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.

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).