News 8/28/12

From Sleepless “Re: Practice Wise. Julie McGovern’s ‘One Project at a Time’ article was great! If only the business world really would acknowledge how much disruption it creates and the resulting levels of frustration.” Sleepless is referring to Julie’s recent post, which addresses the hard work of EHR implementations and how clinics would be prudent to avoid tackling multiple large initiatives simultaneously. She offers some great tips, beginning with:

If other initiatives must be tackled, try to stage the projects to preserve the sanity of everyone involved.

The one-year delay for the ICD-10 code set is confirmed by HHS Secretary Kathleen Sebelius and the new compliance date is October 1, 2014. Following the announcement, MGMA expressed concerns that HHS didn’t undertake due diligence to ensure ICD-10 won’t disrupt cash flows and recommended additional ICD-10 pilot testing before a full roll-out. Meanwhile, the AMA issued a statement recommending “CMS delay the move to ICD-10 by a minimum of two years.”

RCM provider ZirMed hires Kenneth Willman (Humana) as VP of payer solutions and strategy.

I read this profile on startup HealthTap and am not convinced of the model’s viability. HealthTap allows patients to pay $10 to have a secure, private conversation with a physician in a format similar to email. Patients can share documents and images and the doctor then analyzes the case. The patients can choose a physician to engage with “out of a million” in HealthTap’s database (or 14,000 licensed US doctors.) I understand how this could be attractive to a patient, though I have to wonder what kind of doctor would be willing to participate. The company says their site allows physicians to use their knowledge to “build an image” and as a business development tool. I thought we were facing a doctor shortage, not a patient shortage, so how many physicians – particularly quality primary care doctors – really need to recruit more patients? What am I missing?

Emdeon expands its Clinical Exchange solution to include e-prescription routing, lab orders and results exchange, care alerts, medication history, and clinical messaging.

More evidence of telemedicine’s growing popularity: in a survey of 440 mid to large size firms, 9% indicated they had plans to offer telemedicine consultations in 2013; another 27% are considering them for 2014 or 2015.

simplifyMD adds billing software provider Healthpac as a reseller for simplyMD’s EHR.

Seventy-five percent of 21,000 physicians participating in a Medscape survey say they use an EHR system, while an additional 20% plan to adopt one in two years. That sounds high to me, but adoption is no doubt trending up. The top-ranked EHRs among smaller practices were Amazing Charts, VA-CPRS, and Practice Fusion, while groups with 25 physicians or more favored VA-CPRS, Epic, e-MDs, and Medent. The most widely used EHRs were Epic, Allscripts, and Cerner.

Last week on HIStalk we mentioned some key items from the Stage 2 MU final rule, which was published last week. A few items impacting EPs include:

• Stage 2 will begin in 2014, a full year later than the date published in the original ARRA legislation. Providers have two years after achieving Stage 1 to achieve Stage 2.
• Providers don’t have to achieve Stage 1 MU until 2017, though Medicare penalties will begin in 2015.
• EPs have a new core measurement requiring at least 5% of patients seen by the EP to use secure messaging to communicate health information.
• Hospital-based physicians who can demonstrate they funded the purchase, implementation, and maintenance of an EHR without reimbursement from the hospital and use the EHR in place of the hospital’s EHR can apply to receive a MU payment.
• Certain physicians that don’t have a lot of face-to-face time with patients can apply for an exemption to the MU program to avoid Medicare penalties. Exceptions are also possible for physicians that live in geographic areas without sufficient Internet access and those subject to unforeseen circumstances, such as natural disasters.

E-mail Inga.

Practice Wise 8/26/12

One Project at a Time!

We as a human race are experts at creating our own chaos. Just check out the news on any given day for proof. Less publicly advertised is the chaos unfolding in clinics and hospitals all over the country as they make the move to EHR.

What I find most intriguing is the clinics who also decide it’s prudent to simultaneously tackle other large projects and initiatives. EHR implementation is hard work, just in case you’ve not been down this road yet. It is incredibly disruptive to all organizations. Processes may not radically change, but determining how those processes will be performed takes much thought and effort every time you perform them.

If other initiatives must be tackled, try to stage the projects to preserve the sanity of everyone involved.

Some things to consider when doing an EHR implementation:

1. If you plan on doing a clinic remodel (which might be necessary to accommodate computers and new workflows), do that prior to implementation, not the week of go-live. It’s stressful to move computers around after a day of using a new system. Even having the computers in a different place the next day can cause disorientation and confusion for all users.
2. If you plan to replace your phone system, consider that these, too, are computers. You’ll be learning to use another new tool with complex processes, which can take away the ease of answering a call and putting it on hold. This is another frustration point and can be exasperating. Don’t over exasperate yourself!
3. New computer hardware, and operating systems are likely a must-do item for your implementation. Do not order your new systems to arrive right before you go live on EHR. Your staff are not likely to be network engineers, and the differences between Windows XP and Windows 7 — soon to be the completely different Windows 8 — or Office 2003 and Office 2010 are so vast, it’s another point of disorientation for the staff. There is a learning curve involved in these upgrades, and clinics rarely consider additional training for operating system and Office product upgrades. We all just assume we can figure it out on the fly. This is a bad decision. The loss of productivity when employees are trying to figure out logins (user name requiring a domain\user configuration in W7) has kept staff from being able to log in to their computers. If you are doing a major system upgrade of computers, consider this another implementation and treat it as such. Get training!
4. Other initiatives such as Patient Centered Medical Home may be part of the reason you are moving to an EHR. However, trying to meet all the goals and measures of PCMH at implementation is not realistic. Don’t set yourself up to meet some reporting deadline within the first month (s) of your EHR installation.

EHR implementation can be compared to being pregnant. There is a beginning, middle, and end. In the beginning, you are tired and often feel like you have morning sickness. The first trimester is the hardest. In the second trimester, you start to get your legs under you, your energy starts to return, and you feel less beaten down by the EHR. By the third trimester, you start to see the light at the end of the tunnel, it’s starting to be second nature, the product is making more sense (hopefully), you’ve got good workflows and everyone is starting to forget how hard the first trimester was.

If you are going to tackle multiple projects and initiatives, consider doing them before you get pregnant if they are pertinent to a healthy pregnancy (buying computers for the EHR), or else wait until your third trimester or later when you can handle the extra burden gracefully.

Don’t create more chaos than you’ll already have with your EHR implementation!

Julie McGovern is CEO of Practice Wise, LLC.

News 8/23/12

Walgreens plans to deploy the WellHealth EHR, built upon Greenway Medical Technologies’ EHR platform, to nearly 8,000 stores over the next year. The WellHealth EHR platform, which is already installed at 200 sites, provides pharmacy staff with a single patient view of immunizations, testing history, and prescription history.

CMS selects 500 primary care practices across seven regions to participate in the Comprehensive Primary Care initiative, which will pay primary care practices a care management fee of $20 per month per beneficiary to support enhanced coordinated services on behalf of Medicare FFS beneficiaries. Participating practices were selected based on their use of HIT, ability to demonstrate recognition of advanced primary care delivery, and participation in practice transformation and improvement activities.

CPU Medical Management, a division of MED3OOO, announces a vendor partnership with eBridge to offer a combined PM and document imaging solution.

Quest Diagnostics certifies Meditab Software’s Intelligent Medical Software as a Gold Health IT Quality Solution that provides a streamlined and interoperable solution with Quest’s lab orders and results.

If you are a physician, you are more likely to experience symptoms of burnout than individuals in other professions, according to a study published in the Archives of Internal Medicine. Of 7,299 physicians surveyed, almost half claim to be emotionally exhausted or feeling a high degree of cynicism, or depersonalization toward patients. The specialties with highest burnout rates are emergency medicine, family practice, and internal medicine.

Mobile health app store Happtique pilots mRx, a solution that enables physicians to prescribe medical, health, and fitness apps to their patients. Physicians and licensed health practitioners, such as nurses, dietitians, and therapists can select apps to prescribe and Happtique will track how many times patients clicked the “fill” button after an app prescription is sent. App usage, however, will not be measured, nor will clinical outcomes. My take: sounds fun but it won’t take long for patients to lose interest.

E-mail Inga.

Readers Write 8/21/12

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Note: the views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

Staying HIPAA Compliant in the Age of Mobile Devices

Healthcare is rapidly increasing its use of electronic devices. A recent survey found that more that 80% of physicians use mobile devices, such as laptops, smart phones (including Blackberrys, iPhones and Androids), and even iPads or tablets in conjunction with their delivery of patient care.

However, smart phones and tablets are particularly vulnerable to a breach of protected health information (PHI) as they are small and can easily be lost or stolen. Also, while laptops or desktop computers are typically property of the medical practice, physicians are more likely to use their personal smart phones or tablets when transmitting electronic PHI. HIPAA permits physicians to use these methods of communication when transmitting PHI so long as they reasonably and appropriately safeguard the information.

So what does this mean for doctors and how can they ensure they are HIPAA compliant? There are several simple ways to provide protection:

• Lock your mobile device and require password protection. Unlike most office computers, smart phones are less likely to be locked when left alone. Any mobile device being used to transmit PHI should be locked when left alone and programmed to automatically lock after timing out. Additionally, the device should only be accessible by a unique password, prohibiting unauthorized access.
• Enable encryption. Encrypting your device can prevent the loss of electronic patient PHI, along with your own personal data.
• Determine if the device can be remotely disabled. Some mobile devices have the capability to be remotely locked in the event they are lost or stolen. This can prevent PHI data breaches if the device ever ends up in the wrong hands.
• Avoid using public Wi-Fi networks and disable file sharing. Public Wi-Fi networks increase the risk of exposing PHI because anyone with the right software could gain access to your device. When using a mobile device, use a secured connection or password- protected Wi-Fi network. Additionally, disable wireless sharing to prevent inadvertently sharing PHI files with others.

This list is certainly not exhaustive, but highlights a few simple means of protecting electronic PHI stored on or transmitted by mobile devices. Implementing these safeguards can help ensure you are HIPAA compliant while still maintaining the ease and convenience of mobile devices.

Jessica Shenfeld, Esq. is the founding partner at The Law Office of Jessica Shenfeld, a boutique law firm that caters to physicians’ legal needs. She is also CEO of EHR Incentive Help, Inc., which helps physicians satisfy the Meaningful Use criteria and apply for the Medicare/Medicaid EHR Incentive benefits.

News 8/21/12

Epocrates announces plans to offer US medical students its Epocrates Essentials drug, disease, and diagnosis reference product for no charge.

Virginia Physicians selects eClinicalWorks EHR for its 58 providers across eight locations.

River Ranch Radiology (TX) implements RadNet’s eRAD RIS.

The Franciscan Hammond Clinic(IN/IL) and Quincy Medical Group (IL/IA/MO) select SA Ignite’s MU Assistant to automate MU reporting. Franciscan’s 47 providers use Allscripts Enterprise EHR; Quincy’s physician utilize McKesson Horizon Ambulatory Care EHR.

For the fifth consecutive year, Hayes Management Consulting earns a spot on INC 5,000’s List of Fastest Growing Companies for 2012.

The number of visits to retail clinics increased fourfold from 2007 to 2009 with an estimated 5.7 million retail clinic visits in 2009. Almost half of all visits were on weekends or during weekday hours when physician offices were typically closed. Retail clinics still represent a small share of the overall visits in outpatient settings, however, as ERs handle 117 million visits annually and physician offices manage 577 million visits.

Sentara Healthcare (VA) partners with telehealth firm MDLIVE to offer virtual medical consults from its network of physicians beginning in October. The deal also gives Sentara an ownership stake in MDLIVE.

Capario launches an integrated patient pay solution in partnership with TransFirst that facilitates the collection of patient payments, including co-pays, deductibles, and balances after insurance has paid.

The amount of money spent on medical practice mergers and acquisitions continues to climb, with $4.2 billion exchanged on 21 practice M&As in Q2. Hospitals in particular are interested in buying practices to control their referral sources and monitor care quality as hospitals begin to be penalized for readmissions.

The top reasons that doctors working in large independent and hospital-owned groups look to change jobs: financial security, dissatisfaction with current environment, and significant lifestyle changes, such as spousal job loss or personal or family financial strife. Physicians say that student loan repayment is their major source of financial stress.

The 12-physician Orthopaedic Associates of Central Maryland contracts with ChartLogic for its EHR suite. I discovered when I went to the practice’s Website that they have a somewhat annoying “jingle” that plays when you enter the site.  Annoying, yet effective, I suppose since I have been humming mdbonedocs.com all afternoon.

PracticeMax, a provider of practice management services for physician practices, announces the retirement of Rick White as president and the promotion of Patrick Lukacs (above) from VP of software services to VP of operations.

E-mail Inga.