DOCtalk by Dr. Gregg 11/18/11

Out of the Mouth of Blavatsky

About two and a half years ago, I wrote about one of my weekly channeling visits with my local psychic, Madame Blavatsky. Now lest anyone think that I have relinquished my spirit guides and abandoned my spiritualism swami, I am here to tell you that the voices from the other side are just as strong as ever and I am listening with ears wide open to every ectoplasmic-associated, ethereal echo.

Why just this week I heard the voice of none other than the granddaddy of all modern day medicos, Hippocrates. (Well, it was still Madame Blavatsky’s vocal cords he used, but he assured me it was “Hip” – as he likes to be called these days – himself.)

Who’d guess that, even though he’s no longer in mortal form, Hip had joined the techno-geek reform movement in medicine and has been following all things HIT? He admits that his current state of being limits his direct involvement in furthering the goals of healthcare reform (remember: he was truly the first healthcare reformer!) and that he can now only influence through the likes of Mme. B. Still, he has kept in touch, so to speak, with the world of medicine and he was just dying, so to speak, to offer his insights into the future of the world of HIT – specifically, the world of HIT vendors.

I was entranced.

A spirit horn sounded off in the distance as Hip began to prognosticate on the future of health IT vendors. The table rose ever so slightly as cold breezes brushed the hair standing up on the back of my neck in the dark, windowless room. Hip spoke…

“The realm of HIT as you know it will change quite dramatically over the foreseeable next few years. Many of the companies you have come to know will become quite different or will completely disappear.”

Well, duh. Who didn’t know that? Feeling just a smidge of nonbeliever skepticism sneaking in, I asked if he could just a bit more specific.

“It is hard from this side to see clearly all that is written and sometimes the names may be blurred, but I will do my best to tell you of the fate that awaits some of your dear HIT corporate world.”

His (her?) voice trembled as the next words wafted out.

“The pink Dolte will grow as a bolt. The pink gloves dance, penetrating the world of medicine, is actually a very clever marketing scheme devised to subliminally further their pink propaganda while appearing to promote a very worthy cause. Pure marketing genius.

“Can you spare a dime, mista, for my down and out WistA? Not sure what it means, but I see cataracts ahead instead of clear vision.

“Epoch will shudder without their rudder. Doody Hawkmer will be seen running off, barebreasted, on a banana boat to Bolivia, oodles and boodles of beer money in hand.

“Just as with TWA, Allchirographies will go away. The ‘all marketing and sales approach’ will implode upon itself revealing the dearth of substance and support below.

“Luddites will hate as Siri and Watson mate. Not sure who they are, but their vile progeny will eventually bring about the decline and fall of the entire transcriptionist world, libraries, and every ‘minute clinic’.

“minervahealth shall grow in wealth. There is some perturbation in the future energies, though; a possible dimensional shift may occur in which minerva’s leader is seen boarding the banana boat with Ms. Hawkmer. It appears that heavy doses of Stella Artois will be involved. minerva’s status if their leader heads to La Paz is unclear.

“A Quip in time saves nine. Not sure who’s making the ‘quip’ we’re seeing here, but it appears that Virginia and Pittsburgh are somehow in cahoots for a major disruptive force in HIT.

“A man with no name and his Scandinavian dame. This partial phrase came through the ethers as important, though I’ve no clue as to their relationship to future of HIT…other than it is clear they will be instrumental. Something was there, too, about a Jay or a J, but it was all just so foggy”

Suddenly, my cell phone buzzed which, even though muted, was apparently enough to break our cosmic connection. With another cold blow of wind across my neck, Hip was suddenly gone and all I could hear was what sounded like a dial tone coming from Madame B’s mouth.

I wasn’t certain to exactly whom good old Hip referred with each reference, but I did appreciate his weird little rhymes as they helped me to remember his prognostications long enough to get home and get them written down for posterity. I just know they’ll be important somehow. After all, who’s going to doubt the words of the Father of Medicine? (OK, except that bothersome spirit of Imhotep who kept trying to break through my connection with Hip to reclaim his initial role as medicine’s “real” father. Geez, dude…get a life, so to speak.)

From the trenches…

“Eat, drink, and be merry for tomorrow we shall die.” – Imhotep

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 11/17/11

From Lady: “Re: NextGen UGM. You missed it. Styx and Sammy Hagar entertained the crowds. You have to go next year.” Indeed. No doubt I would have been rocking (or slow dancing) in my seat.

The Wichita, KS City Council approves a $6 million bond measure and property tax abatement to facilitate the expansion of Pulse Systems. Pulse intends to buy and renovate a 46,000 square foot building and lease half of it. In return for investing  in Wichita, the city will extend Pulse a five-year property tax abatement. Pulse, which employs 75 people in Wichita, had previously considered moving its operations to the New Jersey headquarters of it parent company.

AdvancedMD announces the availability of its 2011 Fall release, which enables practices to send ANSI 5010-formatted claims.

Pronger Smith Medical Care (IL) rolls out InterSystems Ensemble as its core enterprise integration platform for its 40-physician group. The Ensemble interfaces provide connectivity between Pronger’s legacy EHR and the regional HIE.

AAFP President Glen Stream, MD, encourages members to make “the changes necessary to earn PCMH recognition,” noting the revenue-enhancing opportunities it currently offers and may provide in the future. He cites the example of Maryland’s multi-payer PCMH program, which has distributed $3 million to 54 primary care providers, and payments of $1.5 million to 236 providers from 11 practices in New York’s Hudson Valley.

Greenway Medical launches PrimeDATACLOUD, a care delivery platform that recognizes and aggregates data from various EHR and HIS platforms and facilitates health information exchange.

Florida Medical Clinic selects Humedica MinedShare for clinical analytics to manage its patient population and improving clinical outcomes.

The latest Meaningful Use dashboard from athenahealth shows that 58% of their providers have attested for Meaningful Use. I am not sure what percentage of all EHR users have successfully attested for Meaningful Use, but I will go out on a limb and say it’s nowhere near 58%.

Meanwhile, meridianEMR clients appear to be having good success as well.

Practice Fusion reveals its roadmap for its native iPad application, which will be released in 2012.

Medley Health, a provider of practice marketing and communication services, announces a $20 million Series A financing round from Cardinal Partners, Technology Partners, and Vivo Ventures. Medley will use the capital to expand its physician partnerships, increase staff, and fund development efforts.

Findings from a relatively small sample (350 providers or administrators and 400 HIT firms): one-fourth of providers use tablet computers in their practice, while 38% use a mobile device that supports medical-related apps on a daily basis. About a third of providers use their smart phone or tablet to access EHRs.

 E-mail Inga.

News 11/15/11

Vista Equity Partners wraps up its purchase of Sage Healthcare, which is has renamed Vitera Healthcare Solutions. Vitera also introduces a new Web site, which looks a lot like the old Web site except for this fun banner at the top of the landing page. Betty Otter-Nickerson, former president of Sage Healthcare division, will be stepping down at the end of the year and replaced by new CEO Matthew Hawkins. Hawkins is the former VP and GM of Henry Schein Practice Solutions. 

NextGen Healthcare kicks off its 2011 Users’ Group Meeting in Las Vegas with over 4,200 participants. Keynote speakers include the ONC’s Farzad Mostashari, MD and former Blue Angel John Foley, who was scheduled to discuss achieving high performance. I also looked at a few of #nextgenugm Tweets and saw a number of positive comments on Foley’s keynote speech, as well as a few expressing disappointment that some sessions were full. By the way, the official press release notes that “many” of the company’s ambulatory inpatient users have attested for Meaningful Use and over 100 have earned PCMH designation.

gloStream hires Mark Crall and Steve Luby as co-directors of the company’s partners program.

CalOptima REC adds SuiteMed to its preferred EHR vendor list.

The 175-provider  Vancouver Clinic (WA) implements Epic EMR. Well, I assume it’s Epic, given that the local newspaper says it’s the same EMR used by Kaiser and 24% of the country’s providers.

Practice Fusion hosted a free user meeting in San Francisco last week on the forth anniversary of the company’s founding. CEO Ryan Howard says the company now has 130,000 medical professionals using the system to document the health of 25 million patients. In addition, it refers $40 billion worth of business every year to pharmacies and labs that pay to advertise on the Practice Fusion site.

The local business journal profiles safety-net clinic Grace Medical Home (FL), which recently implemented e-MDs.

SRS appoints Jack Walsh as CFO. He spent 13 years at IMS Health in various financial and strategic roles, including SVP of payers, government, and business development.

Emdeon announces Healthpayers Protect, a new service that allows payers to analyze adjudicated claims before they are paid.

The Colorado RHIO’s (CORHIO) financial model may need some tweaking, given that many Boulder-area physicians are balking at the $85/month connection fee and the initial $2,500 to $5,000 per practice training cost. An estimated 50% of area physicians don’t have an EHR, which means they are unable to connect to the RHIO. Then there are the 70 physicians with Boulder Medical Center who don’t see the need for the RHIO since they are already connected to one another  via their NextGen system. CORHIO’s five-year business plan calls for taking in $26 million in federal grants and $19 million in subscriber fees.

The Supreme Court announces that it will review the healthcare reform law over a two-day period in March.

E-mail Inga.

Practice Wise 11/12/11

How is IT like Medicine?

When you have an issue with your software or on your network, what do you do? If you are a clinician or clinical support tech in a medical practice, you call for IT technical support.

When your patients have medical problems, what do they do? They call you. Patients hope that you will have all the answers and will be able to fix their problem in one phone call or office visit. You hope that tech support will push a button and fix your problem in one call.

How likely are you to find the etiology of the patient’s problem the first time you investigate it? How often do you expect that your tech support will? The old adage is that if you put 10 IT engineers in a room and give them all the same problem, you’ll get 10 different ways to approach it.

I don’t often hear this about medical providers, and I think that’s because medicine is a mature practice, IT as a well-defined discipline is still in its infancy.

Over the years, it’s been my mission to (a) help medical practices understand the nature of IT issues and how difficult they can be to resolve, and (b) to help the tech support community understand how to communicate technical information to the practices in a language they can understand.

Lately I’ve started using medical problem metaphors when describing technical issues to clinical staff. By gosh, they get it! Troubleshooting IT issues is a lot like diagnosing medical problems. When a patient presents at the doctor’s office, they rarely know their ICD-9 code. When a medical staff person calls their IT support desk, they rarely state that they’ve lost connection to their database server due to a failed ODBC connection or the loss of the local area network.

Both parties simply state that something is causing them pain. They can describe the pain in terms that they understand. In both cases, it’s our job to interpret that pain and alleviate it.

How does tech support do this? Start acting like doctors. EHR tech support can practice what they preach – apply EHR vernacular to EHR problems. Encourage the practice staff to start acting like patients in describing their symptoms.

Follow the flow of a visit note when troubl shooting IT issues:

• Chief Complaint: clinic staff – state what your pain is.
• History of Present Illness: what were you doing when the issue started, what were the behaviors (symptoms) that made you realize you had an issue?
• Physical Exam: IT staff, observe the user in their environment. Ask if they can reproduce the problem.
• Review Of Systems: IT staff – evaluate the problem by looking at the software, the user profile, the computer, the network, the server, etc.
• Past Medical History: Has this user/computer had problems in the past? Has the network had problems? Does the application have a history of problems? These are possible keys to what is happening now.
• Diagnosis: This is often a best guess, both for doctors – that’s why there are “rule out” diagnosis codes – and technical support staff. The art of diagnosis is a hard-won battle. Have patience. Sometimes the answer is not clear until much testing (trial and error) has been done.
• Rx: IT prescribes parts or processes to fix the issue. Patients follow the directions prescribed. If tech support tells you not to click on something and you click on it anyway, then you choose to break it. If you tell a hypertensive patient to change their lifestyle and take their blood pressure medication and they don’t, well then, they made a choice. It’s hard to keep people from causing their own pain.
• Services Performed: Communicate to the end user what you have done in terms that they can understand. A patient doesn’t understand the complexities of Latin diagnosis-speak. Clinical staff don’t understand the geek speak of TCP IP and database language either. Remember to use the KISS (Keep it Simple Stupid) method. Bring the explanation down to their level. You don’t look smarter just because you speak in a language your audience doesn’t understand.
• Services Ordered: If you as the local IT technician can’t fix it, you contact the vendor (hardware or software) for additional parts or support.
• Assessment and Plan: Tech support — summarize what you’ve found in clear, understandable terms and how you will work together to solve the problem. Client, adhere to your maintenance plan.
• Results: Measure the effectiveness of what you’ve done. Have you fixed the problem? Do you need to do more to get things working again? Is there a cure or ongoing management?

Today’s software products are exceedingly complex. The human body is, too. Both require that we listen to the complaint and work towards a mutually acceptable solution. Sometimes you have a diagnosis without a cure.

I’m not a doctor or an engineer, but I am someone who has travelled in both the clinical and IT worlds professionally. I know that this is a global communication issue that is easy to fix if we realize that we all speak the same language — sorta kinda.

ulie McGovern is CEO of Practice Wise, LLC.

News 11/10/11

Over 52% of office-based doctors (291,000) are currently e-prescribing, compared to less than 10% three years earlier. An analysis of 2010 data showed that Massachusetts had the highest rate (41% of all prescriptions), followed by Delaware and Michigan. Other key statistics compiled by Surescripts:

• Electronic responses to requests for prescription benefit information grew 125% from 188 million in 2009 to 423 million in 2010.
• Prescription histories delivered to prescribers grew 184% from 81 million in 2009 to 230 million in 2010.
• Prescriptions routed electron­ically grew 72% from 191 million in 2009 to 326 mil­lion in 2010.
• About 79 percent of prescribers used EMRs versus standalone e-prescribing options in 2010, up from 70% in 2009.

Kareo launches an electronic patient statements and payment portal using InstaMed’s healthcare payments network.

The 12-physician Kleinert Kutz Hand Care Center (KY) selects ChartLogic EHR Suite. I see in the same press release that ChartLogic serves more than 1,000 physicians and that 25 “customers” have qualified for Meaningful Use payments. I sure hope that each customer has lots of physicians because 25 customers doesn’t sound like a big number. Regardless, I am glad to see ChartLogic include the stats.

Ophthalmology EMR/PM provider NexTech Systems partners with patient education software vendor Eyemaginations to integrate NextTech Practice 2011 and Eyemaginations LUMA software.

Associated Purchasing selects Greenway Medical’s PrimeSUITE 2011 as one of nine preferred solutions for physicians seeking EHR implementation through the Kansas and Missouri REC programs. PrimeSUITE is also a preferred EHR for at least 10 other RECs.

I am all about free stuff, so this little contest caught my eye. Apple reseller MacMall launches a contest strictly for medical offices and features an office “makeover.” Some of the winning prizes include Nuance medical dictation, Ergotron carts, HP workstations, and Fujitsu scanners. OK, so it’s not like a day at the spa, but it still would be fun to win. The contest runs through January 16, 2012 and includes over $23,000 in prizes.

A new report finds Allscripts to have the largest share of the ambulatory EMR market out of the more than 750 companies offering EMR products. The combined ambulatory and inpatient EMR market is expected to grow to over $8.3 billion by 2016.

HHS’s Office for Civil Rights will begin HIPAA compliance audits this month for office-based physicians, hospitals, and health plans. Twenty audits will be performed in the initial round and selected entities will be notified in writing within 10 days. Officials will visit the audited sites within 30 to 90 days of notification.

E-mail Inga.