News 9/12/17

Top News

A new study confirms what most physicians (no matter the care setting) already know – technology is increasingly taking time away from patient care and contributing to physician burnout. Conducted over a three-year period, the retrospective study looked at the movements of 142 PCPs within the University of Wisconsin health system to find that they spent six hours – over half of their work day – in their Epic EHRs on a daily basis. Nearly 90 minutes of that documentation time was after hours. The physicians reported that the EHR work included billing and coding, documentation, order entry, and system security.

Interestingly, most of the physicians turned down offers of transcription services or voice-recognition software during a six-week observation period. Their reticence to try out new support tools seems to reinforce the fact that they don’t have the time to fit anything else into their workflows.

HIStalk Practice Announcements and Requests

HIStalk sponsors, submit your MGMA details for inclusion in our annual must-see vendor’s guide. Companies that are walking the show floor instead of exhibiting are also welcome to submit their information. The online guide will publish a few days before the conference kicks off in Anaheim, CA on October 8.

Webinars

September 13 (Wednesday) 1:30 ET. “How Data Democratization Drives Enterprise-wide Clinical Process Improvement.” Sponsored by: LogicStream Health. Presenter: Katy Jones, program director of clinical support, Providence Health & Services. Providence is demonstrating positive measurable results in quality, outcomes, and efficiency by implementing clinical process improvement solutions in arming operational and clinical stakeholders with unlocked EHR data. Providence’s army of process engineers use their self-service access to answer questions immediately and gain an understanding of how their clinical care delivery is impacting outcomes. The presenter will describe practical applications that include antibiotic stewardship, hospital-acquired infections, and comprehensive knowledge management.

September 28 (Thursday) 2:00 ET. “Leverage the Psychology of Waiting to Boost Patient Satisfaction.” Sponsored by: DocuTap. Presenter: Mike Burke, founder and CEO, Clockwise.MD. Did you know that the experience of waiting is determined less by the overall length of the wait and more by the patient’s perception of the wait? In the world of on-demand healthcare where waiting is generally expected, giving patients more ways to control their wait time can be an effective way to attract new customers—and keep them. In this webinar, attendees will learn how to increase patient satisfaction by giving patients control over their own waiting process. (Hint: it’s not as scary as it sounds!)

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

Announcements and Implementations

MetroCare Services (TX) will implement Netsmart’s EHR as part of a broader partnership that will see the behavioral healthcare provider eventually implement additional Netsmart technology across its 16 locations. Netsmart’s developers will work with MetroCare’s XenatiX software division on the ongoing deployment.

Avanti Anesthesia, which provides anesthesia services to eye surgery centers in the Houston area, selects Plexus TG’s Anesthesia Touch EHR.

Machine-learning company Macro-Eyes Health develops a predictive patient scheduling tool that uses AI to match up a patient’s preferred time with a physician’s availability.

People

PhyMed Healthcare Group appoints Marty Bonick (Community Health Systems) CEO.

Telemedicine

Chicago-based EazyScripts makes its telemedicine-friendly e-prescribing software available for free to providers caring for patients in areas impacted by Hurricanes Harvey and Irma.

The State of California bans the delivery of medical marijuana by drone, leaving patients to receive their deliveries by mail or human-driven car. It’s a move that will likely deflate the delivery aspirations of some California-based medical marijuana telemedicine companies like Eaze and Meadow MD. Luckily for those patients who experience the side-effect of hunger pangs, California does permit drone delivery of pizza.

Third-party benefits company Cypress Benefit Administrators offers its employer customers telemedicine services from Teladoc.

Government and Politics

As with Hurricane Harvey, CMS issues a waiver ensuring that licensed out-of-state physicians will receive Medicare reimbursements for providing care in Irma-impacted areas of Florida.

Research and Innovation

An MGMA survey of 876 physicians finds that there is still room for improvement when it comes to the Electronic Funds Transfer standard developed by CMS in 2012. Seventeen percent of respondents pay a 2-5 percent fee to receive digital payments from payers, with the majority interacting with a third-party payment vendor. MGMA analysts have called for CMS to issue more specific operating rules around the transparency of such fees.

Other

Providers in Maine head to Florida to help with post-Irma healthcare efforts. Traveling as part of the federal government’s National Disaster Medical System, the dozen include physicians, PAs, RNs, pharmacists, and technicians who expect to stay in the Sunshine State for between 14 and 30 days. Some, like ER nurse Nate Contreras, have just returned from relief efforts in Texas. “We were there for 10 days,” he says. “Yah, we’re tired, but we’re ready to go again. This is what we do.”  HHS is continually looking for providers to join the disaster relief effort. You can find more information about the NDMS here.

Google will match donations for Hurricane Irma relief efforts. It will funnel the money to Network for Good, which will then evenly distribute it to Catholic Relief Services, UNICEF, and the American Red Cross.

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Jenn, Mr. H, Lorre

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News 9/11/17

Top News

HHS continues rescue operations in the Caribbean and begins them in southeast as Hurricane Irma treks through Georgia and downgrades to a tropical storm. The agency has partnered with the DoD to find and rescue 130 dialysis patients on St. Thomas in the US Virgin Islands after the island suffered substantial damage to its healthcare infrastructure. Rescue efforts have relied on CMS emPOWER data to search for Medicare patients who rely on life-sustaining equipment by zip code.

HIStalk Practice Announcements and Requests

HIStalk sponsors, submit your MGMA details for inclusion in our annual must-see vendor’s guide. Companies that are walking the show floor instead of exhibiting are also welcome to submit their information. The online guide will publish a few days before the conference kicks off in Anaheim, CA on October 8.

Webinars

September 13 (Wednesday) 1:30 ET. “How Data Democratization Drives Enterprise-wide Clinical Process Improvement.” Sponsored by: LogicStream Health. Presenter: Katy Jones, program director of clinical support, Providence Health & Services. Providence is demonstrating positive measurable results in quality, outcomes, and efficiency by implementing clinical process improvement solutions in arming operational and clinical stakeholders with unlocked EHR data. Providence’s army of process engineers use their self-service access to answer questions immediately and gain an understanding of how their clinical care delivery is impacting outcomes. The presenter will describe practical applications that include antibiotic stewardship, hospital-acquired infections, and comprehensive knowledge management.

September 28 (Thursday) 2:00 ET. “Leverage the Psychology of Waiting to Boost Patient Satisfaction.” Sponsored by: DocuTap. Presenter: Mike Burke, founder and CEO, Clockwise.MD. Did you know that the experience of waiting is determined less by the overall length of the wait and more by the patient’s perception of the wait? In the world of on-demand healthcare where waiting is generally expected, giving patients more ways to control their wait time can be an effective way to attract new customers—and keep them. In this webinar, attendees will learn how to increase patient satisfaction by giving patients control over their own waiting process. (Hint: it’s not as scary as it sounds!)

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

Announcements and Implementations

Doctors for Responsible Gun Ownership, which I wasn’t even aware existed, is working to develop a directory and referral system that pairs up patients with “gun-friendly” physicians.

Infirmary Medical Clinics, part of the Mobile, AL-based Infirmary Health system, becomes the first provider to utilize Navicure’s new Epic-integrated patient payment software.

Research and Innovation

A study of 3,755 university students in the UK finds that an online therapy program designed for insomnia also helped to improve mental health problems like depression, anxiety, hallucinations, and paranoia. The Sleepio program consisted of six 20-minute sessions administered over the course of 10 weeks. The one red flag the study’s authors have raised is its dropout rate of 50 percent, though they contend the overall findings are similar to previous, smaller studies.

SAMHSA releases results from its latest survey on drug use and mental health, proving the opioid epidemic is alive, well, and in need of federal resources. Nearly 12 million people misused opioids in 2016, with the majority of misuse related to pain relief rather than heroin. While rates of mental health disorders have remained constant since 2008, there has been an increase in serious mental illnesses among young adults.

Telemedicine

Hippo Health partners with Greater San Antonio Emergency Physicians to offer free telemedicine services to victims of Hurricane Harvey.

Green Mountain College in Vermont begins offering its 400 students virtual consults with physicians at nearby Bennington College. New GMC President Bob Allen saw the telemedicine clinic as a potentially effective way to overcome the college’s lack of primary/urgent care services. “It is very new,” says Peggy Gregory, who leads GMC’s Wellness Center. “It was thought of a month ago and we’ve been working at lightning speed to make it happen.”

Government and Politics

Former Congressman and current mental and behavioral healthcare advocate Patrick Kennedy keynotes the Behavioral Health Payment and Care Delivery Innovation Summit at CMS headquarters in Baltimore. Founder of The Kennedy Forum nonprofit, which tackles mental health and substance abuse issues, Kennedy spoke on the need to reimburse mental health treatments and to enforce the ACA-enacted mental health parity law, which mandates the coverage of mental healthcare along the same lines as physical care.

Pennsylvania health officials report encouraging statistics since implementing a PDMP a little over a year ago. Doctor shopping has dropped significantly, with the number of people visiting five or more physicians to obtain prescription drugs decreasing 86 percent, and those visiting 10 or more dropping off altogether. Some healthcare stakeholders, however, worry patients prone to doctor shopping have turned to illegal drugs instead. “You need to look at the combined evidence, and based on what I’ve learned,” says Yunfeng Shi, assistant professor of health policy and administration at Penn State, “it does seem to be the case that the programs have some impact … on reducing misuse and inappropriate prescribing; that’s what the literature shows,” he said. “However, based on our studies, at the same time those programs do seem to have a negative or bad impact, or not much of an impact at all, on mortality rates.”

Other

Married for 75 years, Harvey and Irma Schluter don’t quite know what to make of the attention their names are receiving from local news outlets during this hurricane season. “I don’t know how they’ve done that, to have a Harvey and Irma,” says the 92 year-old Irma. (Harvey is 104.) “I don’t know how that worked out.” Based on the World Meteorological Organization’s system of alternating male and female names for tropical storms that originate in the Atlantic Ocean, Harvey has been used seven other times since 1981. Both names will likely be retired due to their severity.

Following in Harvey and Irma’s footsteps, Air National Guard senior airmen Michael Davis and Lauren Durham skip their planned beach wedding in favor of deploying to help with Hurricane Irma rescue and relief efforts in Orlando. Their decision led to an impromptu marriage ceremony at the Orange County Convention Center, home to many a HIMSS.

Armando Hernandez-Rey, MD hunkers down at the Conceptions Florida fertility clinic in Coral Gables, FL despite mandatory evacuation orders to make sure stored eggs, sperm, and embryos will survive Hurricane Irma. “We’ve got so many [samples] stored,” he explains. “We’re affiliated with the cancer center, so we have probably about three or four samples from men who are about to start chemotherapy. They stored with us to preserve their fertility. If we lose that, they’ve got none left.”

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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Population Health Management Weekly Wrap Up 9/10/17

Alliance Behavioral Healthcare selects ZeOmega’s Jiva population health management software for its 2,200 providers.

Population health management-focused Health Initiatives Consulting hires Ilse Bell, MD (Amerigroup) (not pictured) as senior director of quality and practice transformation, Lisa Israel (The Genesis Group) as director of data modeling and innovation, and Nancy Thompson (I2I Population Health) as VP of training and education.

Enterprise customer communications management solutions vendor Smart Communications will integrate its technology with Casenet’s TruCare population health and care management platform to allow health plans to deliver personalized communications to members and providers via their preferred channels.

Summit Reinsurance Services enlists the population health assessment expertise of XG Health Solutions to help its customers transition to higher-performing, evidence-based care management models.

Honolulu’s local government and healthcare organizations, including the Hawaii Medical Service Association and The Queen’s Medical Center, band together to develop the H4 (hygiene, health, housing and humanitarian) program to help the city’s homeless and alleviate the burden they have placed on nearby ERs and PCPs. The program, which has yet to find its project $5 million funding, will transform a four-story building into a center for homeless services including a primary and mental health urgent care center, detox and wound care center, and inpatient facility. “The surge in chronic homelessness and its crushing impact on our best hospitals on Oahu … make it a statewide public health and economic emergency that has to be addressed,” says Senator Josh Green, an ER physician who is heading up the project. “These hospitals’ survival depends on action.”

The local paper looks at population health management projects in Iowa that are making a difference in the lives of some of the state’s most underserved patients. A pilot program between Jennie Edmundson Hospital, Iowa Legal Aid, home health agencies, behavioral health agencies, and the Connections Area Agency on Aging, for example, has helped to reduce readmissions by better coordinating patient care. Technology like the TAV record (separate from the EHR) has helped program participants access and share patient information including social determinants of health. The participants would like to secure additional funding to include the school district, paramedics, and fire and police departments.

Sponsor Updates

• EClinicalWorks will exhibit at the AAFP Family Medicine Experience September 12-16 in San Antonio.
• Intelligent Medical Objects will exhibit at HIMSS AsiaPac17 September 11-14 in Singapore.
• More than 900 healthcare professionals advance their education and network at the 2017 Aprima User Conference.

Blog Posts

• Functional and Handsome – Patient Instructions for Better Patient Recall (Healthwise)

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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News 9/7/17

Top News

HHS Secretary Tom Price, MD declares a public health emergency in Puerto Rico and the US Virgin Islands as Hurricane Irma stays its course in the area. Seventy people have already been deployed to help local communities respond to storm-induced medical needs. “Assets are being mobilized to address both immediate healthcare needs and prepare for long-term challenges,” Price said in a recent update. “We are doing everything in our power to maintain access to care for those with Medicare and Medicaid by supporting the ability of hospitals and other healthcare facilities that participate in those programs to provide timely care to as many people impacted by the storm as possible.”

HIStalk Practice Announcements and Requests

HIStalk sponsors, submit your MGMA details for inclusion in our annual must-see vendor’s guide. Companies that are walking the show floor instead of ponying up for a booth are also welcome to submit their information. The online guide will publish a few days before the conference kicks off in Anaheim, CA on October 8.

HIStalk Practice Musings

It’s a 10 on the Mellish Meter: Today’s weather couldn’t be better in my neck of the woods. It’s a declaration I feel slightly guilty making given the tremendous amount of weather-induced damage and loss of life in Texas, Louisiana, and the Caribbean. Cooler temps, low humidity, and mostly sunny skies all belie the intense rain and wind my neighborhood will likely receive when Irma hits the east coast early next week. For now, however, I’ll enjoy the hint of fall by spending some time away from screens and tidying up my yard, all while keeping tabs on family members likely to feel Irma’s direct hit. Stay safe out there, dear readers.

Webinars

September 13 (Wednesday) 1:30 ET. “How Data Democratization Drives Enterprise-wide Clinical Process Improvement.” Sponsored by: LogicStream Health. Presenter: Katy Jones, program director of clinical support, Providence Health & Services. Providence is demonstrating positive measurable results in quality, outcomes, and efficiency by implementing clinical process improvement solutions in arming operational and clinical stakeholders with unlocked EHR data. Providence’s army of process engineers use their self-service access to answer questions immediately and gain an understanding of how their clinical care delivery is impacting outcomes. The presenter will describe practical applications that include antibiotic stewardship, hospital-acquired infections, and comprehensive knowledge management.

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

Acquisitions, Funding, Business, and Stock

Weave Communications raises $17 million in a Series B round led by Catalyst Investors. Based in Lehi, Utah, the company develops and markets patient communication software to dentists and optometrists. Catalyst partner Tyler Newton has joined Weave’s board.

People

Rick Pence (Solis Mammography) joins Unifeye Vision Partners as COO.

Northeast Georgia Physicians Group hires Daniel Tuffy (CaroMont Health) as president and chief administrative officer.

PatientPay names Shahzad Qadri (Allscripts) VP of operations.

Telemedicine

Rural health professionals in Indiana point to telemedicine as a stop-gap measure that may help care for expectant mothers in parts of the state with little to no obstetrics services. Their concern stems from a recent study in Health Affairs highlighting the plight of rural counties without hospitals that deliver babies. As of 2014, 54 percent of rural communities lacked such facilities, leaving over 2 million women of childbearing age without access.

Announcements and Implementations

East River Medical Imaging deploys Royal Solutions Group’s RoyalMD physician image viewing and communications software, including custom mobile app, across its four locations in New York City.

The Rothman Institute (PA), which boasts official team physicians for the Philadelphia Eagles and 76ers, replaces its legacy system with Allscripts PM technology.

Government and Politics

Secretary Price gives a rundown of Harvey recovery operations in between visits to Houston and presumably looming tours of Irma-affected areas in the Caribbean and Southern Florida. Speaking with Time from the Secretary’s Operations Center, Price and his team are preparing to help local officials deal with public health issues caused by mold, water contaminants, viruses, and bacteria. “We’ve got more [hurricanes] coming,” he warns. “Actually, I’ve been incredibly heartened by the response on the ground to Harvey. When I was down there last week I was really inspired by the neighbor helping neighbor and Texan helping Texan sense that you got. It really was all hands on deck.”

Other

It’s not what you think: Steve Del Guice indirectly attributes his burnout-induced retirement from dermatology to “pajama time” – those golden hours at home between dinner time and bed time that many physicians now use to catch up on documentation in the EHR. “This is a common problem,” he says. “And the point is that the [EHR] was really not designed so much by physicians or by working physicians. They’re designed more as a billing instrument, as a data collection instrument. So I think that’s important to understand – that the electronic medical record as it exists now is not really friendly towards practicing healthcare providers. It’s very demanding.”

Healthcare pricing transparency and appointment booking company Amino looks at claims and ICD-10 codes from 2016 to determine the strangest ways in which people were injured. It doesn’t seem to have been a great year for livestock. I wonder how they’ll fare in 2017.

• 17,200 patients walked into a wall.
• 25,000 walked into furniture.
• 400 walked into a lamppost.
• 3,400 came in “contact with a powered lawn mower.”
• 300 were bitten by a pig.
• 10,000 were “accidentally” bitten by another person.
• 1,700 were struck by a cow.
• 8,700 were kicked by another person.

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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Readers Write: “Are You Even Listening?” How Your EHR Could Be Killing Your Patient Relationships

“Are You Even Listening?” How Your EHR Could Be Killing Your Patient Relationships
By Jordan Miller, MD

You’re at lunch with a close friend whom you haven’t seen in some time. It’s an opportunity to catch up, share what’s been going on, and participate in some meaningful dialogue. And yet your friend is constantly looking at his or her phone – occasionally glancing up at you as you’re talking as if they are listening. As the person speaking, you can only assume that they’re only half-listening to what you’re saying as they type away. Sound familiar?

A similar scenario is extremely common these days in physician offices. The use of EHRs has been both a blessing and a curse as it relates to patient engagement. In a recent study by Brown University and Healthcentric Advisors aptly titled, “It’s like texting at the dinner table:” A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals,” researchers found the use of EHR systems negatively impacts the quality of physician-to-patient interactions.

The study is based on a 2014 Rhode Island Department of Health survey that asked 744 physicians open-ended questions including, “[h]ow does using an EHR affect your interaction with patients?” The increase in reporting standards and the amount of data that physicians need to report today have resulted in valuable time being diverted from the patient. Instead of the physician and patient maintaining eye contact during the examination, the computer tends to be the focal point. This tends to create an uncomfortable and often cold experience for the patient, and leaves the physician feeling unfulfilled.

This increase in demand for data also attributes to physician burnout* – where the physician works tirelessly to treat patients while keeping up with the day-to-day documentation in the EHR and subsequent reporting. Even the AMA has raised concerns about EHR usability.

While this ripple effect impacts all levels of the healthcare system, it is the patient who suffers the most. With reportedly high levels of physician burnout across the US – between 50 and 75 percent of physicians, by some reports – coupled with poor engagement due to using technology in the exam room, patients get the short end of the stick when it comes to achieving their health and wellness goals.

Shouldn’t medical professionals work as efficiently as possible while improving patient outcomes? With the shift to value-based healthcare and the focus leaning now more on patient outcomes, the answer should easily be yes. But, as we’ve seen from many studies, it’s not that simple. But it should be.

Technological advancements today have positively impacted so many industries, including healthcare (e.g. connected devices, robotic surgery), so why is some EHR technology still lagging?

As a practicing dermatologist, I can attest to the ever-increasing need to document patient information in a way that is usable. If physicians don’t have the right systems and technology in place, it could potentially take a lot time and effort to not only keep a practice up and running, but also make it successful. For years, documenting in a paper chart was the standard, and some physicians still prefer this method. Then it transitioned to what was essentially documenting in a word processing system on a desktop computer. In neither situation is the data collected in a structured way or able to be used for medical wisdom, or collecting and extracting this data to show the physician statistically what might lead to better patient outcomes. Plus, with these methods I had to frequently stay late in the office and bring work home – taking time away from the patient, and from my family.

Throughout my conversations with other healthcare providers, I’ve learned some physicians argue that improving patient relationships starts with the creation and adoption of intuitive technologies that can automate key administrative tasks and simplify documentation during patient visits. Healthcare providers should have an EHR system that improves their daily professional lives and, when it comes to usability, is intuitive and knowledgeable about my specialty, plus saves me time.

In fact, in the aforementioned survey, doctors did recognize that EHR systems can provide benefits to patient interaction related to the easy access to a patient’s history. Other physicians commented that Web-based patient portals improve communication with patients, and some shared that they will often utilize their computers to bring up and display educational illustrations of medical conditions. From the study, it can be assumed that the physicians who bring their EHR system and laptops – or iPads – into the exam room have identified ways to turn a potentially detrimental patient engagement situation into a positive one.

I like to think that I’m a perfect example of a physician who utilizes EHR technology that not only saves physicians time, but also helps improve patient outcomes. Today I use a native iPad platform that’s intuitive, automatically adapts to my preferences, collects structured data, codes patient encounters using the touch-based system and automates outputs. I can reference a longitudinal visual timeline of a patient’s diseases and treatments, allowing me to easily determine if a patient’s conditions are improving or declining over charted time periods. The mobility of the iPad allows me to show my patients exactly what I’m reviewing and use it as an educational tool. It’s technology designed to improve patient engagement and clinical outcomes. Everyone wins.

From a business standpoint, data-driven platforms help make practices more profitable and save time. Health IT systems should allow physicians to document exams while the patient is in the exam room, use that data to automate reporting, automatically generate billing codes with modifiers based on your notes, show your current billing level in real time, and assist with daily operational tasks including referring physician letters and faxes. As precision increases, so could profits. Technology should improve operational and financial outcomes, while at the same time improving patient access and outcomes – and yes, even eye contact.

*If you’re a physician or medical practitioner experiencing signs of physician burnout, there are many helpful resources on the American College of Physicians website.

Jordan Miller, MD is a dermatologist at Northern Arizona Dermatology and senior medical director of dermatology at Modernizing Medicine in Boca Raton, FL.

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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