News 12/19/13

Over time the use of open notes will become the standard of care, predicts that the authors of a NEJM-published op-ed. The clinician-authors note that increasing patient engagement through transparent medical records contributes to improvements in health, care, and costs, and that patients who access their notes have better recall and understanding of their care plans and better medication adherence.

E-MDs Cloud Solutions v. Cirrus achieves ONC-ACB certification for MU Stage 1 and 2 and is compliant as a Complete EHR 2014.

Deloitte includes Kareo on its Technology Fast 500 list of fastest growing technology, media, telecommunications, life sciences, and clean technology companies in North America based on its 797 percent growth over the last five years. Kareo was ranked fifth in HIT and 156th overall.

Troubling: the healthcare industry is making slow progress on preparing for ICD-10, according to a WEDI readiness survey. About 20 percent of vendors claim they are halfway or less complete with product development, while about half of providers have yet not completed an impact assessment. Meanwhile, about one-third of health plans have not initiated internal testing; two-thirds have not started external testing.

Projected physician shortages can be substantially reduced by using new models of primary care, such as the PCMH and nurse-managed health center (NMHC) models, even without increases in the number of physicians, according to a RAND study. RAND projects that if the prevalence of PCMHs increases from 15 to 45 percent and NMHCs from .05 percent to 5 percent, physician shortages could be cut in half by 2025; researchers also believe that medical homes could handle 20 percent more patients through the use of technology and improved coordination.

Solo physician Stephen T. Imrie, MD handles a potential data breach in an arguably more efficient manner than many larger organizations with presumably more resources and available expertise. The San Jose-based physician sent an appropriately apologetic letter to 8,900 patients notifying them that a password-protected laptop was stolen from his home September 23. The computer included both clinical and financial details on patients, including patient social security numbers. Though no misuse of data has been reported, Imrie automatically signed up his patients for free credit monitoring.

CMS implements an informal review process for EPs and group practices who will be subject to the 2014 eRx payment adjustment. EPs/group practices have until February 28, 2014 to email eRxInformationReview@cmg.hhs.gov to request an informal review.

A big welcome to Optum, HIStalk Practice’s newest Platinum sponsor! Optum, which includes the OptumHealth, OptumInsight, and OptumRx divisions, offers a wide variety of products, tools, and services for various segments of the healthcare system. Their technology offerings for hospitals, physicians, and other stakeholders focus on the delivery of integrated, intelligent solutions for modernizing the healthcare system and improving health. Solutions for physician practices include Optum Claims Manager and Optum Intelligent EDI, which are designed to help practices submit clean claims the first time around and maximize reimbursements. Claims Manager can be directly integrated with third-party clearinghouses, billing systems, and PM systems, as well as with Intelligent EDI, Optum’s claims processing solution that successfully provides first-pass payment rates as high as 97.5 percent. Optum also sponsors HIStalk at the Platinum level and we thank them for supporting of our work.

Greenway Medical adds Digital Assent, a provider of patient satisfaction survey solutions, to its online Marketplace of value-added partners.

If you are a physician and looking for some moonlighting ideas to pay off those holiday bills, here are a few suggestions from Medscape. Options include telehealth consults (pays about $20 for a 10 minute consult); health insurance claims reviewer ($85-$200 an hour); and, cruise ship doctor ($150 a day plus free cruising for you and a guest.) Can’t imagine why anyone would choose to review insurance claims over a free cruise.

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News 12/17/13

The Louisiana Senior Care Coalition selects eClinicalWorks Care Coordination Medical Record as its population health management solution for advancing its ACO objectives.

Athenahealth will integrate Merge Healthcare’s iConnect Network into its athenaClinicals EHR to allow users to receive and view exam results and diagnostic-quality images.

US physicians apparently aren’t the only ones concerned with a decline in compensation. Salaried GPs in the UK made an average hourly rate of $61 this year, down from $75 in 2012. The average US doctor, by the way, earned $80 an hour in 2010, not including benefits.

Practice EMR vendor drchrono releases an API that will allow developers to extend and enhance its platform.

Wolters Kluwer Heath integrates its Health Language Provider Friendly Terminology with Epic EHR for mid-size to large practices, as well as for hospitals.

A mere seven percent of psychiatrists were awarded MU incentives last year, a lower percentage than in any other specialty. Industry analysts blame poor usability of EHR systems, the exclusion of mental health centers from program incentives, and a relative lack of EHR vendors specializing in psychiatry.

In an unrelated study published in JAMA Psychiatry, almost 45 percent of psychiatrics refuse private insurance or Medicare. Sounds like another pretty obvious reason why so few psychiatrists qualified for MU.

CMS issues a final rule that confirms physicians who assign their reimbursement and billing to a CAH under Method II are now eligible to participate in the MU program as EPs.

Physicians participating in a Western NY Beacon Community study used technology to help their patients better control their blood sugar levels and reduce the number of avoidable hospitalizations. Participating physicians implemented new technologies and upgraded their workflows. The Beacon Community also used EHRs to generate diabetes registries to track lab and test results and to generate preventative care reminders and guidance. Among the 57 participating practices, the percentage of diabetes patients with uncontrolled blood sugar levels improved by as much as 10 percent over a one-year period.

Congressmen Erik Paulsen (R-MN) and Jim Matheson (D-UT) propose legislation that would mandate the use of clinical decision support software by physicians receiving Medicare and Medicaid reimbursement when they order diagnostic imaging tests. The goal is to provide doctors with immediate feedback and recommendations for the appropriate tests to order. Sounds like a great idea that would likely create a few administrative nightmares.

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From the Consultant’s Corner 12/12/13

Looking Beyond EHR Go-Live: The Value of Continual Optimization

Many EHR vendors have developed implementation methodologies which leverage years of their collective clients’ experience to define “best practice” workflows and clinical content. These approaches are often valuable as they streamline the design/build processes. However, very few healthcare organizations I have worked with are exactly the same. Differences in culture, governance, size, ownership, hospital alignment, patient and payer populations, along with practice management and IT sophistication make a “one size fits all” approach less practical over the long term.

To complicate the EHR implementation decision making process further, medical groups are frequently required to make workflow and application design/build decisions concurrently with their vendor learning curve. Said otherwise, they are often not educated by their vendors about their full options and the downstream benefits/impacts of different options. As such, those downstream impacts are not recognized until after go-live.

Lastly, it is not practical or cost-effective to remediate every user’s concerns or preference during the implementation process. This would elongate the implementation timeline and explode the EHR budget. As such, medical groups need to make trade-offs between what are pre-requisites for go-live and what workflow or functionality can be fine-tuned after go-live.

These are a few examples of why healthcare organizations suffer from EHR project fatigue. While the implementation may end, on-going optimization is really what enables practices to leverage EHR functionality to improve quality and physician productivity.

The work never seems to end after go-live. Add to this list upgrades, clinical documentation enhancement, and training to support government regulations such as Meaningful Use Stage 2 and ICD-10. All of this requires resources and funding after go-live.

Governance will play an increasing role in how organizations prioritize all of the projects that compete for resources. Strong clinical leadership is essential for establishing standards related to quality and productivity. IT leadership will be tasked with organizing and managing projects based on budgets and timelines.

There is no abrupt end to EHR implementation. Optimization comes with continued refinements as physicians experience the system and see ways the EHR can address their unique needs. With strong clinical leadership, clear governance and a flexible vendor implementation approach, you can realize an ongoing, interactive process that paves the way for a successful future.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

News 12/12/13

MGMA asks HHS to begin end-to-end ICD-10 testing with physician offices, saying that the scheduled front-end ICD-10 testing will be insufficient and “could result in operational problems similar to what HHS experienced with the roll-out of HealthCare.gov.”

The Orange County Register names Kareo a top workplace in Orange County in the mid-sized company category.

HealthTexas Provider Network, a multi-specialty group with over 590 employed physicians, pilots White Plume’s ePASS product suite to prepare its physicians for ICD-10.

The American College of Physicians supports the development of a national prescription drug monitoring program that would allow physicians and pharmacists to review a single database prior to prescribing controlled substances.

CMS publishes a tip sheet on conducting a practice security risk analysis, which is a requirement for meeting MU objectives in both Stage 1 and Stage 2.  I thought the myth versus fact section was particularly enlightening, including guidance on when an audit should be done and at what point any risk deficiencies should be corrected.

CMS says it will develop guidelines to ensure that  the practice of copying and pasting in EHRs is used appropriately, and intends to work with the ONC to develop “a comprehensive plan to detect and reduce fraud in EHRs.”  In terms of detection, I have to wonder how difficult it is to modify existing plagiarism detection technologies that academics have been using for years. I’m not a programmer, but why can’t this technology be modified to look for redundant phrases within clinical documentation?

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News 12/10/13

Practice Fusion closes a $15 million Series D round led by Qualcomm Ventures, bringing the company’s total funding raised to date to $149 million. Practice Fusion reports it now has over 300 employees, connects with 300 lab partners, and is actively used by 100,000 “medical professionals.”

Private physician offices are predicted to net profit margins of 12.7 percent in 2013, beating the 9.1 percent predicted for all private companies.

Patients in Fort Meyers, FL experience the longest in-office wait times in the country, according to the physician review and rating service ZocDoc, while Seattle patients have  the shortest wait times. For 2013, more patients in Detroit used ZocDoc’s mobile apps to schedule appointments than in any other city.

PerfectServe introduces Clinical Event Push, which automatically informs physicians of important clinical events, such as patients presenting to the ED, patients admissions or discharges, lab test availability, and new consult orders.

From CMS: 75 percent of Medicaid EPs (106,000) have received an EHR incentive payment, though only 17 percent are meaningful users (disconcerting?) Medicaid EPs are not required to attest to MU to earn initial payments, unlike the 60 percent of Medicare EPs (220,000) who are considered meaningful users and have received an EHR incentive payment. Through the end of October, the government paid almost $17 billion in MU incentives, including $6.7 billion to EPs.

An autism module added to an EHR’s clinical decision support system improves screening rates for autism spectrum disorders, according to a study published in Infants & Young Children. Seventy percent of the study participants agreed that the automation of the screening process helped them adhere to recommended screening guidelines.

CMS proposes a revised MU timeline that would extend Stage 2 through 2016 and would begin Stage 3 in 2017 for providers who have completed at least two years in Stage 2. The start date for Stage 2 would not change – just the end date – though the Stage 3 start date would be delayed a year. The ONC says the goal is two-fold:

To allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.

CMS is expected to release proposed rulemaking for Stage 3 and the certification criteria in the fall of 2014.

Aprima Medical integrates DMEhub into its EHR, allowing physicians to write orders for durable medical equipment directly from their Aprima EHR.

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