News 12/20/11

From CIO on a Mission: “Re: EHRs for surgeons. I’m trying to be helpful to some surgeons who practice at our hospital. They asked me for recommendations of practice-based EHR systems that are more surgeon focused, i.e., manage the episodic care of surgical patients rather than the chronological data of a family practice or internal medicine focused system. I’ve done the usual Google/Bing searches and came up with a few, but wondered if you or your HIStalk Practice readers can help? Thanks.” I passed on a couple of names, but also defer to our expert readers for more suggestions.

Orthopaedic Center of Southern Illinois selects SRS EHR for its nine providers.

The American Telemedicine Association develops a legislative proposal that would expand Medicaid coverage for telemedicine services treating patients with high-risk pregnancy conditions.

Vermont IT Leaders, Inc., the state’s REC and HIE organization, subscribes to CapSite’s online service, giving providers access to CapSite’s  database of HIT vendor pricing and contract terms.

Allscripts partners with clinical decision support and analytics company DiagnosisOne to offer DiagnosisOne’s smartPath platform to its Allscripts’ Professional EHR clients. DiagnosisOne will also provide real-time PQRS patient alerts and reporting to CMS on PQRS measures for Professional clients participating in the PQRS incentive program.

The Arizona REC selects PatientClick EHR as a Tier 3 participant in its Vendor Alliance Program. Tier 1 participants include Allscripts, athenahealth, e-MDs, GE, Greenway, NextGen, and Office Ally.

AHRQ introduces an online guide for reducing unintended consequences of EHRs. The guide, which was developed by RAND, is designed for all types of healthcare organizations from solo physicians to large hospital systems and addresses problems that can occur when implementing and using an EHR.

The New York Times highlights Micky Tripathi and his organization’s data breach tale. Tripathi, who is CEO of Massachusetts eHealth Collaborative, provided the full low-down on the data breach earlier this month on HIStalk Practice. On MAEHC’s blog, Tripathi posted a few follow-up comments about the Times piece, including his opinion that electronic systems are actually more secure than paper and fax. The photo above accompanied the Times story — check out his computer screen.

We mentioned the new KLAS ratings on HIStalk last week, but here is a summary of which vendors took the top three spots in the ambulatory EHR and practice management categories:

• EHR >75 Physicians: EpicCare Ambulatory, eClinicalWorks, GE Centricity
• EHR 11-75 Physicians: athenaClinicals, Greenway PrimeSuite, Allscripts Professional
• EHR 1-10 Physicians: Amazing Charts Greenway PrimeSuite, athenaClinicals
• PM >75 Physicians: Epic, McKesson Practice Plus, eClinicalWorks
• PM 11-75 Physicians: Greenway PrimeSuite, athenaCollector, McKesson Practice Plus
• PM 1-10 Physicians: Greenway PrimeSuite, athenaCollector, OptumInsight Ingenix CareTracker

In the Claims and Clearinghouse Services category, ZirMed, Office Ally, and Navicure were the highest ranked vendors.

Naughty or nice? Tell Inga.

News 12/15/11

The Orthopaedic Group, a 36-provider group in Mobile, AL, replaces its legacy EHR with SRS EHR.

Emdeon and HHS announce a program through which Emdeon will donate Emdeon Clinician EHR licenses to 100 New Jersey healthcare providers practices in medically underserved areas. License fees will be waived for one year from the date a qualified provider contracts with Emdeon. I found this demo of Clinician from this year’s HIMSS conference.

athenahealth CEO Jonathan Bush speaks out in The Hill’s Congress Blog, calling for greater transparency and accountability in the Meaningful Use incentive program. Bush points out that the current program includes no verification process to prove physicians are actually using HIT in a meaningful way. He argues that the lack of verification could potentially lead to billions of wasted taxpayer dollars and “enormous disparities between what physicians and hospitals are able to do with the EHRs and their actual ability to improve care.”

The Maine REC (MEREC) reaches its enrollment target of 1,000 primary care providers. MEREC, by the way, does not charge for its services, and, the statewide HIE will not charge small practices a connection fee for the first year.

The New England Chapter of HIMSS names practicing physician Daniel J. Nigrin, MD (Children’s Hospital, Boston) Clinician of the Year. Nigrin is also CIO at Children’s and a faithful HIStalk/HIStalk Practice reader.

The White House announces that more than $2.9 billion in healthcare fraud has been recovered in 2011, which represents a 167% increase over 2008.

In article highlighting HIPAA privacy, The Boston Globe profiles Leon Rodriguez, director of the Office of Civil Rights. Also getting a mention: Massachusetts eHealth Collaborative CEO Micky Tripathi and his recent HIStalk Practice post, which details his organization’s handling of a patient security breach earlier this year.

E-mail Inga holiday greetings.

News 12/13/11

AthletiCo Physical and Occupational Therapy (WI/IN) selects NextGen Ambulatory EHR/PM for its 50 physical and occupational therapy facilities.

HHS’ Office of Inspector General releases an advisory opinion regarding the exchange of EHR data for patient referrals. At issue: whether a vendor can facilitate a (presumably nominal) charge from a referring doctor to a specialist for a patient’s clinical record, without violating the anti-kickback statute. In reading the advisory opinion, it appears the vendor will not only facilitate the charge, but also keep a portion of the fee. OIG’s verdict: the proposed“coordination” service would not violate the anti-kickback statute. At the vendor’s request, the OIG does not name the vendor, although it sounds a lot like athenahealth to me (unverified.)

Danbury Radiological Associates (CT) selects ADVOCATE to provide billing services for its 20 physicians.

Quest’s Care360 EHR is named the top standalone e-prescribing platform by Black Book Rankings. Practice Fusion earned top scores for its EHR-based e-prescribing module.

e-MDs clients Drs. Mark Woodruff and William Weeks of Southwest Family Physicians are among the first providers in Nebraska to attest and receive Medicare payments for their meaningful EHR use.

The Chicago Health Information Technology REC says it’s on target to reach its enrollment goal of 1,486 primary care providers by the end of the year.

Altos Solutions will extend preferred access to its OncoEMR and OncoBilling platforms to members of the Innovatix non-acute care purchasing organization.

The California Health Information Partnership Services Organization (CalHIPSO) partners with CDW Healthcare to provide technology services and solutions to practices implementing EHRs.

DrFirst embeds technology from Atlas Medical into its Rcopia e-prescribing solutions, allowing Rcopia users to order tests and receive reports from any diagnostic testing facility on the Atlas iOn Interoperability Network.

Dermatology-specific EMR Encite, Inc. integrates NetHealth’s Quality Report System into its product to automate PQRS reporting.

An employee hired to purchase and maintain the IT systems at Wasatch Internal Medicine (UT) faces second-degree felony theft charges for stealing nearly $350,000 from the clinic. Over a 2-1/2 year period, the clinic paid Eric David Christensen almost $400,000 to purchase 51 PCs, warranties, and servers. Results of an audit uncovered that only three computers had been supplied to the office and none had warranties. When confronted, Christensen admitted he had been overcharging the clinic and had falsified records to cover up his actions.

A former physician with Fletcher Allen Health Care pleads guilty in US Court to unlawfully obtaining the private medical information of another person. Apparently Joshua Welch was having a sexual relationship with a woman who was not his patient and wanted to ascertain if she carried a sexually transmitted disease. He faces up to one year in prison and a $50,000 fine.

Overlake Imaging Associates (WA) selects Zotec Partners as its outsourced billing provider.

CMS posts the PQRS measures for 2012, including detailed specifications and release notes on the individual quality measures and measures groups. I found the release notes gave a pretty quick summary of what measures have changed and how.

On EHRtv, Medicomp CEO David Lareau talks Quippe with EHRtv’s Eric Fishman. He discusses the multiple way different EHR vendors are incorporating Quippe into their platforms.

Adirondack Region Medical Home Pilot Program, with implementation support services the Massachusetts eHealth Collaborative, earns Level 3 NCQA recognition for 29 of its 31 primary care practices.

E-mail Inga.

News 12/8/11

From Wednesday’s HIT Policy Committee meeting comes the following facts and figures:

• Over 154,000 Eligible Professionals have registered for Meaningful Use through the end of November, including 115,000 in Medicare’s program and 38,000 with Medicaid’s.
• Medicare has paid EPs almost $183 million; Medicaid has issued an estimated $237 million in incentives.
• The number of EPs that have registered is less than 30% of all EPs.
• Only 21, 425 EPs have received payments through the end of November. That’s about 14% of registered EPs and 4% of all EPs.
• At the time CMS crunched the numbers, 21,308 EPs had attested; 444 were unsuccessful.
• Drug formulary, immunization registries, and patient list are the most popular menu objectives.

The numbers leave me with a number of questions, including why payment appears to be so slow (almost half the total payments were not made until November.) I’m also curious why 444 EPs failed the attestation.  If you are in the know or have a theory, please share.

Anthony L. Jordan Health Center (NY) selects Phytel’s Atmosphere platform for patient outreach, appointment reminder, performance benchmarking, care coordination, and patient education.

Costco, in partnership with Allscripts reseller Etransmedia Technology, announces a nationwide launch of Allscripts MyWay EHR and PM, following sales success and high demand in select test markets. Costco is offering the MyWay package for as little as $499 a month, which includes hosting services, support, training, implementation, and unlimited claims processing.

Weight loss franchise company Pounds and Inches Away selects eMedical Fusion’s PM solutions, which are targeted at cash, hybrid, and concierge practices. eMedicalFusion also announces the availability of EMR interfaces with Amazing Charts and Eclipse.

Patient check-in company Phreesia releases a study of referral trends in physician offices, finding that 50% of new patients are referred by family and friends. I’m sure that individual practices find it beneficial to understand their own referral patterns,  but does anyone really need aggregated referral information, given variations between primary care providers and specialists and across geographic regions? My guess is that Phreesia’s primary motive for compiling and publishing this information to get the attention of pharma companies, payers, and others that might want more to incorporate their own market research into Phreesia’s check-in system.

On the other hand, who doesn’t want to know about wait times? The nationwide average for wait times to see a physician is 21 minutes. Patients in Wisconsin have the shortest average wait time (15 minutes) and Mississippi as the longest (25 minutes.) Wait times for primary care providers average six minutes less than for specialists. I’m not sure what one does with this data unless you’re looking for a reason not to move to Mississippi.

Maryland Health Care Commission adds OmniMD to its SelectVendor Product Portfolio.

E-mail Inga.

From the Consultant’s Corner 12/6/11

Clinical Integration: The Right Time, the Right Thing to Do

“Uncertain” doesn’t even begin to describe the future of healthcare in the US. We all know that the Patient Protection and Affordable Care Act is law, but it’s facing public resistance and an upcoming Supreme Court challenge. What’s more, there’s little doubt that ongoing budget talks in Washington will bring big changes to Medicare and Medicaid. We fully expect that the push toward performance-based reimbursement will only get stronger.

Now steps the just-released Accountable Care Organization (ACO) final rule into this already-confusing swirl step. The rule reflects the comments of thousands of physicians in provider organizations across the country, and is intended to empower them to join the trend toward clinical integration.

Although ACO participation is voluntary, most of the clients we speak with are convinced that this kind of system represents the future of medicine—and not just for Medicare patients under Medicare rules. Physicians—whether rural or urban, independent, or employed—will likely climb on board with the idea simply because it’s the right thing to do for patient care. Clinical integration across patient care settings is one of the best ways to enable providers to reach out to patients to offer better, more proactive services.

Under the new ACO rules, clinical integration can be accomplished in a number of different ways. Overall, the goal is to align providers and institutions with mutual, patient-centered objectives.

Though financial integration is one part of the picture, it’s definitely subordinate to the achievement of quality care. At their core, the rules require a commitment on both sides to the concept of aligning incentives for quality care—with the understanding that cost reductions will follow improvements in quality. They also require participants to recognize the undeniable role of IT in making it all happen.

Whether they’re headed by a physician chief executive officer (CEO) or a lay CEO, and whether they involve employed physicians or independent physician partners, all ACOs should share these four key characteristics:

• Common mission, vision and values
• Mutual respect and willingness to share risk
• Focus on the patient experience
• Commitment to quality care

Fortunately, some of the historical obstacles that have barred providers from working with large healthcare systems and payers are disappearing. For example, recent regulations released by the Centers for Medicare and Medicaid Services (CMS) significantly relax federal anti-trust laws. Everything is pointing in one direction: now, more than ever, is an opportune time for clinical collaboration.

For physicians, relationships with larger organizations make sense. They allow: easier access to the expertise inherent in the clinical programs of larger organizations; greater payer contracting experience; and the ability to leverage economies of scale. And let’s not forget information technology (IT) resources, which will play a huge role in the future of population management and coordinated care.

Clearly the pressure is on for providers and other healthcare stakeholders to align their mutual interests in order to cut the waste from our fragmented healthcare delivery system. With everyone on the same team, we can redefine the current ineffective, poorly coordinated, and unnecessarily costly healthcare system.

ACOs—together with other similar initiatives like patient centered medical homes, bundled payments and outcomes-based reimbursement—will become the foundation for delivering high-quality, cost-effective patient care for everyone. Ultimately, it doesn’t really matter whether ACOs start with Medicare or not. It doesn’t really matter whether the “ACO” moniker stays or goes. The concept of clinically integrated accountable care is here to stay.

So it’s up to providers to take the lead, developing clinically integrated organizations motivated by a common goal to improve access to quality, lower-cost care for all patients.

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.