News 6/12/14

Top News

Private physicians working in the Wesley Medical Center ER face an ultimatum that will likely become all too common as hospitals look to streamline via direct-employment relationships: Become employees of WMC’s staffing vendor, EMCare, or lose their jobs at the hospital. Mark Mosley, medical director of WMC’s emergency department, believes the hiring situation will put patients at risk: “We tried to explain to the administration the relationship we have with physicians in the community, the relationships with nurses, and the kind of patient care we give is not something you can fly in from out of town and buy. It’s created from years of teamwork. When you take that away, you potentially put patient care at risk.” The ER physicians, part of the Emergency Services Professional Association, have until September 3 to make a decision.

A  VA self-audit of 731 facilities finds that 13 percent of schedulers were told to enter desired appointment dates different from what the patient requested, eight percent of facilities kept external scheduling lists invisible to the VA’s EWL/VistA systems, and unrealistic targets encouraged facilities to game the system. New patients waited up to three months to see a doctor. The VA announced immediate changes: eliminating the 14-day appointment target as unreasonable, implementing real-time patient surveys, conducting an external audit, freezing new hires and eliminating bonuses at VA headquarters and regional offices, and creating an HR team to get clinicians hired faster. It also plans to implement a new scheduling solution to work within its VistA EHR, according to statements made by VA CIO Stephen Warren at a recent Senate hearing. Meetings with industry are scheduled for next week, and the agency hopes to have a product in place by the close of fiscal 2015.

In the mean time, the VA releases an interactive map showing average wait times for new patients. Only one facility stands out as having wait times of less than 14 days.

Acquisitions, Funding, Business, and Stock

The local paper notes that Hill Physicians Medical Group (CA) is “making bank on health reform.” The group achieved over a half billion dollars in revenue for the first time, reaching $505.2 million in 2013. HPMG attributes the revenue to cost-of-care savings associated with its participation in three ACOs that same year. Two more were added in 2014. Perhaps that “bank” will be used to fund HPMG’s investments in technology that will be used to improve the way it pays claims to doctors and to transition to ICD-10.

Napersoft announces support of EHR summary documents for patient portals, enabling patients to securely view, download, and transmit their data while helping physicians meet multiple Meaningful Use objectives. Napersoft’s CEO, Bart Carlson, was featured in a recent issue of CEOCFO magazine, where he pointed out that healthcare is one of the company’s biggest areas of opportunity.

This headline takes the cake when it comes to healthcare acronyms the average lay person probably wouldn’t understand. CECity announces that CMS has recognized 10 of its qualified clinical data registry collaboratives for reporting under the Physician Quality Reporting System.

Announcements and Implementations

The Medical Society of Northern Virginia launches the HeaLiXVA HIE that, in its first phase, will enable Fairfax Family Practice, Loudoun Medical Group, Sunrise Medical Laboratories, and Solstas/Quest Laboratories and Radiology Imaging Associates to connect. A second phase will connect local hospital systems. Physicians can subscribe to the new HIE for $25 per month, though EHR integration fees are not included. It’s somewhat refreshing to hear about a HIE just getting off the ground, when so many seem to be running out of grant money and closing up shop. 

Panhandle Orthopaedics (FL) signs on for practice and revenue cycle management services from AssuranceMD. PO’s sole physician, Michael Gilmore, MD seems especially tuned into healthcare IT, peppering his Facebook page with numerous industry-related posts.

The local paper profiles Allen Gee, MD and the virtual telemedicine practice he has established at five clinics across Wyoming. Gee, who was awarded the 2014 Vision Award from athenahealth, is in the process of opening a sixth clinic where patients will be able to check in via handheld devices.

Government and Politics

Sue Bowman, AHIMA’s senior director of coding policy and compliance, outlines top priorities healthcare organizations should focus on leading up to the new ICD-10 compliance date during recent testimony in Washington, D.C. They include:

• Increased testing internally and with payers
• Increasing engagement with physicians and their staff, ancillary departments, and post-acute providers to ensure all stakeholders are moving toward ICD-10
• Evaluating and resolving ICD-9 coding and documentation issues
• Leveraging technology to provide real-time documentation improvement tools that facilitate documentation at the point of care
• Developing a more thoughtful and comprehensive educational plan
• Analyzing data to identify and focus on high-risk documentation and coding areas

Statistics presented at Tuesday’s HIT Policy Committee meeting indicate that of EPs who first attested for Meaningful Use in 2011, 84 percent attested in 2012 and 75 percent in all three years of 2011, 2012, and 2013. Nearly half of those who attested the first year and then skipped 2012 returned in 2013. EHR incentive payments totaled $24 billion through the end of May.

People

Practice management and population health technology vendor Privia Health appoints Andrew Aronson, MD chief medical officer. Aronson will work closely with the physicians of the company’s multispecialty Privia Medical Group (VA) to improve coordinated care value and quality. Privia’s business model is an unusual one. The practice management and population health technology vendor’s clients  came together at the beginning of this year to join the Privia Health brand through the formation of PMG.

Other

Thanks to Dr. Jayne for mentioning that the call for proposals for HIMSS15 is open through June 16. As she points out, that’s nearly 10 months before the actual conference, decreasing your chances of seeing presentations that are fresh and timely. Submitters beware: A user name and password is required, and the submission website works well only with certain versions of certain browsers. Good luck!

The City of Bullard, Texas, renames a portion of Hwy. 69 as N. Doctor M Roper Pkwy, honoring 93-year-old Marjorie Roper, MD. Roper opened Bullard Medical Practice in 1947 in the back of her father’s drugstore, where she practiced medicine for 60 years.

The Patient-Centered Primary Care Collaborative releases the Primary Care Innovations and PCMH Map, which allows users to identify where medical homes are becoming a standard of care in commercial and public-sector health plans. Nearly 500 initiatives are tracked.

5 Questions with Jim Morrow, MD

Jim Morrow, MD is CEO of Morrow Family Medicine (GA), Medical Director of IntelliChart, and sits on the boards of the Georgia Health Information Network HIE and the Institute for Health Information Technology. As MFM’s only physician, he sees between 50 and 70 patients a day with the help of a PA. MFM also includes two MAs and three ancillary staff members. He has used an EHR from Allscripts since 1998.

How has healthcare IT, such as your EHR, impacted your practice? Any before and after anecdotes to share?

• Productivity: I’m able to see more patients because I do not have the time to dictate after seeing patients. I am much more efficient on EHR than without.
• Staffing: I’m able to employ fewer people due to the efficiency.
• Cost: It’s much cheaper to send messages to patients through the portal. I don’t have to involve an hourly employee in that process.
• E-prescribing: Quality increases because errors are minimized. And there are no handwriting problems.
• Quality generally: I have the ability to search lab orders and be sure that ALL labs that were ordered were resulted, as opposed to the paper world where you cannot know if a lab was just never resulted and you lost track of it.
• Quality again: I am able to see how a problem has been handled over a long period of time in an easy glance instead of having to sift through page after page of notes for a particular item.
• Quality still: I am able to know that the average a1C for the practice or for a particular provider is X, and that the provider is or is not doing a good job controlling diabetes among their population.

Where are you with Meaningful Use? As an independent physician, have you benefited from the program, or found it overly burdensome?
I have attested three times, for Stage 1, and received three checks. The EHR reporting module makes this very easy, giving me essentially all the info I need to attest.

What other healthcare IT/clinical programs are you participating in at the moment?
I participate in the Physician Quality Reporting System, along with MU. I’ve received checks every year from them for doing this.

Has healthcare IT enabled you to remain independent?
It plays a large part. It takes a lot of admin burden from me and helps me be as efficient as possible, keeping me from having to join a hospital network.

What are your thoughts on the ONC’s 10-year vision statement for interoperabilty? Do any parts of its plan jump out at you as having significant impact on private practices?
My main thought about the plan is that this is something that should and COULD have been done already. I have preached to anyone who would listen that this is not a technology problem. It is a people problem. People in decision-making seats have just not felt it was worth their money or time to work with others to interoperate. It will be so easy to make happen when vendors and users decide that it is important enough to go ahead and do.

Sponsor Updates 

• Kareo and ChartLogic partner to deliver cloud solutions for surgical, orthopedic, and otolaryngology specialties.
• Truven Health Analytics launches its cost-sharing reduction analysis and reconciliation solution for health insurance exchanges. .
• ADP AdvancedMD supports the Greater Springfield Habitat for Humanity during a corporate team-building day. 
• E-MDs will offer Lightbeam’s population health management solution to its clients.

News 6/10/14

Top News

ONC publishes a 10-year vision statement on the future of interoperability. At 13 pages, it is “an invitation to health IT stakeholders … to join ONC in figuring out how we can collectively achieve interoperability across the health IT ecosystem.” Highlights include:

• Nine guiding principles that stress customization, educating and empowering the public, simplicity and modularity, and leveraging the market.
• Proposed development of an interoperability roadmap.
• Three-, six- and 10-year goals that widen the healthcare ecosystem with each successive year to incorporate stakeholders from outside of the traditional healthcare IT industry, as well as placing more responsibility on the individual patient to provide digital data to caregivers.
• Five building blocks upon which ONC will implement the aforementioned goals, focusing on core technical standards and functions, certification, privacy and security, HIE governance, and a supportive environment comprising all manner of stakeholders.

Several parts of the paper provide food for thought: How will Meaningful Use deadlines line up with these goals? The term “levers” is used throughout, prompting the question of whether ONC will continue to use carrots or sticks to promote interoperability. It does mention that “ONC will help define the role of health IT in new payment models that will remove the current disincentives to information exchange,” so perhaps carrots will be the method of choice. All in all, the paper makes plain that ONC will be around for some time to come, both as a certification body and driver of regulatory health IT change.

Perhaps in response to ONC’s renewed focus on interoperability, the CommonWell Health Alliance announces it will become officially interoperable this summer. The alliance includes such EHR vendors as Cerner, McKesson, Allscripts, athenahealth, and Greenway; as well as CVS Caremark and Medhost. It will be interesting to see if Carequality, a “competing” interoperability organization of healthcare stakeholders led by Epic, will soon follow suit.

The Senate confirms Sylvia Burwell as secretary of HHS. Her first, immediate item of business may be to respond to a trio of letters sent to her from industry organizations including the National Association of ACOs; Alliance for Connected Care; and American Telemedicine Association, HIMSS, and Telecommunications Industry Association. The letters ask HHS to pay for telemedicine services provided by Medicare ACOs. The NAA’s letter does an especially good job of pointing out that many physician-led and smaller ACOs can’t assume the financial risk of providing telemedicine consults for free.

Acquisitions, Funding, Business and Stock

Anthem Blue Cross and Healthcare Partners physician group (CA) announce their coordinated care efforts helped save $4.7 million in the first half of 2013 via reduced hospital admissions, emergency room visits and lab tests. The commercial ACO included close to 55,000 patients with chronic conditions in Southern California who were enrolled in PPO plans. Healthcare Partners established an ACO unit in 2012, and received additional fees from Anthem for its care coordination efforts.

A new study finds that athenahealth’s Epocrates is the top medical reference app on smart phones for the fifth consecutive year, and on tablet devices for the third consecutive year. Sixty-two percent of physicians who use Epocrates use their smartphones to access clinical content in between patient consults, while 39 percent access it during.

The EHR market continues to consolidate, as Medytox Solutions acquires ambulatory EHR vendor Globalone Information Technologies. Medytox’s current offerings include medical transcription, revenue cycle management, and other administrative and practice management software.

Announcements and Implementations

Non-profit primary medical and dental care provider ARcare (AR) receives the Stage 7 Ambulatory Award from HIMSS Analytics. It is the  first federally qualified health center in the U.S. to receive the distinction, and one of only two ambulatory practices not connected with a hospital.

Multispecialty group practice United Medical PC joins the Barnabas Health Medical Group (NJ), part of the largest not-for-profit integrated health care delivery system in the state. Barnabas Health seems to be on a bit of a buying spree, having acquired Jersey Medical Center earlier this month.

Wilmington Health (NC) transitions this month from its 10-year-old Allscripts system to the NextGen Healthcare EHR. The conversion team has been working with NextGen for 18 months to combine its practice management billing application and EHR into one platform.

People

Mr. H provides high-level background highlights of the newly reorganized ONC leadership team.

This article points out that incoming American Medical Association president Robert Wah, MD of CSC, has a healthcare IT background, having been an associate CIO and ONC’s deputy national coordinator. AMA 2015 president-elect Steven Stack, MD has similar roots as the long-standing chair of AMA’s healthcare IT group.

Innovation and Research

The California Association of Physician Groups releases the results of its annual Standards of Excellence survey, which evaluates CAPG members in California and 29 other states on six criteria, including health information technology. Cedars-Sinai Medical Group (NY) and Cedars-Sinai Health Associates (NY) were among the majority of physician organizations surveyed that achieved CAPG’s Elite honor. This year marks the first that CAPG issued the survey in an electronic format.

University of Washington researchers partner with Microsoft to demonstrate the ability to diagnose critical illnesses from a patient’s EHR using natural language processing and machine learning. The deCIPHER research team has so far studied the diagnosis of pneumonia in 100 ICU patients at Seattle’s Harborview Medical Center. The software achieved a correct diagnosis with correct time-of-onset for positive cases in 84 percent of the patients.

Other

The local paper spotlights Jeffrey Sketchler, MD and the three medical mission trips he has taken over the last two-and-a-half years with New Orleans Medical Mission Services. "In medical school, I had no idea that one day I would be doing something like this, but it has been very rewarding and a way to give back," says Sketchler, who, with a colleague, performed 39 knee replacements during his week-long trip in May to Nicaragua.

Lorre reports that she visited athenahealth’s Watertown headquarters in Boston last week, enjoying a social event, a campus tour, and a briefing from Jonathan Bush, who then autographed a copy of his new book for her. Perhaps next time she’ll get a sneak peek of the company’s Arsenal on the Charles location in development. Plans call for three pop-up shops that will vary from week to week. Wouldn’t it be fun if HIStalk merchandise were added to the retail lineup?

Sponsor Updates

• Zephyr-Tec signs a reseller agreement with nVoq to offer speech recognition to its current and future EMR clients for dictation and navigation.
• Optum executives will participate in a workshop with HealthEdge at AHIP’s Institute 2014 June 11-12.
• NextGen’s Sharon Tompkins discusses HQM and P4P reporting and why it matters.
• Allscripts offers presentation replays from its recent population health management analyst summit at the CCM in Pittsburgh, PA.
• E-MDs is named as Austin’s top biomedical R&D employer by the local business newspaper.

Practice Wise 6/9/14

There is no perfect software

Dear Doctor,

I really do understand your plight. It feels like the EHR is ruining your work life. You were not a day-to-day business software user until the advent of the EHR. It’s seemingly been dumped on you from on high, been made a big part of your day-to-day practice, and is probably something you didn’t want. The hardest part of this transition for you is to accept that nothing charts exactly how you think it should, because there is no perfect software. It takes a lot of effort on your part to make it work for you.

Hopefully, I can help you understand the complexities of EHR software in the same way my internist tries to explain to me the complexities of my middle-aged body and its various aches and pains.

True story: (Sorry for the TMI, but this is a concrete analogy.) I complained to my internist of pain in my left upper quadrant several years ago. As my diagnostician, she had many systems to consider as the source of the pain. There’s my musculoskeletal system, GI, cardiovascular, and so on. To rule out each of these systems as the cause of my pain, she took a history, palpated the area, and ran diagnostic tests that included blood work and imaging studies. When she still couldn’t figure out what was causing my pain, she referred me to one or more specialists. At that point, I started this process all over again, giving history of present illness, having full physical exams, and even more studies. Each doctor I saw had a different take on what was causing my pain and how to alleviate it. They depended on my willing and collaborative participation to figure out what was wrong with me. We travelled a road of trial and error together.

These things are not always immediately evident or clear cut. As the patient, I’ve not yelled at my doctors or the people doing the testing. I don’t threaten to sue my primary care doctor for not curing me on the first visit, or for referring me to other doctors that cost more money and still didn’t solve my problem. I understand that each provider is doing the best they can with the tools they have to find the correct answer and offer me a solution. Recently, the solution from my PCP was “Sometimes as you get older, things change and feel different and hurt, with no known etiology. You’ll to have to accept it, get used to it, and live with it.” I took it at face value and thanked her for her efforts.

Could you even imagine if you called your software company with a problem and they told you to live with it? Well, sometimes that is the answer. Usually, hopefully, they will try to develop a solution to your issue (if it is a real issue and not a user-interface issue). Sometimes the user is actually causing the problem – like your patient who is non-compliant and still wants to blame you for their woes.

When you call your EHR support company and state that something is not working, please realize there are underlying systems involved in what appears to you to be the single function causing you pain. First-level support has to triage the urgency of the issue, take a history of the problem, palpate the system, consult the literature, try a cure or two, and possibly escalate the case to a specialist. That support specialist may have to ask you further questions about your experience, continue to trouble shoot, and test solutions. If they can’t fix it, they send it up to development as a bug. The development team takes all bugs very seriously and works on them in a queue based on priority. Although the issue is your top priority, you may be the only one affected by this bug. They may have other bugs that affect a greater number of users, or reduces the functionality of the software in a more significant way. It’s the difference between an isolated stomach ache and a salmonella outbreak. They address the most critical issues first.

This is really no different than a doctor sending a patient out for referral and diagnostic studies when they don’t have the answer. Threatening to sue your vendor when something goes wrong is not an impetus for them to get it right. The impetus to get it right is already there. It’s their job and livelihood to keep customers working in their EHR. Cursing and name calling are also not exactly positive motivation! You wouldn’t consider having a patient treat you this way when you don’t provide an immediate cure.

At least once a week I hear someone say something like, “My spreadsheet program graphs better,” “My email does messaging better,” or “My document editor does that perfectly with spell and grammar check (amazing how many smart people absolutely rely on spellcheck!).” Each of those programs is basically a single-function product. The EHR has features embedded in a complex program that does a thousand times more than that single product. It’s just not that simple! I know that frustrates you, the end user, but it is what it is. Just like my flank pain is not that simple. It’s like me comparing my body to a perfectly fit 20 year-old. It’s not reasonable.

There is no perfect software, just like there is no perfect body. It’s all highly complex and variable. If you can realize that software development and support is a lot like practicing medicine, maybe you’ll be more comfortable with your new reality. Your vendors want your constructive feedback and input. You are the end user, and your day-to-day experience with the product is the most valuable diagnostic and improvement tool they have. Your patients are the best at healing when they collaborate with you in their care. Your software issues are best resolved when you collaborate with your vendors.

I have encountered quite a few physicians and allied health professionals who want me to help them find the perfect software because the first three they tried were all bad. My suggestion is always to look at the entire situation. If they can’t succeed with any product they try, maybe it’s time to take stock of what the common denominator is. Maybe they are unlucky and/or make poor purchasing decisions, and they’ve actually gotten three rotten apples. More likely, however, is that they don’t understand what their role is in making software successful in their practice, so they’re not giving the software a chance to actually work. If they’ve been through three products in four years, and the changes weren’t caused by product acquisitions, etc., then I tell them to take a long hard look at themselves. They need to honestly evaluate their expectations of the software against their willingness to make it work, and then be willing to do the work necessary to be successful. Before throwing the software out yet again, call on a consultant who is an expert in the field who can help determine if the user(s) or the software/vendor is the problem.

Again, assume I am talking about those good vendors who do care about their product and the EHR users who keep them in business, who make a strong effort to provide the best possible product and who respond to your issues. If my doctor blew me off and didn’t address my pain, I’d find another doctor. Thankfully, I have a good doctor, a collaborative relationship, and a pain in my side that we can’t figure out. It’s not her fault. I have faith that in time I’ll learn to live with it.

I hope that you too will learn to live with your software, and even embrace it!

Sincerely,

Your EMR Consultant

P.S. I’m open to a curbside consult!

Julie McGovern is CEO of Practice Wise, LLC.

News 6/5/14

Top News

Just a few days after National Coordinator for Health IT Karen DeSalvo, MD announced an ONC reorganization, GOP leaders send her a letter questioning whether ONC has the statutory authority to regulate healthcare IT products, and if it has authority to receive user fees under its budget request. The authors refer to a recent report that suggests ONC may create a Health IT Safety Center for the purposes of regulating software and other health IT products, and mentions that ONC’s 2014 budget “suggests it will impose a new user fee on health IT vendors and developers to support ONC’s certification and standardization activities.” Like many in the industry, the authors want to better understand the way in which ONC is moving from coordinating and promoting health IT to regulating it, and what role the office will play in developing requirements for health IT and EHR certification.

The Medicare Fraud Strike Force strikes again. After charging 90 people last month for $260 million in false billing, the force pulls in a slightly smaller fish when it indicts Los Angeles-based physician Robert A. Glazer, MD for a $33 million fraud scheme. Glazer allegedly billed Medicare for services that weren’t medically necessary, and were at times not even provided to the intended beneficiaries, among other wrongdoings.

Announcements and Implementations

WakeMed Physician Practices (NC) goes live on Epic as part of a $100 million rollout across the WakeMed Health & Hospitals system. WakeMed joins nearby Duke Health and UNC Health Care systems on the Epic platform. Inpatient rollout is scheduled for Feb. 1, 2015.

Hudson Valley Bone and Joint Surgeons (NY) selects the SRS EHR to replace its current document management solution. HVBJS staff note they chose the new EHR for its Stage 2 Meaningful Use certification, ease of use, and ICD-10 compliance.

Battleboro Memorial Hospital Physician Group (VT) launches MyHealthPortal from Medfusion to give patients access to select portions of their health records online.

Acquisitions, Funding, Business, and Stock

MTS Healthcare partners with The Shams Group to offer an iPad patient-intake kiosk that integrates with NextGen Healthcare’s ambulatory EHR. In other NextGen news, the company claims it has achieved “vendor agnostic interoperability” because one of its client practices has exchanged C-CDA Summary of Care messages with Tucson Medical Center’s Epic system using the Surescripts network.

Greenway Health introduces Entrada’s mobile dictation solution to its PrimeSUITE EHR online marketplace of partners. The marketplace offers value-added solutions for Greenway technologies from 70 vendors.

Government and Politics

The Arkansas Dept. of Human Services taps Community Care of North Carolina to help Arkansas providers apply for status as Medicaid patient-centered medical homes. Physicians who enroll will receive care coordination support and assistance in quality improvement and population health management from CCNC, with the ultimate goal of establishing a Community Care of Arkansas governed by physicians and healthcare organizations in that state.

It seems the VA just can’t catch a break when it comes to bad press. A local paper sheds light on delays and rising costs associated with 41 construction projects for new VA outpatient facilities. Like its wait times, these construction delays are nothing new: the Government Accountability Office revealed earlier this year that only two of the 41 projects were on time, with average delays running to 3.3 years and costs increasing from $153.4 million to $172.2 million. It’s sadly ironic (or maybe just plain sad) that veterans are waiting far too long for appointments while the VA is wasting time and taxpayer money attempting unsuccessfully to open new facilities. Perhaps new leadership will help turn things around. The Wall Street Journal reports that the White House is considering Cleveland Clinic CEO Toby Cosgrove, MD as the next VA secretary.

A 20-year analysis of campaign contributions finds that physicians, who have become increasingly generous, are leaning more towards Democratic causes. Republicans did, however, benefit from increased physician donations from 2009-10, when the Affordable Care Act was rolled out. Authors of the analysis consider the findings “remarkable” because they defy the historical image of physicians as a “conservative, right-leaning bunch … .”

Innovation and Research

A new study finds that the quality outcomes of physicians participating in patient-centered medical homes improve “significantly more over time” than those physicians that are not affiliated with a PCMH. The study compared PCMH physicians who use EHRs with non-PCMH physicians who document on paper or in an EHR. PCMH physicians were found to have quality improvements in four of the 10 measures studied, including eye examinations, hemoglobin A_1c testing for patients with diabetes, chlamydia screening, and colorectal cancer screening. Researchers found that the odds of overall quality improvement in the PCMH group were 6-percent higher than in the EHR group and 7-percent higher than in the paper group.

A national survey of ACOs finds that half identify as being led by physicians, while a third identify with being led by physicians and hospitals. Results also show that physician-led ACOs are more likely to have advanced IT capabilities and comprehensive care management programs, and are more likely to measure and report quality and financial performance at the clinician level. It just goes to show that while a hospital’s economic strength is important, the success of an ACO rests largely on the shoulders of physician leaders. 

People

Healthgrades names Jeff Surges (Merge Healthcare) to the newly created role of president.

Other

Love ‘em or hate ‘em, online physician reviews such as those tracked by Healthgrades show no sign of going the way of Google Health. Kareo releases a social media and reputation management guide for practices that have limited resources to develop an online presence.

Speaking of online reviews, Vanguard Communications releases the Happy Patient Index, a ranking of 100 U.S. cities according to patient ratings of physicians, group medical practices, clinics, and hospitals found on Google+ and Yelp. The top three happiest cities are San Francisco/Oakland, Honolulu, and Madison, while the unhappiest are Laredo, Toledo, and Bakersfield. It would be interesting to compare the utilization of healthcare IT in the happiest cities with that of the unhappiest to see if any correlation exists.

5 Questions with Kate McIntosh, MD

Kate McIntosh, MD is a pediatrician and managing partner at Rainbow Pediatrics (VT), and medical director of regional extension center Vermont Information Technology Leaders, which is working to implement the state’s HIE.

VITL recently conducted a statewide survey gauging patient views about EHRs and HIE. Why did it feel the need to conduct the survey, and does it plan to conduct another?
VITL was interested in the comfort of Vermont residents with the electronic storage of health information, and also their concerns about security and privacy of health information. We were also interested in how much Vermont residents understand about the new consent policy that gives providers permission to access patient information within the state HIE.

The public opinion survey was designed to create a baseline for an upcoming awareness campaign to provide the general public and healthcare providers more information about the benefits of the HIE, and the services available to the providers to access patient information on the exchange. VITL does plan to conduct this survey again as the awareness campaign unfolds to track how attitudes and awareness about health information systems develop within the state of Vermont.

What types of patients were surveyed?
This was a random phone-number survey of both land lines and cell phones within the state of Vermont. We had a very strong participation rate. Vermont has very high community participation, and the researchers were surprised and impressed by the willingness of participants to take part in a very detailed survey. Participants were 49-percent male and 51-percent female. Twenty-seven percent were ages 18-34, 24 percent were ages 35-49, 29 percent were ages 50-64, and 20 percent were 65 or older. Twenty-five percent came from Chittenden County, 10 percent from Rutland County, and the rest were spread throughout the state. Additional demographics included marital status, household size, number of individuals in the household under 17, and level of education. These stats were then weighted to reflect the actual demographics of the state of Vermont.

Do you think patients in Vermont have a higher level of awareness when it comes to EHRs and HIE than patients in other states? Why might this be?
Vermont residents are a well-educated and motivated patient population. They have a high level of awareness regarding electronic health information. This awareness seems to have come primarily from Vermont physicians who are implementing EHRs. I do not have national statistics, but this awareness seems to be on par with a recent survey conducted in Maine.

How far along is VITL in creating the HIE? Will these survey results impact the way in which it moves forward?
Implementing a HIE is an ongoing and ever-changing process of adding more interface connections from more providers and receivers of data, and more connections to other HIEs. VITL is bringing a provider portal online so that providers (with appropriate patient consent) can have direct access to the data of their patients within the HIE. We are actively building interfaces to increase the amount of data flowing through the HIE, and are focusing our efforts on reaching out to data-starved parts of our provider population including home health and hospice agencies, behavioral health providers, skilled nursing facilities, and long-term care facilities.

The survey gives VITL unique insight into the general public’s mindset as we roll out the provider portal. This understanding will help us to better inform healthcare decisions by providing information at the point of care. Both the general public and providers should benefit from improved quality of care delivery, reduced costs, and enhanced patient safety and outcomes.

How is VITL funded? Have you created a strategy for financial sustainability over the next three to five years?
VITL is currently funded through state and federal grants, and we are actively working to transition to more sustainable funding sources. VITL is implementing services that will be provided on a subscription basis, including a data gateway for Vermont’s accountable care organizations, and a secure email and HISP based on the Direct Project standards. Other fee-for-service offerings are in early development phases.

News 6/3/14

Top News

VA Secretary Eric Shinseki succumbs to calls for his resignation (and Washington’s need for a high-profile scapegoat) amidst ongoing investigation into the VA’s “widespread” attempt to cover up long wait times that have contributed to the deaths of veterans. A White House audit of VA facilities across the country found that wait times have likely been manipulated in more than 60 percent of the reports from the 216 sites investigated.

In light of the fact that Shinseki’s ouster will do nothing to fix the VA’s well-documented and systemic wait problems, Sen. Bernie Sanders (I-Vt.) introduces a bill that will potentially give the department long overdue authority to fire poor-performing executives, and allow veterans facing long delays to seek care outside of the VA network, among other provisions. It is this out-of-network idea that might have the greatest impact on veteran care. An entirely new category of physician business model might arise should the bill pass and physicians decide to cater exclusively to veterans.

A HIStalk reader shares an internal memo from National Coordinator for Health IT Karen DeSalvo, MD, which announces that the following will serve as ONC’s leadership team along with Deputy National Coordinator Jacob Reider, MD:

• Office of Care Transformation: Kelly Cronin
• Office of the Chief Privacy Officer: Joy Pritts
• Office of the Chief Operating Officer: Lisa Lewis
• Office of the Chief Scientist: Doug Fridsma, MD, PhD
• Office of Clinical Quality and Safety: Judy Murphy, RN
• Office of Planning, Evaluation, and Analysis: Seth Pazinski
• Office of Policy: Jodi Daniel
• Office of Programs: Kim Lynch
• Office of Public Affairs and Communications: Nora Super
• Office of Standards and Technology: Steve Posnack

While “Anonymous Tipster” calls the reorganization news “[r]earranging deck chairs on the Titanic,” it’s more likely the efforts of DeSalvo to place her stamp on the office and position it for new projects once the Meaningful Use program runs its course.

ONC team members (like the OPAS, above) are likely discussing the reorganization during Healthdatapalooza, taking place this week in D.C. The usual ONC suspects are participating and tweeting, with keynotes scheduled from Atul Gawande, Jonathan Bush, and Kathleen Sebelius, among others. You have to wonder what tone the Sebelius keynote will take, and if the absence of Farzad Mostashari, MD has left attendees just a little less enthusiastic than in years past.

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Announcements and Implementations

The Children’s Health Alliance (OR) selects Wellcentive’s population health management solution and services to support its pediatric quality improvement and medical home programs in Oregon and Washington. The solution will aggregate clinical data from outside providers, specialists, and other services, as well as payer claims data, to give CHA’s 105 primary care pediatricians a comprehensive view of patient care.

The Center for Discovery (NY) announces it will receive an $85,000 HHS grant to develop a telemedicine home network program for patients with severe disabilities living in rural areas. The center will use the funds to perform a cost analysis and needs assessment, provide education and training to fund research, and hire qualified health professionals.

Goldsboro Pediatrics (NC) implements triage software from Keona Health in an effort to improve response time, reduce cost, and increases patient and staff satisfaction. “Eighty percent of phone calls into our practice are low acuity,” says Goldsboro pediatrician Joseph Ponzi, MD. “Keona’s automation facilitates these encounters and allows our staff to focus our attention on the high-acuity cases.”

The National Committee for Quality Assurance recognizes Touchpoint Pediatrics (NJ) as an organization operating at the highest level in its Patient-Centered Medical Home program. Touchpoint physicians emphasized the use of NCQA’s 2011 PCMH standards including systematic, patient-centered, coordinated care that supports access, communication, and patient involvement.

The local paper highlights the mixed feelings many physicians have about medical scribes, especially when it comes to productivity, cost and return on investment. Donald Gehrig, MD notes physicians are willing to accept scribes due to the increased documentation demands created by EHRs. "It’s a perverse adaptation of electronic record keeping required for billable, code-able healthcare, which is not medical care,"  he says. "Doctors like it better than having to go home and type notes until 10 p.m."

Acquisitions, Funding, Business and Stock

Ambulatory surgery center operator Amsurg Corp. announces it will purchase physician outsourcing service provider Sheridan Healthcare Inc. for $2.35 billion. The acquisition will give Amsurg a leading position in radiology, emergency medicine services, children’s services, and anesthesia providers to medical facilities and hospitals on an outsourced basis.

ChartLogic incorporates Kareo’s revenue cycle management solution into its EHR to better enable private-practice physicians to manage the claims continuum. Kareo will provide ChartLogic customers with financial data and graphical dashboards showing key metrics, as well as coach practice administrators on areas for improvement.

Amida unveils its first product just in time for Healthdatapalooza, where ONC’s Blue Button initiative is being highlighted. Amida’s Data Reconciliation Engine is a Blue Button software component that the company claims is the “first production-ready, format-agnostic open source health record interface in the health IT market.” Amida CEO Peter Levin helped lead the Blue Button initiative at the VA during his tenure as chief technology officer.

PMD releases pMD Messaging and a message notification system in Version 8.0 of its charge capture software. The new HIPAA-compliant notification system ensures messages are received and read by users, and utilizes different types of escalating notifications to alert physicians to unread messages.

Physicians Interactive launches an automated voucher and coupon distribution solution within the latest version of Greenway’s PrimeSUITE EHR. The eCoupon solution is designed to improve medication adherence by providing discounts to patients within e-prescribing workflows.

People

Justin Barnes (Greenway) joins the Georgia Institute of Technology’s Advanced Technology Development Center as an Entrepreneur-in-Residence.

Government and Politics

A new report from the HHS Office of the Inspector General finds that Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, prompting it to suggest that CMS go after upcoders.  CMS has disagreed, saying it is not cost effective to undertake such a review. One of its contractors recently reviewed 5,200 medical claims of high-coding physicians, and the process cost more than it caught in overpayments. It’s an odd accounting practice, to be sure.

Innovation and Research

A new report highlights the ICD-10 coding and reimbursement challenges faced by pediatric practices who accept Medicaid in Illinois. Twenty-six percent of pediatric diagnosis codes were found to be “convoluted,” representing 21 percent of Illinois Medicaid pediatric patient encounters and 16 percent of reimbursement. The report’s authors ultimately conclude that the “potential for financial disruption and administrative errors from …  reimbursement diagnosis codes necessitates special attention to these codes in preparing for the transition to ICD-10-CM for pediatric practices.”

An app store for EHRs continues to evolve. A Forbes article details the nascent SMART platform, an open-source technology funded by a $15 million ONC grant that will allow developers to create “substitutable” apps that physicians can easily add to or delete from an EHR. “SMART fits the pattern of a successful business idea because the architecture is closed, proprietary, and independent,” says Clayton Christensen,  a member of the SMART advisory committee. Recently announced committee members also include representatives from CMS, Surescripts, NHS, AARP, Eli Lilly, Hospital Corp. of America, BMJ, and Canadian Institutes for Health Research.

Other

A Kansas urologist who is also the president-elect of the Kansas Medical Society says his practice’s biggest problem is electronic medical records. “Now, we’re basically key-punch operators, transcriptionists having to input the data ourselves.  Voice-recognition software and some of those things help, but it has essentially tripled the time to complete a medical record. How do you accomplish that when we are already working 12 to 14 hours a day?” He says EMRs will shake out within 10 years, but doctors are quitting over them now.

Physicians experiencing slow Internet speeds can now take comfort that at least their connectivity is more reliable than Wi-Fi on the moon. Researchers at MIT and NASA have figured out how to beam wireless connectivity to the lunar orb from a New Mexico ground base at a speed comparable to slower Wi-Fi speeds on Earth.

Have wearables finally jumped the shark? You be the judge: GPSports now offers a compression vest to hold athlete monitoring devices in place. Data culled from the devices is used to benchmark training and recovery protocols. As this article points out, wearables may be beneficial when it comes to tracking health and wellness, but the “ridicule factor” still remains high.

Sponsor Updates

• Michael Simon, principal data scientist at Arcadia Healthcare Solutions, provides a recap of eHealth Initiative National Forum on Data and Analytics.
• DrFirst, Forward Advantage, and Imprivata partner to provide e-prescribing of controlled substances for Meditech and MAGIC/OSAL platforms.
• HIStalk Practice sponsors named on the HCI 100 for 2014 include 3M, ADP AdvancedMD, Allscripts, Capario, eClinicalWorks, Emdeon, ESD, Greenway, McKesson, Nordic Consulting, and Optum.