News 9/10/13

I was drawn to this headline, which suggests that the implementation of a cloud-based integrated EHR/PM solution will save independent physicians from acquisition. The press release covers the results of a survey of CFOs, CIOs, administrators, and support staff from hospitals and physician practices and finds that the majority of practices believe their billing and collection systems/processes need upgrading. Almost half the practices report they are considering an upgrade to RCM software within the next six to 12 months, which is not surprising given the looming ICD-10 deadline. Also not surprising: most practices would prefer a single source vendor for their RCM/PM/EHR solution. I found this result a big more confounding:

88 percent of business managers fear that the ramifications of their outdated and/or auto-piloted RCM systems, particularly those not integrated to EHRs, will force their physician to sell out to a larger physician group or hospital within 12 months or face practice dissolution.

My guess is that practices realize they need to get an ICD-10-ready solution in place or else they won’t be able to get paid. Instead of offering reasons for this high level of fear, Black Book suggests that practices can save themselves from acquisition if  they migrate to a cloud-based solution. What about those practices that have a perfectly satisfactory non-cloud-based PM solution that simply requires an updated version in advance of ICD-10? I am not anti-new technology and maybe I am overlooking something, but the way this information is presented leaves me wondering what kind of funding Black Book may get from some of these cloud-based vendors.

NextGen Healthcare’s parent company Quality Systems acquires Mirth Corporation, which offers the Mirth Connect open source integration engine. The company says the acquisition will allow NextGen to better offer data exchange capabilities, including participation in HIEs. Strategically its appears similar to Allscripts’ dbMotion acquisition in that it provides the company with diversification beyond its core EHR products. NextGen likely hopes the Mirth offering will give the company an edge when competing for a health system’s ambulatory EHR/PM business.

Capario announces it is ready to begin ICD-10 testing with its submitter customers and vendor partners and is offering customers an online ICD-10 submitter testing tool at no charge.

Patients of Advocate Medical Group (IL) file a class-action lawsuit against the practice, charging the group did not do enough to protect their private data. The suit follows the July 15 theft of four unencrypted computers that contained information on more than four million patients.

In the same neck of the woods, a debt collection agency that had contracted with the University of Chicago Physicians Group notifies 1,400 patients that their PHI and financial information had been openly viewable on the collection agency’s website.

The AMA publishes a toolkit to help physicians navigate the HIPAA changes that go into effect September 23. While the 25-page document looks quite comprehensive, practices would probably found it handier a few months ago when most started ramping up for the changes.

Most physicians report being satisfied with their career choice, although 40 percent would choose a different career, given a chance to rethink their career path. I wonder how that compares to the general public, especially since physicians seem to switch careers less frequently  than teachers, EMR sales reps, or even attorneys.

Aprima Medical integrates NoteSwift into its EHR system.

Memorial Health Hermann Health System (TX) takes almost 600 providers live on eClinicalWorks EHR and adds an additional 200 user licenses.

The Rhode Island Quality Institute and BCBS Rhode Island will pay primary care practices up to $10,000 in incentives to use the state’s HIE.

WellStar Cobb Family Medical (GA) goes live on Epic across five of its offices as part of WellStar Health System’s $125 million EHR initiative.

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News 9/5/13

NextGen Healthcare client Williamette Valley Providers Health Authority (OR) deploys a clinical decision support tool developed by the Clinical Decision Support Consortium that takes a request for CDS from NextGen Ambulatory EHR, delivers it to an enterprise clinical rules service at Partners HealthCare for analysis, and immediately returns recommendations within the NextGen application. The Consortium is composed of several provider organizations and EHR vendors, including Partners HealthCare and NextGen, and aims to establish nationwide consistencies for CDS recommendations. The “cool” factor here: community-based physicians have access to CDS data from a large academic medical center across the county and have recommendations available at the point of care.

ZirMed partners with EHR Integration Services to provide Allscripts PM and GE Centricity Group Management customers integration with ZirMed’s RCM, clinical communications, and analytics solutions.

Family physicians top the list of the most highly recruited doctors, followed by internal medicine specialists, according to a report by physician research firm Merritt Hawkins. Also of note: hospital employment of physicians continues to grow, increasing from 11 percent of physicians in 2004 to 64 percent in 2013, and, quality based incentives are included in 39 percent of new physician assignments, up from seven percent in 2011.

NYC REACH, the REC for New York City, assigns Aprima Medical Meaningful Use Champion status in its Vendor Recognition Program.

The majority of medical students use a tablet, smartphone, and computer routinely in a professional or academic capacity, according to an Epocrates survey of future physicians. Fifty-four percent use a tablet as part of their medical training, up from 23 percent a year ago.

HIMSS names eClinicalWorks customer White River Family Practice (VT) winner of the 2013 Ambulatory HIMSS Davies Award of Excellence for its success in improving quality of care and patient safety while achieving a demonstrated ROI. Since its EMR implementation, the practice has documented improvements in several of its quality of care objectives, including the percentage of patients receiving smoking cessation intervention, screened for alcohol use, receiving pneumococcal vaccines, and seen weekly with IVD or diabetes receiving AntiThrombic treatment.

Allscripts announces the GA of Allscripts Professional EHR 13.0, which is ONC 2014-certified and supports both Stage 1 and 2 MU requirements.

Kristi Syling (Vanguard Health Systems) joins PerfectServe as compliance officer.

NextGen Healthcare releases an updated version of its Patient Portal, which incorporates Spanish and two dialects of Chinese.

Kareo tops Black Book’s list of Top 20 Seamless Software Vendors for EHR, Practice Management, and RCM, earning a number one ranking in nine of 18 evaluation criteria and achieving a top five ranking in all categories.

Horizon Eye Care (NC) adopts InteliChart Patient Portal.

Visitors to this year’s Minnesota State Fair can leave with more than oversized stuff animals and fried food hangovers, thanks to BCBS of Minnesota. BCBS is handing out  vouchers for free e-visits through its Online Care Anywhere website.

EMR/PM provider Visualutions will resell Wellcentive’s population health management and data analytics solutions to FQHCs.

California lawmakers reject a law that would allow nurse practitioners to work autonomously. Nurse practitioners are allowed to practice independently in 17 states and the District of Columbia, but California physician groups lobbied against the proposed legislation in their state.

Athenahealth unveils its plan to transform its newly purchased Arsenal on the Charles complex to include 150,000 square feet of office space, walking and biking paths connecting to the nearby Charles River, outdoor meeting spaces, a museum, parks, a farmers market, an accelerator space to incubate small HIT start-ups, restaurants, and, my personal favorite, a beer garden. No doubt the planned improvements will be a draw for prospective employees, especially those considering competing opportunities in Silicon Valley or Verona, WI.

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News 9/3/13

Select Walgreens Healthcare Clinic locations in Indiana will fully integrate their EHR with Community CareConnect, the EMR platform owned by Community Health Network. Healthcare Clinic patients will also have the ability to schedule follow-up appointments with Community Health Network physicians.

EyeMD EMR Health Systems expands its marketing efforts in Canada through a partnership with Winnipeg-based Max Systems, a healthcare billing and scheduling provider.

The IT administrator for a New York orthopedic practice is charged with forgery, criminal possession of a forged instrument, and grand larceny after it was discovered he used a physician’s electronic signature to create a prescription for Percocet.

A Nashville newspaper profiles Urology Associates and Heritage Medical Associates, two of the region’s oldest and largest physician groups, and highlights some of the ways the groups have managed to stay independent and profitable. Heritage’s CEO notes his organization scales its technology and infrastructure to support physicians, while Urology Associates attributes long-range planning and foresight for its decision to implement EMR long before MU legislation. Interestingly, back in my vendor days several years ago, I actually visited both of these practices and even then each was well ahead of their peers in terms technology adoption.

The latest MU numbers from CMS as of July 31: $15.9 billion paid since the program’s inception, including $6.4 billion to 312,000 EPs.

In case you missed it, Dr. Gregg had a great post over the weekend entitled, “Take the Cannoli,” which touches on a darker side of vendor/provider relationships and includes a mention of Practice Fusion’s opt-out approach to sending emails to patients and asking them to rate their physician. Basically, unless a physician opts out of the program, each time a progress note is created in the EHR, the patient is forwarded an email that appears to have come from the doctor and includes a survey. In the last 17 months, patients have submitted almost two million reviews. As Dr. Gregg points out, this wealth of data benefits Practice Fusion far more than its customers.

Like Dr. Gregg, I was a annoyed when I heard about the program. It’s quite likely that no HIPAA or privacy rules are being violated,  but it’s troubling that so many Practice Fusion physicians were apparently unaware that the company was sending emails in their name. Practice Fusion contends it communicated details of the program through various channels when it was first initiated and it mentions the program in its current end-user agreement.

At a minimum Practice Fusion has done a poor job of communicating. Because of poor communication, the company now has a number of customers and prospects who view the organization with some degree of mistrust. Perhaps the company will recognize the program needs to be restructured to be opt-in versus opt-out. After all, who wants emails sent in their name without their knowledge?

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DOCtalk by Dr. Gregg 8/30/13

Take the Cannoli

“The Godfather.” What a classic film. Just chocked full of life lessons, some would say. Unfortunately, they’re not the life lessons most moms and dads would try to instill in their children.

You know, things like, “Violence is an acceptable solution to your problems,” or, “If you cross the family, you’ll get whacked,” or even, “It’s OK to spray grandpa in the face with pesticides.”

Watching it with my Sicilian wife the other day – yeah, that’s right; she’s “connected,” so watch your step, pally – a line popped out at me that rang a sad HIT bell. Rocco Lampone and Pete Clemenza are driving along with traitor-to-the-don, Paulie Gatto, toward Paulie’s unbeknownst whacking. Pete says he needs to “take a leak” and has Paulie pull to the side of a country road. As Pete whizzes, Rocco whacks. Paulie slumps over the wheel, minus some of his brain. Pete zips up and walks back to the car telling Rocco to “Leave the gun. Take the cannoli.”

They leave Paulie and the instrument of his demise for all to see. The message is clear: the Corleone family will not tolerate traitors.

But there’s more than this. Leaving the gun shows their confidence, their arrogance that they can’t be touched. Taking the cannoli adds the “this is all just a part of the job” flavor to the message.

“We whack who we want and we keep the sweets.” This appears to be the take home message that far too many of the HIT “family” have garnered from “The Godfather.” It is becoming ingrained into some vendors’ unwritten corporate philosophies and become part of their modus operandi.

Take, for instance, Practice Fusion’s recent opt-out approach to sending emails to patients, addressed as if having been sent from the patients’ own doctor or other healthcare provider and asking patients to review and rate their provider. Regardless of whether Practice Fusion notified their EHR users via email (I’ve signed up for their EMR – though I don’t use it – and never saw such an email) or whether they wrote about it in their blogs or forums, it seems many providers were unaware that these emails were being sent on their behalf. Thus, the real benefit of these emails is obviously not for the loyal PF-using providers; the real benefit of these ratings is for PF, i.e., the cannoli is theirs.

If this wasn’t a bullet to the head for the providers, why wouldn’t they use an opt-in system instead? Do they think they are wiser or more caring about the patients that these providers serve than the providers themselves? Do they really believe, as they said in response to one blogger’s (John Lynn) recent post about this, that they are the correct arbiters to administer a patient feedback program “designed to provide your practice with a controlled, quality channel for accurate patient reviews”? Who provides this control? Who insures the quality? Who judges which reviews are “accurate”?

Seems to me that PF is a Rocco and their providers are Paulies (though Paulies who hadn’t turned out their boss to any enemy). These PF loyalists took a shot from behind and PF walked away with a cannoli in the form of nearly two million reviews that likely helped bolster investor interest.

I’m oversimplifying, I’m sure, and I’m not intending to pick on PF. There are loads of examples of non-healthcare folks (and some from within our midst) stepping into the healthcare IT space, taking what they could get from it, and walking away with some seriously sweet green cannoli, i.e., cash, that is ultimately generated by the labors of healthcare providers.

To us providers, if you take our money, we are making an investment in you. If we commit to the use of your tools, we are establishing a trust with you. If you take our dollars, or our good faith, and walk away – whether by acquisition, merger, or business failure – you are leaving us in a lurch, often a very expensive lurch from which to “unlurch.” If you take our efforts and then profit from them while leaving us with naught but the “you did a good deed” pat on the back, you have essentially stolen from us.

There are numerous HIT vendors, healthcare websites, and other such Roccos that come to mind, but my mission is not to point fingers or even ask for any cannoli back. My motivation for writing today comes from the mere hope that my colleagues – doctors, nurses, PAs, NPs, etc. – will begin to see that all of our so-called “helpmates” in the HIT space are not always goodly intentioned. They may mouth off about serving the greater good, helping providers or patients, and facilitating improved care, but all too often it appears that C-suites are C-suites; they care more about the cannoli than the caregiver – or the cared-for.

We need to watch our backs…and our cannoli.

From the trenches…

“Leave the gun. Take the cannoli.” – Pete Clemenza, in The Godfather

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 8/29/13

From Sue Orman: “Re: Credit cards from payers. In addition to the exorbitant merchant fees, a problem with insurers using credit cards to reimburse providers is that there tends to be a lot of issues with practices not receiving electronic remits. That violates the spirit of administrative simplification under HIPAA and ACA. Not only does CMS need to make sure that payers are paying physicians their contracted rates, they need to encourage payers to immediately begin using the EFT standard ACH CCD+, which conforms with HIPAA and is less costly than credit card transactions.” Readers more familiar with the payer world and electronic standards can likely speak more knowledgably than me on this, but my understanding is that beginning January 1, 2014, payers will be required to accept EFT in the new standard format if requested by a provider. If a provider does not request the new format, the payer can continue using credit cards for reimbursements, which translates to more fees and less money in the hands of the physician.

eClinicalWorks names HealthNet (IN) the winner of its Improving Healthcare Together video contest. Auburn Medical Group (GA) and Open Door Family Medical Centers (NY) took second and third places.

Doximity, which is like LinkedIn for physicians, now boasts 200,000 licensed physician members, or about 30 percent of the doctors in the country. The platform allows physicians to share patient information in a HIPAA-compliant format and look up colleagues or relevant specialists. Sermo, another physician-only online community has a reported 125,000 users.

HBMA introduces Professional Billing Service Locator, a free platform to help practices locate medical billing companies that serve their region and their specialty.

Physician RCM provider MedData promotes Ann Barnes from president to CEO.

The benefits of a practice’s ACO participation reach beyond the patients covered by the ACO, according to a JAMA-published study. Researchers found that medical groups’ participation in commercial ACOs was associated with savings for Medicare beneficiaries as well, though the quality of care for Medicare patients did not consistently improve. The “spillover” effects may be the result of organizational changes in care delivery, such as incorporating computer reminders to reduce unnecessary and expensive tests.

New York doctors must now check an electronic prescription drug database before writing prescriptions for painkillers and other controlled substances, and, pharmacists must consult the database before filling the prescriptions; pharmacists must also report in real-time when a prescription is filled. The requirement, the first of its kind in the country, is part of the state’s I-STOP law, which also mandates electronic prescribing for all drugs by December, 2014.

In HIT fashion news, Vestagen Technical Textiles secures $8.25 million in financing. The company develops a variety of textile products and technologies, including scrubs that don’t absorb liquids and thus protect workers from potential contaminants. I guess the scrubs’ practicality and safety benefits are suppose to make up for the lack of spicy colors and patterns.

The San Diego newspaper highlights some of the more innovative ways area physicians are using smartphone apps and other technology to engage patients and monitor such things as weight, exercise, blood sugar, depression, and medication adherence. My favorite: Scripps offers pre-recorded videos of doctors so patients can become familiar with their physician prior to the first appointment.

Physicians are split when it comes to whether or not Medicare should make data about Medicare payments available to the public, according to an ACPE poll. Forty-six percent of ACPE members participating in the survey are in favor of keeping the data private and believe the information could “too easily be misinterpreted by the public and be used to portray physicians in a negative and unfair light.” I am with the 42 percent who are in favor of transparency and believe the public has a right to know how tax dollars are being spent.

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