From the Consultant’s Corner 10/12/17

Addressing Physician Burnout – It’s Not Just the EHR

Physician burnout continues to rise in all specialty areas. Fifty-five percent of family medicine and internal medicine physicians who participated in the 2017 Medscape Lifestyle Report reported burnout. Fifty-nine percent of emergency medicine and 56 percent of all Ob/Gyn participants reported burnout. While EHRs are often credited as a major contributing factor to physician burnout, a deeper analysis of the root causes of physician burnout is necessary in order to address this challenge.

Administrative burdens placed on providers have accelerated with a variety of regulatory requirements including MU, ICD-10, and now MACRA. Population health management, value-based reimbursement, and coding scrutiny will continue to influence clinical workflow design and EHR usage. A poorly developed or executed EHR implementation approach will absolutely magnify these challenges. Practice leadership should engage their physician community to separate those EHR-related issues, which can be improved upon through optimization initiatives, from the administrative burdens that require alternative solutions in order to have a meaningful impact.

Up until the past two years, our EHR optimization engagements primarily focused on client goals of improving physician productivity. Increasingly, a common driver of most recent engagements is to reduce or eliminate the time physicians spend on administrative, non-clinical tasks, which contribute to physician burnout. These client administrators recognize the administrative burdens placed on their physicians, and they are keenly astute to the costs and disruptions of recruiting and onboarding new physicians. It is simply more cost effective to address physician burnout proactively, than to replace them.

I recommend several tactics below for provider organizations to start the process of addressing physician burnout. There is no silver bullet, but engaging physicians and making real, sustainable efforts to improve their satisfaction will have meaningful impacts.

1. Inefficient workflows and poor EHR design/navigation are far too common. Unfortunately, many vendors accentuate this problem by well-intended yet unproven “best practice” workflow recommendations. Engage your clinicians to understand the bottlenecks and redundancies of their current workflows. Clinical workflow optimization comprised of using all clinical resources to the maximum level of their licensure is a good first step.

2. EHR personalization, focused on enhancing clinical documentation, order entry, results management, and messaging is another best practice. Additional benefits of EHR optimization include enhanced revenue integrity and reduced charge lag, which accelerate cash collections.

3. Provide continual training opportunities for physicians and nurses to introduce and reinforce advanced tools that accelerate clinical documentation.

4. The use of scribes is not a new concept; however, it is a relatively high-cost solution for shifting the administrative tasks off a physician’s plate. Several models of virtual scribes have started to gain traction and are worthy of consideration as an additional tactic to ease burnout for your most at-risk providers. There are different flavors of these services, each with different value propositions and cost considerations. By offloading most of the EHR data entry to a virtual scribe, more face time is spent with the patient and encounters are closed (and billed) at the completion of the patient visit.

Brad Boyd is president of Culbert Healthcare Solutions in Woburn, MA.

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News 10/11/7

Top News

Seven months after acquiring competitor LeonardoMD, physician practice-focused EHR and PM vendor Azalea Health merges with Prognosis Innovation Healthcare, a Houston-based EHR vendor that caters to rural and smaller hospitals. In a move that echoes those of Athenahealth, Atlanta-based Azalea hopes to leverage Prognosis talent, technology, and relationships as a means to enter the rural hospital market. Prognosis CEO Douglas Cameron will become an Azalea advisor during the transition. Prognosis went through a rebranding in 2014 after being acquired by AO Capital, a private equity firm led by two of the company’s founders.

HIStalk Practice Announcements and Requests

Lorre tells me that now is the time of year that we typically offer a great deal for new HIStalk sponsors – sign up now and get the rest of 2017 for free. Further discounts will apply if you choose to sponsor both HIStalk and HIStalk Practice. Contact her for more details.

Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Announcements and Implementations

Athenahealth offers end users security risk analysis software from HIPAA One through the company’s More Disruption Please marketplace.

People

Russell Senger (Navicure) joins TDP RCM as VP of business development.

Government and Politics

President Trump promotes HHS Deputy Secretary Eric Hargan to acting HHS Secretary.

Coinciding with National Cybersecurity Awareness Month, ONC announces the Secure API Server Showdown Challenge, a two-stage competition in which teams will build secure FHIR servers that will then be dissected for vulnerabilities by healthcare security professionals. Three winning teams will receive a total of $10,000. Submissions are due January 15.

STAT profiles Grubb’s Pharmacy – Washington, DC’s oldest such establishment – and the delivery services it provides to lawmakers on Capitol Hill through the Office of the Attending Physician. Pharmacy owner Mike Kim seems pleased enough with the decades-old government business, though he does get frustrated by the OAP’s inability to send prescriptions electronically. He seems no longer star-struck when high-profile lawmakers come into his establishment: “I still remember John Kerry — it was literally like the day after he lost [the 2004 presidential election], he came in and he was just standing in line with everybody else,” Kim says. “I just remember seeing him standing in line and almost feeling sorry for him — one day he’s a superstar, he’s got his entourage and security detail, and the next day he’s just by himself, he’s picking up his prescription.”

Other

Vermont Public Radio looks at the state’s nascent medical marijuana industry, highlighting the skepticism new clinics like Canna Care Docs face from the traditional medical establishment. Similarly to the early days of telemedicine, current state regulations require physicians to establish relationships with patients seeking certificates by seeing them twice in a three-month period before issuing certificates – once in person and the second via virtual consult. It’s a strategy that doesn’t sit well with Rep. Ann Pugh, who co-authored the state’s medical marijuana law. “To be honest, that’s not a relationship in my mind,” she says of the Canna Care model.

Coming soon to a mailbox near you: The US Postal Service will pilot self-driving delivery trucks along 10 rural routes in 2019 as part of a larger look at how autonomous vehicles can help the federal agency cut costs and keep its doors open. If the test routes go well, the USPS will roll out the vehicles on 28,000 rural routes by 2025.

Sponsor Updates

• Aprima will exhibit at the American Academy of Home Care Medicine Annual Meeting October 13-14 in Rosemont, IL.
• Healthwise will exhibit at Philips Connect2Care October 16-18 in Los Angeles.

Blog Posts

• The lesson of Dallas: A change in thinking (EClinicalWorks)

Contacts

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News 10/10/17

Top News

Healthcare communications and technology company StayWell acquires health and wellness app developer MedHelp. StayWell CEO Nicole Latimer says the acquisition will help extend the company’s reach into women’s health, and bolster its diabetes and weight management offerings.

Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Announcements and Implementations

Pulse Systems adds InteliChart’s patient portal to its EHR.

EClinicalWorks adds OpenNotes capabilities to its patient portal, giving physicians the ability to share their visit notes with patients.

People

Andy Slavitt becomes a special advisor to General Atlantic, a growth equity investment firm that has invested in such healthcare companies as Oak Street Health, CitiusTech, and Alignment Healthcare.

Veteran Jerry Baker (Notifi Health) joins patient payment company TevixMD as president.

Telemedicine

Washington, DC-based OnePath Medical expands its telemedicine services for medical marijuana patients to Maryland, New York, and Pennsylvania.

In Michigan, the Community Health Center of Branch County will use a $10,300 donation from civic organization Women Who Care to support its School Tele-Health Program, which connects students in three counties with a CHC Pediatric and Adolescent Center NP.

Research and Innovation

A follow-up study on the antibiotic prescribing habits of nearly 250 PCPs across 47 practices finds that some slipped back into the habit of overprescribing once the initial study’s “nudges” – which included monthly peer comparisons, top performer accolades, written justification requirements, and suggested alternatives delivered via EHR pop up – ended. Peer comparisons, emailed to physicians on a monthly basis, were found to have the most lasting impact on reducing antibiotic prescriptions, leading researchers to posit that providers should consider permanently integrating such low-cost reminders into their prescribing workflows. Interestingly, the digital delivery of suggested alternatives had no effect on prescribing rates. 

Other

PBS looks at the success Kaiser Permanente has had with its Safe and Appropriate Opioid Prescribing Program. Launched in 2010, the program combines suggested alternatives to medication like yoga, acupuncture, and meditation with pharmacist training and more high-tech hoops that require prescribers to validate their prescription decision within the EHR. The program has helped the Southern California provider reduce opioid prescriptions by 30 percent. 

The last full day of MGMA concludes, with ZDoggMD bringing some presumably much-needed levity to attendees in his opening keynote. (Whether it’s encroaching wild fires, physician burnout, declining reimbursements, or regulatory burdens, I’m sure they needed a few laughs.) Next year’s conference will take place September 30-October 3 in Boston.

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Jenn, Mr. H, Lorre

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News 10/9/17

Top News

The first full day of MGMA kicks off in Anaheim, with attendees taking in the keynote session, exhibit hall, and downwind effects of a wildfire in nearby Anaheim Hills.

News of note from the show floor include PatientKeeper’s launch of a hosted charge capture solution for small to medium-sized practices, and Drchrono’s addition of enterprise task management features – including a dashboard and real-time staff reminders and notifications – to its EHR.

A quick look at the #mgma17 tweet stream found the usual mix of exhibit hall shots, though I have to admit the one above did stand out. Visitors to the CareCloud booth seemed to be having a good time immersing themselves virtually in the company’s offerings.

The association also released its latest report on practice performance, highlighting the fact that better-performing physician-owned practices spend less on operating expenses, including health IT, and see greater patient portal utilization than their lower-performing and hospital-owned counterparts. Top-performing primary care practices all have lower no-show and appointment cancellation rates, a higher percentage of same-day appointments as part of their total mix, and quicker appointment scheduling processes – which might tie into the aforementioned portal usage, assuming online scheduling is available.

Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Announcements and Implementations

The Illinois Bone & Joint Institute selects SRS Health’s patient engagement technology, and outcomes-based data collection and registry tools.

Kareo announces several software updates to its EHR/PM/RCM platform, including automated eligibility checks, balance due alerts, and easier charge capture and patient statement processing.

As part of its quality transformation initiative, Hope Orthopedics of Oregon implements Code Technology’s patient-reported outcomes program across its five locations.

Objective Medical Systems develops a remote monitoring platform for cardiology practices that includes secure patient communication tools and data aggregation across EHRs, labs, and medical devices.

The Pennsylvania Medical Society’s Care Centered Collaborative selects physician management services from Formativ Health in an effort to help its network of independent providers transition to value-based care.

People

AMGA promotes Jerry Penso, MD to president and CEO. Penso, who came to AMGA from the Sharp Rees-Stealy Medical Group in San Diego, will take over from Donald Fisher, who passed away in March after 35 years with the association.

Rachel Neifeld (Rise Labs) joins Fruit Street Health as head of its virtual diabetes prevention program.

James Murray, MS (CVS/Minute Clinic) joins Culbert Healthcare Solutions as CIO.

Acquisitions, Funding, Business, and Stock

Coinciding with its annual user group meeting, EClinicalWorks reports $130 million in Q3 revenue and the addition of 3,750 new providers. It claims to now be “the second most widely used EHR in the country.” The company also announced availability in December of an interoperability development platform that will enable developers to connect to ECW’s API-enabled EHR; as well as a voice-powered virtual assistant, the Healow Virtual Room for telemedicine, and v11 of the company’s core product.

Telemedicine

Developers of the Health Integrated Rescue Operations Telemedical Drone Project demonstrate the latest iteration at the American Osteopathic Association’s annual meeting. The HIRO system is part of a pilot with the Mississippi Department of Emergency Management, Homeland Security, the National Guard, and NATO. Designed to provide emergency care during and after natural disasters, HIRO includes a Microsoft HolonLens VR headset so that remote physicians can treat multiple patients on the scene, smart glasses so that first responders can correspond and transmit visuals to the physician, an automated medication bin controlled by the off-site physician, and what developers are calling a “holographic EHR system display” for remote monitoring.

Other

It’s official: Monday really is the worst day of the week, according to a 2008-2017 Twitter sentiment analysis done by researchers at the University of Vermont Complex Systems Center. Other interesting facts about the first day of the work week:

• Over 50 percent of employees are late to work on Monday mornings.
• On average, productivity on Mondays only spans about three and a half hours.
• Most people don’t crack their first smile until 11:16 AM.

Sponsor Updates

• Versus Technology will exhibit at the ANCC Magnet Conference October 11-13 in Houston.

Blog Posts

• How the University of Maryland Medical System used its EHR to improve HIV/HCV care (Nordic)
• Higher MIPS Scores and CMS adjustments (PerfectServe)

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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Population Health Management Weekly Wrap Up 10/8/17

Scott McFarland (EXL) joins Equality Health as president of its HealthBI division. The Arizona-based company has partnered with UnitedHealthcare to develop a team-based care management program for Medicaid patients in Arizona that will encompass physical, behavioral, and social needs.

EQHealth Solutions hires Lori Kools, RN (WellCare Health Plans) as state director of government operations in Florida.

Washington Regional Medical System (AR) promotes Mark Thomas, MD to VP and medical director of population health.

Sidewalk Labs, an urban innovation group within Google parent Alphabet, announces Cityblock, which will offer residents of low-income communities who are covered by Medicare or Medicaid a care team that provides doctors, coaches, technology tools, and a health plan. The service will launch next year.

Population health analytics startup Cardinal Analytx raises $6.1 million in a Series A round led by Cardinal Partners, which worked with Stanford University professors Arnie Milstein, MD and Nigam Shah to launch the payer-focused company.

BaseHealth names Tamara StClaire (Xerox Healthcare) COO and Nick van Terheyden, MD (NTT Data) CMO.

MissouriHealth+ will implement population health management solutions from Caradigm across its network of 24 community health centers.

North Carolina-based Novant Health, Carolinas HealthCare System, UNC Charlotte, Mecklenburg County Public Health, and Renaissance West Community Initiative receive a $250,000 grant from the national Build Health Challenge program that they will use, via their Building Uplifted Families collaboration, to improve the health and wellness of Renaissance West residents in Charlotte. The money will, over a two-year period, go towards improving access to preventive care, grocery stores and healthy food, and educational and career opportunities.

Lightbeam Health Solutions will provide population health management solutions to members of the American College of Osteopathic Family Physicians.

MCG tweaks its Indicia Web-based evidence-based care guidelines so that they integrate with Epic’s Healthy Planet population health management technology.

Innovista Health Solutions will include CollaborNet analytics, referral, and real-time care coordination technology from Holon Solutions as part of its IT toolkit for IPAs and ACOs in Texas, Illinois, and Georgia.

The Mary Washington health system (VA) expands its use of Koan Health’s analytics to include its Health Alliance ACO, in addition to its employee health plan.

Seven Hills Foundation (MA) chooses Netsmart as the care coordination and population health management provider for the Massachusetts Care Coordination Network.

Sponsor Updates

• McLaren Flint (MI) implements an RTLS-smart pump interface between Versus and B. Braun, allowing clinicians to see on a real-time floor plan where pumps are located and whether they are actively infusing to improve re-distribution.
• EClinicalWorks will exhibit at the Louisiana Primary Care Continuing Education Conference October 10-12 in Lake Charles.
• Healthwise and Intelligent Medical Objects will exhibit at the Cerner Health Conference October 9-12 in Kansas City, MO.

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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