DOCtalk by Dr. Gregg 7/26/13

The Kicker

Blogging sometimes seems like an extended version of tweeting. You blast out your thought(s) du jour to a largely unknown crowd and respond to those folks who happened to read and whose buttons you happened to have pushed. Blogging just involves longer thought trains than tweeting. It’s sort of the interim step between being a full blown (i.e., real) writer and a tweeter.

But sometimes it gets bigger than that. Sometimes, through the interplay of commentary, you learn something cool or you connect with someone you might otherwise never have met. That’s the really fun part — the kicker — to being a part of the blogosphere.

I got just such a kicker recently. Actually, I got a double kicker, though not through my own blog ramblings this time, but rather via the “Comments” section on another.

Those comments were left by Dr. Andrew Schechtman. He shared a bit of his group’s experience as they searched for an EHR. I found his comments on this — and on the current state of affairs of EMRs/EHRs — to be well written and insightful. He seemed a bright light, so I looked for and found him on LinkedIn. I sent a message asking him to chat. We connected via Skype shortly after.

I’m in Ohio; Andrew is in the San Francisco Bay area. I was in a tee shirt and at home as it was later evening for me and I had just hung up from a two-hour conference call. I was tired and hadn’t even had a chance at dinner yet.

Andrew came onto the video call with his stethoscope still draped across his neck. In dress shirt and tie, he closed his office door and said he was just wrapping up patients. I wasn’t sure how this would go since I was beat and his brain was probably still processing the day’s patients and workload.

We started off with the obligatory ”how do you dos” and the “here’s where I come from” stuff. But it didn’t take long to forget my fatigue (and my stomach growls) as the conversation turned to deeper stuff. (Well, “deeper,” if you call HIT “deep.”)

What I found most enjoyable was the demeanor that Andrew exuded. He was an obvious geek, yes, but not in an outwardly obvious way. He was calm, easygoing, considered, and pleasant. He had a good sense of humor and laughed gently. I would wager that his patients would say, “He has a good bedside manner” – confident, but not cocky; caring without being overbearing; lightly delightful.

(Sorta sounds like a man-crush, doesn’t it? Ack. It’s not intended that way; he was just an impressive fellow.)

The first kicker for me (from participating in the blogosphere commentary) was meeting this enjoyable fellow a half a continent away. The second kicker was something he told me while we Skyped.

Andrew was describing his experience with looking at EHRs from various vendors. All the same stuff you hear: too cumbersome, too little “stuffings”, too expensive, too much resistance from his partners, etc. At one point, he had actually adopted one of the better known “free” EHRs and started documenting his encounters even though the rest of the group was still on paper. (He documented digitally and then printed his notes out to stick in the group’s paper chart folders!) But then he started talking about the EHR that he eventually adopted for his group.

He said they had looked at ElationEMR back in 2010 and decided to walk away from it (seeing it as one of the “too little stuffing” EMRs at the time.) About a year later, just as they were just about to go with one of the more widely adopted EHRs – one of the biggies – they decided to give ElationEMR one more look. So much had changed in this startup system, in lots of good ways, that they opted to put their faith in the newbie.

They adopted and implemented. Andrew got the front office up and running with minimal training. In fact, pretty much the entirety of the staff’s training consisted of a little seven-minute Camtasia video he created. (He granted me permission to share it with you, FYI.)

The staff was up and running. Period.

On live day one, after similar minimalistic training, he challenged his partners to “just do one or two patients with it today.”

That day – go-live Day One – with no schedule adaptations, the partners were also up and running, most having documented all of their first day’s encounters on the system. Not just one or two patients, but all of them.

Let me repeat that: not just one or two patients, but all of them.

No downtime. No reduced numbers to accommodate training and workflow adaptation. No major fuss or muss.

That was a real kicker for me. How many EHRs can really and truly be incorporated into a busy practice’s workflow with such little disruption? It’s nice to know it is possible.

Nice to meet you, Andrew, and thanks for the inspiration.

From the trenches…

“The sad thing is he’s a good kicker. He’s a good kicker. But he’s an idiot.” – Peyton Manning (on Mike Vanderjagt)

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 7/25/13

From Chip Hart: “EMR features. I note a disturbing trend of boiling down the quality of an EHR to its stated sum of features. This is a huge mistake and leads to the high dissatisfaction rate docs have with their first EHR purchases. Your chosen EHR should be more about workflow, customer support, and where they will be in five years. Bells and whistles are almost meaningless.” Chip’s comment is in response to a reader’s recent inquiry about the differences in EMR features for large versus small practices. I think his comment is spot on. I’d add that references and site visits are also critical in selecting an EMR. The references should be similar in size to one’s own practice and specialty and not necessarily from the select list provided by the vendor.

The EMR replacement market is predicted to be hot over the next year, according to a Black Box report. Up to 23 percent of physician practices claim they will replace their current EHR technology, with 81 percent of those saying the change will happen within the next year. Vitera, Practice Fusion, Care360 Quest, Cerner, Greenway, GE Healthcare, ChartLogic, and athenahealth were named the “top performing EHRs based on the EHR components that improve practice productivity and profitability.” The ONC reports that about 300,000 EPs have attested for MU, so if Black Box is right, a bit of math suggests that a minimum of 55,000 providers will be looking to replace their existing EMRs within the next 12 months.

MGMA submits a letter to HHS Secretary Kathleen Sebelius expressing concerns about Medicare’s decision not to conduct ICD-10 testing with external trading partners, including physician offices, and asking for a reversal of the policy. MGMA says the failure to change course would decrease the potential for a “catastrophic back-log of Medicare claims following the Oct. 1, 2014 compliance date” and could result in “significant cash flow disruption for physicians and their practices, and serious access to care issues for Medicare patients.”

Kareo acquires ECCO Health, a Las Vegas-based medical billing provider.

e-MDs recognizes six of its clients who have been selected by the ONC as either as an HIT Champion or MU Vanguard.

NextGen will offer LDM Group’s healthcare messaging platform to its NextGen EHR clients. NextGen also announces it will integrate is Ambulatory EHR with Florida Blue and Availity to make patient-specific clinical information available at the point of care to both providers and payers concurrently.

Congress Medical Associates (CA) selects SRS EHR for its 21 orthopedic providers and two locations.

Social media experts recommend physicians maintain at least a “minimal presence” online in order to enhance their practices and protect themselves from unfair criticism. Accenture’s Frances Dare suggests physicians monitor their digital footprint to see what patients are saying about them; have a Website with a blog; and,  open a Twitter account to post practice updates and general health reminders.

The 12-physician SJH Cardiology Associates (NY) selects OnPage Technology’s pager replacement system for HIPAA-compliant messaging with smartphones.

E-mail Inga.

News 7/23/13

From Le Patron: “Black Book report on EHR vendor consolidation. They are spot on. There are too many vendors and way too much physician dissatisfaction to support the status quo. The specialty physicians are especially dissatisfied with the one-size-fits-all vendors. I’ll give you $1,000 for every specialist satisfied with one of the big name vendors if you give me $1,000 for each one who is dissatisfied. I’d be a rich man.” Neither vendor consolidation nor user dissatisfaction are surprising, but don’t put all the blame on vendors. Vendors have had to shift their development priorities to MU and other mandated programs, while workflow enhancements and usability updates have been pushed to the back burner. More vendors, large and small, will be forced to sunset products as ongoing development costs are either deemed unsustainable or not practical , especially for vendors offering multiple EHRs. Look no further than Allscripts MyWay and Mitochon as great examples.

Earlier this month I mentioned the 17 percent drop in EP participation in the MU program from 2011 to 2012.  CMS asked EPs why they had dropped out and learned many felt the program was too time-consuming or too complicated; others claimed they were waiting for Stage 2 requirements; and, more than a third claimed they intended to attest but missed the deadline.

Vitera Healthcare names Jeremy Muench (McKesson Provider Technologies) SVP of client operations.

CIOs and IT system directors in medical groups report median compensation increases of more than seven percent since 2011, according to the MGMA. Compensation for physicians, by the way, grew about three percent from 2011 to 2012.

If House lawmakers have their way, physicians will see five years of 0.5 percent increases in Medicare payments starting next year. The proposed bill repeals Medicare’s SGR payment formula and replaces it with a system based on quality and efficiency, starting in 2019. Physicians choosing to stick with traditional fee-for-service compensation would see a permanent five percent cut after 2018.

E-mail Inga.

News 7/18/13

CMS releases data that demonstrates that the use of EHR is helping providers manage patients’ care and provide more information securely. CMS notes that since 2011, providers have used EHRs to send more than 190 million prescriptions electronically, sent 4.6 million patients an electronic copy of their health information, forwarded more than 13 million patient reminders, checked drug and medication interactions over 40 million times, and shared more than 4.3 million care summaries with other providers.

Approximately 59 percent of physician practices expect the move to ICD-10 will lead to a decline in revenue, according to a eHealth Initiative/AHIMA survey. The most significant barriers for ICD-10 implementation include staffing and training, workflow and productivity, lack of knowledge, and cost of software upgrade.

CMS offers OPEN PAYMENTS mobile apps to facilitate reporting of financial ties between doctors, teaching hospitals, and drug and device manufacturers.

Aprima reports that over 1,000 former customers of Allscripts MyWay have migrated to Aprima PRM since Allscripts’ October announcement that it would not develop new MyWay updates for MU or ICD-10.

Celebration Orthopaedic & Sports Medicine Institute (FL) selects simplifyMD’s EHR/PM system for its 10 providers.

Wishard-Eskenazi Health (IN) selects eClinicalWorks PM for 385 providers across eight locations.

CareCloud releases an update to its CareCloud Charts EHR that includes enhancements to charting, task management, and patient flow management.

A Massachusetts eHealth Collaborative-sponsored study finds that EHR adoption by doctors in three communities generated no statistically significant per-member, per-month cost savings, although EHR usage appeared to be associated with less-rapid cost increases.

A Black Book Rankings survey of 880 EHR consultants finds that most believe the majority of existing EHR vendors will have merged, been acquired, or cease operations within five years. Most of the failing vendors will falter because they delayed usability issues over meeting MU requirements. Well-funded smaller vendors serving niche sectors may do better than vendors who fail to resolve “fundamental flaws caused by being all things to all physicians.”

The AAFP subsidiary TransforMED selects 90 primary care practices in 65 cities as participants in a three-year patient-centered medical neighborhood pilot project.

Allscripts will offer its ambulatory clients LDM Group’s ScriptGuide patient education solutions.

E-mail Inga.

News 7/16/13

Clinical Holdings Corporation, a new physician services business of Ascension Health Alliance, will deploy athenahealth’s RCM/PM services to over 4,000 providers. Analysts believe the deal may be worth $42 million in revenue for athenaheatlh.

Free EMR-provider Practice Fusion is rumored to be closing on a $60 million fourth round of funding, on top of the $34 million raised less than a year ago.

Ambulatory EMR/RCM provider Integrated Solutions Groups, the parent company of Professional Data Services, acquires Data Strategies, a McKesson Practice Partner EMR reseller and the provider of the PDS Cortex PM platform.

Emdeon will integrate the Simplicity Settlement Services by ECHO into the Emdeon Payment Network. Emdeon also announces its recent opening of a 100,000 square-foot facility in St. Louis, MO and the introduction of Virtual Card Services, an electronic payment option to reduce payment distribution costs and payment processes.

Middlebrook Family Medicine (VA) selects Benchmark Systems EHR, billing, and collection software.

Concerned about MU audits? Here are some pre-payment audit preparation best practices, based on the experiences of EPs that have survived pre-payment and post-payment audits:

• Understand core and menu set measures
• Use multi-disciplinary teams
• Document measure compliance
• Analyze security risk
• Have documentation that indicates the installed EHR is certified.

CMS highlights key 2014 deadlines for the EHR incentive initiative and other eHealth programs.

A dozen employees from the Raleigh, NC offices of Allscripts volunteered to help clean up tornado damage in Moore, OK and presented the local hospital with a check for $50,000. Allscripts covered all of their expenses and paid their full salaries.

Physicians in larger states, ER specialists, and pathologists have historically experienced higher levels of PQRS success, according to CMS data.

E-mail Inga.