News 3/26/13

The average turnover for physicians in 2012 hit 6.8 percent, while turnover for PAs and NPs was 11.5 percent. More than a third of practices expect the pace of retirements to increase in 2013. Physician turnover is hitting small group practices especially hard: 19.4 percent of physicians practicing in small groups and over the age of 64 are leaving, compared to 12.7 percent for older physicians in all other groups.

Vitera offers some tips for practices shopping for EHRs. A few highlights:

• Get others in the practice involved in the selection process
• Consider the vendors training and support options, including vendors’ willingness to customize implementations
• Make your final selection based on long-term value and not just price.

Robert Tennant, a senior policy advisor for MGMA highlights some of the ways that the Affordable Care Act will impact small physician practices, including:

• Health plans must return patient eligibility and benefits details to providers within 20 seconds of an inquiry. Practices will presumably take advantage of “real time” eligibility checks, allowing them to collect the correct co-pay and deductible amounts at the time of service
• Health plans must offer electronic funds transfer and not just paper checks. The remittance advice must adhere to a national standard, making reconciliation easier for practices.
• A future rule may require health plans to send providers requests for additional information electronically and allow providers to provide additional information electronically.

Aprima says nearly 200 former MyWay customers have converted to the Aprima EHR and PM platform in the six months since Allscripts announced that it would not be enhancing MyWay to meet MU and ICD-10 requirements. Aprima CEO Michael Nissenbaum says he expects the company to gain up to 1,500 provider users, nearly half of those who had implemented the Allscripts product.

An ONC report shows FQHC providers who work with an regional extension center are more likely to utilize EHRs than providers practicing in other settings (79 percent, compared to 71 percent).

The role of EMR project manager typically falls to the practice manager, requiring the manager to be educated on the MU program; to assemble a team to carry out the plan; to develop an implementation plan; and, to monitor progress. Consultants say the physician’s role is to lead the clinical team and support the practice manager in implementing changes in workflows and staffing roles.

It’s time for our annual HIStalk Practice reader survey, which is different than the HIStalk survey we opened a couple weeks ago. It would help us a lot if you could take one minute or less to answer 12 simple questions. Thanks!

E-mail Inga.

HIStalk Practice Interviews G. Cameron Deemer, President, DrFirst

G. Cameron Deemer is president of DrFirst of Rockville, MD.

Tell me about yourself and the company.

DrFirst pioneers software solutions and services designed to optimize healthcare provider access to patient information, improve the doctor’s clinical view of the patient at the time of care, and enable more effective, efficient administration and collaboration across a patient’s circle of caregivers.

Our growth is driven by a commitment to innovation and reliability across a wide array of service areas, including medication history and e-prescribing, secure messaging and clinical data sharing, and patient behavioral education and medication adherence. We are a Surescripts Gold Certified provider, and have the number one ranked standalone e-prescribing software as rated by Black Book Rankings. We are proud of our track record of service to over 40,000 providers and over 270 EMR/EHR/HIS vendors nationwide.

An estimated 50 to 60 percent of office-based physicians were e-prescribing last year, compared to 40 percent in 2008. How much of that increase can be attributed to government incentive programs?

For over 10 years, the medical industry has been relying on e-prescribing to increase patient safety by reducing errors and adverse drug events caused by illegible hand writing, drug-to-drug and allergy interactions, incorrect dosing, and duplicate therapy. The recent institution of federal legislation aimed at reforming the health care system such as the Medicare Improvement for Patients and Providers Act , PQRS, and the HITECH Act or Meaningful Use has made an impact on the overall adoption of e-prescribing technology in the medical space. In 2007, only six percent of physicians were using e-prescribing, and reports say 65 percent were in 2012.

It is important to note that despite these impressive gains in the medical field, the practice of dental medicine has not yet embraced e-prescribing, partially due to barriers such as misconceptions related to effectiveness given the relative infrequency of prescription volume and a relatively small set of frequently utilized medications, concerns regarding the cost of these solutions, an absence of e-prescribing functionality within many electronic dental records, and the lack of mandates from relevant governing bodies. DrFirst believes the next step for e-prescribing is to help the dental community realize the importance and benefits of e-prescribing to ensure patient safety as well.

Which companies do you see as your direct competitors and why is your offering is superior?

DrFirst doesn’t truly have any direct competitors in terms of apples-to-apples comparison. Beyond e-prescribing, DrFirst offers controlled substance eRx and adherence and patient engagement solutions directly to providers and EHR vendors and also has products that help hospitals and enterprises with medication reconciliation and management, an automated discharge summary, and HIPAA-compliant secure clinical data exchange solutions.

How is the shift from small independent practices to large groups or health system-owned practices impacting your business?

Part of our business continues to support smaller independent practices with affordable e-prescribing and Meaningful Use technology, attestation consultation services, and a variety of apps such as our free HIPAA-compliant Akario secure messaging and texting solution. But, we do not anticipate that this vanishing independent physician market will impact DrFirst’s business because we have diversified our product offering over the last eight years to also support the needs of enterprise level practices, hospitals, health systems, payers, and HIT vendors.

 How does consolidation in the EMR vendor market impact your business?

Consolidation is a market reality and will continue to be so. What’s interesting are the opportunities being created for DrFirst as consolidation occurs.

When it comes to EMR vendors, the reality is the reasons these HIT companies decided to buy versus build and work with DrFirst are even stronger today. Scarce development resources to enhance core products, required development to meet Meaningful Use capabilities along with the complexity, effort, and ongoing costs to deliver full-featured e-prescribing are real challenges. And, it’s getting harder. For instance, continued changes to industry standards require ongoing development effort and cost while key functionality enhancements like electronic prescribing of controlled substances have introduced new complicated requirements and expensive audits to the market. Also, many companies struggle to deliver and enhance a full-featured e-prescribing system, leaving them with inferior solutions used by providers.

Consolidation leads to increased complexity. As consolidation occurs, it exacerbates these problems as multiple products must be managed in different code sets or an effort to consolidate e-prescribing solutions must occur. This is a big task on top of all the other important work to be done. We are seeing a dramatic uptick in qualified interest from companies dealing with these issues resulting from consolidation of companies who have managed their own e-prescribing applications and connections to industry networks. They increasingly understand the real difficulties and costs keeping up with e-prescribing standards, innovation, and managing 24 x 7 networks to proactively support prescriptions being written by their providers. There is a realization that the burden and opportunity costs are too great when DrFirst can do it for them. As a result, we have added additional EMRs and new customers to our integration services as their technology partner.

We are seeing success where others are not due to the options companies can select to align with their strategy and needs. They can white label our award winning e-prescribing solution, Rcopia, or use us as their “e-prescribing engine” that sits under-the-hood of their own e-prescribing user-interface. They control the e-prescribing look and feel for their users while we deliver on industry standards, enhanced functionality, and things like electronic prescribing of controlled substance complexities. It helps companies solve issues of getting to market quickly on a common platform that delivers full-featured e-prescribing, continued innovation to further differentiate capabilities, and re-allocating their internal product, development and operational resources to other priorities.

A number of key services in our solutions portfolio can be integrated by any HIT vendor allowing us to cut horizontally across the entire HIT industry regardless of whether they need an e-prescribing solution. This is a growing part of our business that is also recognized for the benefits discussed earlier when consolidation occurs as they can be delivered across many EMRs managed by a single HIT vendor as a common service.

How well is the market embracing e-prescribing for controlled substances?

For years the industry believed the inability to e-prescribe controlled substances – Schedule II to Schedule V -  combined with DEA restrictions was the single greatest barrier to the broad adoption of e-prescribing. Many practices that prescribe large numbers of controlled substances avoided e-prescribing altogether because it fragmented their workflows.

We spent years working with the DEA and AHRQ in the research, development, and pilot phase of meeting the DEA requirements in order to remove this obstacle so providers could all benefit from e-prescribing. We experienced first-hand the many hurdles in getting to market with EPCS. After we successfully went through the difficult process of certification  we soon we realized that the industry wasn’t aware that many of the barriers have already been removed.

Recently more EHRs have begun to partner with us to offer their physicians a high-quality, scalable, DEA-compliant, fully certified, audited, and low cost solution through EPCS Gold. Vendors no longer have to choose between competing development priorities because EPCS Gold allows them to greatly reduce development costs and effort, and eliminate the effort for audits, certification, and avoid day-to-day system operations, ID proofing and authentication of providers and ongoing security and compliance for constructing and operating a controlled substance e-prescribing system that meets DEA requirements so they can get to market quickly.

Since June we’ve seen a 25% increase in the number of pharmacies enabled to accept EPCS. This includes over 12,000 pharmacies in 38 states, including several major national chains such as Walgreens, CVS, RiteAid, and Osco. Interestingly some states have begun adopting legislation requiring real-time prescription monitoring in order to combat prescription drug abuse, such as New York state’s recent I-STOP law, which will make EPCS required by the end of 2014.

Are there new obstacles impacting your business today or do you see e-prescribing become more stabilized?

Although it is tempting to view e-prescribing as a stable technology, it actually continues to be very challenging for much of the vendor community. EHR and HIS system vendors are faced with ongoing issues including regular enhancement and certification by Surescripts and MU certifying organizations, complying with shifting e-prescribing regulations in the 50 states, developing and administering controlled substance prescribing capabilities – and then complying with the varying state regulations requiring to controlled drug prescribing, ensuring delivery of electronic prescriptions when the pharmacy network fails, and for hospitals, managing the required database maintenance required to effectively integrate with information delivered from ambulatory systems.

In many cases, workflows are inefficient, too, and are a low priority for improvement due to other development demands, such as MU stage 2. Many of these vendors have reached out to DrFirst to take advantage of our flexible e-prescribing platform in order to offload these concerns. We expect continuing growth in this sector as vendors seek outsourced solutions.

News 3/21/13

The CMS Office of E-Health Standards and Services says that between five and 10 percent of all EPs attesting for MU will be selected for prepayment audits. According to the director of CMS’ Health IT Initiative Group, selections will be made “both randomly and also based on protocols that identify suspicious or anomalous attestation data.”

McKesson launches two free mobile apps for the iPad and iPhone. Lytec Mobile is for use with the Lytec 2013 practice management system, while Medisoft Mobile is available for Medisoft V18.

Emdeon reports Q4 revenues of $300 million, up six percent from a year ago, and a net loss of $10 million vs. $70 million.

SiliconMesa partners with DrFirst to provide Rcopia e-prescribing functionality to customers running the SiliconMesa EHR and PM system.

The 42-physician Yankton Medical Clinic (SD) selects InteliChart’s patient portal.

CMS hosts a series of Webinars this week and next to advise EPs and practice managers on participation in the EHR incentive program, PQRS, and the e-Rx program. The Webinars will review the actions that EPs need to take in 2013 in order to earn incentives and avoid payment adjustments.

Please join me in welcoming Nordic Consulting as the newest HIStalk Practice Platinum Sponsor. Last year KLAS ranked Nordic the #1 firm providing Epic staffing and implementation support and it’s one of only four firms to be credentialed for Epic Community Connect. The Madison, WI-based Nordic is the largest Epic-only consulting firm and all  of its 130 consultants are Epic-certified with an average of nine years EMR implementation experience. Nordic consultants have over 800 certifications (an average of four each) and collectively demonstrate expertise on every Epic application. We appreciate Nordic’s support of HIStalk Practice.

More than half of all hospitals participating in a Jackson Healthcare survey plan to acquire a physician practice this year, which is up from 44 percent last year. Though last year many practices initiated the acquisition process, hospitals also purchased practices to build or maintain a competitive advantage and attract physician recruits.

E-mail Inga.

News 3/19/13

The 48-provider Commonwealth Orthopaedic Centers (KY) chooses SRS EHR and PM.

PCPs and endocrinologists that have electronic access to their patients’ formularies and co-pays are more likely to prescribe a less expensive drug for Type 2 diabetes and hypertension.

Through February 2013, Medicare and Medicaid have paid an estimated $4.3 billion in MU incentives to 216,000 Eligible Providers. The most often used menu objectives for EPs are drug formularies, immunization registries, and patient lists; the least popular are transition of care summaries and patient reminders.

athenahealth reports that 96 percent of its participating providers have successfully attested for the 2012 Stage 1 Year 1 MU program.

SRS CEO Evan Steele offers an interesting analysis of MU attestation data as of December 2012, including the observation that many of the 472 EHR vendors with certified Complete EHRs did not have a single physician who had attested by the end of the year. Evan notes that the top 24 EHR vendors account for 80 percent of all attestations and only 32 companies have exceeded 500 attestations. Meanwhile, 112 vendors have had only one to five attestations. Evan’s prediction: many EHR vendors will not be around to see Stage 2.

SuccessEHS successfully moves into production health information exchange with South Carolina’s HIE.

Hayes Management Consulting updates its Web site to commemorate its 20th year in business.

E-mail Inga.

Practice Wise 3/15/13

Electronic File Management – Protecting PHI

The final HITECH related HIPAA rule has been published. There is so much more work to be done to protect your practice data. Before you can set policies around how to keep your electronic data safe, you have to fully understand what electronic data you have and what levels of security are necessary for each category.

As I investigate new technologies to help us track and protect electronic PHI, I realize I’m a huge failure at keeping my past New Year’s resolutions. In particular, file maintenance. Back in the days of all paper files, we had an annual ritual of making bankers boxes, cleaning out files, archiving the old, moving forward the new, labeling the boxes, and putting them in storage. You knew exactly what files you were archiving and where they were going to be stored. It was a satisfying exercise, a visual accomplishment. A truck from the secure storage site came and picked up the boxes and we let them manage the security of the PHI in those boxes. Task completed.

We are focused on helping our clients understand the final rule as it relates to managing their electronic data and keeping PHI secure. Most small practices are unaware of where all their data is stored (consider all the desktop and My Documents folders of each user). There are two issues we are focusing on — data storage size and security.

Our first steps are to help the practices decide what to keep and what to discard. Right now for most offices, if it’s scanned, it’s kept. Nobody is going back to look at what is in patient EHR charts or computer/network directory flat files. They are not aware of the growing issues they are creating. We are seeing huge leaps in database sizes as everyone is scanning documents into their EHR and forgetting about them. Nobody is doing document maintenance as far as I can tell.

In the paper days, you thinned your charts. You didn’t keep old copies of registration forms. You didn’t file preliminary lab results when you got finals. The same edict needs to be applied to your electronic charts.

This may not be easy or a desirable task, but here are some thoughts:

• Review your patients by visit history and clean up charts on all those not seen in the last three years, just like when you pulled charts off the wall by their end tab year stickers. You can also do these tasks on current patient, as you touch their charts.
• Remove all but the latest registration forms (verify if your EHR tracks changes made in the system so you have historical data if needed.)
• Remove all preliminary lab result attachments (if your labs are attached as documents and not discrete data elements), leaving only the final results attached.
• Remove historical patient photos. For instance, if you are a pediatric practice and take photos at different stages in the child’s life, consider getting rid of all but the latest image. Photos are usually the biggest attachment files.
• If you routinely take photos for clinical purposes (i.e., dermatology), check your image size default on your camera(s) and see if you can use smaller images with satisfactory viewing results.
• Although it should go without saying, remove anything that doesn’t belong in the chart to begin with.
• Review your clinic protocols for scanning in charts from other offices. I routinely see clinic staff getting 50-plus page charts from other offices and scanning the entire thing into their EHR. Set a practice-wide protocol of what documents you need from other providers or your previous practice if you have moved. Be concise! You can always call the other office if there is something you need.
• Be aware of chart custody laws; who is responsible for PHI from external sources that are now a part of your chart records.
• If you are preparing to go live on EHR, now is the time to think long and hard about what you will scan and attach. I highly recommend using a professional scanning company to handle back scanning of your current paper charts into your new system. They have better scanners than you have in your office, which compress images much smaller than your office scanner. Also, they should be able to help you make critical decisions about what to scan and what to discard in your paper charts. Thin your charts first!
• Resist the urge to hire a bunch of students to come in and scan charts. They don’t have an understanding of your data, don’t know what to keep, and won’t identify when something is amiss in the chart. The file sizes will be much larger than a professional scanning solution.
• Look at billing documents you’ve scanned. Apply the same IRS record retention rules you do for paper charts and start removing all those images of EOBs etc. that you no longer need to maintain.
• For the sake of space, continue to be ruthless in deciding what you keep and what you don’t. If the documentation can be retrieved from another source (insurance company, referring doctor, lab or hospital) let them be the file managers for you when you can.
• For security, have your staff clean up their Desktop and My Documents directories, get that stuff off the local machines, and especially laptops if they leave the office, and onto a secure drive on your network. Have your IT support turn off group policies that re-direct My Documents directories to the server and teach the end users how to use the shared network drives instead. It’s much easier to secure data when it’s all contained in one place.

Julie McGovern is CEO of Practice Wise, LLC.