DOCtalk by Dr. Gregg 8/17/12

The Gray Lining of the Cloud

The battle rages of cloud versus local host – within the blogosphere, within the EHR sales pitch wars, and within my own little brain. As it does, I came across (or rather, am suffering from) a side of the cloud I have never heard discussed.

We still locally host our EHR. Since we do, I have to keep my Secure Sockets Layer (SSL) license updated (i.e., paid for). If I don’t, our system isn’t accessible and we are back to digging out pens and paper until I pony up the dineros and await the certificate. Fortunately, I have always gotten our SSL renewed on time — though sometimes just barely — and we have remained live.

But what happens when your cloud service provider doesn’t renew their SSL license? Well, we found out about that this week.

Despite my best current local hosting efforts, not all can be maintained within my little realm. For instance, ePrescribing is beyond my control freak domain. I know this because the parent company who now owns my EHR, and who has full dominance over my ePrescribing connectivity, let their SSL license relative to this capability lapse.

Did I get an e-mail or phone call or any notification that ePrescribing was down? I did not. I found out after repeated attempts to send e-scripts were rejected and after calling the VAR who supports me.

Yesterday, our VAR told us that ePrescribing was down system-wide because of said parent company, but would be back up by the evening.

This morning, guess what? Yup. No ePrescribing. And still no e-mail, call, or fax to notify us of what was going on.

Another call to our VAR led me to the inside scoop: our dear EHR vendor had failed to renew their SSL license pertinent to this ePrescribing component in time before the license expired. In fact, so I was told, their SSL license had lapsed three days earlier.

So here we sit with the old prescription pads, penning away prescriptions just like the old days. I’m still paying for my EHR and the support thereof, but one major tool we use every day – many, many times every day – sits idle because someone “out there,” somewhere in the ethereal cloud world, didn’t pony up on time like I always have to do. Something doesn’t seem right about this, does it?

There is definitely a gray lining to the cloud.

From the trenches…

“Behind every cloud is another cloud.” – Judy Garland

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 8/16/12

From DrLyle “ACE 2012. It’s their largest ACE ever with over 4,000 attendees and Mayor Rahm did a special keynote. Glen’s opening address focused on how Allscripts is philosophically and technologically becoming an open system.” Allscripts also unveiled plans for a telehealth solution that integrates the American Well Online Care platform with Allscripts EHR. The announcement was a little unclear as to whether the solution is for the inpatient EHR or ambulatory (or both,) but the integrated product won’t be generally available until early 2013. If you are at ACE, I’d love an email with any updates or cool pictures.

From PairOfAces “Heard that ACE Hardware is having a convention in Chicago at the same place as Allscripts this week.  I’m sure that will present some interesting challenges to Allscripts and the attendees at their conference.” Funny. Both ACE conventions are at Chicago’s ginormous McCormick Convention Center, though in different buildings. The hardware guys, by the way, are being treated to a Rascal Flatts concert, which sounds more much more fun than Allscripts’ trip to Navy Pier.

A Vitera Healthcare Solutions study finds that 91% of doctors want a mobile EHR solution, yet only six percent connect to an EHR through a mobile device. The survey also found that 55% of healthcare professionals used mobile devices to email, phone, text, or send other communications, but only 20% used for medical research on the go.

Fayetteville Medical Associates (TN) selects PatientPoint’s care coordination platform for population management for its PCMH practice.

Harris Corporation will expand Florida’s HIE secure messaging service to 11,000 physician offices that use Care360 solutions from Quest Diagnostics.

We’ll be running a new HIStalk Practice Advisory Board series soon. If you have any burning questions you’d like our expert ambulatory healthcare professionals to answer, please send them my way.

E-mail Inga.

News 8/14/12

The Surgeons of Lake County (IL) announce that an unauthorized user hacked into their computer system, encrypted the server, and demanded money in exchange for the password to regain access the EMR and corporate e-mail files. The practice refused to pay the ransom and instead turned off the server and contacted law enforcement. It’s unclear whether the practice had a backup, but the server remains unplugged. The practice believes the intent of the authorized access was to extort money rather than obtain patient information.

Southern Oregon Orthopedics selects the SRS EHR for its 18 providers.

GE Centricity reseller HealthCo Information Systems partners with Shareable Ink to offer an integrated Centricity EHR/Shareable Ink Ambulatory Record solution to HealthCo’s 600 physician practice clients.

Greenway Medical Technologies reseller iPractice Group expands its direct sales force with the addition of five representatives covering nine new states. iPractice, by the way, announced in June that it had secured $32 million in additional funding.

drChrono adds a  two-factor login authentication feature using technology from Authy.

A journal article says that because medical schools lack educational mandates and guidelines on how to educate students on EHR usage, some institutions may not be providing adequate training. The Alliance for Clinical Education is pushing schools to teach students to document patient charts, practice order entry in an EHR, understand decision aids that typically accompany EHRs, and develop a set of student competencies related to EHR charting.

EHR/PM provider Pulse achieves full accreditation with the Healthcare Network Accreditation program from EHNAC. While looking at Pulse’s Web site, I noticed that if you view their EHR demo in person you can register to win a “$10,000 dream vacation.” I may need to get my ticket punched at MGMA.

Amazing Charts launches a cloud-based version of its EHR, with pricing starting at $100 per month for a single user and $300 per month for up to five users. Amazing Charts also offers a 28-day free trial.

Medical billing and PM services company Orion HealthCorp signs a two-year agreement with GeBBS Healthcare Solutions for its RCM services.

Outpatient physician imaging practice SimonMed selects Merge’s radiology suite, along with iConnect Access for DICOM image and XDS viewing and iConnect VNA for vendor neutral archiving.

The Chico, CA paper talks to several eClinicalWorks clients about the perks and and problems with the move to EHR. Craig Corp MD describes the move as  “a long process with a steep learning curve” that cost his practice “quite a bit, both in the purchase of the equipment and software to run it.” He also adds that “in the long run it will be of great benefit.” Roy Bishop MD notes that MU incentives have motivated many providers to adopt EHRs and that the remaining holdouts are resisting because they fear change.

E-mail Inga.

Healthcare Informatics 8/10/12

Meaningful Use Attestations Show the Rich Get Richer

Meaningful Use charts and graphs are a dime a dozen these days. As much as I’d like to add another bar or delicious pie chart to the mix, I just can’t bring myself to do it. I have no reservations about creating maps from the data, though.

For the uninitiated, GeoCommons offers a convenient way (despite a few errors) to do some quick mapping. Find my map with the datasets I loaded here if you wish to follow along or play around with it yourself.

But back to Meaningful Use.

As you can see, the vast majority of attestations are coming from what we know to be highly populated areas. However, there are a few exceptions in places like Duluth, Minnesota, which is not known to be a bustling metropolis. To help explain some of these, I brought in another data set: the locations of the HIMSS Stage 6 and 7 Hospitals. Yes, yes, I know these are EP attestations and I’m bringing in hospitals, but the vast majority of those attesting are connected with larger hospital organizations.

Loading in the locations of the Stage 6 and 7 sites, you can now see that a lot of those little exceptions are taken care of. Duluth, Boise, Hays, etc. There are still exceptions, but a lot fewer than before. Many of the HIMSS top stage sites also come from densely populated area. HIMSS has this to say about their Stage 6 users in particular:

The total revenue metrics for Stage 6 hospitals ranged from a little less than $100 million to over $1 billion.

And this:

The average ratio of IT capital budget to IT operating budget for this group is 30 percent.

In other words, these are all places making a lot of money and devoting a lot of money to their IT budgets.

Why is this relevant? Meaningful Use is supposed to encourage those physicians that wouldn’t already be moving to an EHR to get one. Instead, those organizations that are already technologically advanced and making a lot of money are the ones doing the attesting.

Maybe there’s a correlation, then, between EHR using communities and overall health. The goals of Meaningful Use specifically included alleviating health disparities and improving outcomes. Let’s compare the attestations with the top 10 healthiest cities according one survey.

Some alignment exists. Maybe the vendors are right – EHRs really do mean better health. Let’s compare with the top 10 unhealthiest cities, though.

Hmmm, more alignment. So the use of an EHR in a community matches the healthiest and unhealthiest communities? Time will tell if health outcomes actually improve with Meaningful Use, but let’s give it the benefit of a doubt and say it does for second. Shouldn’t the incentives be going to the rural areas and those that don’t have a big IT budgets? Right now, it just seems that those rich with big IT budgets and progressive technology are just getting … well, richer.

Feel free to add your own data sets and see what you come up with.

Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s Medical and Practice Management Suite and EHR design and development.

News 8/9/12

The 20-location Physicians Immediate Care LLC contracts with Practice Velocity for its VelociDoc EMR and PM software.

CareCloud hires former Practice Fusion and athenahealth exec Edwin Miller as VP of product management.

Dr. Dennis Gottfried of the University of Connecticut Medical School provides some straight talk about ambulatory EMRs, which he says are expensive, time-consuming to implement, and decrease office efficiency. He also notes that because EMRs produce more complete documentation, they raise healthcare costs since better documentation allows physicians to charge more for the same services. An excerpt:

The theoretical benefits of an electronic record are not matched by its actual performance-a performance that increases costs but detracts from clinical efficiencies and does nothing to improve patient outcomes. Although the adoption of EMRs is one of the few health care measure to enjoy bipartisan support, the technology is not good enough to warrant that enthusiasm.

Allscripts reports its Q2 results, which were below analyst estimates: net income of $8 million ($0.04/share) from $15.9 million ($0.08/share) a year ago; revenues of $370 million compared to $357 million last year. The company also lifted its adjusted EPS outlook for 2012 to $0.77 to $0.83/share; previous guidance was $0.74 to $0.80/share.

NoteSwift announces the availability of NoteSwift for Allscripts MyWay EHR. I’ve never seen the technology, but apparently NoteSwift works with Nuance’s Dragon Medical Practice Edition to capture the entire patient visit. If you are going to the Allscripts ACE convention next week in Chicago check out a demonstration of NoteSwift with Allscripts Pro or MyWay and let me know what you think.

MED3OOO customer Family HealthCare Network (CA) receives more than half a million dollars in EHR incentive payments using InteGreat EHR.

Occasional HIStalk Practice contributor Dr. Lyle Berkowitz provides some expert commentary in a Wall Street Journal article evaluating various telemedicine service providers. Berkowitz’s bottom line is that telemedicine services can be convenient for quick consults but should not replace treatment from a patient’s own health system.

Email Inga.