Practice Wise 11/25/12

Who is your EMR Vendor?

We are at another critical juncture in the EMR evolution. Meaningful Use Stage 1 is coming to an end and developers at your EMR company are madly coding for Stage 2, or so you hope! We are starting to see the expected migration of the EMR birds that can’t fly the Stage 2 path.

I recently asked a state REC why they chose the vendors on their suggested list. They told me because those are the biggest EMR companies in the country. Is bigger really better? If you have not already chosen an EMR or are in the process, or are looking to change products, there are some key points you want to consider when selecting a vendor.

• As a percentage of total business, how much does the vendor spend on R&D of the specific product you are looking at? If it is a vendor with multiple products, touting the amount spent on R&D is not significant to you if your product is the red headed stepchild of their offerings.
• What percentages of their installed providers have successfully attested for Meaningful Use Stage 1 of the product you are looking at, not their entire client base of all products?
• Does the product allow you to meet all the incentive programs now? (PQRS EHR reporting, e-prescribing incentive, MU Stage 1 and soon to be Stage 2, and so on)
• Does the product itself keep you from being penalized now and in the future for e-prescribing and PQRS EHR reporting?
• If the vendor has multiple products, do all of them have the same level of certifications? Some vendors with multiple products have their premier product CCHIT certified and ONC-ATB certified through CCHIT. The rest of their offerings are not CCHIT certified and their ONC-ATB certification is through another certifying body. This is a red flag. More R&D money is being spent on certain products in their line. Is yours one of them?

It is short sighted for any provider who is looking to purchase an EMR to not know how these programs are being addressed by their vendor. It doesn’t matter if you don’t care about attesting to MU now for the incentive money, you will be penalized in the future. And if you don’t participate in Medicare, understand that this is going to be pay-for-performance for your commercial payers at some point, so don’t blow it off.

I often hear from small practices that they are going with Vendor X because they are a big company and less likely to be sold or go out of business. If you are a 1-5 doctor group, do you really think the biggest companies even have you on their radar? Does being a big company mean that they will never be sold? We have all seen that this is not the security blanket many believe it to be. Even if the company is not sold, underperforming products are sunset all the time when a company has more than one product in their offerings.

If you are dealing with a small company that only focuses on one product, you still have some important questions to ask besides the ones listed above.

• Is yours a specialty specific product? If so, what is your install base? Specialty-specific products traditionally have fewer clients, which can mean fewer dollars for R&D. How do you plan to fund ongoing R&D?
• How do you plan to address ongoing regulatory changes? Can you guarantee that you will meet all regulatory deadlines so the practice can take advantage of incentives and not be penalized? When a sales person says, “Of course we will meet the deadlines,” get it in writing. Get a guarantee that if they can’t meet the regulatory deadlines that they will reimburse you what incentives you’ll lose due to their lack of functionality, or pay for the penalties incurred. If they can’t give that to you in writing, move on — that means they don’t have absolute faith in their own abilities to meet your needs.
• How many people do they have providing implementation and support services? I have a few clients who recently purchased a specialty-specific product. Their training and implementation was done on the Internet — nobody came on site to assist. In my experience, that is not conducive to a successful go-live and ongoing proficiency in the product. We are on the West Coast. This vendor is on the East Coast. Their support becomes “on call” after 2:00 p.m. West Coast time. Doctors who are stuck charting a note or trying to send an electronic prescription are truly stuck waiting for an on-call person to call back within their after-hours guaranteed window of 90 minutes. I wish I could get away with telling my supported clients to wait 90 minutes for me to call them back when they are stuck in the middle of their work day.

If your vendor has multiple products and they decide to sunset one, what does that mean for you? It’s nice to hear that they’ll give you licenses to one of their other offerings, but if their other offerings were a good fit for you to begin with, wouldn’t you have purchased that product instead? A one-for-one license swap may seem like a sweet deal, but what is the ongoing total cost of ownership of this other product? How much additional training and infrastructure will you need? If you are going to have to change products, you should consider this like a new purchase and start your process anew, comparing all your options.

Julie McGovern is CEO of Practice Wise, LLC.

News 11/20/12

From Memphis Belle “Social media and EHR. Practices wanting to incorporate social media into their marketing tool box should check out MOGAobgyn on Facebook. They did an exemplary job advising patients of their EHR transition.” I agree. One of the many things that Memphis Obstetrics & Gynecological is doing right is keeping the updates fresh and varied, with posts on a daily basis, lots of pictures and videos, and a good mix of content, including questions posed to patients. MOGAobgyn keeps patients engaged with pleas to share stories on everything from Thanksgiving Day births, experiences with premature deliveries, or using family member for daycare. Last week the practice went live on InteGreat EHR and posted updates and videos before, during, and after the implementation. Nice job.

McKesson will give $1 million in free Practice Choice EMR software to 100 physicians providing charity care across ten cities. To qualify, physicians must be either primary care, internal medicine, gynecology, or pediatric providers; have a history of providing unreimbursed care to the low-income community; and work in a private 1-10 physician practice.

The National Football League signs with  a 10-year contract worth $7-$10 million with eClinicalWorks for EHR.

Medical education provider Pri-Med, a division of Diversified Business Communications, acquires EHR provider Amazing Charts. Amazing Charts will operate as an independent subsidiary and founder Jonathan Bertman, MD will continue to serve as president.

White Plume Technologies releases AccelaMOBILE, its mobile charge capture product, into the Apple App Store.

CareCloud hires Ralph Catalano, a former VP of client development for athenahealth, as VP of operations.

ADP-AdvancedMD introduces a charge capture app for EHR for use on the iPad and iPad mini.

NextGen Healthcare releases its 8 Series EHR content, which includes a new user interface, standardized framework for templates, and streamlined navigation.

Vitera Healthcare introduces Hands-On Lab for virtual product training.

Greenway releases the results of an HIT survey of physicians, CIOs, and consumers. Key findings include:

• 56 percent of patients believe technology helps physicians improve care, though seven percent believe it gets in the way of interaction with their doctors
• 76 percent of practices either aren’t sure about participating in an ACO or have decided they won’t participate
• 16 percent of practices will stop taking Medicare and Medicaid patients if payments are reduced
• 45 percent of patients say they would change doctors if they’re kept waiting too long.

Sixty-nine percent of US primary care physicians report using EHRs, up from 46 percent in 2009.  About a third of doctors say their patients have the ability to e-mail the practice and have online tools to request appointments, referrals, and prescription refills. The study of 10 “high-income” countries also finds that despite health reform initiatives, a high percentage of physicians in all countries complain of untimely access to information from hospitals and specialists. In addition, over half of US doctors report that grappling with insurance restrictions is a major problem and that often their patients go without care because of costs.

E-mail Inga.

DOCtalk by Dr. Gregg 11/17/12

International Paper Co. Merges with Bic Pen to Build EHR

Now there’s a headline I just might love.

Why? Because it occurred to me that back in the days of paper and pen, I never once thought about the financial stability of the companies that provided the tools for documenting my trade. Those companies just seemed so rock solid, so just “always there.”

Seriously…for any of you who’ve been around long enough, did you ever once worry about the market status or potential acquisitions of Mead Paper or Pilot Pens? Did you ever have to consider pen technical support or paper training sessions? Did you ever think about what would happen if your pen supplier went belly up?

Remember when “system downtime” was a break for lunch?

I was conversing with perhaps the wisest and savviest person I know the other day when this thought occurred. (He’s HIT smart, yes, but generally all around brilliant, too … and even comes with a charmingly mannered personality.) I was picking his brain about some potential EHRs and he helped walk me through some of the current industry status for factors anyone must consider these days when thinking about their HIT needs, such as:

• Company financial viability
• Stock prices
• Market forces
• Potential for acquisition
• R&D resources
• Corporate culture
• Future technological anticipations
• Etcetera, etcetera, etcetera

Granted, my brain is now fuzzed with age, silicon dust, and/or lack of sleep, but I’m pretty sure I never used to have to consider such commercial concepts when trying to document patient care. And, I know my practitioner predecessors never once gave a single thought to any of these factors when trying to provide healthcare services.

Having been through the private and public corporate acquisition mills, having had my choice of digital documentation deleted, and having lost countless hours of family time trying to interpret the HIT tea leaves, it has become clear to me that I am spending far too much of my professional life thinking about and doing things that I never anticipated and for which I was miserably undereducated in school. The “learn as you go” for this new side of healthcare considerations has been… well… interesting.

So, would the footprint of our old friends, the pen and paper manufacturers, help relieve this corporate chaos which HIT hath wrought upon healthcare provision? Naaaah. But the nostalgia for those carefree days of documentation is such an agreeable daydream…

…until I remember I can barely read my own handwriting.

Everything’s a tradeoff.

From the trenches…

“The act of putting pen to paper encourages pause for thought, this in turn makes us think more deeply about life, which helps us regain our equilibrium.” – Norbet Platt

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of Today! exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 11/15/12

From Soak Zone: “Re: NextGen UGM. Great logistics and sessions and a Shamu encounter. Got to love it. You should go to next year’s meeting in Vegas!” Thanks for the invite – you never know. I read many of the comments from the Twitter feed and Facebook and almost all were very positive. Just a couple of complaints about bus logistics to Sea World, but I’m sure transporting 4,000 people has its challenges. Thanks to the readers who sent comments and pictures.

No surprise here: MGMA-ACMPE finds that its members are more satisfied with payers that pay promptly and respond to their inquiries rapidly and accurately. Medicare Part B was the highest-rated payer, though none of seven payers included in the survey earned overall satisfaction ratings in the “moderately” or “completely” satisfied range.

Culbert Healthcare Solutions expands its customer base to more than 150 organizations and gains the 159th spot in the healthcare industry segment on Forbes list of fastest-growing private companies.

Greenway adds a rules engine to its PrimeRCM service that integrates billing intelligence with clinical care. Greenway expects the added technology to produce cleaner claims and lead to better collection rates, as well as to advise providers of payer care guidelines when ordering tests and procedures.

Vitera Intergy EHR/PM client MU Medical Management (AZ) selects ClearDATA Networks for hosting services.

The US will need at least 52,000 more family doctors by 2025 as the population continues to age. Policy officials offer several possible fixes, including better pay for primary care physicians, increased care from PAs and NPs, and, more care provided through PCMHs.

Worcester Business Journal awards eClinicalWorks top honors for its employee rewards and recognition.

Barry Pointe Family Care (MO – above) and Desert Ridge Family Physicians (AZ) are named finalists in the NextGen Healthcare/Intel Innovation Awards, while Hunterdon Healthcare Partners wins Grand Champion honors.

Also from NextGen: the company will connect to the Surescripts Network for Clinical Interoperability for secure messaging and clinical data sharing.

What’s not to love about this story? Patients of Russell Dohner, MD of Rushville, IL don’t seem to mind that he does not accept insurance and doesn’t have a computer or fax machine. Every morning patients from a four-county area line up to see the 87-year-old physician, who charges a mere $5 for an office visit. He barely makes enough to pay his staff, which includes an 86-year-old nurse and 85-year-old secretary, and says this of his 57-year career:

“I always just wanted to be a doctor to help people with their medical problems, and that’s all it’s for. It was never intended to make a lot of money.”

E-mail Inga.

News 11/13/12

Emdeon reports a Q3 loss of $15.2 million, which represents a 341 percent decline over a year ago. Revenue was up 5.3 percent to $297 million. Emdeon attributes the loss to increased interest expenses and costs associated with the company’s acquisition by Blackstone a year ago.

The 2013 Medicare fee schedule includes a new program that pays physicians between $160 and $230 (assuming no SGR cuts) per care coordination incident associated with the transfer of patients to skill nursing facilities. Also new for 2013: physicians must participate in the physician quality reporting system (PQRS) to avoid Medicare payment reductions of 1.5 percent in 2015.

The American College of Physicians will provide free access to its online Medical Home 2.0 practice management tool to physician offices participating in Wellpoint’s PCMH program.

SplashData publishes a list of Worst Passwords for 2012 based on stolen passwords posted online by hackers. Happy to say none of my passwords made the list, but if any of yours did, you might want to consider some of these anti-hacker password tricks.

Aprima announces that it has settled the lawsuit brought against it by Allscripts, which had claimed that the wording of Aprima’s advertised “MyWay Rescue Upgrade Program” violated state and federal laws. Aprima agreed to changed its advertising, but will continue to market its product to users of the Allscripts MyWay EHR. Allscripts previously announced that MyWay will not be upgraded to handle ICD-10 or Meaningful Use Stage 2, but customers will be offered a free conversion to its Professional product.

One in three cell phone owners use their phone to look up health information. Among adult smartphone users, almost 20 percent use their device to monitor or manage their health.

NextGen kicks off its 2012 User Group Meeting this week in Orlando with over 240 individual educational and networking sessions. We have a new Twitter feed box for sponsors on your right that’s running tweets from the conference. If you’re there and have any insights or photos to share, please send them my way.

The Reedsburg Area Medical Specialty Center’s Orthopedics & Consulting Services, Reedsburg Physicians Group, and Surgical Specialists go live this week on GE Centricity EMR.

E-mail Inga.