DOCtalk by Dr. Gregg 1/17/12

I Can’t Get No…

Every once in a while I put on a pair of skin tight leather pants, rip off my shirt, puff up my lips, and strut about frenetically with arms akimbo – somewhat like a chicken – singing Mick and company’s famous line “ I…can’t…get…noo-o… …sa…tis…fac…tion.” (There’s a visual for you!)

Having peeled the leather off and slipped into some much more age-appropriate sweat pants, I’ve stopped strutting and will now explain my lament, which of course has an HIT riff running through it.

I still love my EHR, Bond Clinician. (Since it was acquired-acquired-acquired and then sunsetted, I no longer feel any obligation to call it by anything other than its original, Bond-given name.) Yes, it has features and functionality that are less than optimal, but after looking about with a fair degree of diligence this past year, I still haven’t seen another EHR out there that comes close for overall look, feel, or technical sexiness. But, sadly, my beloved Clinician will grow more and more anachronistic as it stays forever trapped in the annals of HIT throwaways. I need to find my next EHR “Brown Sugar.”

Don’t get me wrong; I have seen some very attractive and some very functional EHRs. The problem for me, though, is mainly two-fold:

1) The good-looking EHRs are rarely evolved enough or complete enough or else they come with a heavy dose of an EHR provided to bolster the practice management/billing tool or else they’re designed to promote some other principal focus (e.g., labs) or;

2) The more highly functional EHRs are almost always just plain butt-ugly (not unlike the aforementioned Mr. Jagger.)

As I’ve stated before, I’ve seen some fantastic parts and pieces that combine both the design elegance and the Apple-esque usability that I seek. Thus, another Mick-generated semi-proverbial lyric applies: “You can’t always get what you want, but…sometimes…you can get what you need.”

The spoiled, angst-filled, teenage brat inside me rebels against this, though. My inner little monster whines, “I’ve seen beauty in EHRs. I was a part of the design team for ‘Notes 2.0’ for Eclipsys’ Peak Practice, nee Bond Clinician, which was headed toward the EHR hall of fame for both its beauty and its tech savvy wizardry. Waaaah. I want a beautiful EHR that’s just as full of gorgeously implemented function as Clinician 2.0 would have been and just as easy to use as my iPad. I want all those great parts and pieces in one fully integrated EHR. Waah, waah!”

I’ve listened to far too many vendor hyperboles to even be swayed anymore by the sales pitches. No, your tools aren’t the end-all, be-all for medical practice record keeping. No, your patient portal isn’t going to drive swarms of new patients to my door. No, your billing and scheduling functions aren’t seamless. No, “functional” is not the same as “good.” No, “usability” isn’t just about “easy click-ability” or voice recognition. No, gathering useful data is not the same as having data gathered usefully.

I again hear Mick sing “…but if you try sometimes…” when a few vendors have asked me to contribute to their product’s development over this past year. Helping create the visually-stunning and truly provider-friendly system that would lead me back to the contentment I now feel with my dear Clinician is intriguing. I mean, I helped Clinician move up the food chain and I’ve learned tons since then. I understand at least a thing or two of what it takes to make digital healthcare click. Plus, I’ve developed a pretty wide-ranging overview of this industry from my little trench (and more than a few connections that could be really handy.) Maybe I can help develop an EHR to provide a similar sense of system satisfaction to that which I now feel with my dear Clinician – and, hopefully, help some fellow providers feel the same as they digitize.

Thus, I’m considering the possibilities, at least with a couple of them. I’m not yet committed because it isn’t just the consulting that’s important to me: the heaviest factor is that I’ll be also using it as my next EHR, using it every day. Being a happy with what I currently have makes the thought of changing a bit tough.

With a rather different position, perspective, and experience base than most docs (who are typically less geekoid, likely to their benefit,) it does make some sense to try to make a difference. “But, I try, and I try, and I try, and I try…,” goes the Mick within my head.

If I do go the consultancy way in some form or another, I’ll try to create a relationship that doesn’t cloud my trench grunt blogger perspective. I absolutely need to get on with getting a new EHR, but I highly value the honor of being able to write “from the trenches” here on HIStalk/HIStalk Practice and want to maintain the uncluttered honesty it allows.

Mr. Jagger has said, “It’s all right letting yourself go, as long as you can get yourself back.” My fear: some consultants never quite seem to make it back.

From the Stoned trenches…

“I’d rather be dead than singing ’Satisfaction’ when I’m 45.” – Mick Jagger

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 1/17/12

From REC Fan “Re: Meaningful Use deadlines. I just got this email from CMS that has some good reminders for EPs. The deadline for registering and attesting to meet MU and receive payment for the 2011 calendar year is February 29, 2012. February 29th is also the last day EPs can submit pending Medicare Part B claims for CY 2011. Providers who applied to for MU incentives but did not met the $24,000 threshold for Part B allowed charges should look for their incentive checks (based on 75% of the EP’s charges) sometime in April.” REC Fan also forwarded this link for EPs who interested in registering and attesting.

Princeton Orthopaedic Associates (NJ) selects SRS EHR. Speaking of SRS, CEO Evan Steele recently shared with me that last year the company grew its revenue 37% over 2010’s results and increased sales by 104%.

Omaha Imaging (NE) selects Atlantic Health Management Solutions to provide billing, collections, and provider contracting and credentialing for its eight physicians.

The Arizona REC adds Navicure to its Vendor Alliance program.

The AMA updates the website for its Practice Management Center, which is accessed by about 7,000 visitors a month. Among changes, AMA has added a Knowledge Center that provides access to practice toolkits, webinars, and white papers.

Physician offices added 67,600 jobs in 2011, which is more than double the 25,300 created in 2010 and the second highest number in the last 10 years.

MED3OOO points out that  KLAS scores for its InteGreat EHR increased 11% over the last year.

I noticed that athenahealth’s 2012 User Conference is coming up April 1-4 in Boston.  What really caught my eye was mention of the keynote speaker, Abraham Verghese, who authored of one of my favorite reads, Cutting for Stone. I am sure the 50 different educational sessions will also be great.

Small to medium-sized practices plan to buy tablets at a faster pace than larger practices in 2012, with 73% of the smaller offices expecting to make a purchase. Practices anticipate spending on average a cumulative total of $6,800 on tablets over the next year.

Gateway EDI’s director of client services says that small labs and physician offices of one to five doctors are experiencing more problems than larger organizations in the transition to 5010. Gateway’s Jackie Griffin attributes the problems on smaller entities’ lack of resources to prepare for the transition and predicts most will experience a financial shortfall over the next 45 days. I wonder if other vendors and practices agree with Griffin’s assessment. 

E-mail Inga.

News 1/12/12

CMS releases a Meaningful Use Attestation report from November 2011 that provides insight into which EHRs have the most attestations. I played with the numbers a bit and created this chart showing the top ambulatory EHR products in terms of attestations. EpicCare Ambulatory tops the list with 28% of the 21,318 attestations; eClinicalWorks follows with less than 9%, Allscripts Professional at 5.6%, and athenaClinicals is at 5%. And if you combine all of Allscripts’ ambulatory EHR products, they have 7% of the ambulatory EHR attestations. Fascinating stuff that raises questions, such as what percentage of vendor users does each attestation number represent? For example, eClinicalWorks reports having 60,000 physicians on their combined PM/EHR product, meaning only 3% of their providers have attested. That compares to athenahealth, which claims to have 6,000 athenaclinical providers, meaning 20% of the EHR providers have attested. It will take some time to find more facts and figures, but I’m hoping to dig deeper. [Update from Inga: Based on the vast differences in practice demographics and reasons for buying a particular EMR product, comparing  each vendors’ percentage of attesting providers may have limited value. For example, though eCW has 60,000 physician users, a significant number are CHC providers who are ineligible to qualify for MU incentives. A vendor offering a free solution, such as Practice Fusion, may attract more providers who are more interested in basic EMR functionality than in qualifying for MU incentives. Regardless of how you crunch the numbers, however, the overall number of EPs attesting through November (21,318) seems quite low.]

By the way, CMS says that as of December, 35,515 EP had successfully attested for Medicare Meaningful Use incentives. while another 355 were unsuccessful. Medicare paid EPs $275 million.

Practice Fusion announces it has raised an additional $2 million in funding. The company has now raised over $38 million from Band of Angels, Felicis Ventures, and others.

Adventist Health will implement Cerner Ambulatory EHR across its 130 outpatient clinics.

Winchester Radiologists (VA) contracts with HealthPro Medical Billing to provide billing services for its 17 physicians.

Massachusetts Eye and Ear Associates selects PatientKeeper Charge Capture and PatientKeeper P4P for its 250 clinicians.

Billing service provider MedData acquires MedDirect, a provider of RCM management and patient communication services.

Idaho Health Data Exchange (IHDE) signs an agreement with Greenway Medical to provide interoperability between Greenway’s PrimeSUITE EHR and IHDE’s HIE.

The American Podiatric Medical Association partners with HealthFusion to promote the use of HealthFusions’s MediTouch EHR.

The number of retail clinics grew 11.2% last year to 1,355 and is predicted to continue growing into 2012. One reason: the forecasted increase in demand for medical care, fueled by health reform and more access to medical coverage. CVS, one of the country’s largest retail clinic, plans to open 500 new MinuteClinics over the next five years.

Age makes a difference when it comes to physicians perceiving benefits of HIT. The majority of US doctors believe that technology does not improve diagnostic decisions, improve health outcomes, or improve the quality of treatment decisions. Most doctors under the age of 50, however, believe HIT offers numerous benefits, including a positive impact on outcomes, faster access to health services, reduced medical errors, and improved care coordination.

E-mail Inga.

News 1/10/12

The Miami paper profiles CareCloud, an up-and-coming provider of a cloud-based PM solution. The company has hired 30 people in the last five months (110 total employees) and raised $20 million in new VC funding. CEO Albert Santalo says the company is not yet profitable, though it grew revenues about 600% in 2011. The basic solution is $499 a month. It also offers an RCM option based on a percentage of collections and just rolled out an EHR.

US health spending grew 3.9% in 2010, which was only .01 percentage points faster than the 2009 rate and the second-slowest rate in 51 years. The slower growth is blamed on high unemployment, loss of private health insurance coverage, lower median incomes, and higher patient deductibles and co-pay. Total 2010 spending was $2.6 trillion, or $8,402 per person.

At the same time healthcare spending is falling, payer reimbursements are declining. The average commercial payer reimbursements for new and established office visits fell 2.86% in 2011, though Medicare paid more than commercial payers for almost all office visits.

Physician RCM provider MDeverywhere partners with collection agency Transworld Systems to jointly promote their services.

Pediatric Orthopaedic Associates (GA) selects SRS for its 12 providers.

Wayne Physical Medicine (NY) and LC Internal Medicine Clinic (LA) choose Waiting Room Solutions’ PM/EMR solution. Waiting Room Solutions also just partnered with UnityFax to offer its clients integrated inbound fax service.

The 46-provider Northeast Georgia Diagnostic Clinic contracts with MediRevv for AR management.

The American Academy of Pediatrics and Sanofi Pasteur introduce vaccine packaging technology that includes a 2D scan for tracking lot numbers and expiration dates. Pediatricians will no doubt be sending enhancement requests to their software vendors to integrate 2D scanning with their EMR application.

The number of physicians employed by hospitals has grown by 32% since 2000. Hospitals employ 212,000 physicians, or about 20% of all physicians.

E-mail Inga.

DOCtalk by Dr. Gregg 1/7/12

“No Soup for You!”

The Soup Nazi. Another Seinfeld expression that has penetrated modern cultural phraseology.

I’m guessing there are very few folks unfamiliar with the Seinfeld phenomenon whereby so many turns of phrase have eked into our communal awareness and lingo from just one TV show, albeit one very cleverly written TV show.

Thus, due to this social phenomenon, I could not help but conjure up the Soup Nazi’s “No soup for you!” when discussing the upcoming HIMSS Annual Conference & Exhibition with a friend the other day.

“What in the heck do soup and HIMSS have in common?” you might wonder.

Well, remember when Elaine thought she was ordering from the Soup Nazi? She commented that he looked “exactly like Al Pacino, you know, Scent of a Woman, hoo-ahh, hoo-ahh!” only to have her order for some yummy soup rebuffed with a Gestapo-esque, “No soup for you!”

Similarly, my desire to attend this year’s conference has been “no soup for you-ed” by HIMSS and its schedule change. There’s just no way that I could afford to pay both the costs of attending AND the costs for being away from the office during the majority of a work week. Not unless I use HIMSS as my vacation. (Uh… no… I don’t think so.)

Previously, it was hard enough to attend on the weekend and a Monday or Tuesday. Time away from the office is time when no income is being generated, losing thousands of dollars as bills pile up and still paying staff to man the fort. But, it was doable and worthwhile, especially to be able to attend all the HIStalk fun – i.e., HIStalkapalooza, et al.

I get that HIMSS is more and more oriented toward the vendor world and the large provider institutions, despite the fact that over half of healthcare is still delivered in smaller communities by smaller practices. It makes more sense for them to have their salaried folks come during their regular work week than to pay their people extra to travel/work on the weekend. But for me and, I’m suspecting, most of my small trench ilk, that is the exact opposite logic for our needs.

Then, on top of being “no soup for you-ed” on the event timing, the HIMSS meetings seem to me to have pretty much taken on a “big boys” focus. (No gender discrimination intended.) It makes me sort of miss TEPR – Toward the Electronic Patient Record – Conferences that, while not as well run as HIMSS, had a much greater end user focus with a nice blend of vendor “ooo” and “ahhh” mixed in with meetings and talks that were more useful for us onesy-twosies.

I’m still a HIMSS member, but I feel my membership has been a bit rebuffed just as were Elaine’s comments to the Soup Nazi.

Realizing how late it is to be whining about this and realizing , too, how little effect my whine will have, I nevertheless felt compelled to throw this out into the Internet air, just a mini-bitch on behalf of us little guys who so often get left out of the “soup.”

From the trenches…

“Do you ever get down on your knees and thank God you know me and have access to my dementia?” – George Costanza

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).