News 5/31/12

Gateway EDI announces it has signed its 100,000th client and expanded its client base by 19% over the last year.

HHS’s Office of Inspector General reports that use of the two highest-level codes for established office visits has increased by 17% over the last decade, while use of high-level codes for ER visits has risen 21%. The OIG attributes the increase in part to the jump in overall services provided to patients. Wider use of EHRs have also made it easier for providers to meet billing requirements for higher codes.

e-MDs customer Orlando Heart Specialists earns Bridges to Excellence Cardiology Practice Recognition for providing superior patient care and is presented with the Florida Health Care Community Award. The clinic’s administrator says the practice’s use of e-MDs has facilitated data evaluation and has been instrumental to the winning of the awards.

IDC Health Insights releases a report on the ambulatory EMR/EHR market for small practices and assesses 11 products from nine vendors. It’s hard to glean much from the press release and the full details are only available to subscribers. However, I agree with this warning from IDC research director Judy Hanover:

“If providers allow the constraints of meaningful use to dictate their technology choices and limit the goals for implementation, they may only see the short-term incentives and not the long-term strategic advantage that EHR can bring to their practices and may fail to compete under healthcare reform.”

Hayes Management Consulting announces that its MDaudit software provides an E&M bell curve reporting module to help organizations identify providers who are consistently coding higher than their peers.

Over the last couple of months I have switched almost all my bills to online payments. I must say I am loving it and wondering what took me so long to get on board. I have established paperless billing with as many vendors as possible and appreciate the convenience of direct links to make payments, the auto-reminders, and the absence of paper, envelopes, and stamps. No surprise, but physician offices are way behind other industries in terms of offering online bill payment. For interested practices, American Medical News presents three options for establishing online bill payments for patients, including the relatively simple and cheap option of PayPal.

Premier Bone & Joint Centers (NE/WY) select SRS EHR for its 10 physician practice.

gloStream introduces gloSuite v7, which includes a practice portal for physician communication, secure direct messaging, and an option to run on an iPad.

E-mail Inga.

Readers Write 5/29/12

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!

Health Informatics [helth in-fer-mat-iks]: The Next Generation
By David Wellons

In Aaron Bordofe’s excellent article on May 15 discussing healthcare informatics, he accurately describes the struggle I’ve had defining and developing solutions that provide answers to improving information flow in healthcare so that it benefits the patient, provider, and payer.

I was the director of healthcare marketing for a large telecommunications company. From my prior decade of HIT experience in PMS/billing, EMR/PHR, and QM/UM/CM/DM systems, I worked on solutions for the NHIN and RHIO structures in the 1998-2006 timeframe. Those RHIO concepts have evolved into the current health information exchange (HIE).

One issue I then struggled with was the answer to a simple question. If my entire medical history from all 25+ disparate providers I’ve seen during my life was available in electronic format, just what meaningful clinical information would need to be displayed to a provider seeing me for the first time? What information would they be willing to wade through in order to treat me?

My conclusion was this: show them my current diagnoses, current medications, and recent vital signs. That would give them a starting point as a basis of treatment. My tonsillectomy at age 5 would not be of interest.

I still felt that something was missing from this data mix. I have only recently discovered the answer: provide the doctor with care and treatment opportunities based on my analyzed clinical information.

What if the system displaying the data to the provider also analyzed the data and, noting a diagnosis of diabetes, calculated that I had not had a foot exam and A1c and microalbumin tests in the last 12 months, and prompted the provider to perform them? I would get better care and the provider would have the incentive to review my consolidated record because it would allow them to practice better medicine and would present revenue opportunities to them. The payors would not object since, in the long run, their members would be healthier.

Where would I get reliable, meaningful clinical information that my caregiver and I could use to improve my health? First and foremost would be the EMR systems of providers, available through HIE networks and direct interfaces. Natural language processing (NLP) could be used to read transcribed notes, extract additional data values, and add lab and pharma data to complete the record.

Claims information would be a source of last resort. It would be used only to round out the record due to its great latency in receipt and unreliability as a source of accurate medical information.

Then, perform the analytics and display it to the provider.

The benefits of such a system to all three parties in healthcare would be immense. Add to this the ability to compile and monitor the progress of patients with certain disease states across all caregivers and our overall national health levels would benefit greatly. Another major benefit would be the measurement, reporting, and statistical capabilities that are a natural by-product of such a solution to support PCMH and ACO programs.

David Wellons is a 25-year veteran of the HIS industry involved in sales, marketing, and product development of solutions for payers and providers.

News 5/24/12

Humana notifies physicians and other providers of a system glitch that led to the rejection of 450,000 claims submitted through the Availity clearinghouse. The claims were originally submitted between April 26 and May 10 and rejected after Humana asked Availity to begin enforcing a new 5010 claims edit for linking diagnosis and procedure codes. CMS, however, recently announced it would reevaluate this particular edit requirement. Humana has now instructed Availity to relax the edit until CMS issues new guidance; the insurer also advises providers to resubmit any rejected claims.

Epocrates leads the market in the digital medical category, according to a Manhattan Research study. More than half of physicians use the app on a daily basis with drug references the most commonly accessed tool.

EMR/PM provider Cloud MDs signs a letter of intent to acquire Doctors Network of America, a Mississippi-based provider of physician billing consulting services.

Four Tennessee orthopedic practices agree to participate in a bundled payment system with BCBS of TN. The program will provide a set payment for an entire episode of care for total knee and hip replacements, including surgery, post care, and physical therapy. The TriZetto Group will supply a range of program components to support the payment bundling solution.

Lakeland Healthcare Group (IL) selects Merge Healthcare’s radiology solutions for its radiology practice.

The New York Times looks at the increasingly popular “direct primary care” model, which  is similar to the concierge model but less expensive. The article profiles Qliance, a direct primary care clinic in Washington state that charges patients $59 a month for unlimited doctor visits, 24-hour email access to medical staff, and same-day or next-day appointments.  That’s considerably less expensive than the $1,000-$2,000 per year fee charged by concierge practices for similar services. Call me a cynic but it sounds like the main difference between the two models is price. Of course the “direct primary care” label is probably more appealing to the masses, who may perceive that “concierge” practices are only for the wealthy and elite.

Pennsylvania Governor Tom Corbett announces that the state’s Medicaid program will begin covering telemedicine services to include consultations between patients and all physician specialists, who will be able to remotely diagnose patients, recommend and monitor treatment, order tests, and prescribe medication.

E-mail Inga.

News 5/22/12

From FastCar: “Re: drchrono. After almost selecting Practice Fusion, we are now considering drchrono. Our doctors like that it runs on the iPad and the billing and EHR are integrated. To get all the functionality we need will cost $400 a month per doctor. Do you have any readers that might be able to share any insights on the company or product?” Readers?

E-prescribing rates continue to rise, with adoption by office-based physicians hitting 58% by the end of 2011. Adoption rates were highest in smaller practices of six to 10 physicians (55%) and two to five physicians (53%.) Forty-six percent of solo physicians now e-prescribe compared to 31% at the end of 2010. Adoption rates were highest among internists (81%), endocrinologists (78%), cardiologists (76%), and family practitioners (75%.)

Vitera Healthcare Solutions appoints Shantanu Paul (Allscripts/Misys) SVP of product development.

EHR provider Pulse Systems completes its move to a new 24,000 square foot office in Wichita, KS.

Las Cruces Orthopaedic Associates (NM) selects the ChartLogic EHR Suite for its five-physician practice.

After a three-year decline, AMA membership grew about one percent in 2011 to approximately 217,000 members, including 8,577 first-year residents who were granted free memberships. The association also reported a 3.35% increase in profits to $24.8 million.

The 90-physician Illinois Bone and Joint Institute implements several Web-based documentation solutions from Emdat, include Emdata Mobile and ShadowScribe speech understanding technology.

Dr. Oz and 75 medical students perform physicals on 1,000 Philadelphians in an hour and enter results into Practice Fusion’s EMR. Practice Fusion then compared the results with data from other large cities. In addition to raising health awareness, the Dr. Oz Show episode underscored the impact an EHR, combined with data analytics, can have on public health. More than two-third of the Philadelphians, by the way, were overweight and almost half had high blood pressure.

ONC announces the Ocular Imaging Challenge, a contest to encourage the development of applications that improve interoperability among office-based ophthalmic imaging devices, measurement devices, and EHRs. I recall from my vendor days that the lack of device integration was biggest EHR adoption barrier for ophthalmologists, so I applaud this initiative. The winning development team takes home a $100,000 award.

A healthcare attorney suggests that physicians ban the snapping of smart phone pictures by patients and declare their practices “picture-free” zones. He argues that a no-photos policy reduces the risk of violating other patients’ privacy. My opinion: ridiculous. While I appreciate the privacy concerns, I have spent a considerable amount of idle time in waiting rooms and exam rooms over the last couple months. Once I have checked e-mail, read an article or two, and caught up on my latest Scrabble game, my iPhone camera has allowed me stay amused while snapping pictures of paper charts, nurses’ shoes, and ancient desktop PCs. We’ve become a society addicted to snapping pics to document our every activity, especially if we have extra time on our hands. Maybe I’d have a different opinion if doctor office visits involved less waiting.

E-mail Inga.

DOCtalk by Dr. Gregg 5/19/12

Data Tsunami and a 9-Year-Old

Two recent stories on very different topics from two very different sources sort set off some strange sounding sirens of synchronicity in my cerebrum recently.

The first was a post on PhysBizTech.com entitled “The Data Tsunami,” written by Medicomp’s CEO, Dave Lareau. The second was from Inc. com entitled “What a 9-Year-Old Can Teach You About Selling,” written by Tom Searcy, author, consultant, and large account sales expert.

The former was all HIT. Dave discussed the fact that the first phase of health data collection is well underway. It’s sort of like the recession of the ocean just before a giant tidal wave rolls in and inundates everything in sight. The tsunami itself will be washing through as health information exchanges (HIEs) really start to exchange health information… in a meaningful way, that is.

Dave contends (and I agree) that HIEs and standards such as SNOMED, LOINC, HL7, ICD –XX, etc., will soon bring about an inundation of our clinical shores with tidal waves of data. Providers, as well as most current EHR/EMR systems, are ill prepared to contend with this pending onslaught. His take home is all about the need for efficient tools to help end users actually understand and contend with all that data. If the flood of newly accessible data isn’t managed, if it isn’t provided to providers with something I’ve previously called “Meaningful Views”, then the data tsunami will surely send us all out, head over heels, lost and adrift, into our newly created “Sea of Stats.”

The latter blog post I mentioned, the one by Mr. Searcy, was centered on selling, but I found it just as fitting for HIT. The article’s tagline was, “If you want your conversations to have real impact, you need to simplify your message.” He uses his innocent young daughter’s probing, though simplistic, questions to illustrate the need for clarifying and keeping messaging simple. In order to help buyers who may lack context (and the seller’s expertise) to truly understand the messages you are trying to convey, simple messages work best. He provides some great examples and I highly recommend reading his short and sweet missive to gather the full flavor. As he points out, both complex messages and simple messages may each be accurate, “but that doesn’t make them right.”

Doing a little two-and-two work seems pretty apparent when you put these articles side by side. That is, in the coming data-drenched world that HIT and HIE are bringing, if we don’t keep true to meaningful views for providers, we’ll all drown in a meaningful-less mess of metadata and it’s mother at the bottom of an ocean that’ll make the Marianas Trench look like a mud puddle.

To follow Mr. Searcy’s advice, we need to keep it Stupid Simple, at least on the surface. Users don’t need to know – and don’t really care – about all the under-the-covers complexities. We just want our meaningful views via those efficient tools mentioned by Mr. Lareau.

From the trenches…

“Most of the fundamental ideas of science are essentially simple, and may, as a rule, be expressed in a language comprehensible to everyone.” – Albert Einstein

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 the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).