News 3/27/14

A newly posted bill to patch the SGR for 12 months includes a minimum one year delay for the adoption of ICD-10. The bill, which was negotiated by House and Senate leaders, is expected to go for a vote Thursday, March 27,  four days ahead of a scheduled 24 percent cut in physician Medicare pay. If passed, the ICD-10 adoption date will be pushed until October 1, 2015 and legislators would have another year to pass a permanent repeal of the SGR payment provision. AHIMA quickly announced opposition to the ICD-10 delay saying it will cost the industry money and wasted time implementing the new code set. Can I just say I am tired of all the politics? Few people want to see doctors getting a 24 percent pay cut so look for the legislation to pass and ICD-10 to be delayed – unless the ICD-10 provision is somehow stripped from the bill.

Aprima Medical and Etransmedia announce an upgrade program for Etransmedia customers using the Allscripts MyWay platform. Etransmedia customers, which include providers that purchased MyWay through Costco, have the option to become an Aprima client, or, to use the Aprima system but remain a hosted client of Etransmedia. Both options provide current Etransmedia customers with one free Aprima licenses for each existing MyWay license.

Surescripts awards e-MDs its White Coat of Quality award for applying best practices to the use of e-prescribing technology.

The 220-physician Summit Medical Group (TN) names Ed Curtis (Hattiesburg Clinic) COO and Joseph Ortiz (4D Imaging Systems) CIO.

CMS reminds Medicare EPs that the deadline to attest for MU to receive a 2013 incentive payment is March 31 at 11:59 p.m. ET. The deadline for Medicaid EPs varies by state. This part of the notice is a bit troubling:

Due to the large volume of providers attesting, please submit your data as soon as possible and during non-peak hours to avoid system delays.

CareCloud launches CollectiveIQ, a billing rules platform that is embedded within the CareCloud platform to improve claims accuracy.

Athenahealth adds Precyse University to its More Disruptive Please program and will offer users access to Precyse’s ICD-10 educational tools.

The American Academy of Ophthalmology launches IRIS Registry (Intelligent Research in Sight), a centralized data repository and reporting tool that aggregates outpatient clinical data from EHRs for practice benchmarking, for monitoring patient care, for tracking interventions, and for evaluating outcomes.

More medical schools are expected to include some EHR requirements in their curricula because the exposure to IT systems is increasingly considered a crucial element of the medical education experience.

California Health Report looks at EHR adoption among the state’s physicians and clinics and finds the process is not always smooth. Implementation issues are related to technology and to human factors and most physicians take two years to become competent on EHRs. An official with the California Healthcare Foundation notes, “there’s still a lot of room for improvement.”

A local paper profiles Sanford Health’s (SD) e-visit program, which is available to  patients for $55 and connects them with a Sanford provider who will prescribe medications and/or offer medical advice within four hours. Currently the only patients eligible for e-visits are adults enrolled in the clinic’s MyChart patient portal program who present with one of seven non-emergency conditions.

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DOCtalk by Dr. Gregg 3/26/14

Is Being OK OK?

In the fields of healthcare and technology, perfection is essential. In healthcare, anything less may get you sued. In the tech world, if it doesn’t get you sued, you certainly won’t be in business for long if your tech offerings are filled with glaring flaws. (Imagine how long you’d keep using your iPad or smart phone if it remained annoyingly glitchy.)

Contrast this with the popular mantra, “Don’t let perfection become the enemy of the good.” This is such a perfectly human sentiment; it recognizes both our penchant for overthinking and our inherent inability to ever be truly perfect.

Whether you’re OK with “OK,” “O.K.,” “ok,” or “okay,” being OK implies acceptability. It implies good enough. It implies sufficiency. It implies decent. But, is it OK in healthcare IT to be OK?

Trying to make everyone happy is quixotic. It’s never going to happen. Someone won’t like how you did this, or they won’t like how you said that, or they just won’t like your approach. Thus, you just know that all of your best efforts are, at some point with some person, going to fail. Despite all the minutia minding and detail addressing, someone will be displeased with you.

In healthcare, you try to do your best. You try to address your customers’ needs as best you can, try to make sure to “do no harm,” try to attend to the pertinent details, all while hoping that payment reform and insurance requirement changes and federal or state regs will allow you to keep trying to serve your patients…and pay your bills.

In the land of HIT, it’s pretty much the same. There’s no health IT vendor on the planet who has 100 percent customer satisfaction. No matter how good your tools are, no matter how cutting edge your designs, no matter how responsive your tech support, someone somewhere is going to find fault. (I must admit that sometimes I’m one of them!) No HIT vendor anywhere does everything well…despite what their marketing folks may say.

When I look at EMRs or EHRs, one of the most important things I look for is a sufficient number of “happy factors” that make my overall user experience pleasant enough that I can overlook the missed or poorly addressed elements. Honestly, there haven’t been that many systems that engender a feeling of “Oooo…this is cool” often enough. Many have some of those moments; few have enough of them.

When HIT consulting, I try to stress the end user experience to the vendors, even while understanding their resource limitations and developmental timeframe restraints. Vendors can spend all of their resources trying to make each little detail perfect. But, there are so many darn details in any EHR/EMR, that I’m sure even Epic doesn’t have the resources to attend to each one completely, despite its Fort Knox of cash and (not so) small city of employees. Top off all the medical minutia with the seemingly endless requirements for MU, ICD-10, PCMH, ACO, HIPAA, P4P, PQRI, and a laundry list of other acronyms requiring attention, and it’s easy to see that the details demanding developer deliberation are virtually limitless.

Is it possible, then, in either healthcare or health IT to decide that good enough is good enough? Can you be OK with being OK?

You can. I’m certain of it. (Frankly, I don’t see any other option most days!) And, OK is good. You may not be able to “please ‘em all,” but if you strive for perfection and achieve OK-ness, that’s really an accomplishment. Humans are not, almost by definition, perfect. You can sometimes be great, sometimes be not-so-great, and overall be perfectly OK. You take your best shot each day and hope you hit somewhere in the good part of the old Pareto’s Principle (80/20 Rule.)

The hard part isn’t achieving perfection. That’s a pipe dream. The hard part is learning to be OK with being OK, even as you still strive for more. You always want to try for perfect, but you have to be able to see that less than perfect can still be good.

Good.

Fine.

OK.

Psychiatrist Dr. Thomas Harris once told us that we’re all OK in “I’m OK – You’re OK.” Even if you don’t agree with his overall approach, the sentiment stands: it’s just fine to be OK, in healthcare IT or anywhere. Just be a grand OK. Be an exceptional OK.

OK?

From the trenches…

“I’ll lean on you and you lean on me and we’ll be okay.” – Dave Matthews

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 (OHIP).

News 3/25/14

EHR usage in small physician offices has helped spur overall EHR adoption to 61 percent, according to an SK&A report on physician office EHR use. Other key findings:

• The adoption rate for single doctor offices grew from 42.3 to 53.7 percent from 2013 to 2014.
• EHR adoption rates increase as the number of physicians practicing at each site rises; as the number of exam rooms at each site increases; and, as average daily patient volume rises.
• Physicians working for integrated health systems have higher adoption levels than providers working under other type ownership models.
• Epic, eClinicalWorks, and Allscripts lead other vendors in terms of market share.

St. Francis Health System (OK) will go live across its 70 physician offices in May and at its hospitals in June.

The AAFP offers an online PCMH planner to help practices achieve medical home practice transformation by assessing a practice’s current program and identifying specific goals to fill any gaps. The subscription-based planner starts at $100 for members and $149 for non-members.

How do these things still happen? A Topeka, KS man opens a dumpster in his office complex and finds discarded medical records, complete with patient names and social security numbers. Perhaps not coincidentally a document scanning service has an office in the same complex. The state attorney general’s office have removed the charts for further investigation.

The Naval Branch Health Clinic Albany (FL) announces the availability of secure email between patients and providers using RelayHealth’s secure messaging service.

GMed introduces a revenue cycle management service that complements its existing gastroenterology-specific EHR and practice management, report writing, and patient portal platform.

The Robert Wood Johnson Foundation launches Flip The Clinic, an initiative meant to transform the average doctor visit to be more satisfying. The idea is to have the Flip The Clinic website serve as a hub for patients, providers, and other stakeholders to share ideas for improving the physician visit experience so that it’s more satisfying for patients and optimizes physician expertise. I like the concept and the mission, but I’m not convinced it’s something the average patient (or physician) will take the time to find and participate in. I hope I’m wrong.

The use of copy and paste functionality in EHRs should only be permitted in the presence of strong technical and administrative controls, which include organizational policies and procedures, requirements for participation in user training and education, and ongoing monitoring. That’s the recommendation of AHIMA in a newly published position paper that warns users that the efficiency and time savings benefits of copy/paste functionality should be weighed against the potential for creating inaccurate, fraudulent, or unwieldy documentation. The use of copy and paste functionality is too entrenched in EHRs to be eliminated so kudos to AHIMA for offering solid and realistic recommendations to reduce the potential risks.

The Federation of State Medical Boards is considering a policy that could impact the delivery of telemedicine services by requiring a physician to be licensed where the patient is located. The policy also requires the same standards of care apply for both virtual and face-to-face encounters.

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News 3/20/14

Saint Peter’s Healthcare System (NJ) selects athenahealth’s athenaOne EHR, PM, and communication system for its 176 hospital- and clinic-based physicians.

American Family Care, which operates 160 urgent care facilities across 26 states, agrees to pay the federal government $1.2 million to resolve allegations that it knowingly submitted claims using billing codes higher than appropriate for the actual service rendered. The case stems from a whistleblower lawsuit filed by one of the organization’s former claims processing directors.

Nationwide 62 million people have no or inadequate access to primary care given local shortages of physicians, according to a report by the National Association of Community Health Centers. Not surprisingly the Association recommends the government provide community health centers with plenty of funding to help address access challenges, but I think the fix requires more than just more money. I’m reminded of a session during  HIMSS featuring occasional HIStalk contributor Lyle Berkowitz, MD, who correctly stresses the need for innovation and technology in healthcare to improve access:

If we don’t adopt new technology and change the way we deliver care, it will be harder and harder to get to see a doctor, it will cost more, the rich will cope, the poor will suffer. Many will die earlier than they would have if cost effective treatments were available. We have to act now before the healthcare system goes into meltdown.”

The Drummond Group certifies Kareo EHR for MU 2014 Stage 2.

CMS releases Road to 10, a free online resource to help physicians in small practices in their transition to ICD-10. The tool to build an action plan (actually a  “catch-up plan”) looks pretty handy and allows providers to customize their roadmap based on practice size, specialty, and  the type of technology used in the practice.

Not so surprising findings from a RWJF-funded study: physician practices participating in ACOs tend to be relatively large, members of an IPA or PHO, less likely to be hospital-owned, and more likely to use care management processes and EHRs as compared to practices not participating in ACOs. Researchers found that 61 percent of practices have no plans to participate in ACO, which raises the question of how to get the balance of practices on board with ACOs, if in fact the ACO model proves to provide better and more cost-effective care.

Welcome to new HIStalk Practice Platinum Sponsor Arcadia Healthcare Solutions, which is headquartered just outside of Boston and has additional offices in New York, Seattle, and Nashville. Arcadia provides services and technology for EHR outsourcing; data integration and population analytics; and care delivery transformation and coaching. Clients of the 12-year-old company include five Pioneer ACOs, leading academic medical centers, national health systems, managed care organizations, and several Blues. Arcadia’s advisors can help practices  improve key ambulatory network measures 15 to 30 percent in six months by bringing together EHR and claims data and helping providers use it. Some of its EHR optimization accomplishments include reducing log-in time by 50 percent, improving system performance by 27 percent, and increasing physician satisfaction by 20 percent. Arcadia provides expert advisors rather than, as it says, “high-priced management consultants who leave nothing behind but PowerPoint.” Thanks to Arcadia Healthcare Solutions for supporting both HIStalk and HIStalk Practice.

InstaMed launches InstaMed Go, which allows providers to collect patient payments via smartphones from any location with the payments posted automatically to their practice management systems and receipts emailed to patients.

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News 3/18/14

From Soothsayer: “Re: Castlight Health fallout. Given Castlight’s tremendous IPO success, look for more HIT companies to follow suit. A few we might see within the year: Practice Fusion, CareCloud, and ZocDoc.” Castlight’s share price surged 149 percent during its Friday IPO, giving the company a valuation of more than $3 billion. That’s a pretty impressive debut, especially considering Castlight had $13 million in revenues and a $62 million net loss in 2013. There’s clearly a lot of interest in the HIT sector so I’m with Soothsayer on this one.

CMS wants to recoup improper payments made through its PQRS and e-prescribing incentive program and will launch a four-year program to look for potential errors, inconsistencies, and gaps related to data handling, program requirements, and clinical quality measure specifications. According to a Federal Register notice, CMS will survey 400 group practices, registries, and data submission vendors and perform a limited number of follow-up interviews.

Disturbing: researchers from the University of Illinois at Chicago find that transitioning from ICD-9 codes to ICD-10 could lead to a significant loss of data, based on an analysis 220 hematology-oncology and outpatient diagnostic codes. Specifically researchers found the transition affected eight percent of state Medicaid codes and one percent of codes in the University of Illinois Cancer center; potential costs associated with the information loss totaled $479,299. What’s particularly troubling is that the study focused on hematology-oncology codes, which involve fewer ICD-10 codes and thus less convoluted mappings than codes in other specialties.

The House passes legislation to permanently repeal Medicare’s SGR payment formula, but, full passage of the law is unlikely because it includes a provision to delay the ACA’s mandate requiring all individuals obtain health insurance. Without a repeal or a temporary patch, doctors face a 24 percent cut in Medicare reimbursements as of April 1.

UnitedHealthcare, Aetna, BlueCross BlueShield, and Humana tell the AAFP they’ll be ready for ICD-10 by the October 1 deadline, though some of the carriers express concerns that small, private practices are behind in their preparations.

What employed physicians like most about not being self-employed: not having to deal with the business of running an office and not having to deal with insurers and billing. According to a Medscape survey of 4,600 doctors, employed physicians complain about the lack of input into how they practice, but 70 percent of physicians who were once self-employed report being happier employed.

On the heels of a recent study questioning the effectiveness of the PCMH model in improving care and reducing costs, the NCQA previews 2014 PCMH recognition standards, which include more emphasis on team-based care. Other areas that NCQA is “raising the bar,” include:

• Care management focus on high-need populations
• Alignment of quality improvement activities
• Additional integration of behavioral health

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