News 6/18/13

From RyanS: “Re: KLAS Mid-Term Report. Physician’s Computer Company earned the top customer satisfaction scores in both the ambulatory PM and EHR software categories.” The Mid-Term report is based on performance scores gathered over the previous 12 months. RyanS provided a few other highlights, including:

• PCC Partner PM (1-10 physicians) blew away the practice management competition with a score of 95; Epic Resolute/Prelude/Cadence (> 75 physicians) was next with a score of 88.7;  Greenway PrimeSuite Practice (11-75 physicians) was third at  88.6.
• Top performers in the ambulatory EMR segment were PCC EHR (1-10 physicians) with a score of 95.5; EpicCare Ambulatory (over 75 physicians) at 88.3; and SRSsoft EHR (11-75 physicians) at 86.7.
• Top clearinghouse providers were Navicure (92.3), ZirMed (92.5), Office Alley (91.1), and Practice Insight (90.1).
• KLAS recognized McKesson Practice Partner (11-75 physicians) as the product demonstrating the biggest improvement since its December, 2012 awards, jumping 13 percent to 56.7. AdvancedMD EHR (1-10 physicians) gained 12 percent to 76.2.

Vitera Healthcare Solutions announces that it has acquired Birmingham, AL-based SuccessEHS, which offers PM/EHR, electronic dental record, dental imaging, and revenue cycle solutions. SuccessEHS, which has doubled in size in the past two years, will be operated as a division of Vitera and expand Vitera’s user base to  10,500 organizations, 415,000 medical professionals, and 85,000 physicians.

CureMD offers discounted subscription rates, and free implementation, training, and data migration for the 4,400 users of the Mitochon Systems EHR platform. Last month Mitochon announced it was exiting the physician EHR market and would no longer market its free EHR product.

The office manager for Summersville Pediatrics (SC) shares her practice’s experience migrating from MyWay to Aprima Medical’s EMR with assistance from Aprima dealer ConXit Technology Group.

CareCloud hires Tom Cady (athenahealth) as VP of professional services.

Nature Coast ACO (FL) expands its relationship with eClinicalWorks to include eCW’s Care Coordination Medical Record.

Nuance releases a new version of Dragon Medical Practice designed for smaller practices that includes voice shortcuts to aid searches for medical information and more than 90 specialized medical vocabularies.

A computer outage in the Canadian province of Alberta caused about 202 medical clinics to lose access to patients’ health information for more than five hours last week. “Thousands” of patients were affected and many practices turned patients away. One physician told a local paper, “When this happens it cripples you. We didn’t even have Internet access. This is also a financial loss for physicians.” The EHR vendor blames the outage on a faulty network device that routes data to the clinics.

e-MDs relocates and expands its headquarters and will operate out of a 30,000 square foot administrative campus in Cedar Park, TX, a 40,600 square foot technology campus in Austin, TX, and a separate data center providing business continuity and disaster recovery services.

Vitera Healthcare releases Vitera Medical Manager EHR, a Web-based EHR, analytics, and transaction platform for current Vitera Medical Manager customs.

The primary motivator for becoming an ACO or PCMH is to improve patient outcomes, according to a survey by eClinicalWorks. Almost all respondents believe that an integrated EHR would be the most valuable HIT feature for an ACO or PCMH.

An MGMA report provides more evidence that ICD-10 readiness is moving slowly. The greatest concern is the lack of communication and critical coordination between physician practices and their EHR/PM/clearinghouse vendors  regarding software updates and testing. Less than five percent of practices report they have made significant progress when rating their overall readiness for ICD-10 implementation.

Emdeon acquires Goold Health Systems, a provider of pharmacy benefits and related services to state Medicaid agencies.

Forty-two percent of practicing physicians are dissatisfied with their jobs, leading many to consider leaving medicine and taking early retirement. Decreasing autonomy, low reimbursement, and administrative hassles were the key drivers of dissatisfaction.

The number of retail medical clinics is predicted to climb from 1,418 at the end of 2012 to 2,868 in 2015.

In an AAFP News interview, Farzad Mostashari, MD discusses EHRs, ROIs, productivity, improved patient care, and more. Regarding productivity:

If physicians just replicate the existing paper-based processes in a digital way, they probably are not going to get huge productivity gains. But if they redesign the care flow to designate what things are done by people versus what’s done through the EHR technology, then that really adds to productivity. That’s how I would summarize the experience of folks who have made EHR implementation a wonderful business decision.

E-mail Inga.

News 6/13/13

CMS releases the 2011 PQRS and e-Prescribing Incentive Program Experience Report, which includes the following highlights:

• The PQRS program paid 280,229 EPs a total of $262 million in incentives
• The eRx program paid 282,382 EPs a total of $285 million in incentives
• 135,931 EPs were subject to 2012 eRx payment adjustments because they did not meet the reporting requirements in the first half of 2011, or didn’t qualify for an exemption, or didn’t meet the exclusion criteria for the adjustment.

King’s Ridge Christian School (GA) becomes the first student health clinic to implement simplifyMD’s EHR software.

CureMD Healthcare will make Mitochon Systems’ clinical content platform available within its EHR. What is particularly interesting about this announcement is that last month Mitochon announced it was exiting the EHR market. The press release that Mitochon emailed me today suggests the company has a new business model, though its not reflected on its Website.

Physician compensation is increasingly tied to measures of quality and patient satisfaction according to an MGMA report on 2012 physician compensation. Quality metrics accounted for three percent of primary care physicians’ median compensation of $216,462 and two percent of specialists’ median compensation of $388,199.

Swedish Covenant Hospital (IL) selects eClinicalWorks EHR and RCM solutions for its 150 employed physicians with Swedish Covenant Medical Group.

The AHRQ publishes a guide for primary care practices connecting to RHIOs and addresses such topics as organizational readiness when connecting an EHR to a RHIO, clinician buy-in for information exchange, technical issues, and modifying clinician workflows.

EHRs have the potential to facilitate patient-physician communication and enhance collaboration according to an opinion piece published in JAMA. The physician-authors encourage clinicians to introduce the EHR in the exam room with a verbal explanation and invite patients to view the screen to review test results and other data:

“Self-motivated and empowered patients are likely to regard the invitation to view their electronic chart as an act of transparency that enhances the collaborative nature of the patient-physician relationship.”

As a “self-motivated and empowered” patient, I must agree. Last month I met with a specialist following a procedure. He spent most of the exam in front of the computer but I loved that he invited me to look at the photos he had taken of my esophagus (which confirmed my suspicion that my esophagus is not my best feature.)  I left feeling pretty good about my doctor and better informed about my health.

Piedmont Eye Center (VA) selects SRS EHR for its seven physicians.

Pulse Systems hires Samuel Ambrose (VeriTeQ) as chief marketing officer.

NextGen reseller ITelagen will market its support and services package with IMO Problem (IT) Terminology from Intelligent Medical Objects.

E-mail Inga.

News 6/11/13

As of the end of April, approximately one out of every two Medicare EPs were meaningful users of EHRs. Other key stats reported by the HIT Policy Committee last week:

• 63 percent of all Medicaid EPs have received an EHR incentive payment, though only 10 percent are meaningful users
• EPs have been paid over $5.9 billion from Medicare and Medicaid since the inception of the EHR incentive program
• Of the 194,080 EPs that have attested for MU, only 213 were unsuccessful.

Horizon Health Center (NJ) expands its relationship with eClinicalWorks to include eClinicalWorks Care Coordination Medical Record for advancing its ACO objectives.

iMDsoft and Anesthesia Business Consultants (ABC) partner to offer iMDsoft’s mobile solution for electronic documentation with ABC’s F1RSTUse EHR platform.

Black Canyon Surgical Center (CO) goes live on Cyramed EHR (previously known as Source Plus EHR) by Mountain Medical Technologies.

Clinigence, a 2013 PQRS Qualified EHR Data Submission vendor, will offer PQRS reporting capabilities to SpringCharts EHR users.

athenahealth ranks 13th on Forbes Fast Tech 25 2013, which includes the fastest-growing publically traded technology companies with minimum revenues of $150 million, minimum market value of $500 million, and sales growth of at least 10 percent for each of the past three fiscal years.

EHR and PM provider MEDENT adds Surescripts’ Basic Messaging and Communications offering for the secure transmission of patient health information.

Endo Health Solutions considers selling its HealthTronics division, which develops and markets the meridianEMR and UroChartEMR platforms used by over 2,000 urologists. Such uncertainty is never fun for end users, not to mention sales people.

A Kansas newspaper profiles two physicians who are on opposite ends of the spectrum in terms of embracing technology. The first doctor is 85 and dictates his notes to an assistant, who handwrites the notes into patients’ charts. The second physician is 32, uses a free EMR, communicates with patients through email and Twitter, and conducts appointments through Skype and FaceTime. He also expresses frustration with the poor design of most EMRs.

“When you’re used to using very clean designs — a MacBook, an iPhone, Twitter, Facebook — and you sit down on an EMR (electronic medical record system), it’s like stepping back in time 15 or 20 years.”

Athenahealth scores highest in ambulatory EMR usability according to a new KLAS report. Success in achieving high usability in different EHRs ranged from 55 percent (McKesson) to 85 percent (athenahealth), while athenahealth and eClinicalWorks had the best usability “out of the gate.”

MyMedical Records agrees to dismiss its patent infringement lawsuit against WebMD and settle the dispute out of court. Meanwhile, MyMedicalRecords initiates a similar lawsuit against Allscripts subsidiary Jardogs. In case you missed it, earlier this year Mr. H interviewed MyMedical Records CEO Robert Lorsch  who said his company sends out “somewhere between 600 and 750 letters as week” to providers and PHR vendors about potential infringement. He also reiterated that, “we are not trolling with these patents.”

I wonder if MyMedicalRecords has sent one of its letters to Cleveland Clinic. Cleveland Clinic announced last week that  it will add physician notes, images, pathology reports, and results to its Epic MyChart patient portal. I personally can’t wait for the day I can log onto my doctor’s Website and download my records. Just this morning I called my doctor’s office to request a copy of a report. I spent 10 minutes navigating the phone system, only to leave a message. I got a call back within an hour, which pleased me. However, I was told  they could not email me the report, but could mail it to me if I signed a release, which they could fax me (not email me) and I could fax it back. Great, except I haven’t had a fax machine in at least five years. Guess I will be driving across town to the doctor’s office if I want the report any time soon.

E-mail Inga.

HIStalk Practice Interviews George Lazenby, CEO, Emdeon

Geoge Lazenby is CEO of Emdeon of Nashville, TN.

Tell me about yourself and the company.

I am CEO of Emdeon, which is  a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers, and patients in the US healthcare system.

How has business changed after the Blackstone acquisition?

The biggest change has been the transition to being a private company. Under Blackstone’s ownership, we’ve been able to shift our focus away from analyst calls and quarterly performance and place it more squarely on our customers and long term growth strategies.

Describe the incidence of paper-based claims and how the Emdeon Payment Network can help increase electronic payments.

Electronic claims are now at 95 percent. Conversely, electronic payments are only about 10 to 15 percent of total payments in healthcare.The Emdeon Payment Network is a comprehensive suite of services that combines electronic and print payment infrastructures with an intelligent analytical engine to leverage the payer’s chosen distribution channels for healthcare payment transactions.

Emdeon Payment Network has been designed to give payers a strategic, cost-effective solution by providing more opportunities to shift transactions from costly paper checks to electronic payments, while providing considerable postage and operational savings for any remaining paper check payments. The Emdeon Payment Network can help payers significantly reduce provider payment distribution expenses and potentially eliminate provider payment distribution printing costs completely over time.

Further, by switching most paper check-based provider payments to electronic methods consisting of virtual card payments, Automated Clearing House (ACH) direct deposit payments, and Image Cash Letter (ICL) payments, provider enrollment challenges can be significantly reduced. Emdeon Payment Network examines inbound payment files and routes each payment using the payer’s chosen payment distribution methods to minimize payment distribution expenses.The Emdeon Payment Network has been designed to virtually eliminate the burdens typically associated with payment management by offering payers a comprehensive approach to electronic and print payment distribution.

What opportunities will the Affordable Care Act create for the company?

The Affordable Care Act decreases the number of uninsured patients and results in more covered lives.This expanded population increases utilization on the healthcare system as a whole and utilization of care engages the revenue cycle system, which is good for Emdeon. Further, as more people seek coverage and additional payment models evolve, providers will have a need to understand additional funding sources, such as patient payments. Emdeon offers technology to assist with estimating the patient’s financial responsibility up front which can help with providers collect funds at the point of service.

What does Emdeon Clinical Exchange EHR Lite do and what products does it compete with?

Emdeon Clinical Exchange encompasses products and services that are designed to unite healthcare communities. Today, hospitals, physicians, labs, payers, and pharmacies use Emdeon’s leading healthcare information network to securely exchange health information nearly seven billion times annually.These healthcare stakeholders are demanding greater connectivity to each other and the ability to facilitate comprehensive, end-to-end clinical information exchange.

Emdeon Clinical Exchange integrates Emdeon’s electronic prescription routing, lab orders and results exchange, care alerts, medication history, clinical messaging, and ONC-certified EHR capabilities into a comprehensive SaaS-based platform.This robust collection of clinical components is designed to work with our customers’ existing systems and workflows, and therefore can help minimize financial risk by providing a relatively inexpensive alternative compared to higher cost capital-intensive solutions.

Furthermore, by connecting to our customers’ existing infrastructure, our SaaS-based exchange can have virtually-instant clinical connectivity to the EHR systems we empower. Most of these EHR systems are already Emdeon customers so integration is seamless.

Everybody’s talking about analytics tools. What are practices look for in that area?

Providers are looking for analytics that help them run their offices more efficiently that increase reimbursement and help them properly document care to comply with increasing quality standards. Examples are comparisons of practice patterns to evidence based medicine protocols to identify gaps in care. These analytics both improve care quality and help providers document how they practice against these standards for compliance/reimbursement thresholds.

How is the company addressing healthcare fraud, waste, and abuse?

Emdeon has built a leading payment integrity and cost containment solution by acquiring three market leaders – The Sentinel Group, EquiClaim and TC³ Health – and integrating them with Emdeon’s vast healthcare network. By combining the best of these companies’ recognized leadership in fraud, waste and abuse technology, investigation expertise, cost management services and comprehensive audit and recovery services, Emdeon is able to offer healthcare payers one complete solution to help en,sure accurate claim payments throughout the adjudication lifecycle.

By leveraging Emdeon’s vast claims data and network, these services enable superior detection of fraud, waste and abuse, and the reduction of costly errors and time-consuming manual processes. As a result, payers can increase efficiencies, maximize returns, and have confidence that their healthcare payments will be correct.

How do you see the small physician practice changing in the next few years, both in general and from a technology standpoint?

Expect 2013 to be a turning point for participation in emerging Medicare payment initiatives that are driving the formation of accountable care organizations, shared savings programs, bundled payment pilot projects, and value-based payment modifiers. And, if Meaningful Use is not enough of an incentive for practices to ramp up EHR deployment efforts, these new initiatives surely demand they look closely at enabling solutions to access and utilize the data needed to improve care and reduce costs.

Additionally, January 1, 2014, is the deadline by which all payments under Medicare must be conducted via electronic funds transfer. And, while providers will not be required to accept electronic payments from commercial health plans, all payers will be required to have the ability to facilitate these transactions.

From a technology perspective, technology and service solutions providers continue to roll out innovative tools that assist providers in responding to the many industry challenges, ensuring they will have material impact on the cost-quality curve while receiving accurate and timely reimbursements for the services they provide.

Bowtie Confidential 6/7/13

Healthcare Data Governance and Data Stewardship

There is a wealth of articles about data governance, including one that I wrote earlier for HIStalk. It is becoming clear that in today’s complex healthcare environment, data governance and ownership are emerging disciplines with evolving definitions.

As the data-driven healthcare environment provides benefits (e.g., data aggregation enables more efficient care delivery, decision support systems, etc.) and the potential for risk/harm (e.g., incorrect data entry), the industry is realizing the importance of accurate healthcare data, which is dependent on technology.

Through data governance, organizations exercise control over the processes and methods used to input, aggregate, use and re-use data. Data stewardship is an evolving role in this space. The disciplines need to be seen as more than an IT responsibility and as the responsibility of end users as well.

To realize data’s full benefits and minimize potential risk, care providers and others with access to health data must follow sound data stewardship policies and procedures which address the security and privacy of patient data and the quality and integrity of data collected, stored and currently (and prospectively) used.

The data stewardship role is responsible for working with and managing data in terms of integration, consistent definitions, structures, metrics, derivations, etc. – strategic and tactical views of data that will enhance quality, metrics/reporting and efficiencies and effectiveness in delivering care. Both identifiable and de-identifiable data is included within this context. Healthcare environments will need different operations and solutions. However, the presence of data stewardship (an owner or custodian with authority and accountability for the use of health data) is needed.

What is data stewardship?

Healthcare data stewardship’s main objective is the management of the organization’s data assets to improve usability, accessibility, and quality. The data steward works with technology database administrators, data warehouse staff and others to:

• Assist with approval of clinical and business naming standards
• Develop consistent data definitions
• Determine data aliases
• Develop standard calculations and derivations
• Document the business rules of the corporation
• Monitor the data quality in the data warehouse
• Define security requirements

As the demand for data warehouses (with reliable and “quality” data) has grown, so has the need for a data stewardship function. An integrated, enterprise-level view of the data provides the foundation for the shared data that is so critical in the data warehouse.

A typical healthcare organization should consider assigning one data steward to each major clinical/business / operational data subject area. These subject areas include business office, registration (admitting), radiology, laboratory, pharmacy, cardiology, etc. The size of the organization will dictate the number of data stewards needed. A small practice may need just one to oversee all of the data.

The data steward usually works with a select group of employees representing the assigned subject area. This “committee of peers” is responsible for resolving integration issues concerning their subject area. The results of the committee’s work are passed on to the data administrator for implementation into the corporate data models, meta-data repository, and ultimately, the data warehouse construct.

Just as there is a data architect in most data administration functions, there should be a "lead" data steward responsible for the work of the individual data stewards. The lead’s responsibility is to clearly establish each data steward’s domain.

With data stewardship and enhanced governance, an organization can improve data quality, protect sensitive data, promote efficient information sharing, provide trusted business-critical data, and manage information throughout its lifecycle. The data stewardship program enables organizations to develop a strategic approach to utilizing data as an asset to ensure the security and privacy of the data for/of their patients. The program can improve financial performance, increase operational effectiveness and efficiency, and allow full compliance with regulatory requirements.

Of course, it is not about data alone. Data stewards must work with businesses to map collection needs and, where possible, find better or more efficient sources. Then, the steward can create appropriate use policies to limit the collection of unnecessary data and, later on, audit data practices to ensure business compliance.

Data stewardship enables organizations to improve financial performance, increase operational effectiveness and efficiency, and allow full compliance with regulatory requirements.

Rob Drewniak is vice president, strategic and advisory services, for Hayes Management Consulting.