DOCtalk by Dr. Gregg 6/2/13

_HIT Happens

Some days, dealing with HIT and EHRs leaves little to smile about. Those days are great for a little “_HIT Happens” observational humor.

Q: How many EHRs does it take to screw in a light bulb?
A: We may never find out because they won’t work together.

Q: What’s the best use for most EHRs?
A: Obtaining government incentive money.

Q: Why did the EHR cross the road?
A: Because MU said it had to.

Q: How are wisecracking yokels the same as EHR vendors discussing data migration?
A: Both commonly use the line, “You can’t get there from here.”

Q: What did the EHR say to the PM?
A: We’ll never know; the interface failed.

Q: How do you guarantee a loss of EHR data?
A: Migrate to a new EHR.

Q: When is an EHR like a “ball-busting” contagious disease?
A: When it has MUMPS.

Q: How do EHRs make doctors’ lives easier?
A: No…seriously…how?

Q: What do you get when you cross an HIT geek with a clinician?
A: An argument.

Q: Why are HIT experts and doctors so opinionated and egoistic?
A: No, seriously … why?

Q: What do you get when you have twelve HIT pros in a room?
A: Thirteen different opinions about the best way to manage an IT project.

Q: If Johnny has five EHRs and he gives Susie two EHRs, how many EHRs does Johnny have left?
A: Trick question: nobody’s stupid enough to have more than one EHR at a time.

Q: When are you likely to scream at your EHR?
A: Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, (still counting …)

Q: How can you get an EHR vendor’s support team to answer your call for help?
A: You can’t, unless you have their address, some extra frequent flyer miles, and a baseball bat.

Q: What do you get when you take the “E” out of “EHR”?
A: Paper … tons and tons of paper.

Q: How do make an EHR crazy?
A: Ask it to manage immunization rules.

Q: Why did the EHR buy cool sunglasses and a Porsche?
A: Because it wanted to be HIPAA.

Q: Why was the EHR so popular?
A: Because it gave good UX.

Q: What do patient privacy and cloud-based EHRs have in common.
A: Nothing.

Q: Why is a locally hosted EHR better than cloud-based EHR?
A: Baseball bats are ineffective on clouds.

Q: Why couldn’t the EHR find true love?
A: Seriously? Have you ever used an EHR?

Q: When will EHRs achieve true maturity?
A: Stardate 500606.67

Q: What’s the best way to wrap up a long day in front of an EHR?
A: Again, it has to do with the aforementioned baseball bat…

From the trenches …

“We all have [_]hit on our shoes. We’ve just got to realize it so we don’t track it into the house.” – Karl Marlantes

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 5/30/13

From Weird News Andy: “Re: Dr. gives up all insurance. Lots of great quotes here.” A physician in Maine stops accepting insurance but anticipates his practice will continue to perform well financially, despite losing several hundred patients. Thanks to WNA for pointing out several of the doctor’s more interesting comments, including, “I’m freed up to do what I think is right for the patients.” That testimony alone should help business, since few patients prefer doctors who do what’s wrong for the patient.

Sibley Heart Center Cardiology (GA) selects MediRevv to provide A/R management services for its 40 physician practice.

ADP AdvancedMD launches MyICD-10, a Website to help practices prepare for the ICD-10 that includes Webinars, articles and news on the new code set, and a recommended preparation timeline.

Fifty-four percent of physicians say they are “satisfied” or “very satisfied” with their EHR vendor, compared to 63 percent a year ago, according to a Zirmed-sponsored of 1,291 physicians. Only 57 percent of EHR adopters report that their systems have made them more efficient and just 43 percent report a return on their technology investment.

Advocate Physician Partners (IL), a care management collaboration with Advocate Health Care, implements its 500th independent physician on SynAPPs, Advocate’s cloud-based version of eCW’s EHR.

PDR Networks, a provider of patient drug safety and support services for EHR and e-prescribing platforms, will market OPTIMIZERx Corp.’s eCoupon financial support technology, which integrates with e-prescribing workflows.

Clyo Internal Medicine (OH) selects simplifyMD as its EHR provider.

Practice Fusion announces preferred billing partnerships with ADP AdvancedMD, CollaborateMD, and NueMD. Absent from the list is Kareo, which was a long-time Practice Fusion partner that launched a competing free EHR a couple months ago.

The Texas Medical Association, Dallas County Medical Society, and Harris County Medical Society establish Physician Services Organizations for Patient Care, which will bring together providers, health plans, and technology vendors to test and develop new care models for physician practices.

Medical practice software and billing service provider Encoda is awarded a patent for automated direct-to-payer RCM technology.

Almost one-third of physicians buying EHRs today are replacing EHRs, compared to 21 percent three years ago according to a study by Software Advice. The top reason for replacing a legacy system: dissatisfaction with current EHR.

E-mail Inga.

News 5/23/13

More than half of all doctors and other EPs (291,000) have received MU incentive payments through the end of April, according to HHS Secretary Kathleen Sebelius. HHS has met or exceeded its goal for 50 percent of doctor offices and 80 percent of eligible hospitals to have EHRs by the end of 2013, leading Sebelius to conclude that, “we have reached a tipping point” for EHR adoption.

Net Health, a provider of clinical solutions for outpatient specialty care, acquires Integris, a provider of an EMR/PM solutions for the urgent care, occupational health, and hospital employee health markets.

The New Jersey chapter of Entrepreneurs’ Organization and the Star-Ledger/NJ.com name SRS CEO Evan Steele the winner of the Garden State Entrepreneur Excellence Award in the $10M+ category.

Greenway Medical adds ClientTell’s ReminderManager patient communications solution to its Online Marketplace as a certified API solution for the PrimeSUITE platform.

Athenahealth names Midland Orthopaedics (SC) the winner of its athenaVision award for helping “make healthcare work as it should.”

DocuTrac, a provider of EMR technology for behavioral health, will add DrFirst’s e-prescribing technology into its QuicDoc EMR Professional and Enterprise edition software.

Cerner’s PowerChart Touch mobile solution receives a bronze award for Best Clinical Health Care Experience at the 2013 International User Experience Awards.

Greenway Medical announces the availability of its PrimeMOBILE mobile access solution for the Windows 8 platform.

PracticeMax, a provider of PM and technology services for physician offices, acquires the Phoenix-based ABC Medical Management, a provider of billing and PM services for anesthesia and pain management specialists.

More than one third of physicians participating in a CareCloud/QuantiaMD survey predict their practices will be less profitable in the next year, compared to 22 percent foreseeing increased profits. The biggest perceived threats to profitability were declining reimbursements, rising costs, ACA-related requirements, and coding and documentation changes. Other key findings from the survey of 5,102 physicians include:

• Almost half believe that increased operational and billing pressures will leave their practice unable to accept any of the expected influx of insured patients from the implementation of the ACA.
• A mere nine percent were “very confident” in the current process for getting paid.
• The majority of physicians spend more than 20 percent of their time coding, documenting, and performing administrative tasks, rather providing than patient care.
• Almost sixty percent of independent physicians were not looking to sell their practices.

E-mail Inga.

News 5/21/13

Mitochon, a provider of a free EHR product, announces it will exit the market and cease its physician service by mid-June. According to the company’s Website, Mitochon had been able to offer its product for free because it used “healthcare related messaging/advertising in a HIPAA, FDA compliant methodology.” On the FAQ page, Mitochon included a question about how a buyer will know if the company “will still be around in five years.”  I wonder how many providers felt re-assured by this response:

We have integrated with AT&T’s Health Cloud, Medicity, and Covisint’s Health Cloud, a major hospital in Southern California, we are an IBM Global Entrepreneurial Partner, and we are fully certified by the government.

As a side note, Dr. Gregg would likely be the first to concur there are really no guarantees that any selected EHR will be around in five years.

CMS posts the 2014 ICD-10-PCS files, including code tables, index, and coding guidelines. CMS notes that the FY 2014 ICD-9-CM diagnosis codes will not be updated.

Blue Ridge Physicians for Women selects Benchmark Systems’ PM software.

River Ranch Radiology (TX) and its affiliate Sendero Imaging and Treatment Center demonstrate Stage 1 MU using eRAD’s RIS.

Kettering Anesthesia Associates (OH) contracts with Zotec Partners for billing services.

e-MDs will integrate dashboardMD’s business intelligence reporting solutions into its PM platform to automate revenue cycle monitoring.

Rob Anthony, deputy director of the HIT Group for CMS’ Office of E-Health Standards and Services offers tips for prepping for a MU audit.

Only 17.2 percent of physicians believe a practice led by a nurse practitioner should be certified as a medical home, though more than 82 percent of NPs feel it should, according to a survey published in the New England Journal of Medicine. Less than four percent of physicians agree that NPs should be paid equally for providing the same service, compared to 64.3 percent of NPs.

DoctorBase, a provider of mobile solution that connects patients with clinicians, announces it has surpassed 10,000 doctors on its platform.

CMS Deputy Administrator Jonathan Blum says that the agency could choose in the future to build on its recently released database of average charges for inpatient services to include charges for outpatient services.

Physician reimbursement Betsy Nicoletti offers tips to ensure medically-compliant billing when using an EHR to document E/M services.

The physician social networking site Doximity collaborates with Cleveland Clinic to include CME for practicing physicians using Doximity to learn on the job.

E-mail Inga.

DOCtalk by Dr. Gregg 5/18/13

Dear Allscripts,

I fully realize that you have bigger fish frying on the Allscripts skillet. Further, you probably don’t really care about what one little solo trench grunt thinks, but I’d like to throw this out there anyway. If it gives you any cause to pause and reconsider any future decisions, maybe that’ll be worthwhile. (Lord knows some Allscripts decisions over the past few years could have benefitted from a pause or three.)

While I know you are aware of most of the backstory, please indulge me a moment for those who may not know it so well as I run through a brief history.

About two and half years ago, you acquired Eclipsys. When you did, you acquired my then-favorite EHR, Peak Practice. (I’ll try to call it Peak Practice, but I still think of it as Bond Technologies’ “Clinician,” which was the original incarnation’s name.) You then built a beautiful set of Web pages devoted to the new “Allscripts Peak Practice” and promised end users that it would continue to be supported.

Not being a corporate insider – and not having fly-on-the-wall transmogrification capability – I have no real clue as to why you decided shortly thereafter to pull Peak’s plug. I was told it was because you had too many products and Peak was more difficult to support, in part because it was so technically sexy. The founders understood how to support it, though Eclipsys certainly had its share of difficulties in learning how to implement it correctly. Maybe the latter colored your go-forward decision. Regardless of the reasons, Peak’s plug was pulled and the Web pages vanished.

At the time of the acquisition, I was working on the Eclipsys design team for Peak Practice’s “Notes 2.0.” (I had moved up the food chain with Clinician, starting with helping the Bond team bulk out the pediatric side of its offering, through MediNotes, and onto Eclipsys. It was a rocky ride, to be sure, but it had really started to get good.) We were fairly far along with the notes engine’s redesign and it was going to be gorgeous! If we’d have been allowed to finish its development, I have no doubt that it would stand up against ANY current EHR for both functionality and user experience.

I know this because two and a half years later, I am still using Clinician…er, Peak Practice. Why? Because frankly, after far too many demos, I haven’t seen much that is truly any better. Most often what I see doesn’t even come close. (OK, I have seen a couple of systems recently that do have some serious knock-my-socks-off wow factor, but, overall… diddly squat.) Most available EHRs/EMRs trail far behind Peak Practice in usability and functionality, if implemented correctly. And this remains true despite Peak having absolutely no development these past two and a half years! If Peak would have gotten development focus in that time … well, I can hardly imagine.

Moving forward, you offered to move existing Peak Practice clients onto your MyWay product for free. Many did. I did not. (Didn’t like it, not one little bit.) Now as you know, you’ve also sunsetted MyWay. If I was one of those poor wretches who had been forced to migrate once and then once again within about two years, I’d be livid – either that or I’d have transitioned into forestry or some other trade wholly non-EHR-related.

Migrating from one workflow to another sucks. Period. Doesn’t matter if it’s a better workflow in the end or not, the transition is still difficult. You know, it’s the whole “providers just want to provide, not become techies or practice redesign experts” thing. Paper to digital, digital to digital – transitioning your processes is an encumbrance, a nuisance, and, honestly, just a pain in the derrière.

Why did I lay out this whole trail of tears? Because I was recently informed that the EDI server which you maintain and which facilitates my e-prescribing and lab interface (for which I had to pay good money to obtain) is to be shut down August 31. I was told I can keep using Clinici…er, Peak Practice on my servers, but will lose those capabilities.

Once you’ve gotten a taste of the future, it’s virtually impossible to consider going back to the meager meals of the past. I want my delicious interfaces. Thus, without intervention or switching to a new system, I’ll be forced into Luddite mode.

Thus, my dear Allscripts, you’ve again left me feeling abandoned and abused. Is it your fault? Not really. You have a business to run and shareholders to satisfy. I get that. But, maybe, just maybe, the decision to tank Peak Practice in place of the now-tanked MyWay was a regrettable decision and one that deserves a revisit. Maybe the following option would be a cause to pause here for a moment to reconsider your choices.

The founder of Bond Clinician once offered to buy Peak Practice back from you. I was told you wouldn’t give it up because you didn’t want the competition. But considering the recent success rate in the outpatient EHR world that you’ve “enjoyed,” perhaps a little creative thinking might be in order. Why not offer Mr. Bond (or anyone else smart enough) the opportunity to buy back the rights to Clinicia…er, Peak Practice, perhaps structuring a royalties deal where you and your shareholders could reap the benefits without worrying about supporting the product?

Sounds like you have your hands full unscrambling some recent events and turning a rather large ship into calmer waters. Perhaps doing the right thing by Peak and letting it go would create some good karma. Besides, do you seriously think competition from a revived Clinician would be something you really need to worry about for the foreseeable future when there’s so much else more pressing on your To Do list? Do you really think letting a great system go to pasture is doing you, your shareholders, or the world of healthcare in general any great service?

Sincerely,

From the trenches…

PS: I know, this is more fantasy than anything, but it was fun to dream just a little.

“You can’t put abandonment and alienation under arrest.” – Carrie P. Meek

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).