News 1/22/13

A growing number of pharmaceutical companies and other businesses are taking advantage of advertising opportunities within cloud-based EMRs. EMRs such as Practice Fusion generate ads based on keywords and allow advertisers to message directly to doctors at the point of care. More than 85 percent of the major pharmaceutical companies currently run ads within Practice Fusion.

athenahealth announces it will offer an anesthesia-specific billing solution for hospitals and independent practices.  MedOasis will provide the capabilities for anesthesia coding, charge-entry, contract management, and compliance.

EMR/PM provider iSALUS Healthcare and RCM firm CIPROMS partner to integrate and co-promote their services to physicians.

A study published in JAMA Internal Medicine suggests e-visits may be just as effective as in-person office visits for uncomplicated ailments such as sinus infections and UTIs. Researchers also found patients receiving online care were prescribed more antibiotics, perhaps because providers used more conservative treatments when unable to see patients in person. Even with additional prescriptions, e-visit care costs for UTI patients were less than in-person visits ($74 versus $93 a visit.)

Neighborhood Health Plan and Partners Health (MA) will provide $4.25 million in grants to 49 community health centers to expand HIT systems, train on Meaningful Use and medical coding, and train and build capacity for performance improvement.

Last week HHS Secretary Kathleen Sebelius announced the final omnibus privacy and security rule that expands HIPAA’s reach to business associates, increases penalties to $1.5 million per violation, and clarifies breach notification requirements. One provision that particularly impacts practices is the requirement for providers to give patients their medical information in electronic form if requested, assuming the data is stored electronically. Another provision that could require vendors to modify their software and practices to change workflows allows cash-paying patients to instruct providers not to share treatment information with their insurance company.

AMA News reviews the new CPT codes for transitional care management and complex chronic care coordination, including advice on when to use which code. The new codes went into effect January 1 and allows practices to bill for coordinating the care of patients when discharged from a hospital or with multiple chronic conditions.

Last week the HIStalk Practice Advisory Panel provided some good insight into the resources their practices use when comparing HIT vendor and products. A few of my favorite comments:

Lately we’ve awarded three contracts without a formal RFP or competitive vendor selection process. Unfortunately, that approach has been both expensive and has resulted in us owning products or buying consulting services that have failed to meet the functionality or quality our users desire. Hopefully we’ll learn a lesson soon.

When our administrators looked for an EHR, they simply looked at the market leader in our niche market, got a one-hour demo, and chose it. Turns out that’s not a good method.

Google and Web research. EMRConsultant.com. Personal recommendations from colleagues. Demos, demos, demos.  Getting access to a test site for extended, unrestricted hands-on experience seems to be the most helpful.

Greenway Medical Technologies, Inc., announces that Greenway PrimeSUITE 2014 (17.0) is compliant with the ONC 2014 Edition criteria and was CCHIT-certified as an EHR Module.

E-mail Inga.

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DOCtalk by Dr. Gregg 1/18/13

Another Hectic Day in Healthcare, 2063

Health Affairs’ January 2013 issue has an article entitled “Primary Care Physician Shortages Could Be Eliminated Through Use Of Teams, Nonphysicians, And Electronic Communication.” Using simulation analyses, the authors argue that the looming primary care physician shortage predicted by the Association of American Medical Colleges is inaccurate, or at least avoidable. (Shortages of 45,000 to as high as 200,000 PCPs have been projected.)

Their new assumptions on changing demographics and alternative methods of care may make sense, but I wanted to sidestep suppositions. Thus, I went straight to the most reliable source I know: my dear old spirit guide, Madame Blavatsky. She immediately channeled one of the finest techno-futurists to ever pass over, Arthur C. Clarke! Though the spirit ethers wouldn’t allow a direct connection – something to do with a recent “Clarke-Asimov Spirit Treaty” – she was allowed to pass along a typed transcript of a short story written by Clarke about a day in the life of a primary care doc in the year 2063.

If “Ego” has nailed yet another future science prediction, it may bode well for the attractiveness of primary care to the next generation!

I relay the tale to you exactly as I received it:

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I step from the autoshower, clean and fresh. It never ceases to amaze me just how perfectly the sensors know what water temperature I prefer each day. It’s never exactly the same day to day, according to the home central water readouts, but it always feels just perfect.

After daily ablutions are complete, I step into my cozy office just off the master bedroom to begin patient care. Today it’ll all be from my home, which I enjoy, though I admit that the live visits with patients in their homes are my favorite. Still, much of the work is so integrated and the reality of the virtual is so nearly real, it’s sometimes hard to know where live care and care-at-a-distance diverge. (The old term “telehealth” isn’t really used much anymore because it’s all so integrated.) Still, there’s something that’s just more deeply satisfying with live, in-person visits.

As I begin another day of virtual office work, I think of the old days when I used to actually have to log in using passwords and iris scans. The DNA sensors (which have since made those old, cumbersome, and not infallible security measures obsolete) are so seamless that I often forget that there ever was a security issue. Not that DNA sensors didn’t have their own security flaws in the early days, with hackers replicating DNA sequences as easily as they used to hack Java. But since the upgrade to DNA/RNA cross matching and the SensoCheck verification response system, there hasn’t been one successful breach in over a decade.

Before I set to business, I think of my own daily health SensoScan and, almost immediately, it completes before I finish settling into my chair. (I’ve always loved how SensoTools can activate with just a thought.) No major disruptions in vitals, heartscan, brainscan, organ function, or antibodies. Circulatory status fine, chemistries stable, and respiratory function remarkably unremarkable. Nucleic sequence mutations remain within acceptable limits. I do note one slight variation: some notable decrease in pigment in new hair growth. But, when you’re 79 – and since I opted out of the regeneration recoding – you gotta expect a little of that. I actually prefer the little bit of gray that now highlights my head and mutton chops. [A nod to his friend, Asimov? – Dr. Gregg]

As I turn my eyes toward the SensoScreen zone, the space above my desk becomes awash with 3D imagery of patients and their data updates. All is “green-and-go” on my patient panel except for the always curious Mrs. Sturnburner. She questions whether her SensoReads are accurate – again – because they don’t show any notable problems –again – despite her ongoing assertion that her bowels aren’t working as they should – again. I direct a personal note to her that these slight variations in intestinal consistency are a normal fluctuation and remind her – yet again – that dietary fluctuations cause routine changes in bowel output and peristaltic activity. At 124, she has had a hard time believing anything the SensoReads tell her. (Understandable, since she spent so much of life distrusting the frequently flawed data from the pre-SensoTools days.)

After scanning, I verify that all of the patient data, reports, notifications, and current SensoFeeds have been successfully transmitted via the SensoHIE. (How we ever survived in the days before health data was auto-transmitted and collated is beyond me.) The SensoHIESync shows full and intact data integrity with all communication lines green. Consultant feeds are clean and SensoPharm shows no outstanding needs or conflicts.

Speaking of SensoPharm conflicts, it seems sort of antiquated that there’s even a “Conflicts” alert anymore since all pharmaceuticals are either autoinduced, genomic redactions, or constructed on demand via in-home Senso3DPrinters. None of these can ever be initiated with any possible therapeutic conflict potential. Still, the “Conflicts” alert lingers as a holdover from the days before full Senso-integration. Sorta quaint, really.

All of a sudden, up pops a request from Jemma Thompson. It seems her five year old has swallowed one of the pieces from his recent Christmas present, the new “Al-Zirc Legos Master Planet Builder” set. The new alumina-zirconia nanocomposite-stabilized pieces don’t pick up well on SensoScan, so she’s a little freaked out even though the child seems fine. I dispatch one of the new VirtGo Hoverbots to her home; it arrives within minutes. Its robotic 3D ultrasound arm quickly locates the small round toy floating safely within the child’s gastric juices. I reassure Jemma that all will be fine and instruct her on how to adjust the SensoStool settings on her toilet to make certain that the toy’s passage is autorecorded. She smiles warmly, though I’m not sure if it’s for me or for the SensoStool scanner that keeps her at a comfortable distance from any manual fecal examination.

With the Hoverbot floating its way out of Ms. Thompson’s door, I relax in my chair and notice the time. I can barely believe that it’s nearly noon! The hour has just whizzed by. I think to myself that I’ll probably need to schedule an old-fashioned, real person, hands-on massage after such a hectic day.

Hopefully tomorrow will be less stressful.

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From the trenches…

“All that we are is the result of what we have thought. The mind is everything. What we think, we become.” – Gautama Siddharta

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).

HIStalk Practice Advisory Panel 1/17/13

The HIStalk Practice Advisory Panel is a group of physicians, ambulatory care professionals, and a few vendor executives who have volunteered to provide their thoughts on topical issues relevant to physician practices. I seek their input every month or so on an important news development and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a practice, you are welcome to join the panel. Many thanks to the HIStalk Practice Advisory Panel members for willingness to participate.

For this report, I asked panel members: When purchasing HIT systems, what resources do you use to compare vendors and products?

I don’t put a lot of stock in KLAS. What I do put stock in is actually talking to users of the products, and not necessarily those given on vendor-supplied reference lists. Our organization participates in various external quality organizations, specialty organizations, and advocacy groups. All of them have listservs where you can ping the rest of the members to find out what products they are using for a particular business need, or how they like a particular product. It’s a good real-world resource.

I also ping CMIOs that share the same primary vendor as we have. They’re well positioned to tell what products they use to fill functionality gaps or that compliment our EHR.

Lately we’ve awarded three contracts without a formal RFP or competitive vendor selection process. Unfortunately, that approach has been both expensive and has resulted in us owning products or buying consulting services that have failed to meet the functionality or quality our users desire. Hopefully we’ll learn a lesson soon.

Combination of talking to peers (e.g. people I know, AMDIS listservs), reading about them, doing demos. We’ll see if KLAS has info on them as well.

Industry groups (AMGA, Premier, SG2, HIStalk, etc) along with consultants in certain cases to identify potential options and then detail comparisons of the vendors in an RFP type process.

When our administrators looked for an EHR, they simply looked at the market leader in our niche market, got a one-hour demo, and chose it. Turns out that’s not a good method.

If we were to choose today, I would look at user comments on KLAS and see what is being mentioned on blogs like HIStalk.

We haven’t purchased any new HIT systems for the employed physicians in several years. For private practice physicians, I provide them with the latest reports from KLAS, AARP, AMA, etc. I also share with them the top five market share EMR vendors in the region. Additionally, I provide them with two or three names of the clinics using each EMR system in the region so that they are aware of the colleague / competitor decisions in the market they serve. I also provide user group information for each EMR vendor if there is a local presence.

KLAS, hospital offering, advice from colleagues.

Google and Web research. EMRConsultant.com. Personal recommendations from colleagues. Demos, demos, demos.  Getting access to a test site for extended, unrestricted hands-on experience seems to be the most helpful.

News 1/17/13

A study published in Annals of Family Medicine finds that EHR adoption by family physicians has doubled since 2005 and will exceed 80 percent by the end of 2013. Researchers also found family physician adoption rates were higher than those of other office-based physicians as a group, but say the reason is “unknown.” My theories: EHRs are better suited to the workflow of FPs; FPs are more motivated than higher-paid specialists to adopt EHRs and take advantage of MU incentives; and more low-cost EHR options exist for primary care physicians than specialists. Any other theories?

White Plume Technologies will offer its charge capture and coding solutions customers Wellcentive’s AccelaPQRS, a registry-based alternative to claims-based PQRS reporting.

GE Centricity resellers Alliance Healthcare Solutions and Final Support merge to form Quatris Health and become the largest VAR for GE Centricity practice solutions.

ACPE finds that only 12 percent of physicians find online physician ratings helpful. More than a quarter say the rating sites are a nuisance and over half don’t believe their patients have used one. However, 81 percent of the physicians who check their profiles think the ratings are at least partially accurate.

AMA submits comments to ONC urging that Meaningful Use Stages 1 and 2 be evaluated before committing to a Stage 3. It says its members most often express five concerns: (a) passing requires a 100 percent score; (b) the core measures are inflexible with regard to practice patterns and specialties; (c) the program needs to be independently evaluated; (d) EHR certification needs to place more emphasis on software usability; and (e) healthcare IT infrastructure barriers prevent data sharing. AMA wants three years between stages to give EHR vendors time to prepare – one year for making the rules, one for product development, and one for implementation.

The AAFP also submits comments that call for a delay of Stage 3 until at least 2017 and an elimination of all penalty provisions. It says HHS should (a) focus on problems that require coordination rather than wasting resources on criteria such as CPOE, demographics, lab results, and counting and verifying electronic prescriptions; (b) promote simplicity over complexity; and (c) require the implementation of measures that have broad, clinically-proven impact rather than experimental measures that may not be mature enough for the MU program.

E-mail Inga.

Guest Post: Committing to an ACO Model: Factors to Consider Before You Take the Leap

Just as value-based care can take many different forms, every path to prepare for this transition itself is unique. Some practices are moving into full-fledged ACOs quickly. Others are testing the waters with hybrid models and pilot programs.

Before taking a bold step toward accountable care, you should consider the following success factors:

Leadership and internal culture

To manage this transformation, your organization must be able to attain buy-in at all levels. This begins with a leadership team that is aligned with the vision and willing to invest in it. Leaders must spearhead change management efforts and effective internal communications. Driving quality and innovation will also require input from all staff, both clinical and non-clinical. This will be easier to accomplish if your culture already promotes collaboration and openness to new ideas.

Technology and infrastructure

If your practice uses basic electronic medical records (EMRs), there are additional investments ahead. Actionable patient data will be the driving force of improved quality of care. Rather than offering volumes of patient data to providers, information must be targeted and meaningful.

There is much focus on the need for HIE technology in an ACO or population-based care management initiative. However, first-generation HIE technology, which simply aggregates data, will not suffice. To support collaboration and decision-making for your panel of patients, providers will need advanced capabilities that enable the sharing of meaningful and complete data across the care continuum. This actionable data combined with analytics can also be used to create dynamic care plans that offer real-time insight for the care team and your patients.

Technology can empower your patients to make better healthcare decisions. Social media, mobile applications, and online tools are all effective outlets to engage patients. These resources can also help reduce network leakage and optimize utilization.

Level of clinical integration

Clinically integrated networks (CINs) are a strong foundation for ACOs. CINs can easily promote shared protocols, efficiency goals, education, and training. If your practice isn’t ready to move directly into a full ACO, this structure can be a good starting point.

Population health management expertise

ACOs must be able to stratify patients by risk. Based on this data, your practice can develop strategies to manage those with the highest risk / costly health conditions. Once patient data is matched with the latest clinical standards, new ways to improve outcomes may be found. This analysis of population health will also provide a good baseline for your goals around quality and measuring progress.

If your organization lacks expertise in this area, you should consider working with a health plan that has proven expertise. Care coordination payments from these health plans can help you plan for these infrastructure investments.

Market growth potential

Practices in a highly competitive market will likely be motivated to take on risk in hopes of greater rewards. Market growth will also be an important strategy to offset reduced utilization. Organizations that can readily attract and retain patients will have a distinct advantage.

Whether you’re creating a full ACO or a pilot program, these factors should be considered prior to launch. By preparing to face these challenges now, your practice can position itself for a sustainable future.

Bruce Henderson is head of Integrated Solutions, Aetna Accountable Care Solutions.