Practice Wise 5/13/12

IT Investment is Necessary

You’ve picked your EHR software. The vendor likely has provided you with a document outlining the hardware and network specifications needed to support your software. That’s just the beginning of what you ultimately need. It’s easy to be overwhelmed by the technical information about expensive hardware and network purchases and the plethora of individual computer choices. Don’t let overwhelm of the moment cause you to make decisions you don’t fully understand.

You are not alone in your inability make these decisions. That’s how many independent medical practices feel when they buy their EHR and then have to buy the hardware to access and optimize their software. They rely on their software and network support vendors to help them make the right choices for them. From an IT standpoint, this is a hard thing to advise people on, there are so many choices and reasons why some choices are better than others.

Starting with the individual computers, the most common question I hear is, “Should we buy tablets or laptops or full workstations? Thin clients for FAT clients?” Each of these has its pros and cons. There are many factors to consider, these are a few that are driven by individuality vs. technical specifications:

Providers and Clinical Staff

How mobile is their position?

• Nurse/MA: highly mobile, rooming patients, charting, ordering tests – they might be better served with a laptop or tablet.
• Provider: will they chart in the exam room, at a central workstation or go back to their office between encounters? Laptop or desktop purchase based on their individual charting preference, sometimes both are in order.

You want portability. You decided to use laptops. Now which ones? Weight is one of the defining factors for this choice. If you care carrying the machine around all day from room to room, you don’t want to be lugging an 8-pound, 15 -17” laptop.

• Consider an ultra-book. There are several good models on the market with solid state drives that are very light and quick to start up.
• Battery used to be the big decision point, but even those with ‘long life’ batteries end up plugging in throughout the day, so this is less of an issue than we once thought.

You need touch screen or full tablet handwriting capabilities.

• Pure tablets are light and portable, but screen real estate is small. Will the amount of charting and the functionality of your EHR bode well in that environment?
• Convertible tablets, heavier than the ultra-books, are an option for greater screen size than some pure tablets.
• Touch screen laptops. Some are lightweight and give you the option to click your screen and type without rotating the monitor position. Look for solid state drive machines for better performance. These are a good happy medium.
• There are straps that you can put on the base of the laptop/tablet that allow you to slide your hand between the strap and machine, providing a little bit of stability when holding the laptop in one hand and typing or writing with the other.

Front Desk, Billing Department, Admin Users

Stationary workstations work best – thin or fat clients.

• If scanning and taking webcam photos, fat clients work best in the long run. I know, I know — great tools such as remote scan exist, but they are not problem free.
• Consider dual monitors for the billers/payment posters.
• USB ports on the front of machines for ease of accessing temp file shares such as thumb drives.
• Do you need CD/DVD drives for providing electronic chart copies to patients to meet Meaningful Use?

Proactive network support is the biggest decision that is most often overlooked and under budgeted. I don’t know how to convey to small and medium practices that they need to bite the bullet and understand that IT is a sunk cost, and plan for it in their monthly budget. When you were running PM software only, although it was not best practice, you could get away with using your IT vendor for break/fix service calls and new hardware purchases. Now that you are running EHR, you can’t afford to not have a managed services contract with your IT vendor.

Short- and long-range plans for software upgrades and license management, hardware replacements, and ongoing patching and monitoring are all essential elements in maintaining your EHR. Items to consider in your managed services contract:

Asset Management (Both Software and Hardware)

• When Microsoft products upgrade, how long will your versions be supported? How quick is your EHR vendor to develop their product(s) to the latest versions available? This was a big issue with operating systems such as Windows XP. When it was no longer available, clinics needed to buy a new hardware and the EHR didn’t support Windows 7 (or the next versions going forward). Proper asset management includes plans to replace the operating system with any other underlying software that your EHR needs to run in conjunction with your EHR upgrade roadmap.
• Hardware that exceeds its warranty period. How easy will it be to obtain replacement parts? Most hardware vendors do not maintain inventory on outdated parts, forcing you to upgrade your hardware, which can be problematic when it is unplanned. Plan on replacing hardware around the time your warranties expire. The good news is that three years used to be the standard warranty period and most vendors are offering 4-5 year warranties on bigger hardware purchases such as servers.
• Patching and updates. Without someone paying close attention to the regular updates pushed by the software and hardware vendors of all your assets, you may miss vital high priority updates that put your organization at risk for down time, security breaches and data loss.

After 12 years doing this work, I continue to be astonished by the number of groups that don’t see the value of IT managed services contracts. Your EHR is the heart of your business, which is often a multi-million dollar business that supports the livelihood of providers, staff, and their families, as well the care of thousands of patients. Yet in order to save money on the front end, they are willing to risk losing their network and/or data. This is shortsighted thinking that I hope will not prove catastrophic to you in the end.

I’m not your IT vendor and have no financial gain in your decision, but I urge you to review your current IT management solution and get on a proactive managed services plan if you are not already on one.

Julie McGovern is CEO of Practice Wise, LLC.

News 5/10/12

e-MDs reports a 20% increase in revenue and a 10% increase in employee count over the last year. The company also says it was profitable for 2011, maintained cash reserves, and invested nearly 40% of its annual revenue into R&D.

CalHIPSO reports that over 7,700 enrolled providers are in various stages of EHR implementation, including 210 that have demonstrated MU. The REC also says it has initiated a second round of EHR vendor selection, building on its initial group of seven vendors.

Northeast Georgia Physicians Group selects Phytel’s Atmosphere platform to help transform its 30 ambulatory care clinics into PCMHs.

MHMD, the physician network of Memorial Hermann Healthcare System (TX), begins work with TransforMED to transform six of its medical practices into PCMHs.

The 17-physician Florida Cardiology selects dashboardMD to provide evidence-based PM management services, including BI dashboards and healthcare analytics.

Advanced Data Systems collaborates with clinical laboratory LabXpress to offer an orders and results interface between ADS’s MedicsDocAssistantEHR and LabXpress.

athenahealth earns the #4 spot on Forbes annual Fast Tech 25 list of “growth kings.” Quality Systems, the parent company of NextGen, was ranked 19th.

ONC launches the Health IT Dashboard, which presents key information about the impact of federal policies and programs related to HIT. I like pretty graphics, and this one detailing key performance indicators for RECs caught my eye. Although according to the numbers at the top, only 11% of providers enrolled in RECs have demonstrated MU, leaving me to wonder how that compares to the original goals of the ONC and RECs.

Sermo reveals that its Real-Time Medicine Mobile App for Physicians accounts for 45% of total traffic on its platform. One of the app’s most popular features is iConsult, which allows physicians to take or add a photograph at a patient’s bedside and ask for opinions from relevant specialists. Sermo says 77% of iConsults are answered within an hour and often as quick as one minute, with each inquiry averaging 12 responses.

ONC releases a handbook for physicians and their practice staff that discusses the importance of privacy and security to EHR MU and how to integrate best practices into daily operations.

Physician social networking site Doximity appoints Linked-in co-founder Konstantin Guericke to its board of directors.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

News 5/8/12

Allscripts’ Board of Directors approves a Stockholder Rights Plan that would allow stockholders to buy Allscripts’ common stock at a 50% discount in the event of a hostile takeover attempt. Allscripts says the move was not done in response to any current hostile takeover attempts, and, the current stock price does not adequately reflect the company’s long term potential. The plan effectively means management has to approve any takeover, which seems to favor the management team over shareholders. Perhaps a hostile takeover that includes a premium share price might be more financially beneficial in the eyes of some stockholders.

Apex Medical Group d/b/a Nephrology Consultants (TN) agrees to pay $4.36 million to settle allegations that it submitted false and fraudulent claims to government health programs through a pattern of up-coding for various physician services or billing for services never rendered. The case stems from a whistleblower lawsuit filed in 2005 which alleged that the physician owners-managers inaccurately filed claims to Medicare and TennCare for a variety dialysis services. The owners settled without admitting wrongdoing. The whistleblower will received over $400,000 as part of the settlement.

Emdeon acquires TC3 Health, a provider of cost containment solutions for healthcare payers.

Southern Brain & Spine (LA) selects SRS EHR for its 10 providers.

RCM provider PracticeMax acquires KLO Professional Billing, a provider of billing and PM services for physician offices.

The 25-doctor Valley ENT (AZ) selects ChartLogic’s EHR Suite.

Bloomberg Businessweek profiles eClinicalWorks CEO Girish Navani and his company’s community analytics offering, which provides reporting, alerting, and messaging capabilities for population health management. Navani, by the way, predicts eCW’s 2012 revenues will hit $250 million.

Physician offices added 5,500 of the healthcare industry’s 19,000 new jobs in April.

The AMA issues a reminder to physicians that June 30, 2012 is the deadline to report on at least 10 electronic prescriptions to avoid the 2013 Medicare e-prescribing program penalty. Physicians unable to meet the program requirements can apply for a hardship exemption by June 30.

E-mail Inga.

DOCtalk by Dr. Gregg 5/4/12

Crash and (Just a Little) Burn

Earlier this week was pretty darn technically frustrating for me. I had a combo-fiasco happen where multiple servers and “uninterruptible” power supplies failed when we took three power hits within minutes of each other (on a nice, sunny day, no less!) This led to our locally-hosted system going down for a day and requiring full database restoration and the rebuild of half a day’s patient data from notes, memory, e-prescriptions, etc.

Then, as I was writing a blog to describe the problem and talk about how we dealt with it, I had the strangest issue with Word. It saved the post – which had the above title – but the post itself was an old one. In other words, the title saved correctly, but not the body of the story. (I’m still scratching my head on that one.)

But you’ll note that though I’ve kept that original title, I have veered far afield from my original content. Recent news about my EHR vendor – well, they’re still sort of my EHR vendor – has usurped both this post’s title and content. You’ll see why I felt the title was worth repurposing if you continue to read just a bit further. (And, if Mr. H consents to posting this — which he may not – since the news I’m about to add will be “unsubstantiated”.)

Many of you know that there really isn’t much love loss between Allscripts and me. When I broke the news that they were about to announce the sunsetting of my chosen EHR, Peak Practice, on October 5, 2010 (I remember because it was my birthday), their powers-that-were weren’t happy with me. I haven’t been much of a fan of what I’ve seen from them since and haven’t been terribly shy about saying so.

Along comes the news about the failed power coup, subsequent loss of old Eclipsys folks from dismissal or resignation, and the serious stock price tankingness. Yes, there was a little “I knew it would happen” smirk on my face for just a moment, but it didn’t last, as I also have friends and colleagues who either work there or who use their software. I know that this isn’t good news for them, so my personal “Yo, it’s karma, dudes” moment didn’t last.

But, here’s the kicker. I have it from an exquisitely good resource – no, it’s not an Allscripts employee – that they are about to “go legacy” with their Enterprise product.

My source also sent along his/her thoughts on the meltdown, which I’m going to share verbatim here:

Eight years of bad decisions are coming home to roost:

1. Repeated acquisitions at premium price for technologies and systems that do not integrate.

2. Senior management constructed of deal makers, attorneys, and marketers. Barely a single product or clinical person among them.

3. Inability to retain key technical and clinical personnel due to (2) above.

4. No coherent strategy other than to acquire and grow revenue through acquisition of disparate businesses.

The effects of these four interrelated factors ripple throughout Allscripts and its customers. Tullman is the driving force behind this. It will not change as long as he remains in charge.

I really have nothing to gain by putting this out, and even the momentary sense of “See, if you hadn’t sunsetted my dear old Peak Practice, none of this would have happened” is completely overridden by my sorrow for the end users of Allscripts products who are the real losers (well, them and all those now significantly less well-invested shareholders.) I’m not sure if there are any real winners here.

Maybe I should have retitled this “Crash and (A Whole Lotta) Burn”.

From the trenches…

“As a single withered tree, if set aflame, causes a whole forest to burn, so does a rascal son destroy a whole family.” – Chanakya

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).

News 5/3/12

Olmsted Medical Center (MN) extends its partnership with MED3OOO through 2017.

Practice Fusion launches an API that allows any laboratory to connect directly to its EMR and send lab results using standard HL7 data files.

From Wednesday’s HIT Policy Committee meeting:

• The Medicare and Medicaid MU programs have paid EPs an estimated $1,671,000 through the end of April.
• RECs have now enrolled more than 40% (132,000) of all primary care providers in the country; 50,000 of those are in practices with fewer than 10 physicians.
• Drug formulary, immunization registries, and patient list are the most popular menu objectives for EPs.
• Of the 62,807 EPs that have attested, 258 were unsuccessful initially. All but 99 of those have successfully resubmitted.

Navicure announces it has added 344 new practice locations to its client base during the first quarter of 2012, a 112% increase over Q1 2011 bookings. The company also reports its first quarter revenues were up 24% from a year ago.

Federal officials charge 108 doctors, nurses, and other healthcare providers with almost half a billion dollars in fraudulent Medicare billing during a “nationwide takedown” on Wednesday. HHS suspended or took other administrative actions against an additional 52 providers for “credible allegations of fraud.” Officials have so far arrested at least 87 individuals.

athenahealth earns a spot on Boston Business Journal’s 2012 list of Best Places to Work.

Sermo partners with TheVisualMD, a producer of visual health content, to offer video and other media tools.

West Tennessee Bone selects SRS EHR for its 11 providers.

Anthem Blue Cross (CA) rolls out the Availity information network at no charge to physicians, giving them access to patients’ eligibility and benefits and the ability to submit and monitor claims online.  Physicians will also have access to CareProfile, Availity’s claims-based EMR, which provides 24 months of a patient’s most recent medical history.

A JAMA-published study suggests that text messaging, electronic reminder devices, and pagers might improve medication adherence in the short term, but the long term effectiveness remains unclear.

E-mail Inga.