DOCtalk By Dr. Gregg 12/9/13

Does Health IT Care?

The other day I received an email from an HIT-related buddy of mine. He’s perhaps the brightest bulb in the HIT chandelier that I’ve had the privilege to know. In the email he used a term (and I quote it here except for the full expletive) to describe the HIT space as: ”motherf…inginteroperableidioticbigdatatalkingpredictiveanalyticHITindustryoverpromising-underdeliveingdreamweavingdouchebags.”  (MFIIBDTPAHITIOPUDDWDBs, for short.)

This from the same fellow who I’ve heard detail many of the complexities of the intricate HIT realm, both operational and political with clarity, precision, deep insight, and well-considered reason. His less than enthusiastic stereotype was like pure “cognitive fodder” as I knew how well he understood those of whom he spoke.

His rather saucy turn of phrase set me to wondering: does health IT actually care, or are we all just a bunch of MFIIBDTPAHITIOPUDDWDBs?

I swallowed the notion, and found myself chewing on its cud.

I thought about people I know/have known throughout various HIT-related experiences. I thought about corporate HIT cultures I’ve witnessed. I thought about HIT entrepreneurs I’ve met. I thought about doctors and nurses and geeks and gadgets and sales guys and C-suites. I thought about myself.

I thought about the bright-eyed newbies with so much passion and spirit. I thought about wizened old HIT patriots. I thought about those within whom the spark burns brightly and those within whom there appears to be naught but char.

I thought about “good guys” who turned, or who maybe were just never as good as they first appeared. I thought about “bad guys” who later showed shiny silver linings.

I thought about waste cases and value props. I thought about soul suckers and salvationists.

I thought about advocates and champions. I thought about people who fought tooth and nail to retain their rights to paper-and-pen. I thought about those dragged kicking and screaming into digital-dom. I thought about futurists and Monday morning quarterbacks. I thought about the converted and the lost.

I thought about e-patients and insurers. I thought about privacy rights protagonists and datasharing dreamers. I thought about population health and personal genomics and biomedical informaticists. I thought about my wife and sons and how all this HIT stuff must seem to them.

I thought about times when I’ve over-promised and/or under-delivered. (C’mon…we’ve all done it.) I thought about big HIT dreams that evaporated like so much smoke. I thought about personal HIT predictions that came true and those that now appear idiotic.

I thought a lot about things I’ve read on the pages of HIStalk sites.

Once I’d thought a while about all of this, and more, I realized that my buddy was spot on – and spot off. We are all MFIIBDTPAHITIOPUDDWDBs. And, yet, I’d wager that the vast majority of us also truly care, that we’re honestly trying to make healthcare better through HIT.

Maybe not all the time. Maybe not every effort. Maybe some motivations are not always so high-minded. Maybe some of us have less of a silver lining than others.

But overall, across the HIT board, across all the ups and downs and goods and bads, through all our human foibles and personal peccadilloes, I think it’s safe to say that HIT cares.

When we’re not being MFIIBDTPAHITIOPUDDWDBs, that is.

From the trenches…

“I tried to think, but nothing happened.” – Curly

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 12/5/13

From Boeing: “Re: McKesson Seattle. McKesson is closing its Seattle office, the original home of Practice Partner, the EHR product McKesson acquired several years ago.” While not officially confirmed by McKesson, Boeing provided us with internal McKesson communications as verification. Apparently McKesson intends to continue distributing, supporting, and developing the Practice Partner EHR and will allow Seattle support personnel to work remotely from home. Some development staff are being asked to relocate to Atlanta.

Two-thirds of US primary care physicians reported using EMRs in 2012, up for 46 percent in 2009, according to findings from the 2012 Commonwealth Fund International Health Policy Survey. In comparison, more than 90 percent of primary care physicians in the Netherlands, Norway, New Zealand, the UK, and Australia reported using EMRs in 2012. More than a third of US physicians allow patients to request prescription refills online or email medical questions.

San Diego Orthopaedic Associates Medical Group (CA) selects SRS EHR for its nine providers and two offices.

CareCloud and Quantia name Bernard Abbott, MD, CMIO of Family Health Centers (MD), the winner of their Health IT Case Study Challenge contest based on the organization’s success using technology to improve the practice’s financial and operational health.

Greenway Medical Technologies will integrate data analytic tools from Inovalon into its PrimeSUITE EHR platform.

Texting while doctoring could create a patient safety hazard, according to an opinion piece in the Annals of Internal Medicine. Physicians typing in an EHR during a patient encounter may miss signals of depression, disagreement, and lack of understanding. The physician-authors blame Stage 2 MU criteria, which require doctors to type in their own orders, and suggest a technologically-supported, team-based model of care may allow physicians to give patients their undivided attention.

Outpatient physicians report more emotional exhaustion than inpatient physicians according to a review and meta-analysis of 54 studies on physician burnout. Personally I always find a teeny bit of comfort (not to mention smugness) knowing that I really do have it worse than the next guy..

Email Inga.

News 12/3/13

CMS finalizes the 2014 Medicare Physician Fee Schedule, which includes a 24 percent payment cut if the SGR formula is not amended. CMS also proposes a policy beginning in 2015 to support care management outside of routine office interactions by establishing separate payments for managing the care of certain Medicare patients. The final rule also includes provisions regarding physician quality programs and the Physician Value-Based Payment Modifier.

In a separate announcement, CMS says it will pay providers a flat rate for Medicare visits to outpatient clinics, regardless of the severity of the patient’s condition.

EMR/PM provider CureMD acquires medical billing company AviaraMD.

Elmwood Health Center (NY) becomes the first practice to submit immunization data to the New York State Immunization System across the HEALTHeLINK HIE.

EHRs offer more than just a handy way to store patient notes, according to researchers from the Palo Alto Medical Foundation Research Institute and the University of Minnesota. Researchers conclude that patient data from EHRs provide reliable measures of the process of care and the patient-centeredness of a primary care practice. They also found that the volume of electronic messages between clinicians and  the frequency of in-person patient visits were associated with better patient health outcomes.

CMS publishes an interactive tool to help providers determine their eligibility for various ehealth programs.

Entrada, a developer of workflow products that are integrated with EHRs from athenahealth, Allscripts, Greenway, and NextGen, raises $1.12 million in new equity.

Email Inga.

News 11/26/13

From Ralph N: “Re: Practice manager interview. That interview sounded like a paid advertisement from athena.” While Erin was clearly enthusiastic about her billing and EMR provider, be assured that vendors never pay us for interviews, Readers Writes, or other posts. On HIStalk we have a section that is clearly labeled “Sponsor Updates” that includes items that may not be considered “hard news.” Often our sponsors ask us to consider interviews with their CEOs or clients – which we do not always agree to do – but in this case athenahealth is not a sponsor. Recently we asked multiple ambulatory EMR vendors for the names of potential interview candidates who were successfully using EHRs in their practice and appreciate athenahealth’s assistance in connecting us with Erin.

Nuance Communications announces the general availability of Dragon Medical 360 l Network Edition 2.0, which allows clinicians to document using multiple devices and provides an accuracy level of 98 percent or higher out of the box.

A Virginia gastroenterologist shares his transition from an academic practice to a small private group that he labels a “medical oasis.” He finds particular pleasure in the office’s low-tech set-up and absence of an EMR, which he calls old-school, unacceptable, and effective:

I write, by hand, notes that contain the information I need to help you feel better. When I finish our visit, I dictate a letter and often call or text your referring physician to let them know what’s going on. I bill based on the notes, but no one’s costing out the "elements of the encounter."

He is happier in his work and claims his patients are as well. Somehow the story makes me sad.

CMS publishes a tip sheet for EPs on Stage 2 HIE requirements. The document outlines the required data elements and provides guidance on data sharing objectives for summary of care documents, clinical summaries, and patient electronic access. EPs that have completed at least two years of Stage 1 MU can begin Stage 2 in 2014.

The use of secure messaging portals in EHRs may not improve outcomes or costs, according to a review published in the Annals of Internal Medicine. Researchers, who considered findings from 46 studies, conclude that “portals represent a new technology with benefits that are still unclear.”

A study of 215 primary care physicians reveals a significant decline in lab ordering rates when providers have a real-time display of cost information within their EMRs.

As Mr. H mentioned on HIStalk over the weekend, we are about to hit the traditionally slow news time in HIT.  If you are like me, your to-do list for the next few weeks includes not only work, but also plenty of holiday merriment, cooking, shopping, and decorating. Be assured that we won’t keep you away from the eggnog any longer than necessary by padding our posts with irrelevant news. 

On that note, I’m not sure if there will be enough news for a second news post this week. Just in case, best wishes for a very happy Thanksgiving!

Email Inga.

DOCtalk by Dr. Gregg 11/22/13

Big Data, Self-Care, and a DeLorean

Feeling bored the other day, I decided it was time for a road-time trip. Thus, I pulled out the DeLorean, threw a stale grilled cheese into the Mr. Fusion, cranked up the flux capacitor, hit 88 MPH, and headed off again to the future. (I won’t say when, because I don’t want to scare folks. Let’s just say it’s sooner than you might expect.)

After exiting the space time continuum, I decided to drive over to my doctor’s office to see what had become of healthcare. Sadly, it had been replaced by a Walmart. (I noticed an amazing number of Walmarts on the way there, by the way.) Noticing a caduceus logo now featured just below the main sign, I pulled up and walked in.

A big “Wal-Care” sign was prominently positioned just inside the entry with the caduceus logo to its right. I turned in to see an array of kiosks and cubbies occupied by people tethered to digitalia and discoursing with holographic talking heads floating eerily in space above each counter. I noticed one real, white-coated person walking around and went up to make some inquiries. Her lab coat had “Dr. Cammy” embroidered above the right breast pocket.

“Dr. Cammy,” I started. She turned and smiled. “Might I ask you a few questions?”

Her smile grew larger. “Oh, my, yes!” she exclaimed with a rather mixed expression of surprise and joy. “I get so few questions these days. How can I help …” She stopped mid-sentence. “Wait…I know you…you’re that guy, that doc with the DeLorean,” she said with both pronouncement and query.

I smiled, sheepishly. “Guilty,” I say.

“So, you’re actually here from 2013, right?” she asked.

“I am,” I acknowledge.

“I’ll bet you’re curious about all this,” she said as she swept her left hand across the room.

“You’re very insightful,” I say.

“Thanks. You know, I don’t get to use my insight much anymore. Healthcare has changed so, so dramatically. I’m more custodian than caregiver, it seems. After the ‘BD&W Meld,’ the self-care appsets sort of took over, relegating docs to more monitor than mentor roles. Well, that’s true for those docs who could continue to find work anyway. I read somewhere that the majority of displaced doctors appear to have ended up selling either Amway or Mary Kay.”

“Whoa, whoa, whoa…a little fast for me,” I interrupt. “Doctors are disappearing? Self-care apps took over? And what’s this ‘BD&W Meld’ you mentioned?”

“Oh, I’m sorry,” she apologized. “That’s right. In your day, doctors were still pretty revered, weren’t they? Well, they were sometimes. All that has really changed, let me tell you. How can I condense the events…? OK. OK. I know. Remember when everybody used to go to the doctor when they were sick?”

I nod.

“Well, now that there are so many self-care appsets and devices available– and so cheap – that people go to themselves, so to speak, instead of someone else when they’re ill. They can scan and measure and examine almost anything, right from home,” she exclaims, a little bit sadly. “It doesn’t leave a whole lot for healthcare providers to do.

“For folks who don’t have the latest and greatest tools at home, they can come here and use one of our Wal-Care kiosks. It doesn’t even cost them anything, as long as they make a minimum in-store purchase.”

“Hmmm,” I ponder, trying to look less shocked than I felt. “What if they need surgery or chemo or radiation treatment or some such?”

Dr. Cammy looked around the room to see if anyone needed her. They did not. She sighed, just a smidge, and continued, “Well, between personalized genomics, robotics, Big Data, and Sir Watson, there’s far less need for ‘real’ doctors to get involved. People don’t get nearly as much invasive care anymore, not like in your day. When they do need some form of procedure, heck, sometimes they can schedule it themselves, show up, have the procedure, hang out in auto-post-op a bit, and head home without even seeing a live person.”

“Um,” I stumble, “you mention ‘Sir Watson.’ Who is tha… wait… no… you don’t mean ‘Watson,’ the IBM computer, do you?!”

“Yeah,” she chuckles. “Can you believe it? Good old England’s Queen Latifah III, herself, knighted Watson a couple of years back. It made all the news threeds. The first non-human in history to receive knighthood.”

“Threeds?” I say quizzically.

“Oh, right. You didn’t have those yet. Threeds are ‘3-Ds.’ It’s how most content is delivered anymore. Like those holographic talking heads all these people are talking with,” she said as she pointed across the room.

I think I see the connection and ask, “So then, is that the ‘BD&W Meld’ you mentioned? Big Data and Watson? Or should I say, Sir Watson?” My smirk leaks out a bit more than I intend.

“Yep, sure is,” she admits. “When they finally figured out that they could take all that mega data folks were collecting – which was mostly just sitting on a gazillion different servers doing nothing – and feed it to Watson, things went bananas. Watson just sort of looked like the Second Coming to some, spewing out all these connections that no one had ever even dreamed existed. He literally changed the world, even more than Saint Jobs. That’s how it earned its royal dubbing, even though some folks in healthcare thought it more an Antichrist than a savior.”

My mind was reeling. Big data had finally found use, but its use put providers out of business? People could now take their healthcare into their own hands – and devices? Walmart had become the major primary care player? Watson was now a ‘sir’? Jobs a saint?

“Dr. Cammy, I feel sort of faint,” I admit, feeling the wooziness all the way to my toes.

“Oh,” she says with disappointment. “Kiosk 7,” she directs.

From the trenches…

“The future ain’t what it used to be.” – Yogi Berra

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).