News 10/19/15

Top News

Athenahealth launches Let Doctors Be Doctors, a website and hashtag that physicians can use to complain about their EHRs. It’s a fairly brilliant marketing move, given that the company’s product development team will benefit from the feedback. Plus, ZDoggMD seems to be a campaign spokesperson, ratcheting up the cool factor considerably.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Executives attending the KLAS Keystone Summit in Utah agree to objective interoperability metrics and ongoing reporting, though no details are released as to what the measures are; how they were agreed upon; and how executives from Epic, Cerner, Greenway Health, Athenahealth, and EClinicalWorks, among seven other vendors, will go about reporting them. KLAS naturally plans to serve as the organization that will assist the vendors in creating a plan to launch and monitor the collaboration. Though the announcement is vague, I would be interested to learn what a dozen leading EHR vendors, particularly Epic, agree upon, and how ambulatory might figure into the equation.

Relay Health announces the successful processing of $25 billion in ICD-codes stemming from 13 million claims made using the company’s RCM technologies.

Announcements and Implementations

Talksoft offers a mobile survey tool to benchmark patient experience and practice performance.

EClinicalWorks launches 10e, a cloud services platform incorporating EHR functionality with population health and patient engagement tools

X-Ray Associates of New Mexico, the state’s largest outpatient provider of medical imaging services, selects the RIS V7.6 software suite from MedInformatix.

Reliance Medical Group (NJ) implements MD Revolution’s RevUp for CCM solution, offering its 40 physicians clinical decision support, enhanced patient engagement services, and care-plan access in between patient visits.

Government and Politics

The American Osteopathic Association makes clear its disappointment with the Meaningful Use program, stressing that additional though unspecified changes are needed beyond those announced with much fanfare last week. “When only 10 percent of providers are in compliance, it’s clear that a substantial overhaul is needed in order for EHRs to achieve their stated purpose,” says John Becher, DO, president of the American Osteopathic Association. “At this juncture, the meaningful use program as it stands is not strengthening the critical physician-patient relationship that osteopathic physicians hold sacred, which is exactly the opposite of the law’s intent.”

Healthcare.gov bashing ramps up, with the New York Times pointing out that the federal health insurance exchange’s “window shopping” feature is behind schedule due to unanticipated bugs and a lack of payer-submitted data. Due to the delay, users shopping for policies ahead of open enrollment are not able to view health plan benefits, prices, and details. HHS now plans to launch the new search tool closer to November 1.

ONC’s Office of Standards and Technology Director, Steven Posnack, lays out how the agency plans to move forward with implementing the final rule’s regulatory requirements, including certification companion guides and draft test procedures for each EHR certification criterion. NIST will also make available “alpha” versions of 2015 Edition testing tools for early feedback and pilot testing.

Telemedicine

An Accenture report suggests that utilization of virtual tools in the areas of self-care, patient management, and annual visits could potentially save PCPs $10 billion annually. The report makes an interesting comparison to the amount of time PCPs could save if certain tools are used in certain care settings: For example, using virtual solutions in diabetes care could free up 11 percent of the PCP workforce, which the company equates to $2 billion in savings each year.

The American Academy of Sleep Medicine publishes a 12-page position paper with recommendations of technical specifications and best practices for specialists to consider when incorporating sleep telemedicine into their practice. Though comprehensive, the AASM makes sure to point out that specialists should be prepared to adjust their practices based on the anticipated rapid expansion of telemedicine technologies. The academy anticipates that potential areas of expansion will include high-risk population management, wearable device technology, bundled payment schemes, integrative care models of delivery, wellness programs, and home health.

Other

Researchers in London determine that physically fit office workers won’t benefit from working at a standing desk as opposed to a seated one, no doubt leaving millions of standing desk owners wondering about their return policies. The researchers found that “extended butt parking” didn’t result in a higher risk of premature death for employees already active, proving that a gym membership is far more valuable to your health than the latest ErgoDepot desk.

Sponsor Updates

• PerfectServe will exhibit at the Western Section AUA Annual Meeting October 25-29 in Indian Wells, CA.

Blog Posts

• Top 10 Hospitals Where Patients Prosper (Billian’s HealthData)
• RTLS – The ‘Chocolate’ that Energizes Your EMR (Versus)

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Readers Write: What Med Students Really Think About Healthcare IT

What Med Students Really Think About Healthcare IT
By Kenneth Iwuji, RN

Results from the annual Future Physicians of America Survey are in, presenting me with a well-timed opportunity to weigh in on some of the survey’s most interesting findings. This year, 1,026 respondents (75 percent of whom were third and fourth-year medical students) shared their opinions on medical training, preparation for practice, state of patient care, interoperability and how they plan to use digital medicine. Here is my take on what I consider to be the most interesting highlights:

Timely access to patient records needs improvement. Almost all students believe that easily sharing patient records among care teams is critical to improving patient care, yet 44 percent are concerned about the ability to do so within a hospital or practice; 73 percent worry about the ability to share patient information across unaffiliated practices. Other findings show that 96 percent believe improving the ability of EHR systems to access patient data from other systems is important to providing better patient care.

This point especially resonated with me. I’ve been a registered nurse for seven years and still practice while in medical school. I’ve worked for various health systems that use numerous vendors and it’s always been nearly impossible to synchronize patient information; the systems can’t talk to each other. In order to gain critical information about my patients, I still find myself making telephone calls and faxing request for release of medical records, which just doesn’t cut it in emergency situations. It also leads to a lot of waste in the system — we have no choice but to repeat tests and procedures because we cannot gain access to the results when needed. It baffles me that these systems can’t find a way to sync up — every other electronic device in our lives does.

Students are lukewarm on telemedicine, preferring face-to-face visits. When it comes to leveraging digital tools to enhance delivery of care, 41 percent of students turn to a medical app first for clinical answers while only 29 percent would seek advice from a peer first. Almost all would encourage patients to use monitoring devices (97 percent) or email them for treatment advice via a patient portal (74 percent). Yet 98 percent of medical students would prefer to see their future patients face-to-face for the initial visit as opposed to virtually. Even for follow-ups, 89 percent of students favor the traditional face-to-face exam. This may strike some folks as strange, given the surge in telemedicine in the past few years. There are benefits to telemedicine, of course, especially when care isn’t readily accessible to patients, but there is no better substitution for face-to-face visits that allow a physician to perform a thorough examination and form a relationship with the patient. Great physicians do not rely only on technology or laboratory tests and procedures to make diagnoses and formulate treatment plans. Coming up with the most accurate diagnosis or even differential diagnosis involves spending time with the patient and obtaining a detailed history; the best way to do that is face-to-face.

Burdensome documentation is overwhelming. (I can personally attest to this.) Seventy-one percent of third- and fourth-year students report they spend more time documenting encounters than seeing the patients themselves; 80 percent expect they will continue to document more than interact with patients when they become physicians. Again, this feels to be a shortcoming of the technology — instead of being able to spend my time taking care of the patient, I have to stay glued to the screen. EHRs should be more user friendly — simple changes could make a big difference. For example, sometimes I find myself double charting the same information in different screens. After I chart information once, it should carry over to the next needed screen.

Finally, dissatisfaction with practice management training continues. For the fifth year in a row, medical students said they have been inadequately prepared to run a successful healthcare practice: Only eight percent feel equipped to manage a practice and only 4 percent to bill and code. I personally am not especially frustrated by this, though it seems some of my peers are. I view school as the place where we learn; we shouldn’t be expected to become experts until we are in practice.

Despite my frustrations with healthcare technology, I still have faith that it will continue to evolve and will eventually work seamlessly for all providers; the barriers just need to be broken down. There is no reason why information shouldn’t flow freely and securely, providing benefits to patients and allowing doctors to do their work.

Kenneth Iwuji, RN is a fourth-year medical student at Texas Tech University Health Sciences Center School of Medicine.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Population Health Management Weekly Wrap Up 10/18/15

IT solutions provider UST Global makes a $5 million stock investment in Sandlot Solutions.

Apollo Medical Holdings completes a $10 million investment from physician-led managed services organization Network Medical Management, which is slated to soon nominate a representative to Apollo’s BoD.

Verisk Analytics is rumored to have retained Morgan Stanley to sell its Verisk Health business in what should be a billion-dollar deal.

Geisinger Health System (PA) makes Cerner’s HealtheIntent population health management platform a vital component of its Unified Data Architecture platform after a successful proof-of-concept project in which Geisinger used the tool to aggregate clinical and financial data from its Epic EHR and insurance company. The two organizations, along with XG Health Solutions, are also working to develop SMART on FHIR applications to manage specific patient populations and improve outcomes.

Seattle Children’s Hospital signs a three-year contract with Wellcentive to implement its population health management and value-based care solutions. The hospital will use the tools within its Seattle Children’s Care Network and Pediatric Partners in Care program.

EClinicalWorks launches 10e, a cloud services platform incorporating EHR functionality with population health and patient engagement tools. The new product also integrates telehealth visits, as well as wearables data.

Dātu Health enters into an accelerator-style partnership with St. Joseph Health that will see the company move it development operations from Boulder, CO to Orange County, CA to more easily collaborate on developing its Digital Encounter and Persuasion Engine technologies with healthcare companies within SJH’s investment portfolio. SJH announced a $10 million investment into the St. Louis-based startup earlier this month.

Sponsor Updates

• Intelligent Medical Objects will exhibit at the EClinicalWorks 2015 National Conference October 16-19 in Nashville.
• Leidos Health will exhibit at the Georgia HIMSS annual conference and tradeshow October 23 in Atlanta.

Blog Posts

• Epic MyChart patient engagement strategies: Buy-in, special challenges and Meaningful Use (Nordic)

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Readers Write: All Practice Models Have Ups and Downs

All Practice Models Have Ups and Downs
By Tom Giannulli, MD

Like all physicians, I’m very interested in improving and simplifying medical reimbursement, so I’m always fascinated by how practices are using different payment models to stay independent. A new survey, Practice Model Perspectives 2015, indicates growing frustration with the payer system, which comes as no surprise. However, what is interesting is that, while many physicians are looking at alternate business models like Direct Primary Care (DPC), no model is free of challenges. Every approach has its ups and downs, and to be successful, practices need to look at all of their options and choose a path that makes sense for them based on their unique situation.

The survey showed that about 24 percent of practices were already using some kind of private pay structure or membership program. Another 46 percent of physicians said they were considering making a change to direct pay, concierge, or other membership models in the next three years. Interest in changing or adding alternate payment plans is high.

The top reasons for making a change were separating from the payer system, spending more time with patients, and improving work/life balance. Not surprisingly, private-pay doctors indicated they work fewer hours on average, spend less time on administrative tasks, and have more time with patients. What was more interesting were some of the responses from providers using different models.

No matter what business model you use, there are challenges. The need to find patients to support your practice is important for all providers, but more so for private-pay physicians. The survey found that this is the biggest challenge for concierge and direct-pay physicians. I think this explains why many of these practices haven’t gone all in, so to speak. Only 28 percent of respondents had all of their patients on a membership plan. The largest group — 37 percent — had only 25 percent or fewer of their patients on a membership program.

It’s important to note that while providers can transition their whole practice to direct pay or concierge models, they don’t have to do it that way. By having only some patients on a membership program, there is far less risk. If it goes well, then physicians can look at transitioning more of the practice. The key is proper planning and choosing the right place with the right patient mix.

The Technology Angle
In addition to some of the challenges around creating a viable model, all providers indicated the need for tools and software to support their practices. Over 80 percent of the physicians who responded were on an EHR, and nearly half had a patient portal. Where the practices differed was in the use of newer technologies.

Practices using private-pay models were more likely to use telemedicine, kiosks, and practice-marketing software. Fee-for-service practices were far more likely to put an emphasis on billing software. Choosing and using any software comes with its own benefits and challenges, and these days it seems there is no way around the need to use technology to help increase your chances at success.

Ultimately, the survey shows that all models come with benefits and challenges. To find the right fit, physicians need to think about their larger goals and risk tolerance. There are many options available today, and you don’t have to choose a single model. You can build a practice that meets your unique needs by combining different models to create an agile physician practice.

Tom Giannulli, MD, MS is CMIO at Kareo of Irvine, CA.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Readers Write: Family Physicians Set the Path for America’s Healthcare

Family Physicians Set the Path for America’s Healthcare
By Javette Orgain, MD

Family physicians, students, residents, and others from across the US descended on Denver earlier this month to learn about the latest research in medical care and procedures, elect their leadership, and network with one another during AAFP’s annual meeting, the 2015 Family Medicine Experience.

The message they took away from the meeting: Family medicine continues to lead the nation in identifying the policies that are building a healthcare system of efficient, high-quality care that improves individual and community health.

“Our time is now,” said newly installed AAFP President Wanda Filder, MD.  “America is hungry for answers to a broken US healthcare system. We have tapped into what America needs. We are the answer to what ails the US healthcare system.” Noting the success of the Family Medicine for America’s Health initiative and its public education counterpart, Health is Primary, Filer said legislators, policy makers, and the public now realize that family physicians provide ongoing, coordinated, and comprehensive care for both patients in overall good health and those with multiple, highly complex health conditions. Policy makers now understand the healthcare system must pay for the medical expertise and time that family physicians invest in each of their patients.

Community Health Moves to Center Stage
If one theme dominated the 2015 AAFP Congress of Delegates, it was the commitment of family physicians to their patients. From speeches to resolutions, family physicians demonstrated their focus on ensuring all patients have what is needed to enjoy good health.

The resolutions put before the Congress addressed multiple issues: affordable access to care and medications; an environment in which physicians can focus on patient care without heavy administrative burdens or cumbersome reporting requirements; healthy communities; preservation of rural hospitals; and a host of other issues affecting individual and community health.

Among the resolutions that passed were those that called on the AAFP to:

• Collaborate with public health agencies to reduce the negative effects of income, education, and nutrition inequality in order to improve health outcomes.
• End non-medical exemptions for immunizations.
• Support a federally funded adult vaccine program.
• Support expanded use of Naloxone to allow first responders and other non-physicians to administer the medication in an emergency overdose.
• Support decriminalizing the possession of marijuana for personal use and encourage NIH to conduct appropriate research on the health effects of marijuana use.
• Urge Congress and federal agencies to investigate policies that result in pharmaceutical price increases that create barriers to generic medications.

Educational Sessions Bring Medical Research to the Exam Room
With their work complete, AAFP’s 116 delegates joined more than 3,800 of their colleagues for four days of continuing medical education on research, diagnosis, and treatment of illnesses, chronic-care management and patient-centered care. Attendees chose from more than 140 sessions on prenatal care, cardiovascular disease, cancer, fibromyalgia, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, and psychiatric and neurological conditions.

Family physicians came away from their four days inspired by their leaders and their colleagues. “This is a time that we can network, this is a time that we can become educated,” said another attendee, summing up the meeting. “This is a time that we can get to meet our leaders. This is something we can learn, we can create, and then we can take back home. I’m in rural medicine. I need something new. We need to be stimulated and we get it from the conference.”

Javette Orgain, MD is vice speaker of AAFP and medical director of Village of Park Forest Health Department.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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