From the Consultant’s Corner 3/23/12

Now Is Not the Time to Delay Your ICD-10 Preparation

That sound you hear is an entire industry collectively groaning and sighing. Why? Because the Department of Health and Human Services (HHS) is taking steps to postpone the date when “certain health care entities” must start using the ICD-10 diagnosis and procedure code sets.

Many of those who’ve already started down the path to ICD-10 conversion are groaning in frustration over the proposed compliance delay. You may want to listen to them. The sighs of relief coming from procrastinators should be your wake-up call to keep pushing full steam ahead toward ICD-10 compliance.

It’s like when the college professor gives you an extra two weeks to finish an important term paper. The procrastinators take their feet off the gas, while the A students keep preparing diligently. The latter is exactly what your organization should be doing with regard to ICD-10.

I often compare the ICD-10 transition to pulling off a Band-Aid. It’s going to hurt no matter when you pull it off, so you might as well face the pain sooner rather than later.

Let’s face it. Balancing many priorities — including governmentally-led programs such as achieving Meaningful Use (MU) and 5010 — have been a tall order and an all-consuming task for most healthcare providers, vendors, and consultants. Simply keeping up with the various phases of MU has robbed most providers of the time and resources needed to do ICD-10 impact assessments and project plans. Many of the payers, IT vendors, and clearinghouses are likewise playing catch-up. So while a few major stakeholders have made steady progress toward ICD-10 implementation, most have not.

Lately there’s been talk of a dual track, where some organizations need to meet the original Oct. 1, 2013, deadline for ICD-10 compliance while others get an extension. In a word, that would be disastrous because it would add an extra layer of confusion. Determining which healthcare entities are using ICD-9 and which are using ICD-10 after October 2013 would be difficult at best. But that may be the situation in which we’re placed, so we need to be prepared.

If HHS does decide to grant you a few more months to get ready for ICD-10, don’t squander that time. Put it to good use by continuing to consult with your physicians, payers, and vendors. If they’re behind schedule, hold them accountable. Don’t forget that hospitals and practices have the most to lose from being behind the curve on ICD-10. There can be major disruptions to cash flow, so now’s the time to refocus and get cracking.

You can start by asking yourself these questions:

• Have we done an ICD-10 impact assessment?
• Do we have a project plan and a conversion team in place – one where the roles are clearly defined?
• What are the budgetary requirements which need to be planned for?
• Do our IT partners currently have the development bandwidth for ICD-10 conversion?
• Are our payers and clearinghouses making good progress or dragging their feet?

If the ICD-10 deadline does get pushed back, that doesn’t mean you can start lounging in a hammock. Getting ready for this new coding system is a huge undertaking. Hospitals and practices that use this extra time wisely will have far fewer headaches when the real deadline arrives.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation, and information technology.

News 3/22/12

EZ DERM announces that its EHR iPad app now incorporates Nuance Communication’s medical speech technology for app interaction, navigation, and clinical documentation.

RCM provider MD On-Line acquires MD Technologies, a provider of RCM products and the Medtopia Manager PM system.

Practice Fusion forwarded me an email that reminds its customers that lab integration is available at no cost and that connections are currently available with 16 regional and national reference labs. Assuming it all works as advertised, free integration to that many reference labs is impressive.

The American Academy of Pediatrics updates its Child Health Informatics State Resource Map, which provides a snapshot of HIT activities in each state, including contact information for RECs. The AAP also offers an EMR Review Site where pediatricians can read reviews and provide comments related to the performance and features of specific EMRs. Both tools look quite handy and do not require a subscription to access; however, I could not find more than one or two reviews for each of the EMRs listed on the Review Site.

Paul Grundy, MD is one of four NCQA 2012 Health Quality Award honorees for his early championing of the patient-centered medical home model. Grundy is president of the Patient-Centered Primary Care Collaborative and global director of IBM Healthcare Transformation.

Waiting Room Solutions announces multiple new clients for its EMR solution including Integrative Health and Hormone Clinic (IA), Healthcare One (OK), Lynda J. Wright, MD (ME), and Orlando Executive Health (FL).

Holy Name Medical Center (NJ) names PriorityOne Consulting a preferred vendor to assess the IT infrastructure of its affiliated physicians’ offices and assist practices with the adoption of Aprima EMR.

Three Hoag Orthopedic Institute (CA) physicians will be the first to participate in a new automated bundled payment model for knee replacement surgery.  The Bundled Payment Initiative, which pays a set, comprehensive fee for a given episode of care, is a collaboration with Aetna and the Integrated Healthcare Association.

The Wall Street Journal profiles Colorado’s Westminster’s Medical Clinic, a small practice struggling to make ends meet. After losing money in 2010, the three-doctor group joined a medical home project in hopes of improving its bottom line; in 2011 the practice profited just $29,261. The physicians sell dietary supplements to augment their income and are now considering charging patients a monthly fee to offset the costs of its online portal and on-line consults. Meanwhile, the physicians work demanding hours, leading one of the doctors to say the situation was “just too much” and that his life was “insane.” I’m sure he has thousands of peers who would concur.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

News 3/20/12

The 38-provider OrthopaedicCare (PA) selects GroupOne Health Source to implement its eClinicalWorks EHR.

Central Virginia Health Network will offer Phytel’s Atmosphere platform, including Phytel’s Insight and Coordinate modules, to the network’s 300 community physicians.

Athenahealth will hire 80 people to work at its Belfast, ME office, raising its headcount by 20%.

The Dean McGee Eye Institute (OK) selects ifa united i-tech to provide its EMR v6 solution.

Gateway EDI finds that 56% of practices report moving forward with ICD-10 preparations, despite the potential delay of the implementation deadline. An additional 33% of practices have not begun planning and 11% are postponing preparations until a new deadline is announced.

AMA Board of Trustees Chair Robert M. Wah, MD provides commentary on EHR following his recent participation at HIMSS. In addition to providing an overview of some of the meeting’s highlights, he offers some thoughtful remarks on the role of technology in providing care and the role of physicians in deploying technology:

The use of technology must be seen as a way to improve care for our patients and not seen as a technology program or project. It is also clear that physicians must be involved in this process from the beginning of development and through deployment of new technologies.

One of the thirteen recently fired Everett Clinic (WA) employees speaks out about the incident that led to her dismissal. RN Kathleen Crossler was fired after a new electronic monitoring system tagged her for violating patient privacy rules after looking up her husband’s lab results – at his request. A clinic representative notes that the organization’s confidentiality agreement states that employees cannot look at files even if they are asked by friends or family to check medical information. The 65-year old Crossler intends to appeal her termination.

Essentia Health (MN) rolls out its MyHealth portal, giving patients access to lab results, immunization records, and appointment requests.

The top two ways to describe patient engagement, according to healthcare organization leaders participating in a National eHealth Collaborative study: patient uses educational material and online resources to learn about better health or their own health conditions, and, patient uses tools and resources to management his medical record and other health data. The proposed Stage 2 MU regulations include several facets of patient engagement, though there isn’t agreement on what it means to “engage” a patient.

Joslin Diabetes Center (MA) announces plans to offer telehealth services nationwide using the American Well communications platform integrated with the practice’s NextGen EHR.

Practices that adopt the PCMH model of care experience higher morale and job satisfaction rates among physicians and staff members, according to a study published in the Archives of Internal Medicine. However, the model also leads to an increase in physician burnout. Researchers attribute the morale boost to providers’ ability to offer better access to care and increased communications; the increased workload associated with the PCMH model is blamed for the burnout.

The local paper interviews Girish Kumar Navani, CEO of the Westboro, MA-based eClinicalWorks, which has grown in its 13 years to a $200 million company serving over 60,000 physicians and employing 2,000. Girish summarizes the success of the company under his leadership as follows:

Being a good businessman is intuitive. In a way, it means doing what your heart tells you to do. You have to believe in doing what your sense of ethics tells you to do. And you have to let your decisions be driven by treating people the way you would like to be treated. I am an avid football and Patriots fan, and I look at it like this: I may be the quarterback, calling the plays, but I am still huddled with the same 11 guys. I am still on the field — the quarterback doesn’t make calls from the sidelines.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.

DOCtalk by Dr. Gregg 3/18/12

Between Heaven and Earth

L-L-L-L-LET’S GET READY TO RUMBL-L-L-L-L-LE!!!

In the main HIT arena …weighing in at a hefty XX pounds …with more paper system knockouts over recent decades than current scorers have been able to track …the current world champ for health information technology …. LOCAL ”HEAVYWEIGHT” HOSTI-N-N-N-N-N-N-G!!!!

And, the challenger …tipping the scales at ….well, no one’s really sure how much a cloud weighs …with a nearly perfect record in just over decade (or just under depending on who’s keeping the scorecard) …the number one contender … CLOUD ”FLOAT LIKE A BUTTERFLY” COMPUTIN-N-N-N-N-N-G!!!!

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In a fun verbal match the other day, I was sparring with one of my mostest favoritest ever tech support gurus over the value of local hosting for HIT versus the developing wave (some might say tsunami) of cloud-based services and tools.

His opening shot was that cloud-based services were great for certain things, but not so much in the world of health.

I countered that cloud-ed services and tools were so end user friendly, especially for us onesy-twosy docs, as they’re much easier on our limited tech support capacities and paycheck-to-paycheck incomes.

His shot to my right kidney was that if your Internet access goes down, you’re hosed.

I covered with my right elbow and the fact that redundant Internet access avenues could almost always allow a quick reconnect to Web resources.

Starting a ringing that continues in my left ear today, he connected with an uppercutting, “Even though cloud server farms are redundant and backup generators with stored fuel are on hand to last for weeks, it has occurred that cloud services have gone dark, even for some techno-giants.” He landed with his “Complex systems have complex failures; that’s cloud computing” quote.

I tried to protect my head with a rising left and a “Being prepared for when the cloud REALLY fails” reference along with the fact that there are clouds that can protect clouds, like Backupify, (though it isn’t designed to do any of the cloud chores we were brawling about).

He shot a roundhouse from the right. “It may be OK for some companies to be down for a bit, but are you OK with the possibility that you could go down? I mean, it sounds good for the vendor to say ‘We have a 99.9% up time,’ right? But, that small percent becomes humongous if it happens to you in the middle of a busy practice. What if you have no access to any patient data for an hour, two, maybe a day or two?”

I gave him a fairly feeble body blow with my, “Well, we just pull out the old pencils and paper and struggle on the old-fashioned way for a bit. We still remember how to write”

Jab, jab…”That may be OK for you as you’re just one guy, but what if you had several or dozens of providers? If the disconnect lasted for any length of time, like with Microsoft’s Azure failure last month, that could lead to a whole heap of data re-entry and a whole lot of ‘best guess’ health provision with clinicians unable to access relevant patient data during those interim pen-and-paper patient visits.”

Bob, weave, duck and cover…”I guess I can’t answer for everybody, but from the cost and upkeep involved with local hosting, it’s gotta be easier and more cost-efficient to live life in the cloud. Sure, I do really like knowing I have my patients’ data right here in my office, but it’s not as if I haven’t had our own server troubles. I mean, we’ve had downtime, too. ”

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I had to get back to patients, so the call, and the bout, ended. Judges scored it 10-9, 9-10, 10-10: a draw.

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However, it led me to an idea, probably springing from my ever-growing “app me, baby” orientation: Why couldn’t there be a middle ground, something between the cloud and the local host? Why couldn’t there be an app that would, if my cloud turned dark or Internet connection failed, allow me to continue to at least enter patient health and PM data into a local digital barebones skeleton? That local app could allow the temporary, locally-stored data to be extracted and directed into the correct slots in the real system once the Internet was back or the cloud had again become accessible (i.e., white and fluffy)…you know, without the pen-and-paper intermediary.

Sure, access to historical patient data might be temporarily unavailable, but back in the day I never put off a patient when their paper chart got misplaced. And, it wouldn’t have to be completely seamless; it might take a little personnel time to get the data swapped over. But, it would make it far less cumbersome than a paper-based backtrack. Such a local app could easily minimize the disruption to seeing patients, allow ongoing digital data entry, and facilitate data reconnect thus enabling the advantages of, and minimizing one of the objections to, the cloud for us little guys – maybe even for bigger folks, too.

This could be a real haymaker punch for cloud-based EHRs. Something between the cloud and the local host. Something between heaven and earth.

From the trenches…

(PS – I understand MediNotes used to have something similar, but that’s sort of moot, eh?)

“Sure, there have been injuries and deaths in boxing – but none of them serious.” – Alan Minter

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 3/15/12

KLAS looks at customer satisfaction by EMR specialty and identifies  internal medicine as the most satisfied specialty, followed by family medicine, pediatrics, and OB/Gyn. Ophthalmologists were the least satisfied. Of the fully rated vendors, Cerner and Epic were found to offer the most comprehensive and highly rated EMR solutions across multiple disciplines.

Thirteen employees of The Everett Clinic (WA) are fired on HIPAA violations and the practice is still investigating another 11 employees. The 400-physician practice reports that it suspects violations of 55 patient records, which were viewed by 43 employees; some employees, however, may have had a legitimate reason for viewing the records and may be cleared. The snooping employees were flagged by a newly installed electronic monitoring system.

Surescripts awards Pulse Systems its White Coat of Quality for prescription accuracy and completeness.

Sales of EMRs grew an estimated 14.2% in 2011, making it a $17.9 billion market.

Northwestern Health Sciences University (MN) selects BackChart EHR for its University clinics.

AHRQ proposes a 27-month, $793,456 information collection project focused on assessing how HIT affects the quality of care in small to medium-sized physician practices.

AHIMA, MGMA-ACMPE, and several other healthcare groups introduce informational brochures to promote the understanding and use of PRHs among consumers and clinicians.

Greenway Medical Technologies announces its first quarterly results as a publicly traded company: revenue up 30% to $29 million, EPS –$0.01. Shares closed Tuesday at $13.75, up from February’s IPO price of $10 but down from their high of just over $15.00 on March 1.

Medical billing and EHR provider Zeus Healthcare appoints Larry Havelis CEO. Havelis previously served as VP of sales for Quest Diagnostics and VP of sales for Allscripts.

E-mail Inga.

More news: HIStalk, HIStalk Mobile.