DOCtalk by Dr. Gregg 7/12/13

The Nightmare Just Off Elm Street

SETTING: Nowhere, Ohio. Park Avenue Medical Building and parking lot, just down from Elm Street.

SCENE: A dark and stormy night.

CAM pans from Elm Street and Park Avenue corner street sign to an empty parking lot as rain beats down relentlessly. CAM moves toward the Park Avenue Medical Building. Building windows are dark save for one lit window on second floor. CAM slowly moves toward it. CAM zooms in through rain-drenched window to posterior of a lone man, PROVIDER, hunched sadly over a laptop PC. Lightning strikes and thunder rolls. CAM moves over his shoulder to focus on laptop screen. View of an electronic health record entitled “Extormity” comes into view over PROVIDER’s shoulder.

PROVIDER sighs heavily and sinks even lower into his chair.

PROVIDER
Cripes, even the big ones with all the bells and whistles suck. (PROVIDER sighs again.)

CAM pulls back to reveal a translucent, ghostly figure fading into view several feet beyond laptop, facing PROVIDER.

GHOST
Woooooooooo…wooooooooo. (Chains rattle somewhere OFF CAM.)

PROVIDER barely budges as he wearily looks up to GHOST. GHOST looks a bit dismayed.

PROVIDER
Dude, I’ve been looking at EHR demos for hours every day and night the past six weeks trying to find a new one. You gotta do way better than that if you want any kind of scare factor. I’m pretty much scare-sapped at this point.

GHOST
Aw, man! This is my first gig as a ghost. I thought I had the training down. Shoot, you’re really messing with my new ghost confidence.

PROVIDER
Sorry. I didn’t mean to poo-poo your poltergeisting. It’s just that weeks of going cross-eyed looking at all these EMRs and EHRs and PHRs and PMs and patient portals and all has me fully strained and drained. If you think some booing and chain-clanking are scary, you should see some of these monstrosities.

GHOST
Really? You mean computer stuff? I’m sort of a computer guy…well… I was when I was alive. That’s rather disturbing to hear. Computers should be cool and helpful, not draining. Lemme see. What’s the problem?

GHOST floats through laptop and PROVIDER to stand behind PROVIDER.

PROVIDER
(Shuddering.) Whoa…that was a little freaky.

GHOST
Oh, yeah, that’s a pretty cool part of being dead!

GHOST peers at laptop. He lets out a low, rumbling noise, like a belly growl.

GHOST
Ugh. Really? That’s the state of EHRs these days? I can see why you’re stressed, my man.

PROVIDER
Yeah. Tell me. And this is actually one of the better ones, at least for functionality.

GHOST groans again, a deep, unnerving snarl.

GHOST
You got any others I can see? This is pathetic.

PROVIDER
Sure. (Pulling up another tab on his laptop screen.) Take a look at this one. It’s one of the more popular ones. Well, “popular” at least in terms of sales. Most of the users I’ve spoken with, though, don’t seem to be so impressed.

GHOST
What a mess! Look at all those lines and columns and rows. Looks like the old Windows 95. Look at all that clutter. There’s nothing intuitive about it. This makes it look like EHR folks have learned nothing about user experience measures.

PROVIDER
Yeah. Most keep promising that their “next UI” will be “really awesome,” but few have figured that out beyond a sales pitch. Here’s one that does a little better.

PROVIDER pulls up another tab on the laptop. A more eye-catching EHR pops open.

GHOST
Well, that’s pretty. Sophisticated, clean, looks smart. What’s wrong with that one?

PROVIDER
Not enough “oomph” in the tank. Has a pretty nice UX – nice until you actually have to dig into the meat of care provision matters. Lots of missing functionality. Would takes a ton of time to customize to our needs. And their billing system is pretty woeful. It seems like you can get some of what you want in all of them, but none of them have all of what you want, or even all that you need.

GHOST
Too bad. And too bad I’m dead. If I was still alive I would jump feet first into this. I had no idea the development was so horrendous of such important systems. Electronic health records should be leading the way for IT creativity and functionality. I mean, really, they are at the crux of some of the most important needs for humanity. I can’t believe their design and dev work are so behind the times.

PROVIDER
So, who are you anyway…or who WERE you before you started your new chain-shaking role? How do you know anything about computer UX and UI work?

GHOST
Oh, I forgot. You probably don’t recognize me in un-earthly form. (Extends a ghostly hand.) Hi, I’m… er… I WAS… Steve Jobs.

PROVIDER attempts to shake hands, but hand passes right through.

PROVIDER
Figures. I finally get with somebody who could actually do something about the state of EHRs and he’s a ghost. And not even a very good one. I need a drink.

GHOST
Wish I could join you. By the way, how come you’re not using a MacBook?

From the trenches…

“Maybe I should just pick up that bottle and veg out with you; ignore everything going on around me by getting good and loaded.” – Nancy Thompson in A Nightmare on Elm Street

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 7/11/13

CMS proposes changes to payment policies, including a provision to begin paying providers in 2015 for non-face-to-face care of Medicare patients with multiple chronic conditions. To be eligible, providers will be required to use a certified EHR. Other proposed changes include the addition of new quality reporting measures for 2014; an expansion of telehealth services to include sites designated as health professional shortage areas in rural or urban areas; and, the addition of transitional care management services as an eligible Medicare telehealth service.

The percentage of physicians using at least a basic EHR system increased from 25 percent in 2010 to 38 percent in 2012, according to a Robert Wood Johnson Foundation study, while the percentage of practices participating in an HIE has jumped from three to 10 percent. Other notable findings:

• The highest relative increases in adoption were among physicians with historically low adoption levels, including older physicians and those working in solo practices or community health centers.
• As of 2012, physicians in rural areas had higher rates of adoption than those in large urban areas, and physicians in counties with high rates of poverty had rates of adoption comparable to those in areas with less poverty.
• Small practices continued to lag behind larger practices.

ONC National Coordinator Farzad Mostashari, MD discussed the findings at a press conference and predicted that full EHR adoption will be slow until 2014 – just before penalties for not hitting MU standards start in 2015.

The success of e-prescribing initiatives can be tied to federal programs offering financial incentives for e-prescribing providers, according to a report authored by representatives from the ONC and Surecripts, Federal incentives resulted in the addition of 94,000 new e-prescribers between July 2008 and December 2010, leading the authors to make the less than profound conclusion that “financial incentives can drive providers’ adoption.”

Greenway Medical will add PatientPay’s online patient payment solution to its PrimeSUITE EHR/PM platform. Greenway also announces that providers are successfully exchanging CCDs between the Greenway platform at Doctors May-Grant Associates (PA) and the Epic system installed at Lancaster General Health’s Women’s & Baby Hospital (PA).

The 340-provider UT Medical Group (TN) signs a three-year contract with MediRevv for its Day One Self Pay A/R Management services.

E-mail Inga.

News 7/9/13

From Gloria: “Re: EMR features. Can you please help me understand if there is any major difference in EMR features for practices depending on the number of providers? For example, how would an EMR used by a solo physician differ from an EMR used by a large practice of 41+ physicians? Do both of them not do the same thing..namely treat the patient for conditions?” I am sure many readers can answer this better than me, but here are a few thoughts. While most EMRs include the same basics, such as the ability to track patient history and capture clinical notes, EMRs used by larger groups tend to include more features and functionality. For example, many EMRs catering to small primary care practices have less developed templates and rely more on free-text data entry. Larger groups have a greater need for care coordination, especially if patients are seen by multiple providers within the same practice, and will likely seek a variety of bi-directional interfaces to automate high volumes of orders and results. The architecture behind an EMR is also important since a program designed for small offices may not scale beyond a handful of users. Beyond features and functions, many EMR vendors don’t have adequate training and support resources to satisfy the demands of large groups. Readers, please offer additional insights.

The medical director for 70-provider South Texas Medical Clinics says its recent implementation of EMR has allowed the practice to “substantially” reduce its percentage of medical errors below the national average. I assume that STMC uses eClinicalWorks since it is part of Memorial Hermann Medical Group, a large eCW client.

The American Academy of Ophthalmology plans to implement an eye disease patient database that will enable ophthalmologists to statistically review and analyze their own care and compare it to benchmarks and peer physician performance. The Intelligent Research In Sight Registry (IRIS) will be populated with de-identified data collected from practices’ EHRs and serve as a PQRS EHR submission vendor.

HIMSS Analytics recognizes 31 Bon Secours Health Systems (VA) ambulatory clinics with the HIMSS Stage 7 EMR Ambulatory award for its implementation of Epic.

Almost one-third of physician executives participating in an ACPE survey believe that healthcare costs go up when hospitals buy physician practices.

The doctor shortage and an improved economy has led to an increase in physician recruitment activities. A quarter of practicing physicians report receiving 24 to 40 job solicitations a month.

E-mail Inga.

News 7/4/13

ONC releases its patient safety and surveillance plan which provides guidance on the reporting and tracking of patient safety issues. Issues addressed include a requirement for certification bodies to confirm functionality of certain capabilities in the field and for MU and certification standards to include more patient-related objectives.

Through the end of May CMS had paid $15.1 billion in EHR incentives since the program’s January 2011 inception. That includes almost $6.2 billion paid to EPs.

Piedmont Orthopaedic Associates (SC) selects SRS EHR.

Nine medical clinics affiliated with San Francisco General Hospital reduced average wait times for an initial consultative visit from an average of 112 days to 49 days after implementing an electronic referral system. In a New England Journal of Medicine commentary piece, the physician-authors contend that referral and consultation systems that link PCPs and specialists, such as their homegrown eReferral program, have the potential to improve the care of individuals and populations and lower costs.

EHR, PM, and RCM provider MTBC acquires Metro Medical Management Services, a New York City-based RCM company.

Happy Independence Day!

E-mail Inga.

News 7/2/13

As rumored on HIStalk this weekend, Intuit announces plans to divest its health group, including the patient portal business it acquired from Medfusion in 2010 for $91 million. I wouldn’t be surprised if Intuit tried to find a buyer among its pool of resellers, which includes Allscripts, GE, and Greenway. I realize Allscripts recently purchased Jardogs’ patient portal technology, but Allscripts could still be a potential suitor given its large number of customers using the Intuit product.

Allscripts, eClinicalWorks, and Epic lead all vendors in ambulatory EMR adoption, with just over 10 percent of the market each. Almost three-quarters of all practices using EMRs are supported by the top 20 vendors; over half of practices with more than 41 physicians use Epic.

CareCloud hires Paul Henry (ADP/AdvancedMD) as VP of small group sales.

Women’s Healthcare Associates (LA) selects the Vitera PM/EHR platform.

The ONC Beacon-EHR Vendor Affinity Group names Adele Allison, national director of government affairs for SuccessEHR, as co-chair, along with Chuck Tryon of MyHealth Access Network.

ZirMed announces that its first claims acceptance rate is averaging 98 percent or higher.

A Nebraska practice warns patients of the possibility of identity theft after a physician loses a thumb drive containing 2,125 patient records. The office says the lost records included patient demographic information but no social security numbers.

Thanks to SRSsoft CEO Evan Steele who did some number crunching and found that 17 percent of EPs earning an $18,000 EHR incentive in 2011 did not earn the $12,000 incentive in 2012. To earn the incentive in 2011, EPs had to demonstrate MU for 90 days. A full year’s demonstration was required for the follow-up year. As Evan states, “a 17 percent loss rate in any business is wholly unacceptable, and this failure does not portend well for the future of the EHR Incentive Program.”

Porter Research looks at ICD-10 readiness among physician practices and finds that most are concerned with disruptions in cash flows when the new code set goes into effect. Of practices that have not yet started preparing for the transition, more than a third believe they have adequate time to prepare. The rest either don’t know where to begin or lack time, staff, or training resources.

Administrators at two Phoenix children’s clinics claim the use of scribes for EMR documentation has improved physician workflow, eliminated transcription costs, and improved revenue cycle. One orthopedic surgeons says the scribes “may have very well saved the clinic by helping with the implementation of the new EMR.”

E-mail Inga.