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).

HIStalk Practice Interviews John McConnell

John McConnell is president and owner of McConnell Golf. He co-founded Medic Computer Systems (acquired by Misys in 1997 for $923 million, now part of Allscripts) and was chairman and CEO of A4 Health Systems (acquired by Allscripts in 2006 for $272 million). 

You left Allscripts and the HIT world four years ago. What have you been doing since then? 

I started McConnell Golf in 2003 when I purchased Raleigh Country Club while also being CEO of A4 Health Systems. After that company’s sale to Allscripts in 2006, I wanted to pursue a new industry challenge and have focused on growing McConnell Golf. Today we own eight clubs and employ over 500 people. McConnell Golf  hosts the Wyndham Championship, which is a PGA event at one of our clubs in August,  as well as a Nationwide Tour event in June.

Do you think today’s business and HIT environment could support startup companies similar to the ones you built with Medic and A4?   

There will always be room for new companies and new products. At Medic, we developed most of our products when I was with that company. At A4, we were much smaller than Medic and other competitors, so we acquired other businesses with established technology in order to get to market faster at lower costs. 

I see the same opportunities today for smaller businesses to be acquired by larger HIT entities due to time and the research and development investment required to create and execute on new ideas. On numerous occasions, I am asked to review new products that small startups are developing, and many are very good ideas that can fulfill a niche in HIT. Certainly I think developing large-scale, enterprise-wide solutions would not be the best place for small companies to invest and compete today.

If you were starting an HIT company today, what area would you choose?  

Analytics. Information from the various HIT systems tied together to help reduce costs, eliminate service redundancy, identify fraud, and improve patient care will be huge.

Is healthcare software becoming as commoditized as hardware? 

Most mature systems are very comparable today, and I see a continued lower-margin business for most of the vendors in their software sales. Service revenue is the future for most HIT companies, which is similar to how IBM moved from hardware into consulting as margins in their historic business eroded. 

The same business rules apply today as in the past. Those companies that can gain customers with efficient marketing and implement their solutions in a timely and cost-effective manner will gain market share. Pricing will continue to drive a lot of buying decisions. Web-based solutions are quicker to build, implement, and maintain, so lower pricing should be the norm for the customers.

What are the good and bad aspects of Meaningful Use? 

I think Meaningful Use will help control the ongoing rise in healthcare costs going forward if it is given time to succeed. Having greater automation and less paper will be good for everyone. Technology helps reduce costs and errors in delivering healthcare services, so those are positive benefits. 

Bad aspects may be that caregivers spend more time documenting and looking at computer screens than with the patients. I also see the trend for the older physicians to retire sooner than later as their reimbursements are reduced further by not implementing technology.

Who in the industry do you really admire? 

My top three in no order of preference are Neal Patterson from Cerner, as he had a long-term vision for HIT and never let the Wall Street crowd interfere with it. I admire Judy Faulkner at Epic because of her emphasis on software, company culture, and maintaining the private company status. Patrick Hampson at MED3OOO  has reinvented that business at least three times from its founding in 1995 to adapt to industry dynamics, so that takes sincere leadership skills.

What ugly lessons did you learn running publicly traded companies? 

The biggest issue that I found for myself personally was that I started managing the business to meet Wall Street expectations instead of our customer ones. Each quarter end became challenging for our business and employees because of the pressure and pride we felt not wanting to lose any money for investors that bought our stock. Quite honestly, that caused us to make some poor business decisions in granting discounts or other incentives to our prospective customers at quarter end that we most likely would not have offered as a private business. 

Today I sit on one public board, and the government regulations now in place for public companies are very challenging and expensive to manage. Personally, I also see more investors looking for short-term results in stocks that they buy instead of valuing the company’s long-term potential. However, even with the negative issues that I have outlined, public markets provide valuable capital to businesses to grow to new levels that benefit many.

Allscripts is in the midst of a rough patch with its recent board turnover, missed earnings, and drop in stock price. Do you think this is just a bump in the road or do you predict more turmoil in coming months? 

I have been off the Allscripts board since 2008, so my familiarity with the business is not very current. Their management team has certainly built an impressive business in both revenues and customers, so they enjoy a very strong position in the industry.

Integrating large acquisitions and different product lines in a short period of time will be challenging for any company. That is most likely the major reason why Allscripts recently hit a bump in the road in their business financial results and significant loss of shareholder value. With any board, you often have diverse opinions on the business strategy to pursue, so that can create major conflicts among its members.

News 5/17/12

Emdeon reports its Q1 results: revenue of $286 million, up 5.4%; net loss of $17.3 million versus profits of $7.3 million a year ago. The company attributes the loss primarily to costs associated with taking the company private when PE firm Blackstone Group purchased Emdeon last year in a $3 billion deal.

Kareo releases enterprise-grade claim scrubbing technology that checks for claim errors in real time as billers enter procedure and diagnosis codes.

The MGMA-ACMPE asks HHS to consider a six-month extension on the June 30 deadline for submitting hardship exemption requests to avoid 2013 e-prescribing penalties. The organization says practices need more time to assess their success in reporting for the first several months of 2012, when many practices were facing claim rejection problems associated with the 5010 transition. MGMA-ACMPE also requests the creation of an appeals process to contest past and future CMS prescribing award, penalty, and exemption decisions.

EMR provider Practice Velocity names Carol R. Parks, MD its EMR physician specialist.

3M Health Information Systems announces it will provide open access to its Data Dictionary under an agreement with the DoD and VA. The DoD/VA are integrating 3M’s technology into its joint EHR; the terms of 3M’s agreement requires the company make the Data Dictionary software and terminology content openly available to physician practices and other providers.

The Trizetto Group announces that its subsidiary Gateway EDI has acquired NHXS, a provider of contract compliance and point-of-service adjudication workflow automation. Gateway will incorporate NHXS’s capabilities into its EDI and RCM offerings.

The Tampa Business Journal profiles Vitera Healthcare, formerly Sage, which was purchased by Vista Equity Partners last year.  CEO Matthew Hawkins admits the company laid off a number of workers earlier this year (on the lower end range of 120 to 300) but plans to hire 50 to 100 new employees over the next six months, including individuals with technical and clinical experience. Hawkins also says Vitera will invest $25 million this year to develop a cloud-based version of its software, a native iPad app for Intergy, and a Web-based tool for physician-patient communications.

Austin Diagnostic Clinic (TX) goes lives on PatientKeeper Charge Capture for its 120 physicians.

Pacific Cataract and Laser Institute (WA) says its use of NextGen’s NextPen solution has allowed the practice to streamline its new patient registration process. The NextPen solution, which is based on Anoto Digital Pen and Paper technology, uses a digital pen to capture patient data for upload into the NextGen Ambulatory EHR.

Farzad Mostashari announces that ONC will add a chief medical officer to “infuse a clinical perspective” on all ONC activities with clinical implications, including safety, usability, clinical decision support, MU policy developing, and quality. Jacob Reider MD, who currently serves as a senior policy advisor for the ONC, will serve as acting CMO until a permanent placement is made.

Mostashari, by the way, along with former CMS administrator Donald Berwick, MD and others, co-author a guide for physicians on the EHR incentive program. Berwick notes that even though more than 30,000 clinicians have qualified for incentives, many others are unaware of how to prove they are meaningful users of EHR.

Medical billing company Fi-Med Management announces it will add 145 employees over the next three years as it expands operations. Fi-Med says it has secured preliminary approval from the Wisconsin Economic Development Corp. for a $750,000 loan to finance a new Web-based application to manage physicians’ billing activity.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

Readers Write 5/15/12

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]: A Noun?
By Aaron Berdofe

Health informatics is a term that has garnered a multitude of definitions over the relatively short term it has been in use. Papers have even been written about it, positing definitions containing the synergistic relationship between the disciplines of medicine, operations management, human interaction, and computer science.  

They are all very complicated and important sounding, so I certainly don’t want to deride the academic effort that went into pondering the question of what health informatics is. But, having now completed all of my course work for the Masters of Health Informatics degree at the University of Minnesota, I feel obligated to offer an alternative.  

I am, in fact, now an expert at answering this question. My response has been whittled down from (a) a technical and philosophical lecture (did you know it was derived from the Russian word informátika?), which has eyes glazing over within the first few words, to (b) a succinct statement which induces a thoughtful, "Hmm" before moving on in the conversation.

I wish I could just say something simple, like "I’m a doctor," where people not only understand, but grasp the gravity of what you do. But I’m not one, so I cannot.  

Instead, I have settled for people being able to understand the general idea of what I have been pursuing higher education for and apply through my consulting career, but perhaps not quite being able to connect to how it relates to them.  This remains true even of people within the healthcare industry.  If a little mystery is what makes a man attractive, I am unquestionably worth a second look.

My definition is this:  health informatics is a study of the flow of information through healthcare and how that information is used. Do we deal with computers? You bet we deal with new-fangled technological tools! However, technology no more defines an informatician than a wrench does a plumber. Thus, why I don’t like to include it in my definition.  

The emphasis should be on the information, not necessarily the mechanisms that sometimes help it move.  Is health informatics a multi-disciplinary field?  Certainly, but so was everything else at one point or another. Health informatics is a new field that is diligently integrating itself into healthcare.

Right now, the industry is focused on obtaining clinical information with carrots and sticks (I’m looking at you, Meaningful Use!) through EHRs. Yet the dirty secret is that EHRs can’t actually be proven to be useful in terms of ROI, improved patient safety and outcomes, or practice efficiency. And it’s not the technology that is the problem. Creators of EHRs don’t know what problem their technological solution is trying to solve, but we’ve all agreed that the processes of healthcare should advance themselves into the digital age.  

Therein lies the problem that health informatics will have to solve.  How do we adjust the flow and processing of information throughout healthcare to improve the lives of patients and make it a sustainable business? This question is why I’m in health informatics.  

Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s medical and practice management suite and EMR design and development.

News 5/15/12

The AMA asks CMS to consider an additional one-year delay for the transition to ICD-10. Last month, HHS issued a proposed rule that would push the deadline back from October 1, 2013 to October 1, 2014. AMA believes that overwhelmed physicians need a deadline no sooner than October 1, 2015.

e-MDs hires former CO-REC director Robyn Leone as director of public policy and government initiatives.

Barrington Orthopedic Specialists (IL) selects NextGen’s EHR, PM, Portal, and other solutions for its 15-physician practice.

The percentage of doctors using tablets has nearly doubled since 2011, with 62% now claiming to use of some sort of tablet device. The Apple iPad is the preferred device for 81% of the tablet adopters.

ChartLogic announces that six orthopedic groups recently selected ChartLogic EHR Suite.

Twelve orthopedic and radiology practices select Merge Healthcare’s specialty EHR products.

KLAS takes a look at SaaS ambulatory EMRs, which are becoming more popular for providers who want minimal upfront cost and less IT involvement. Overall satisfaction scores were close for the top six vendors: CureMD, Practice Fusion, athenahealth, MIE, MedPlus, and Sevocity .

The 91-provider College Park Family Care Center (KS) contracts with eClinicalWorks for EHR.

A Texas ED doctor develops HealthCareWaitTime.com, a site that allows hospitals and physician offices to post patient wait times online and gives patients the option to schedule appointments and communicate securely with their providers.  Interestingly, Dr. Harvey Castro has developed more than 30 medical smartphone apps over the last few years.

The AMA submits a letter to CMS, asking for less-aggressive criteria to achieve Meaningful Use. Some of the specific suggestions:

• Give physicians the ability to opt out of requirements that don’t apply to their routine scopes of practices
• Limit requirements to actions within a physician’s control and not rely on patients or other third parties’ use of technology
• Eliminate penalties for not meeting MU standards by October, 2014.

Here’s something fun to kick-start your week. Nuesoft creates a parody of Jay-Z’s “99 Problems” to highlight physician frustrations with the ICD-10 transition. If you’d like to be a music video star, Nuesoft is soliciting additional video clips and photos to be edited into the above video.

E-mail Inga.