DOCtalk by Dr. Gregg 9/16/13

Cannoli and Crowdsourcing

In a recent post, I discussed the “take the cannoli” attitude that pervades certain segments of the HIT world. Several very kind comments via email about that post plus a recent “event” caused me a mental revisitation of the concept.

The event is the HealthTap “Summer 2013 Top Doctor Competition.” This has brought a slew of emails to my inbox. Several a day from the HealthTap promo peeps, in fact, which in their seemingly never-ending thrust to inspire my participation, have actually ended up causing me to react quite contrarily.

Lemme ‘splain, Lucy.

I was a very early HealthTap contributor, and because of those early efforts, I’ve continued to grow a certain “presence” in the HealthTap community via the social network, grown upon my early input. I say “early input” because it has been quite some time since I’ve engaged with the HealthTap platform to any real extent. I haven’t provided any new answers to medical questions or attempted to spread my online presence there in quite a while. I wasn’t 100 percent sure why I hadn’t continued participating with the HealthTap platform until I got hit with the cannoli, so to speak. Their recent email onslaught clarified my reticence.

The key concept behind HealthTap is crowdsourcing. They have created a platform for consumers to interact with healthcare providers that is free for all. (So far!) Consumers ask brief questions and doctors from all around provide short, non-patient-specific answers. Providers can also throw out little snippets of medical wisdom and knowledge that are available for all to search and see. There are followers and networks; there are contests and award badges – all the typical social network fun is there in a fairly nice-looking tool.

One conundrum re: HealthTap has been that of time. If I spend time providing expert knowledge or answers to questions there, it means I’m not spending time elsewhere – not with my family, not chillin’, not doing something that generates income, not in our local free clinic, not blathering on HIStalk Practice. While garnering a sense of “I done somebody good” is not an ignoble thing, in this situation it is a very impersonal sense of do-goodness. It isn’t like helping a friend, a family member, a patient, or a neighbor.

Now, I have no qualms about helping folks unknown – and I hope I have, at least a little – but what the recent overkill of HealthTap Summer 2013 Top Doctor Competition emails has done is to confirm my suspicions that my do-good sensibilities are being manipulated. (i.e., I think I see somebody taking my cannoli.)

HealthTap thrives via provider input. In fact, they’ve scored millions of dollars in investor capital based solely on the value of the provider expertise they’ve accumulated. But, unless you’ve nothing better to do, a provider gets zilch from the investment of time and intellectual property save a sense of trying to do something good. (Well, that and a digital wall full of contrived digital “awards.”)

With this new contest, I’ve recently been receiving several emails every day trying to inspire my further contributions so that I can “win” in their summer games. These emails are obviously auto-generated and daily conflict with themselves and the website’s own ranking telling me I’m in some #1 or #18 or #2 “Top” spot, all on the same day. Maybe I’m wrong, but I’ve started to feel a little put upon. I’ve started to feel more manipulated than inspired. I’ve started to wonder why I should spend my insufficient spare time helping the HealthTap hierarchy make millions when all I get is a badge. (“Badges? We don’t need no stinkin’ badges!” comes immediately to mind.)

If HealthTap is making money off my years of costly training and even more years of garnered health experience and all I get is a good feeling (OK, and a badge), isn’t that essentially a “take the cannoli” slap in the face?

There are probably lots of good folks at HealthTap, and I realize I’m not endearing myself to them here. I also know that lots of my colleagues likely disagree with my take on this. To be clear, I don’t have anything against the overall concept of making good, concise, and easily readable health answers freely available to consumers. But I’m sorry; I think too many companies are getting in on this whole “take the providers’ experience and knowledge and leave him or her naught but a thank you – or a badge” concept. (EHR vendors have been doing this for some time – taking their provider users’ experience and input to help create a more saleable product, often paying nada for the contributions.)

We’re in the healthcare realm here. It isn’t akin to asking a consumer what they like or don’t like about a refrigerator or toaster; consumers typically have no expertise nor vested interest in the value of their insights. OK, maybe they hope they get a better toaster someday, but, they generally haven’t trained for years as appliance design gurus. In the healthcare space, this is taking formally acquired know-how and profiting from it, with no remuneration to the expert.

In this particular instance, consumers get help while HealthTap gets money. The least HealthTap could do is share a little of that profit with the professionals they rely upon to generate both the resources and the profit.

If you’re going to make money off our (providers’) efforts or expertise, please have the courtesy to share. Healthcare doesn’t need any more vultures. Providers are getting squeezed enough as it is.

In other words, leave us some cannoli.

From the trenches…

“He looks like he’s just been told there’s no cannelloni in the world.” – Phil Stone

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 9/12/13

Health IT expenditures are rising as physician offices continue to adopt and optimize EHRs, according to an MGMA cost survey report. Annual IT expenditures per FTE physicians were $19,439 in 2012, a 28 percent increase since 2008. Offices also report increases in median staffing costs as additional personnel are hired to manage operations and provide clinical, and ancillary support. MGMA theorizes the increased staff costs may be the result of initiatives to improve patient satisfaction and provide more patient-centric care. The full report must be purchased so it’s unclear if MGMA proposes options for cutting costs, such as migrating to a cloud-based EHR to reduce IT expenses or merging with a larger practice/selling out to a hospital to leverage IT and staffing resources.

A couple of recent studies indicate the use of EMRs in physician offices can positively impact care. In a JAMA-published study, researchers found that switching from paper to EMRs led to “modest reductions” in the number of ED visits by diabetics (519 vs. 490 visits per 1,000 patients) and hospitalizations (251 vs. 239 per 1,000 patients). Also in JAMA:. a research letter reported that using an EMR that included automated growth monitoring helped doctors pick up on cases of possible growth disorders among kids.

And from another JAMA article: small EHR-enabled clinics that participated in an P4P incentive program showed slightly more improvements in cardiovascular care processes and outcomes.

Twin Fountains Primary Care Clinic (TX) implements simplifyMD’s EHR/PM platform.

MGMA-ACMPE names Garth Jordan (EDUCAUSE) COO.

ZirMed will offer tools to help providers transition to ICD-10.

Athenahealth releases the Demandforce automated marketing and communication service created by Intuit. Demandforce will be available on the athenahealth Marketplace for providers using athenaCommunicator and is designed to increase patient engagement, attract new patients, and measure the impact of marketing and social media efforts.

I just received my first MGMA party invite and it looks to be a fun one. Interestingly the invite highlights the host company’s RCM solutions, and makes no mention of the fact that it is a leading provider of ambulatory EHR solutions. Could this be a foreshadowing of what vendors will be highlighting this year?

eClinicalWorks and NextGen reseller PracticeMax acquires Chicago-based Medi-Data Service, a provider of billing and PM services.

Every year US consumers spend 52 hours researching  health information online, but only make three visits to the doctor. Americans are most likely to search a pharma-sponsored website after being given a diagnosis from a physician, but also jump to the web before filling a prescription and after experiencing new symptoms. WebMD is the online resource most often accessed by physicians.

Ophthalmology EMR provider Medflow will use DataMotion Direct to enable the secure exchange of PHI for its 2,800 physician customers.

The 110-provider Prima CARE (MA/RI) selects Ingenious Med’s mobile revenue capture technology.

Email Inga.

From the Consultant’s Corner 9/10/13

What’s Your EHR’s ROI?

Mention “return on investment” in the same breath as “electronic health record,” and you’re likely to get a mixed reaction because the promised benefits of reducing costs and improving quality have been offset by reduced physician productivity or dips in financial performance for many organizations. While these risks are real, the potential “soft” benefits of improved quality and enhanced patient satisfaction, as well as “hard” benefits of improved revenue, are also real.

Given the capital investment needed to purchase and implement an EHR, you’d think that every healthcare organization installing these applications would have documented baseline performance; set clearly defined goals in terms of quality, expenses, and revenues; and established processes for monitoring their progress toward meeting these goals. However, I’ve found that’s not the case for most organizations making these large-scale investments.

In my experience, those organizations that do actively monitor results and work toward specific ROI goals seem to have better success with their EHR implementation, both clinically and financially. While some may not be seeing a cash increase at the end of the day, they are closing the gap between expenses and revenue. More importantly, they are better positioned for competing in an evolving reimbursement landscape where there is a shift from volume to value.

So how do you define and measure the ROI for your EHR? Here’s where you can start.

Measure baseline performance. Before starting down the road to implementation, you have to understand key baseline performance measures, including patient satisfaction, physician productivity, revenue cycle performance, and perhaps most importantly, key quality measures. By understanding these measures, leadership can set quantifiable goals and monitor the progress toward those goals. What is not measured is not going to be managed, and what is not managed is not going to improve a practice’s quality-cost curve.

Set expected ROI goals, not just financial goals. While a practice may not see a purely financial return from its EHR investment for several years, it is important to monitor financial results in order to mitigate risks of decreased physician productivity and practice revenue. Because quality will play an increasingly important role in reimbursement, workflows and system build decisions during implementation must support the capture of clinical data in a manner that ensures reporting is transparent and efficient.

Monitor ongoing performance. Unfortunately, once the system is live, the work is not necessarily finished. Dashboards and reports must be utilized to continually monitor your organization’s performance and to compare results with expected outcomes. While the goal is to ensure continual improvement, this step also is effective in proactively identifying post-implementation problems.

By setting realistic goals for your EHR, defining performance measures, establishing baselines, and monitoring data over time, your organization can truly get a handle on whether the EHR is living up to expectations and delivering a solid return on investment.

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

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.

Email Inga.

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.

Email Inga.