DOCtalk by Dr. Gregg 10/28/12

If It Was a Wonderful Life

Whoa … it was seriously disturbing hearing that voice coming from Summer, our beautiful, sweet, genteel Golden Doodle. She’s not prone to any noisemaking, rarely even a bark, no less the raspy, smoke-ravaged voice of my old spiritualist and now occasional spirit guide, Madame Blavatsky. You can imagine my non-intoxicated – honest! – surprise. (She’s a bit of a mischievous disembodied soul, reading my thoughts without permission, popping into my reality without invitation.)

“So,” she starts in her husky Ukrainian, semi-masculine voice, “you vant to see vhat the vorld vould be like if HIT had started vith a plan, a grand design, huh?”

I nodded at Summer, remembering how I had recently wondered just such a “what if.” Still, I was somewhat uncertain if this was a waking ghostly emanation or some mini-stroke, epileptiform fantasy my neural synapses were concocting. I was pretty sure Summer hadn’t been raised anywhere near Odessa, thus the accent seemed to clinch the fact that this wasn’t really my dog speaking. The sound of the football game on the TV semi-assured me that I was still sitting on my couch. The cool feel of the Pepsi in my hand seemed to imply that I wasn’t comatose or stroking out.

“So, you vant to see vhat could be, huh? You vant to know vhat you’re missing? Well, so be it, my little Solnyshko,” she semi-growled.

With a wag of her tale and a blink of my eyes, I was suddenly standing at a work counter in my office, looking down at a tablet computer. But it was unlike anything I’d ever seen…

The user interface was gorgeous! Everything I needed was right there, without extraneous clutter. Everything I wanted was accessible, without extravagant effort. Everything was clean and friendly and visually pleasing … and it made sense, stupid simple sense.

I touched the tablet and useable items popped in and out without screen refreshes or wasted motions. I wanted a lab result: it was a click away. I needed to check an old note: pop, there it was, without covering my current view. I wanted to track BMI and blood pressure trends: tap, click, there it was in beautiful Technicolor clarity.

Somehow I knew I needed to see a specialist’s consult note. I also somehow knew it wasn’t necessary for it to have been “sent” to me; it was available in the cloud. I tapped the referral reference and, blip, there was the note, pulled from the common HIE platform. Even better, it was easy to read – not too short, not too long; it was plain old Goldilocks “just right.” I could easily see the provider’s overall intent and just as easily drill down to see the deeper story details. I could sense the deep connection to the core values around which all had been built, the grand design of HIT grandfather, Larry Weed. It was SOAP note structure and straightforwardness empowered by well-designed HIT “steroids.”

I tapped the screen to place an order and was suddenly sucked through a Matrix-esque screen of descending green code, going deep into the digital bowels of the system. There I saw the pure simplicity of the surface world replaced by complex yet smart digital wizardry. Systems spoke with each other in incessant ones and zeroes, but they all spoke one seamless language. I could sense there was no interface mumbo jumbo and no translational transgressions; everything was stupid smart. It was designed from the ground up to work as one system. Every section of the system complemented every other section. Data flowed like grease through a goose.

Speaking of waterfowl, I had the distinct impression that I was looking at the feet of a duck paddling furiously under the water while knowing that on the surface of this medical computer network “pond,” the EHR “duck” appeared to be gliding effortlessly across the clear, still surface. It was HIT as it should be. It all worked. It was all connected. It was all accessible. And, it was all absolutely wonderful!

The sound of my cell phone yanked me from my reverie. I was pulled, unwillingly, back through the Matrixian coded channels to current reality. It was an after-hours call from a distressed parent.

I tried to pull up their child’s record on my home PC, but something had failed and I was unable to connect with my EHR server. It was a moot issue anyway, as this parent’s question revolved around the psychologist’s recommendations from their evaluation two weeks ago and I just knew I wouldn’t have access to any such documentation – not now and possibly not in the foreseeable future.

As I did my best to answer this pleasant parent’s anxious queries based upon the limited information to which I had access, I looked over at Summer and could swear she winked at me as I saw a white lotus reflected in her eye. Blavatsky…er…Summer, even appeared to be smirking as she rasped one last vocalization: “George Bailey you’re not, Solnyshko, but vhat’re you gonna do?”

From the trenches…

“After enlightenment, the laundry.” – Zen proverb

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).

MGMA12 Wrap-Up 10/25/12

I am back home, drowning in emails, and feeling a bit stressed. On the one hand I kind of wish I could attend more conferences (RSNA and a few of the larger vendor meetings come to mind) but then my body reminds me how exhausting it is to learn and network all day, socialize and network all night, and then wake up way too early in the morning to write a post.

I already shared most of my pictures, but I managed to dig up a couple more goodies. Hang on for my somewhat rambling assortment of observations and impressions.

I’ll start with a shout out to all the HIStalk sponsors who displayed their signs in support of HIStalk. A big thank you to Vitalize, Sandlot, Capario, MedAssets, White Plume, Culbert, IMO, M*Modal, Versus, MedAptus, Gateway, SRS, eClinicalWorks, and IngeniousMed. I am quite sure there were more since my notes aren’t perfect (nor necessarily legible.)

I stood in line with a gentleman who ran an anesthesia-focused MSO and was surprised by his comment that most of his physicians used scribes in the surgical suite. Maybe that’s not particularly uncommon and I just incorrectly assumed most physicians in this area were entering their own notes.

I mentioned earlier that the Iatric rep produced a nice, concise elevator pitch. I also had a chance to meet CynergisTek CEO Mac McMillan, who was in the Iatric booth when I stopped by (the companies jointly offer an automated solution for monitoring access to patient data.) McMillan modestly shared that he is often an educational presenter on privacy and security for local HIMSS chapters and other professional organizations. I figured out later than he is actually chair of the HIMSS Privacy  & Security Policy Task Force, making him one of the authorities on the topic. I have thus added him to my list of HIT brushes with greatness.

NextGen had a smaller and more open booth than I recall in years past. It was so welcoming that I decided I needed demo, having not seen their EHR in a few years. NextGen has long had a reputation as one of the premier ambulatory EHRs, and rightfully so. However, I must say I was a little disappointed in the product. Graphically it looks dated. Even though the gentleman doing the demo – who did an excellent job – was able to move around the system quickly any time I asked to see a particular feature, it seemed as if it took at least three to five clicks to navigate anywhere. I understand that the EHR has a great deal of flexibility in its templates, but the basic patient summary screen seemed lacking. For example, the default view did not show a patient’s complete history on a single screen. You could click on tabs to see problems, medications, and other detail but at a glance you could not determine if the patient actually had any data attached to those tabs. For a specialist it might be work perfectly well but I can see how a primary care provider could become frustrated with the workflow.

Meanwhile, I checked out CareCloud’s new EHR and I must admit it looked beautiful. Navigation was very intuitive with lots of drag and drop options and a look and feel similar to Facebook. I think they are on to something. However, the product was just released in January and currently fewer than 100 doctors are on the platform. The current templates seem better-suited for primary care and my impression is that for now CareCloud intends to focus on the core product, versus developing features to address the needs of every specialty. I also noted a few product gaps, such as limited clinical decision support utilities (the rep said they are still deciding whether to build or buy that functionality.) I should add that a doctor friend of mine looked at the product as well and was very impressed with the functionality, though was concerned that the company is still relatively young.

Most of the booth “gimmicks” weren’t too original: photo booths, money booths, spinning roulette wheels for prizes, etc. The give-aways included Kindles, iPads, Starbuck gift cards, and cold hard cash (my favorite, though I didn’t win any.) I’m happy with my $5 Starbucks gift card, courtesy of Emdeon.

I suppose I knew this before, but after hearing a few MGMA-led sessions, it’s obvious the organization spends considerable time and effort lobbying for its members in Washington.

MGMA reports total attendance was about 5,100, including representatives from 356 exhibitors. On Monday I inadvertently Tweeted that attendance was 51,000 (what’s an extra zero here and there?) and was horrified the number was re-Tweeted multiple times before I noticed my error. Whoops.

I had forgotten about this picture. These mariachi guys provided some Sunday afternoon entertainment in the convention center. I have no idea why Ronald McDonald was sitting on a bench in the middle of the convention center (I didn’t notice a  McDonald’s), but he was clearly enjoying himself.

I think I have a small gal-crush on MGMA president Dr. Turney. Not only does she like shoes, she is a self-proclaimed “data geek.” Got to love that.

Kudos to Gateway for donating $5 to breast cancer research for every badge swipe.

Here’s the iPractice Group booth, which was one of my favorites for its openness and good use of a relatively small space.

MGMA published results of a member survey that found only 18 percent of group practices were participating in new Medicare payment delivery models or demonstrations. The lack of predictability in current Medicare payments is the primary barrier impeding practices’ ability to experiment in new payment models, while other practices note a lack of applicability to their particular size, specialty, or location. If a degree of stability returns to the Medicare payment system, 82 percent of practices say they’ll explore new payment and delivery models.

I took a peak at Intuit Health’s mobile patient portal app. Truth be told, Intuit had these fabulous foot massage chairs and I asked to sit in one. I was unable to see a regular demo from the massage chair so the sales guy handed me his iPhone and let me walk through it on my own. I wish my physicians had something similar for appointment scheduling, prescription refills, and sending secure communications. It was super easy to use. And the foot massage was incredible.

Intuit was not the only vendor offering patient engagement tools. I attended a session on healthcare social media with David Harlow of the Harlow Group and I believe he was the one who pointed out that new federal laws will continue to drive patient engagement. Not surprisingly both niche vendors and the traditional EHR/PM companies were promoting patient engagement options, including mobile versions.

I sat down for a few minutes with athenahealth CEO Jonathan Bush. He was his typical irreverent and rambling self – and happened to be wearing Batman cuff links. I will be writing up a separate summary of that conversation.

A few of the vendor announcements this week include:

• An ADP AdvancedMD survey finds that 74 percent of physicians do not feel they have control over the financial aspects of their businesses. In addition, over half see their patient count increasing.
• Almost half of the practices participating in a SuccessEHS survey report an annual loss of revenue in excess of $25,000 due to preventable denials.
• eClinicalWorks launches an all-inclusive RCM service that includes its eCW’s PM/EHR at a cost of 2.9 percent of monthly collections.
• Navicure adds 280 new practice locations in the third quarter of 2012 and increases revenues 30 percent from a year ago.

E-mail Inga.

From MGMA 10/23/12–Part 2

From Ty Burrell “Re: MGMA and HIStalk. Greetings from Venice, the over-priced tourist/convention nightmare better known as San Antonio. Flying out I struck up a conversation with a very nice gentleman who was also going to MGMA. We formally introduced ourselves and he said his name was Mike Nissenbaum. I kind of laughed and said I felt like I already knew him due to HIStalk and all the recent press. His face lit up with a smile and he had great things to say about HIStalk and all that you do.  I bumped into him today and he said he was on the lookout for Inga. Thanks for all that you do (and the connections you facilitate)!” Ah, what a nice note! The last couple of days have been a whirlwind and my attempt to be a social butterfly, informed expert, and blogger have left me exhausted and sleep-deprived. Your comment serves as a great reminder of why we do what we do. By the way, Dr. Jayne and I coincidentally had a brush with HIT greatness last night. As we were walking into the Hyatt for a party, Michael Nissenbaum was walking out. Not only did Dr. Jayne share my geeky excitement with the encounter, she was also appropriately impressed that I recognized him.

In another chance encounter, I briefly met MGMA CEO Susan Turney. When I saw her she was wearing running shoes and a  black pant suit, so of course I couldn’t resist asking her about the ensemble. Dr. Turney shared that she had broken her foot a few months ago and was alternating between running shoes and high-heeled pumps for presentations. Which led to a discussion of which designers offered the best flats for both fashion and comfort. I am always amazed how much my “real life” bleeds into my Inga world.

I usually like to ask participants, including vendors, what they feel are the hot topics for a particular show. I think for this convention, the biggest “buzz” was the lack of buzz. That is to say there was not one major overriding theme or single topic overshadowing others, nor any big product announcements. However, practices seem to be quite concerned about finances and express  a good deal of uncertainty about what the future holds. Key issues include the looming SGR cuts, the election outcomes and the impact on ACA reforms, ICD-10 and the threat of interrupted cash flows, and changing practice ownership models. The cloud of uncertainty is forcing many practices to take a wait and see attitude and put on hold anything but the most essential projects. That’s not great news if you are a vendor selling an innovative new product, unless it promises a low-risk ROI. Practices with 10-year-old EHR/PM systems that can handle ICD-10 and Meaningful Use are less likely to switch products any time soon, even if their product lacks the bells and whistles found in newer offerings.

That being said, several EHR vendors told me that much of their booth traffic came from Allscripts MyWay clients who are exploring their options. And, an exec with one of the clearinghouses shared that they were having many new conversations with recently displaced MyWay resellers scrambling for new alliances.

I heard rumors that MGMA was going to repeat a couple of sessions that were too full to accommodate everyone. Don’t know if that actually happened but I did observe a number of educational sessions were filled to capacity.

Here’s a picture of my assorted trinkets. My favorites are the McKesson water bottles, a $5 Starbucks gift card from Emdeon, and the green sneaker key ring from Pulse. Still wish I could have gotten one of the Pulse folks to give me a pair of real green sneakers.

Vitera Health had a big crowd on hand when they announced Vitera Stat and Vitera Intergy Mobile for iPad. Vitera Stat is a subscription-based PM/EHR product designed for independent physicians and practices with limited IT resources. I recall they bought the technology several months ago and have been polishing it, though I don’t recall the product’s original name. One has to wonder if Vitera will eventually try to scale Stat for larger practices as a replacement for Intergy.

Thanks to MED3OOO for the energy drink that got me through the day. I liked the bear, too.

I feel like I am piling on to mention this but I never once saw much action in the Allscripts booth. In years past you could always count on Allscripts to have one of the highest-traffic booths. Not so at this year’s MGMA.

ADP AdvancedMD maintained a reasonable crowd every time I walked by. If I understood correctly, AdvancedMD gave participants a book on practice management for sitting through a short presentation. I was kind of stuck on the notion that an old-fashioned “book” could draw a crowd, but their approach appeared to work.

Props to Emdeon, who must have hired a professional to attract people to hear the company pitch. He was both entertaining and effective in terms of drawing people in and delivering the company story.

I might add that hiring “professionals” doesn’t always prove effective. One of the larger EHR companies had either hired a couple lovely ladies to draw people to their presentations or perhaps had the marketing newbies fill that role. I had a conversation with one that went something like this:

Lovely: Would you like to see our demo starting in five minutes?
Me: No, but is that your new mobile EHR you are holding? (She’s holding an iPad.)
Lovely: Oh, I don’t know if this is a new iPad or not.
Me: No, not the iPad, the software.
Lovely: Oh, this software is for getting people’s names for the demo.
Me: Oh, so do you have a mobile version yet?
Lovely: I really don’t know.
Me (as I walk away): Hmmm.

Balloons are fun and all but I saw a few too many adults wearing balloons on their heads. This guy offered to make some bling for Dr. Jayne and me but we took a pass.

I took advantage of the chair massage, courtesy of Laserfiche, and was quite content to watch the short and informative video at the same time. Incidentally, the young woman who gave me the rub informed me I was “tight” and needed to see my local therapist. I am considering taking her advice and sending Mr. H the bill.

I have quite a bit more to share, including  some impressions of my NextGen, CareCloud, and Intuit Health demos, but I will leave that for my wrap-up tomorrow.

E-mail Inga.

From MGMA 10/23/12

It’s bright and early Tuesday morning. I intended to do a longer post but the Internet connection at my hotel keeps dropping. For now I am posting  a few photo highlights from Monday.

From my scenic early-morning walk to the convention center.

There was a packed house for the opening State of the Healthcare Industry panel discussion. While informative, I think it would have been more effective with fewer panelists and more diverse opinions. AMA president Jeremy Lazarus, MD did the best job staying on message and keeping his comments relatively brief and to the point.

athenahealth was offering free Kindles if you watched a demo. Needless to say their booth was hopping.

athenahealth’s Maria Chow sent me a photo of her booth shoes. She’s my hero.

I noticed overflow crowds at several of the sessions, especially ones related to physician compensation and managing the financial health of practices. Anyone unclear about practice administrators’ biggest worries?

Thanks VaxServe and Passport Health for the free flu shot. Booth 1620 if you want to get one Tuesday morning.

Longest line of the day: waiting for just-out-of-the-oven cookies at the MGMA booth. It was worth the 10 minute wait.

A glimpse of the exhibit hall.

Thanks David Harlow for the informative session on healthcare social media. Good tips on why practices should maintain a social media presence and cautions for staying out of trouble.

Dr. Jayne and I hit seven parties in six hours last night. My feet will never be the same. Here’s the incredible guitarist who provided the entertainment at Practice Insight’s  cocktail party.

Things were hopping at the NextGen cocktail party, which was mostly outdoors. I think this was party #4 and by this time Dr. Jayne and I were glowing in perspiration from the muggy weather. We attempted to keep cool drinking margaritas but I’m not sure that helped.

Why was this man playing bagpipes in the street? We have no idea.

We were sad not to score an invite to the Vitera party. Dr. Jayne banged on the fence in an attempt to be a party crasher.

As we peered over the fence I did manage to take a stealth photo of the Vitera party.

Salsa dancers at the athenahealth Fiesta bash. I immediately thought of Mr. H, who would have loved the girls’ skimpy attire. I took this shot moments before I was dragged to the dance floor. Since it was party #5, it seemed perfectly reasonable to salsa dance in my five inch heels. Dr. Jayne was snapping pics of me for later bribery opportunities.

athenahealth actually hosted two parties. At the later event, Jonathan Bush donned a skimpy wrestling outfit and took down an opponent. It had something to do with the cloud beating up software. Personally I think JB just likes any excuse to wear skimpy costumes. Dr. Jayne and I thought he looked pretty buff, though.

Party #6 at Pat O’Brien’s. Got there a little late but things were still hopping when we arrived.

When Dr. Jayne posts her MGMA summary I am sure she will brag about the fact that she was able to party much later than me. Let the record reflect that my heels were higher. The translation: she was smarter and and my feet were crying. As she stayed out all night finding trouble, I was the one heading back to the hotel at 10:30. And yes, I was that person walking barefoot along the River Walk holding her shoes.

E-mail Inga.

From MGMA 10/22/12

Hola from San Antonio, where it was a warm 80-something degrees yesterday when I strolled from my hotel to the convention center just before noon. I’ve been to San Antonio before and find it a beautiful spot, though flooded with tourists. I spent most of the afternoon in the exhibit hall since few educational sessions were on the agenda.

I did attend the MGMA Town Hall, which was led by MGMA-ACMPE President and CEO Susan Turney, MD. Much of the discussion centered on the hot topics that are keeping administrators awake at night, including the ICD-10 transition and possible SGR cuts. Turney stressed the important role of technology in the care process and for keeping practices financially healthy.

I was near the front of the pack to enter the exhibit hall when the doors opened at noon.

Aprima had a primo booth location, which was just inside the main exhibit hall entrance. Signage was all about offering a “lifeline to Allscripts customers.” I asked one of the Aprima guys whether they have been busy in light of the recent MyWay announcement. He was surprisingly guarded in his remarks and didn’t say much more beyond noting a bit of an uptick in interest from MyWay customers and resellers.

If this is how all Texas men look, I am moving South. Quite a few folks were wearing Western attire. I don’t know if that’s their regular look or just an enthusiastic promotion of the locale.

Thanks, McKesson, for the free water bottles that were placed right next to water coolers throughout the convention center.

I need to verify the exact number of exhibits, but I am guessing it is over 500. Significantly smaller than HIMSS, but still enough that I didn’t have a chance to see everything in the couple of hours I spent cruising the aisles. Vitera and Allscripts seemed to have the largest booths, though not necessarily the busiest. athenahealth, NextGen, and Greenway also had a big presence. I was surprised by the relatively small McKesson and Cerner booths.

Thanks to all the sponsors who were displaying signs in support of HIStalk. A few I noted include Vitalize, Iatric, Emdeon, Vitera, DrFirst, Capario, Sandlot, White Plume, Culbert, IMO, and M*Modal.

The supplemental exhibitor roster included a list of vendors that had cancelled, which I found a little curious. I don’t think MGMA was attempting to criticize them for canceling, but merely informing attendees not to look for these vendors.

Speaking of criticism, I spent a few minutes chatting with a company that offered a code search program. The woman showed me the software on her tablet and it looked user-friendly enough. When I asked her why I would search for codes using her program instead of through my EMR, she asked me what EMR stood for. Really? Her booth partner rescued her, but her response left me quite unimpressed with her company.

I have seen this knight before at other shows though I don’t recall what company he belongs to. He (she?) stands like a statue until someone gets close and then makes a sudden move to scare them. I wouldn’t get any closer than about six feet because I find the whole thing quite creepy.

No, these folks were not lined up try to win an iPad, nor to watch a magician perform his tricks. Instead, the crowd was hovering in front of a big TV watching Sunday afternoon football.

I’m always impressed with vendors can give a short and effective elevator pitch on their companies and products. A few standouts were Diagnosis One (clinical decision support tools), Q-Genda (scheduling), Iatric (privacy audits and more), IMO (clinical coding), and MedAssets (group purchasing.)

Seriously, how can anyone not love mariachis? This little band entertained the crowd at the opening reception. The reception was immediately following the opening keynote session by Erik Wahl, who spoke on ways to make organizations more productive and profitable – I missed it. The reception appeared pretty well attended, maybe because the drinks were free.

The food stations at the reception predictably featured quite a bit of Mexican food. I heard it was good but I didn’t try any.

That’s an ice sculpture, in case you couldn’t tell.

I saw lots of hot shoes throughout the day, of course. Even a few guys were sporting some great looks.

I was not the only one wearing my cowboy boots. Love the boot/skirt pairing.

I don’t have spurs for my boots, but must get some.

I am off to attend the Monday morning keynote session, which is a panel discussion on the state of the healthcare industry. Then I’ll spend an hour or so in the exhibit hall , followed by a few sessions this afternoon. I am  thrilled that my BFF Dr. Jayne scored a last- minute invite to attend, so we’ll be hooking up for some party hopping tonight.

If you have any session or exhibit suggestions, comments,  or pictures, send them my way!

E-mail Inga.