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?

Email Inga.

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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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..

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