DOCtalk with Dr. Gregg 5/6/15

HIT Challenges of Being Independent (i.e., non-Borgian)

Being an independent physician these days sometimes feels like you’re a close relative of the Raphus cucullatus (dodo bird) – fewer and fewer of us to be found. Even with the increase in “concierge” or “direct patient care” practices, there’s a whole heap less of us unaffiliated, non-grouped-up guys and gals around.

Making decisions for a small practice is far simpler than those that large groups, institutions, and associations (the Borg) must make. Investigate, consider, decide, implement. No multiple meetings, no committees, no group think. Sure, you must be fully “fail fast” capable, but changing directions and making adjustments is so much easier and quicker when you’re small.

This is as true for deciding which office supplies you need as it is for which HIT you want to utilize. The only problem is that HIT requires a lot more thought, and yields much bigger disruptions if (or when) failure occurs.

Case in point:

We have what I believe is perhaps the easiest to use EMR ever invented, Elation EMR. Maybe there are others coming along that will rival it, but I’d say our system can likely hold its own against any system for optimal user experience. Plus, it’s very cost efficient. It works just wonderfully for our little practice.

We also have an absolutely gorgeous patient portal, or “Online Care Center” as they call it, created by the good folks at konciergeMD. I’ve never seen its rival for functionality nor user experience, especially for pediatrics. Plus, it’s downright beautiful. Our patients/parents just love it and use it … and use it often.

I spent a long time looking for our first EHR (Bond Clinician) and enjoyed it. It had a rudimentary patient portal that we never implemented because it was clunky and ugly.

I spent even longer looking for our next EMR (Elation). We (my staff and I) have enjoyed it even more. It also has a patient portal, but it’s pretty vanilla. (Sorry, Elation folks; I love you, but your tremendous EMR experience isn’t matched by your portal experience.)

I spent longer still looking for a patient portal that I felt was easy, useful, and gorgeous enough to present to our families. The one we chose has our families actually using it, and feeding back very positive comments about it, on a regular basis. (Compare that to the oft bemoaned poor consumer adoption/use of so many patient portals.)

The rub is that choosing an HIT tool, regardless of the size of the company backing it or the company’s longevity to date, brings no guarantees. Our first EHR was from a startup (Bond) that eventually was gobbled up and moved up the food chain and corporate digestive tracts of MediNotes, then Eclipsys, and eventually Allscripts. Three of those companies, some older and much bigger than a startup, are no longer around. (And the fourth has had its issues.) And, of course, our EHR was eventually digested within the belly of Allscripts, excreted as now-forgotten digital stool, if you will.

The lesson? Big or small, there are no longevity guarantees regardless of which HIT product or vendor you choose.

Our current EMR is still thriving (I believe), but now our beauteous Online Care Center is about to go away. Well, sort of. The original company, konciergeMD, was acquired by Accolade. Accolade wanted the technology, but only wished to incorporate the tech into their tools. They sought to sell off the IP and rights to the Online Care Center itself, as they are not in the EHR nor patient portal vendor arena. Eventually, that is exactly what they did, though they sold it not to a company who would continue to offer it as an independent product. They sold it to an EHR vendor who plans to use it in conjunction with their EHR product. (I can’t blame them; it’s such a wonderful portal.)

However, this puts our little practice back into high tech quandary. Do we switch our patients over to the less-lovely and less-pediatric-friendly patient portal associated with our wonderful EMR? (A very cost effective move. Minimizes workflow disruption for us, though requires some change phenomenon for our families.) Or do we look for another patient portal to deploy? (Not many independent portals available. None as pediatric-friendly. Not nearly as cost-effective an option.) Or, possibly, do we consider switching from our wonderful EMR to this other EHR that now owns our favorite patient portal? (Tons and tons of ramifications there, the most significant of which is the workflow turmoil for our office wrought by such changes, something none of us enjoy.)

Such a dilemma.

I know the Borg face similar decisions, too. And their decisions often don’t have the fail fast capabilities that we enjoy. They often involve obscene amounts of money, too. Their HIT monies and the associated decisions are likely more than proportionally greater, too, as they often choose to go with very large systems from very large companies charging very large fees requiring very large implementation workloads and very large workflow disruptions. I sometimes feel a little sorry for them. (Consider all the reports you read these days of disgruntled providers – and patients! – who are stuck using various mega-systems that they find cumbersome, disruptive, and a plain old pain in the butt to use.)

I do so love being an independent. There are many, many advantages, and those advantages far outweigh the disadvantages in my book. While it might be nice to have others with whom to share big decisions, and maybe even share some of the blame when things don’t work out, I don’t think the tradeoff for innovative and adoptive adeptness is worth it. However, I must admit, when facing such situations, a little “Borgian-ness” might be more comfortable.

From the trenches…

(P.S. Would it be a first give up an EMR because of the patient portal, rather than giving up a patient portal because of a decision to switch EMRs?)

“Seven was a former Borg who had been human and had been assimilated. She was [now] regaining her humanity.” – Jeri Ryan

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership.

Contacts

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

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News 5/5/15

Top News

ONC Coordinator Karen DeSalvo, MD testifies at today’s Senate HELP hearing, fielding questions from Senators Al Franken (D-MN), Patty Murray (D-WA), and Lamar Alexander (R-TN) on the role of healthcare IT in precision medicine, what steps ONC is taking to help researchers protect health data, the importance of cyber security, and how the office will work to streamline EHR adoption reporting. NIH Director Francis Collins, MD also made an appearance, announcing the launch of a cohort of 1 million people for President Obama’s Precision Medicine Initiative.

HIStalk Practice Announcements and Requests

HIStalk HIMSS15 patient advocate and scholarship winner Amanda Green (@LAlupusLady) will host the next #HIStalking tweetchat on Thursday, May 14 at 1pm. As a lupus sufferer, Amanda is particularly excited about hosting during Lupus Awareness Month. Details and topics are coming soon.

Announcements and Implementations

CareMore Medical Group (NV) selects the Allscripts Chronic Care Management program.

PCP network Tandigm Health (PA) signs on to use NaviNet’s new Open Advanced Referrals tool. Part of the company’s Open network, the tool enables practices to submit and access referrals in real time, and to view cost and quality metrics associated with those referrals.

Sysmex America partners with LIS company Medicus Middleware to develop two new lab solutions for the Sysmex XP-300 hematology analyzer. Both connect the analyzer directly to a physician practice’s EHR, and include a user interface for reviewing and accepting results.

Acquisitions, Funding, Business, and Stock

The Nashville Business Journal profiles Entrada, a local company that specializes in mobile documentation for EHRs. CEO Bill Brown explains that a merger or acquisition could be in the 10 year-old company’s future, thought the next two to three years will see it continue to focus on product development and its partnerships with Athenahealth, Greenway, NextGen, and Allscripts.

Retail technology firm Inmar Inc. partners with co-working space Flywheel – both based in Winston-Salem, N.C. – to launch the Inmar Digital Health Challenge. Contest organizers are looking for digital health solutions that leverage disparate data sources to “discover health-related correlations and insights that enable individuals and their support groups/families to collaborate, monitor and improve a patient’s health.” Applications are due at the end of May. The competition runs through July 20, after which five finalists will compete for $25,000 in prize money and future funding opportunities.

People

GAO appoints Donna Cryer (Global Liver Institute), Brent Snyder (Adventist Health System), and Kathleen Blake, MD (AMA) to the HIT Policy Committee.

Government and Politics

HHS Secretary Sylvia Burwell announces $101 million in funding for 164 new health centers in 33 states and two U.S. territories. Over 550 health centers have opened over the last four years as a result of ACA financing.

Research and Innovation

British postgraduate students develop SimPrints, a pocket-sized finger scanner that wirelessly syncs with a health worker’s smartphone via an app to check patient records in the developing world. Mass production is likely within the next 12 months at a cost of $50 per scanner.

Telemedicine

Kura MD acquires The Telemedicine Group, parent company of TeleMed2U, a physicians’ group that offers healthcare services to prisons, rural health clinics and more. Terms of the deal were not disclosed, though it’s worth noting Kura MD is likely tapping into the $1.5 million in Series A funding it received in February to facilitate the deal.

Other

Artist, author, and patient advocate Regina Holliday announces a health data access rally at HHS headquarters in Washington, D.C. at 12 pm ET on May 20. “I am asking you to stand with me, to paint with me ….,” she explains. “Let’s show that we care in this very public way. Even if we are just artists, even if we are just regular people, we care about getting access to data. Let’s paint about core measures and blue buttons on a concrete field. Let’s gather The Walking Gallery and show HHS we care.” Her first memoir, “The Writing on the Wall,” hit Amazon’s shelves last week.

Contacts

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

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News 5/4/15

Top News

HHS announces that Pioneer ACOs have generated over $384 million in savings during the program’s first two years. The ACO model, which serves over 600,000 beneficiaries, has also contributed to more timely care, better patient communication with providers, less use of in-patient hospital services, fewer tests and procedures, and more follow-up visits, according to CMS evaluations.

Webinars

None scheduled soon. Contact Lorre for information about webinar production and promotion services.

Acquisitions, Funding, Business, and Stock

Utah-based startup HydrantID launches a subscription model for buying SSL certificates, citing client EHR and PM software company ManagementPlus as one example of its attempts to gain a foothold in the healthcare industry.

Forbes dissects the rise and fall of VC funding in healthcare IT compared to therapeutics and devices from 2003-2013, citing Aledade, Omada Health, Iora Health, and Doctor on Demand as companies that have made investment waves. The authors point out that, “Physicians are in a relatively good place compared to institutional providers such as hospitals and home healthcare. While some venture capital money is focused on replacing physicians with less expensive technologies, a good deal is focused on enhancing the reach of physicians. This is not true for hospitals and other facilities, which are invariably a target for cost savings.” I wonder if physicians realize what a “good place” they’re in.

Announcements and Implementations

Harrington Family Health Center, a FQHC based in Harrington, ME, goes live on Athenahealth, which held its most recent earnings call last week. Mr. H provides a recap of Jonathan Bush’s commentary here.

Intelli-Bill integrates TransFirst’s payment processing solutions into its HorizonMIS medical billing services. Intelli-Bill is a division of billing and PM software company American Medical Systems.

Acumen Physicians Solutions and DSI Renal partner to enable physician rounding notes from Acumen to interface with DSI’s clinical system. In turn, DSI will recommend using Acumen’s EHR and PM system for nephrologists.

CVS says in its earnings call that its Epic rollout is on schedule and will be completed by mid-year.

People

Henry Chao, the CMS CIO and deputy director who led the rollout of Healthcare.gov, has retired.

The Texas Medical Association elects A. Thomas Garcia III, MD president, and Don Read, MD president-elect. Both will likely be involved with TMA’s new physician services company, PracticeEdge, which aims to help independent physicians contract for services including data analytics, value-based care arrangements, group purchasing, and administrative assistance.

The Physicians Foundation elects Walker Ray, MD president, Lawrence Braud, MD vice president, and Lawrence Downs secretary.

The Federation of State Medical Boards elects new board and committee members.

Government and Politics

Former California State Assembly Republican candidate Susan Shelley outlines the reasons why citizens should opt out of the Cal INDEX, highlighting the errors associated with EHRs: “Electronic health records are only as good as the data entry that created them. A health information executive in Atlanta said a system with poorly designed drop-down menus had led to 92-year-old women being diagnosed as crack addicts.” Last time I checked, EHRs are also only as good as the end users entering the data that prompts the drop downs.

Rep. Ted Poe (R-TX) introduces H.R. 2126, a bill that would prohibit HHS from replacing ICD-9 with ICD-10 in implementing the HIPAA code set. The bill has been referred to the Committee on Energy and Commerce and the Committee on Ways and Means, and is unlikely to pass unless Poe gains critical-mass support for the delay. Poe’s first attempt to block the ICD-10 transition, when he launched a similar but ultimately unsuccessful attempt to prevent the switch.

CMS posts 64 updated electronic clinical quality measures for EPs, who will use them to report 2016 quality data for CMS quality reporting programs including the Physician Quality Reporting System and EHR Incentive Programs.

Research and Innovation

AHRQ publishes a brief recommending EHRs include areas for vaccinations, development, physiologic medication dosing, pediatric disease management, pediatric norms and the relationship between pediatric patients and their caregivers, especially focusing on adolescent privacy.

Telemedicine

American Well launches the Telehealth 2.0 suite of services for physicians, enabling them to conduct remote video consults and perform a range of practice management tasks.

The American Telemedicine Association updates its state policy reports identifying gaps in coverage and reimbursement, and physician practice standards and licensure. Not surprisingly, Texas joins Alabama as the only states with the lowest composite score due to revised telemedicine clinical practice policies in their states.

HealthSpot upgrades its software to include online scheduling and a PHR.

Other

English asthma patient Kate Warriner becomes the first in the country to use her iPhone to treat her condition. Using technology from NHS partner EMIS Group, Warriner uses the phone to record results of lung tests, which are then automatically shared with her physician. “This means my GP has a complete record of my readings, alongside my medical history, and can prescribe me further medication as I need it to manage my condition effectively,” Warriner explains.

Sponsor Updates

• Versus Technology recaps its HIMSS15 presentation on “Transforming Process Improvement through RTLS Data.”
• Nordic Consulting releases the fifth episode of its “Making the Cut” video series on Epic conversion planning.

Contacts

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

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Population Health Management Weekly Wrap Up 5/1/15

Top News

IBM, Apple, and Japan Post Group will deliver iPads to up to 5 million senior citizens in Japan by 2020. The IBM-developed apps include medication and lifestyle reminders, community services access, and electronic monitoring that extends Japan Post Group’s fee-based home visits. The postal agency is the country’s largest employer, and is also an insurance provider. The partnership is part of IBM’s larger population health initiative, kick started earlier this year with its Phytel acquisition and creation of the Watson Health business unit.

Announcements and Implementations

Independent physicians association Health First Network (FL) will deploy Mirth’s Care Enterprise to its Medicare ACO providers. The tool will be used to connect their different EHRs, coordinate data to avoid duplicate tests and treatments, and benchmark network performance.

NextGen Healthcare launches NextGen Care, a risk-scoring tool that will enable providers to identify gaps in care, automate outreach, and manage specialist referrals, particularly for those with chronic conditions.

Government and Politics

NIH and the National Institute on Minority Health and Health Disparities announce grant opportunities for businesses looking to develop “a product, process or service for commercialization with the aim of reducing disparities in healthcare access and health outcomes.” Applications are due July 23. Phase 1 funding could reach $150,000, with Phase 2 likely exceeding that.

Research and Innovation

A report finds that Cognizant, Accenture, and EXL are in the “Winner’s Circle” when it comes to population health and care management service providers due to their clarity of vision, collaboration with clients, and depth and breadth of experience.

A survey conducted at HIMSS finds that nearly half of attendee respondents find data analytics and business intelligence to be the biggest health IT topic for 2015. A similar percentage reported confusion around what type and amount of healthcare data to collect, no doubt leading to the lack of buy-in many feel is the biggest barrier to new IT projects.

People

Nancy Lane (ValueOptions) joins Vanderbilt University Medical Center as senior vice president for population health management.

Other

A lack of research suggests that our obsession with tying specific dates to health-related awareness campaigns does little to actually improve anyone’s health. Thirty-seven of the more than 200 official health awareness events listed on the HHS 2015 National Health Observances calendar occur this month alone. Only five evaluations of health awareness days exist, and all of which were performed outside of the U.S.

In this op/ed, Drew Harris, director of health policy at Thomas Jefferson University’s School of Population Health, outlines the dark side of big data:

The dark cloud on the horizon of this bright, data-driven future is the loss of all privacy. There are no more secrets when every heartbeat is measured and tracked, every neighborhood is categorized for safety and health benefit, and every blood test is a strong clue to our ultimate end. In some ways, aggregated health data violates the laws of economic scarcity—the more there is, the more valuable it becomes. Some people will want to own it—or steal it.

When our data becomes as precious as our very lives, new policies governing its use are necessary. We must find ways to balance public utility with individual liberty, and ensure health data systems are unhackable and data-use rules are strictly enforced. Punishment for violations must be as severe as the potential damage. Unless this is done, no one will trust data-driven population health and the benefit of sharing will be lost as health data systems grow alone in walled-off gardens.

Contacts

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

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Readers Write: Putting the Patient First Means Fixing a Fragmented Healthcare Ecosystem

Putting the Patient First Means Fixing a Fragmented Healthcare Ecosystem
By Terry Edwards

The New York Times recently shed light on one of healthcare’s worst-kept secrets: Fragmented care is the norm to the detriment of patients. Too many patients experience disconnected transitions as they move across a variety of care settings. Many patients complain about how each of their providers seem to ask the same questions. This repetition is more than an annoyance; it’s further proof of just how little each clinician knows about the patient’s medical history, and makes it difficult to ensure patients are sticking to the appropriate treatment plan. This disconnect between care settings has a negative impact on providers as well. According to the Institute of Medicine, fragmented care and other inefficiencies cost the healthcare system at least $130 billion annually. Moreover, a survey from the Agency for Healthcare Research and Quality reported that poor communication during care transitions can lead to duplicate testing, medication errors, and lack of follow through on referrals – all of which drain staff and resources.

As our healthcare ecosystem moves toward value-based care and population health management, it is becoming even more critical for providers to get on the same page about a patient and collaborate more efficiently and effectively.

Healthcare professionals understand how important this is to get right. My organization, PerfectServe, recently commissioned Harris Poll to conduct an online survey of 955 medical professionals. Ninety-eight percent of those surveyed (both clinical and administrative) indicated that improved communication with patients is critical to improving population health. While there is consensus that communication and collaboration are keys to success, I have a few theories on why this is still missing from day-to-day practice:

· Misdirected incentives. Much of the healthcare industry remains wedged firmly in fee-for-service. Coordinating care makes little financial sense for physicians, who are paid per task, not for improving patient care. Without the appropriate financial incentives in place, coordinated care is the exception, not the rule.

· Overreliance on the EHR. The EHR was heralded as the answer to everyone’s healthcare problems – from claims to improving the accuracy of patient records, creating greater care team access to relevant information, and better coordination of care. Our survey showed that only about half of hospital-based physicians and primary care physicians in large practice organizations believe the EHR is sufficient for care coordination and collaboration. The EHR has an important role to play in healthcare delivery, but, like most “miracle cures,” it can’t fix everything and needs to be considered in its proper perspective.

· Too little time. Clinicians in all roles are feeling crunched for time to treat patients and handle all of the administrative tasks required of them. According to a 2012 study by the Physicians Foundation, more than 57 percent of physicians report working more than 50 hours per week, and eight out of 10 (81 percent) physicians describe their practices as either over-extended or at full capacity. This makes it harder for clinicians to find the time to reach out to their colleagues to coordinate patient care.

· Gap between clinical and administrative teams. One of the challenges identified in our survey is a wide disparity in understanding between administrative (hospital administrators and office managers) and clinical (physicians, nurses, and case managers) respondents. For example, while 94 percent of hospital administrators say they are familiar with their organization’s population health management strategies, only 61 percent of hospitalists responded the same way. And while administrators might not be needed to coordinate a patient’s care, they’re absolutely critical to making sure clinicians understand organizational priorities in terms of coordinated care and population health. They also need to understand clinician workflow so that they can invest in tools and technologies that enhance rather than impede workflow.

Healthcare organizations are making great strides in tackling many of these issues. Value-based care will encourage clinicians to collaborate more with other care team members to help reduce inefficiencies and ensure smooth care transitions. The move to larger, integrated health systems may help create stronger relationships by connecting providers under a similar umbrella, facilitating referrals within the system. And many healthcare providers are looking at different tools to make sure their clinicians have what they need to collaborate with other care team members easily and through the appropriate channel.

Managing the health of patient populations is no easy task, but providers are rightfully focused on forging a path to get there. To accomplish this successfully, organizations need to create a strategy to transition their fragmented system to one which fosters true collaboration.

Terry Edwards is CEO and founder of PerfectServe in Knoxville, TN.

Contacts

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

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