News 2/26/13

Memphis Obstetrics & Gynecology Association goes live this week on MED3OOO’s InteGreat EHR.

Medical practice plaintiffs who filed a class action lawsuit against Allscripts for its decision to not enable the MyWay EHR for future MU stages or ICD-10 will learn Tuesday whether they can continue with their suit or will instead be forced to accept binding arbitration. If the complaint is certified as a class action, Allscripts will be required to provide the names of all MyWay customers to the plaintiff’s attorneys, who say all 5,000 MyWay physician users would then be automatically included in the suit. Attorneys for Allscripts have filed a motion to block the suit, arguing that the doctors signed a contract requiring their differences to be settled by binding arbitration.

The Westboro, MA paper profiles a new mobile app from eClinicalWorks that will be offered free to consumers and eCW’s physician customers. It can send patient reminders to smartphones or computers, allow patients to access their medical records and lab results, and allow patient-provider messaging, including refill requests.

The medical director of HealthInsight Utah reports that use of specific HIT tools has enabled Utah Beacon Community providers to achieve a 10 percent improvement in hypertension levels for 2,000 patients. Some of the HIT tools used the development of registries, patient lists, and reminders; the creation of templates that capture data accurately and alert staff of particular requirements; the use smart clinical support tools that include reminders, alerts, and flow sheets; and, the addition of medication adherence assessment options within EHR templates to prompt providers to review e-prescribing lists and determine if patients are filling their medications.

The Maryland State Medical Society introduces the Center for the Private Practice of Medicine, which will provide resources to help independent physicians stay in practice, including assistance with HIT, office management, billing, and related tasks.

Curious: a study published in the Canadian Medical Association Journal finds that people of high socioeconomic status are 50 percent more likely to be able to schedule an appointment with a primary care provider than those of low socioeconomic status, even though Canada’s universal healthcare system pays physicians the same for either group. Researchers blame discrimination.

Greenway Medical announces that its PrimeSUITE EHR platform has achieved PCMH 2011 Prevalidation status from NCQA.

Rose Marie Nelson of MGMA Health Care Consulting Group discusses the need for population health management tools to effectively manage patient populations and qualify for reimbursement incentives. She notes that EHRs alone may not offer all the required functionality to identify and proactively manage and report on multiple unique populations. Duly noted. Nelson gave me the name of a couple PHM products that I will check out next week at HIMSS.

Another emerging HIT requirement for physician offices are tools for shared decision-making that include feedback loops that allow providers to verify whether or not patients follow through on recommended actions (tests, specialist consults, etc.)

New federal legislation is making physicians a larger target for healthcare fraud investigations. Of the 2,309 civil and criminal healthcare fraud cases opened in 2012, 21 percent involved physicians, compared to 15 percent in 2010.

E-mail Inga.

News 2/21/13

Kareo launches a free application, cloud-based EHR that can be used as a standalone application or integrated with the company’s PM and billing services. It was developed using technology acquired from Epocrates, which exited the EHR business a year ago. Kareo notes that the EHR is “advertisement free” and says it will provide support and updates at no charge. The company hopes that the free EHR offering will attract more clients for its PM and billing service products.

Kareo also announces the appointment of Tom Giannulli, MD (Epocrates) as CMIO.

The Rhode Island REC introduces an EHR adoption program for specialists that allows specialty practices to receive the same assistance and benefits previously only available to certain primary care providers.

Over time more patients will rely on doctor rating Websites to find physicians, predict researchers from the University of Michigan. A poll of parents reveal that insurance, location, referrals, and provider experience are the most important factors when selecting a pediatrician. Parents under the age of 30, however, were twice as likely as older parents to also consider online ratings.

“Data suggest that younger families are more likely to rely on online ratings, which means over time we’d expect the use of these Websites will keep increasing.”

Up to 17 percent of physicians are planning to change EHR vendors by the end of the year, according to a Black Book Rankings poll. Key findings include:

• Vendors are blamed for being too busy selling and implementing systems while development issues are left on the back burner.
• Users complain of unmet needs and MU is blamed for creating an artificial market for dozens of immature EHR products.
• The majority of practices considering a switch say their current solution does not meet the individual needs of the practice; that their practice did not adequately assess its needs before selecting an EHR; and that the design of their EHR is not suited for their practice specialty.
• Specialties least satisfied with their EHRs are nephrology, urology and ophthalmology
• Specialties most satisfied with their EHRs are internal medicine, family practice, and general practice.

Greenway will integrate the Physicians Interactive eCoupon voucher and coupon distribution system into its PrimeSUITE solution.

CareCloud reports it concluded 2012 with its 12th quarter of consecutive revenue growth, expansion into 45 states, management of more than $1.5 billion in annualized A/R, and inclusion of more than 4.5 million patients on its platform.

Healthpac will embed PatientPay’s online bill management services into its practice management system.

Surescripts awards e-MDs the 2012 White Coat of Quality for upholding high quality e-prescribing standards.

MGMA-ACMPE releases DataDive: 2012 Procedural Profile Module, a Web-based tool that allows users to develop an organizational profile which can then be benchmarked against peers using national MGMA data. The goal is to help practices better understand patient demand and and future workload.

E-mail Inga.

HIStalk Practice Interviews Wyche T. Green, III, President and CEO, Greenway Medical Technologies

Wyche T. Green, III (“Tee”) is president and CEO of Greenway Medical Technologies of Carrollton, GA.

Tell me about yourself and the company.

Greenway is passionate about creating a smarter healthcare system; a system that embraces the electronification that is taking place today in which the provider and the consumer can thrive and that eventually leads to improving population health. The current healthcare system is closed and not very innovative. I believe it’s changing and I think about the day when data captured on each one of us in a smarter system will actually assist in improving the care we receive and the care that the next generation will receive.

We’re building platforms that enable providers to embrace electronification, embrace the consumer, and begin this quest of improving population health.

I have never considered our company as strictly an electronic health record company. It just happens to be a component of what we do. We provide ambulatory solutions that connect to enterprises and hospital systems. You will see very soon that components we offer such as PrimeEXCHANGE around interoperability, the communication portal PrimePATIENT and the data intelligence within PrimeDATACLOUD alone can service communities of health in their own right to solve community issues that may or may not utilize the core of our PrimeSUITE EHR. If you think about the struggles of the establishment of HIEs, PrimeEXCHANGE currently supports more than 5,000 connections allowing widespread provider access to ride a platform that can exchange with systems like Epic, Cerner, and Relay Health, and more than 600 hospitals, labs, HIEs, and registries.

The collective power of these platforms and solutions enable physicians, leaders and patients – in communities large and small – to create a smarter healthcare system where everyone benefits. As healthcare rapidly evolves, our culture is committed to providing these powerful tools to successfully navigate change. As the healthcare system realizes our common goal of unlocking, assessing, sharing and applying decision-making information, population health will certainly improve. That’s what we stand for.

We started the company in 1998 in Carrollton, Georgia where we remain headquartered today. We have grown from a closely-held investor base to trading as a public company listed on the NYSE. A lot has changed over the last decade but our mission and passion to create a smarter healthcare system endures.

Who are your most direct competitors and what factors are causing them to increase or decrease in influence?

For me, for Greenway, it’s changed. I think it is shortsighted to consider that your competitors come from within your direct market. We’re pushing for significant and meaningful change in how we manage healthcare, but sometimes there are forces that impede or slow that change. Today, the industry is faced with an economic issue with how we pay for healthcare services.

We are moving from production medicine to value or outcomes-based medicine. Innovation is playing a major role in that transformation. Greenway is driving innovation to enable that transformation. But today, the majority of the system is still built around fee for service. How long will that take to change? Those are the biggest competitors in the industry today.

Everybody talks about product usability and ONC seems interested in transparency in that area. What efforts does the company make in terms of usability and how do you see market demand affecting that?

For Greenway, it’s focusing on solving customer issues and creating value for them. That is the key. We are working on usability innovations that may not make it into the mainstream for years to come, but customers have real issues today and we are crafting powerful solutions for them. They will face new issues tomorrow. We will continue to create and deliver more innovation to answer this unending call. That’s something we are acutely focused on.

So usability translates into customers issues. If providers can’t use your technology at the point of care, how will we get to a clinically-driven revenue cycle? Greenway has invested a tremendous amount of energy with subject matter experts across the more than 30 different specialties we currently serve and provide templates to optimize the workflow at the point of care. This way aspects like clinical decision support and payer-based care plans that are ultimately going to be important to the consumer, are done inside these provider workflows. Again, focusing on customer issues and creating real value for them is the priority, and usability will advance our providers ability to successfully adapt to this changing landscape.

How has life changed since becoming a publicly traded company?

Primarily it has given Greenway a debut on a much larger stage to tell our story. We are now able to tell our story from the New York Stock Exchange, the center of capitalism. That is a big arena to communicate our message of positive change around the creation of a smarter healthcare system.

Greenways awareness continues to accelerate and add momentum to our purpose. Larger organizations are having conversations with us about how we can solve their issues in innovative ways. How we can solve community issues through PrimeEXCHANGE, through PrimePATIENT, through PrimeDATACLOUD. We are having these discussions.

People are beginning to understand that Greenway creates powerful ambulatory platforms and solutions, not just an electronic health records. Which is what we’ve been all along. Now stakeholders better understand the value of what our platform is capable of.

Everybody’s talking about Big Data and analytics. What do you offer and what will you need to offer as business models and requirements change?

The key is again our cloud-based portal PrimePATIENT that includes the HealthVault PHR, Blue Button functionality and other scalable integrations. Platforms that allow communities to solve issues in their area as it relates to how patients interact with each other and with providers. Issues with how I exchange information across my community from systems that might not be Greenway.

PrimeEXCHANGE also gives us this capability. Our PrimeDATACLOUD platform allows us to share clinical, financial and administrative data across multiple settings and allows different analytic engines to pull data to run different types of analysis. One thing is for sure, no community is alike. We believe one size fits one, not one size fits all. We have to define in each community what the value–based system is going to be and what data and analysis is essential.

In some areas of the country, we have a tremendous variation on how you keep score. That can be very confusing for providers. To be able to create the flexibilities of different types of analytics that can be run based on what that community has defined as what’s important to them and their stakeholders. That flexibility is critical in healthcare.

I heard somebody describe it in a way that we’re playing in a soccer game with 12 people, but there are 50 referees. That’s so true. So creating innovative platforms that allow the communities to drive what they deem is valuable, what they deem as outcomes, we’re able to do that with these portal, interoperability, and data intelligence platforms.

You offer PrimeRESEARCH that connects life sciences companies with physician practices. Is that a significant demand, and do you see that as a competitive differentiator?

Yes, it’s a major differentiator. It’s very much about creating a smarter system. Where is most of the care in this country delivered? It’s delivered in ambulatory environments and communities. Why wouldn’t we want life sciences and research connected, or research and providers connected at this intersection?

There is an abundance of useful and relevant information in our systems that need to be unlocked and used properly. When leaders, providers, and communities can leverage the exacting information they need to improve their efforts, we are making big steps in creating a smarter healthcare system. This is something that has not been done in this country on any type of scale. We’re doing it for the first time.

We’re in 43 different clinical trials today for providers who haven’t really participated in any type of research since medical school. Now they’re offering solutions, offering information, they’re being educated in ways that they haven’t been in many, many years. I believe as more and more of the consumer mindset emerges in healthcare, we’re going to demand access to this type of information. It’s going to be done in that patient-to-provider relationship.

Right now we can query our network of customers to securely identify relevant patients that match a given study. We support the practices to enroll patients, collect study data, and provide remote monitoring that becomes another source of provider revenue. I see that early Stage 3 proposals include a core measure seeking the ability of EHRs to query enrollment systems so providers can seek out available studies. We’ve already eclipsed that task but I’m glad that policy is catching up to the importance of ambulatory platforms and clinical studies.

Some are calling for EHRs that are open and that allow the use of third-party apps to add or change functionality. How would you summarize the state of openness of the EHR market and Greenway’s interest in incorporating that capability?

We offer the most open platform in the market today. Our advanced application programming interface has allowed innovation to explode in this industry. We have more than 100 different relationships in various stages of development or currently operational on behalf of our customers and their communities.

We launched our Greenway Marketplace API a year ago during HIMSS12, so the doors are open for others to collaborate and innovate with us. This year in January we announced more innovations around web services to accommodate all partner platforms along with encryption and connection advancements.

If you look at the range of cloud-based and integrated solutions coming together they reach across clinical, financial and administrative needs. Isabel Healthcare, for example, is a Michigan-based company that has developed a comprehensive diagnosis decision support solution. Krames Staywell out of Illinois specializes in patient education materials. codeHERO brings charge capture to a wide variety of remote technologies, and another company we work with, DMEhub, coordinates the electronic prescribing of medical equipment and devices. You can see the unlimited potential here.

We understood and our partners have come to understand that the annual or relegated software releases are too slow and we needed to unlock the velocity of innovation. It’s not about where the data comes from, it’s about data liquidity. That’s a term we have used for a decade. Unlocking useful and relevant data so it flows to the right people at the right time in the right places, securely and safely. I believe others are seeing why this is important in what historically has been a closed, isolated market locked within four walls, but the rules of the road are changing.

How will the EMR industry look different in five years than today?

The industry is going to continue to evolve and we will continue to innovate. I think you’ve touched on some of those aspects in your questions around research, open development, usability, and data. Also consumers are changing their habits on how they access information to seek the best care. The makeup of our customers is changing. We have customers like Walgreens. Who thought that Greenway’s ambulatory platforms would be serving an organization like Walgreens? Walgreens is stepping in to fill a void within primary care and Greenway is a strategic partner in that.

We are also working with the Evolution Health division of Emergency Medical Services Corporation to provide house call medical services to mobile providers. We are working with physician affiliates of Hospital Corporation of America and launching a community outreach and EHR adoption program with Baylor Quality Health Care Alliance.

We are beginning to see larger and larger health systems begin that dialogue with us because they understand how innovative this platform is and they understand the value it brings to their customers. This is exciting!

But make no mistake, with the current economic landscape and the healthcare reform that’s hitting this country, coupled with a short supply of primary care physicians coming out of medical school, drastic changes in healthcare payment and delivery are ahead. With all of that change, with all of that disruption, come incredible opportunities for organizations that are innovative enough and can drive value on behalf of their customers.

News 2/19/13

The CalHIPSO Regional Extension Center launches service offerings that include Meaningful Use tracking, EHR readiness, and eligibility registration attestation.

DeKalb Health (IN) selects e-MDs Solution Series for its 19 providers.

RCM provider MediGain acquires ASC Billing Specialists, a PM and A/R management company specializing in ASCs.

Telligen Iowa HIT REC achieves 100 percent of its goal of 1,200 providers live on certified EHRs with active quality reporting and e-prescribing.

Researchers from Indiana University devise an artificial intelligence (AI) framework that may outperform physicians in making cost-effective clinical decisions that result in good outcomes. The researchers used EHR data to compare real outcomes and costs associated with 500 cases with the hypothetical models generated by computer algorithms. The results indicate that AI could improve patient outcomes by 30 to 35 percent.

gMed releases gGastro+, a gastroenterology-specific EHR with integrated endoscopy reporting, a patient portal, and practice maintenance.

Vitera says its v8.10 release includes enhancements to Intergy EHR and PM, Practice Analytics, and Practice Portal.

CMS hosts a 90-minute call February 19 at 1:30 EST to discuss avoiding the 2014 eRX and 2015 PQRS payment penalties.

Michigan lawmakers introduce legislation that calls for the creation of a single universal prior authorization form for prescription drugs.

Covisint reports that its customers have earned more than $30 million in incentives using its DocSite PQRS solution.

Patient-centered medical homes deliver slightly better care in terms of patient satisfaction and preventive care, but may not result in cost savings according to a study published in Annals of Internal Medicine.

MedCity News categorizes the three types of organizations buying EHRs in 2013 as 1) small provider organizations purchasing their first EHR; 2) practices switching EHRs as part of a merger or acquisition by another organization; and 3) providers that are disgruntled with the current EHR and looking for a replacement.

E-mail Inga.

DOCtalk by Dr. Gregg 2/17/13

Byproduct versus Focus

Byproduct was walking merrily down Fifth Avenue when he ran smack dab into Focus.

“Hey! Focus, my old friend!” Byproduct bellowed. (He had always been a rather boisterous fellow, most notably when extolling his own virtues.)

“Hiya, Byproduct,” Focus smiled. “My, don’t you look fine in your William Fioravanti bespoke tailoring and sparkling Harry Winston accoutrements!”

Byproduct beamed unabashedly. “Yes, indeed. Times have been very good, very good, Focus. Here in the States, the whole healthcare digitization issue has had me rolling, simply rolling in it!” he exclaimed.

Focus could see Byproduct’s chest swell as he crowed of his success. Always keeping his eye on the ball, Focus drove straight past the huff and fluff to wring the core of Byproduct’s message to the fore when he said, “Yes, here in the U.S. documentation has been creating more mountains of offshoot data than anyone ever imagined. Too bad, isn’t it?”

“What?! Too bad?” roared Byproduct. “My God, man, this is the heyday of all heydays. Me and the missus are getting ready to purchase our fourth far-too-large mansion. We’ve a passle of private jets and a mountain of Maseratis. We’re heading off to tour the world for the next two months. If you call that “bad,” then I’m happy things are so bad!”

With a glint in his eye, Focus went on, unfazed by Byproduct’s blustering. “Well, my old friend,” Focus said, “I wouldn’t be away too long. It seems there are changes afoot in the world of healthcare documentation that may just derail your digital data heydays.”

Just the slightest bit of air slipped from Byproduct’s swollen chest as he asked, “What do you mean? What could possibly derail this wonderfully massive data capture behemoth I’ve masterminded?”

Focus replied, “Oh, it isn’t that capturing more and more data won’t continue, my dear Byproduct. It’s just that the glory days for healthcare data capture are waning; a new day for healthcare data is dawning and it’ll be all mine.”

“Bullhockey,” said Byproduct. “From coding and billing to Meaningful Use, what could be more important than data capture? Healthcare data piles are growing exponentially; if I was a stock, I’d be bigger than Apple.”

“True, my old pal, true. But from Imhotep and Hippocrates to Pasteur and Mostashari, healthcare data collection has never been the true driver. It’s always been a byproduct – a necessary element, for sure – but nonetheless an offshoot of the true mission of healthcare. That true mission,” continued Focus, “has and always will be the care of people’s health. That’s why it’s called ‘health care.’”

Byproduct looked momentarily flummoxed, but quickly regained his bravado. “Nice try, my naïve Focus, but this train is running full throttle. Everyone knows that it’s the data collection that gets paid. Data capture is what HIT is all about. The days of pen and paper created mountains of irretrievable pulp-based records that may have held interesting content, but which were becoming impossible to utilize. Everyone knows,” he continued, “that digital data capture is the key to making that content accessible.”

“You are, as always, so correct and yet so misguided, dear Byproduct,” came the now impassioned Focus. “Data capture is imperative for the logarithmic growth of health information. Information technology can do wonderful things with all that data, wonderful things which were previously unthinkable. The problem isn’t data capture, per se; the problem is that data capture has become the sole focus of so many who are now involved with healthcare.”

“So you’re saying that data capture is important, but not central?” Byproduct asked quizzically.

“Exactly,” replied Focus with emphasis. “People’s lives aren’t sets of data points; they’re stories, stories full of nuance and subtleties. The same is true for their health. That’s why they call them ‘medical histories.’ Technology has not been invented which can truly capture those stories and yet it’s those stories which provide the core of health meaning. It’s those stories with their vagaries which provide true value. It’s those stories which people tell to their doctors and nurses and such and it’s those stories which give those healthcare providers the keys to understanding, diagnosing, and treating.”

“But EHRs are all designed to capture discrete data, Focus. They are all predetermined, point-and-click input portals. Without that, it’s just uncapturable, typed-in text. How can you possibly create predefined elements to cover every possible nuance?” questioned Byproduct.

“Ahhh, my dear colleague and cohort, there indeed is the crux,” agreed Focus. “Perhaps it’s the design of data capture that has blurred the vision for HIT. If data input were rehumanized, allowing people to tell health stories instead of inputting predefined phrases and terms, then the true meaning of the data – the story – could be preserved. Data capture can be improved and can be done more on the back end, after the story has been told.”

“Not possible,” retorted Byproduct. “Everyone knows that it’s templates and dropdowns that rule the worlds of HIT data collection. Providers will just have to figure out another way to share your so-called ‘stories.’ You can’t template that.”

“No, not using your approach you can’t. But, there are new ways to document coming, new digital tools that can capture discrete data while allowing the medical story to be told. I’m betting your heydays are numbered, my old friend,” consoled Focus. “These new methods might just bring me, Focus, back to the fore of healthcare.”

“Balderdash!” snorted Byproduct. “I’m just too big to be stopped!”

“So were TWA and Pan Am at one time,” Focus replied. ”Have you seen Quippe? Or how about CLiX?”

From the trenches…

“It is very difficult to get people to focus on the most important things when you’re in boom times.” – Jeff Bezos

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).