, etc.) to keep offering at least some kind of insurance to employees. The article says lifetime caps have dropped to as low as $250K in some cases, which coupled with high copays could leave patients with help only for the middle ground.

Odd lawsuit: a physician complaining of throat problems is told he’s OK in a 1999 hospital exam, but dies in 2007 of esophageal cancer missed by the pathologist in the original exam and not discovered until 2005. His widow is suing the hospital, but the statute of limitations has run out since the clock starts ticking when the alleged malpractice occurs. She wants the law changed so her lawsuit can go on.

A Michigan doctor has all his medical evidence and expert testimony thrown out by a judge when it’s found that he was paid $500 per exam by personal injury lawyers for claiming 7,323 patients had radiologic and respiratory evidence of the asbestos complications the lawyers were suing over. He netted a cool $3.6 million despite having minimal qualifications to interpret films. A previous example from West Virginia is cited where a radiologist made $10 million from a "lawsuit mill," claiming he examined 515 patients in a single day, all of whom had something litigable, no doubt.

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