DOCtalk by Dr. Gregg 10/29/11

Inside the Show Inside the Show Inside the Show

“Behind the scenes is the most enlightened place to be.”

I’m a firm believer in that statement. From way back in my early years as a sound engineer to my current HIT-related years, that message has been repeatedly driven home, over and over and over. Lemme ‘splain…

Back when rock was king and no one trusted anyone over 30, I started learning how to do audio mixing – after a short stint as a regular roadie – working weekends, starting when I was just 13. (Geez…I’m into my fifth decade paying into Social Security … really?!) In smoky bars where it was a slow night if there wasn’t a brawl or knife fight through coliseums, college shows, and Carnegie Hall, I watched and worked with all sorts of musical acts, always seeing the show from the inside.

From the blank slate of an empty hall through set-up, through show time, through tear-down – the evolution/devolution of the show was always more fascinating to me than the actual show. For instance — and not to burst anyone’s star-struck bubble — most celebrities aren’t really that cool off-stage. But, even this revelation was far more interesting to me than any performance ever was. (OK, Randy Newman is like the nicest guy ever and B.B. King is so good, so fun to watch, but they’re more exception than rule.)

Move now into the current century and the realm of HIT. I’ve been lucky enough to be able to use some of those very same skills that I learned on the rock-n-roll road helping drive the creation and expansion of the Pediatric Office of the Future (POF) exhibit for the American Academy of Pediatrics (AAP) which is all about helping advance the understanding and use of superior tech for better healthcare delivery. I’m still recovering from this year’s event, which featured 31 mostly very generous sponsors in our 4,500 square foot exhibit. (Vendor tradeshow folks: imagine your exhibit headaches multiplied times 31.)

Our “show” runs inside of the much larger AAP exhibition hall “show” – a “show within a show.” As with most such academies – I’m sure – it’s challenging when trying to do outside-the-box stuff while following inside-the-box rules and regs. But, then, that’s what driving into the future is always about, right? Pushing boundaries, asking “Why not?”, figuring out how to make that new square peg actually fit the old, round hole. I can say with confidence that building our POF show inside the confines of the larger AAP show has been one of the greatest learning experiences and one of the most challenging chapters of my life.

Remember, we’re not an exhibit hall; we’re just another exhibit within the hall, except we had many different sponsors that we needed to organize into one harmonized space. And, our sponsors came in all sizes, from health industry giants to HIT start-ups. Adding to fun is the seemingly inbred bent within the world of HIT for smoke and mirrors!

As I’ve been the primary point of contact for all of these folks, I’ve also often been privy to what happens behind many of their “curtains.” Sometimes, it’s pretty; sometimes, not so much. Many little “shows” inside our “show inside the show.” And it doesn’t matter if they’re large or small; some can be just as dysfunctional in their early stages as others who have grown that way in their older, bureaucratic stages. On the other hand, some rookies “get it” right off and some powerhouses run like silk over satin.

Given the convention hall rules, the union crew rules, the AAP rules, the sponsors’ needs, the attendees’ needs, the mirrored smoke, and our own limited resources, we pulled off one heck of a show. It was good enough to get great buzz back from the upper AAP levels about our boundary-bending exhibit, an acknowledgement sometimes difficult to attain when you’re a bleeding edge pusher. And, most of our sponsors were happy – especially those that understand how hard it can be to bring “new” into people’s lives (or into academy confines!)

I always hope everything goes perfectly and that each generous sponsor and every attendee glows from their experience. For me, though, it isn’t the “Did it all work?” or the “Was everybody perfectly satisfied?” questions that matter so much. No show goes exactly how you plan it. There are always let-downs, learning points, and little lemons you can’t turn into lemonade. But, just as I learned as a road-ravaged, rock-n-roll sound man, you have to expect the unexpected, learn how to deal with all of the “fourth and forty” moments (crises, which happen in every show, that force you to “punt”), and figure out how to better the show for both “the talent” and the fans next time.

Being a part of the backstage drama is the best seat in the house, way better than the front row. You get to see all of the gory details that eventually produce what (hopefully) ends up looking like a well-rehearsed show. Knowing what makes it all tick, where the duct tape and staples are, what is smoke and what is mirrors, makes it so much more fascinating.

From the trenches…

PS: I recently discovered that there’s an ultra-secret board of directors pulling all of the healthcare information technology strings consisting of David Copperfield, Lance Burton, Criss Angel, David Blaine, and run, of course, by the sardonic Penn & Teller. (By the way, I’m pretty sure this is the same board covertly running all health insurance payors.)

“The little foolery that wise men have makes a great show.” – William Shakespeare

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).

MGMA Wrap-Up 10/27/11

MGMA11 is history and I’m happy to be home. My poor feet are swollen from extensive walking in non-sensible shoes and I’m more than a little sleep deprived. Other than those small complaints, it was a great convention I learned more than a few new things. A few final bits of news and impressions:

Official attendance, according to MGMA: more than 5,700, including 3,500 attendees and representatives from 399 exhibiting companies. Those numbers represent a 19% jump over 2010. MGMA is no HIMSS in terms of size, but it did seem busier than the last couple of years. I don’t know if there is an official explanation for the increase in attendance, but I’m sure it helps that Vegas hotels are affordable this time of year and flights are reasonably inexpensive. Practices are also facing a host of pressing issues, including Meaningful Use, looming deadlines for ICD-10 and 5010, evolving reimbursement models, and declining reimbursement. There was no shortage of sessions covering each of these topics.

During the meeting, MGMA and the American College of Medical Practice Executives (ACMPE) announced their official merger, effective January 1, 2012. MGMA is the much bigger organization, with 22,500 members, compared to ACMPE’s 6,750. The new MGMA-ACMPE is creating a unified board of directors. Both organizations will automatically transfer members into the new entity.

The most popular giveaway: the iPad2. MED3OOO awarded 100 iPads to attendees who were randomly selected to participate in short demos of Quippe and InteGreat EHR. Medicomp provided the Quippe overview and handled the live drawings. Needless to say, booth traffic was heavy for both companies.

Other seemingly hopping  booths: athenahealth, Allscripts, Greenway, and Pulse. No coincidence that all have big booths and central locations.

I have a preference for booths that are very open, such as Sage’s and ZirMed’s. This photo of GE’s booth was taken from the main aisle. To “enter” the booth, you had to walk around to the other side. Granted there was an exhibit hall entrance near the other side, but it would seem the traffic was heavier on the less uninviting side.

I’ve said in the past that I like NextGen’s booth, which has cool lighting and these arches that go over the top of the booth. I didn’t take a picture this year and this photo was from a previous convention. Despite the eye-catching look, it’s a bit intimidating to have to walk into the booth to get a peek if you want to look over someone’s shoulder at a demo. NextGen, by the way, was promoting the fact its customers have submitted $8 million in Meaningful Use applications. I’m not sure if that was just ambulatory or if it also included inpatient.

The monorail that runs along the Strip was down at least part of the time during the convention. MGMA had provided attendees with monorail passes (in lieu of buses) to transport people from outlying hotels to the convention center. No monorail meant people had to pay $10 to $20 for cab rides, and taxi lines were often long. I am sure MGMA was not happy about the glitch.

McKesson had a smaller booth than in years past, while Cerner’s looked a bit bigger (though smaller than McKesson’s.) It seems to me that the size of the booth matters less than the location. As expected, the vendors with far outside booths spent a lot of time talking to each other rather than attendees. Or, more likely, looking at their phones and checking e-mail.

Some people don’t like Las Vegas, but I find it a great for people watching and I love the wide variety of food and and entertainment options. Next year MGMA heads to San Antonio, a less-flashy but still fun locale. Hopefully my feet will recover by then.

E-mail Inga.

From MGMA 10/26/11

Tuesday

On Monday, ONC head Farzad Mostashari led a session on Meaningful Use and “other critical topics.” Only about 100 people attended, which surprised me a bit.  On the other hand, Meaningful Use and HIT are but one area of concern for practice administrators. A few highlights:

• HITECH is proving effective at spurring EHR adoption, with adoption expected to hit 40% by the end of the year.
• As EHR adoption grows, so will its benefits, including better care coordination, improved decision support, and better patient care.
• As payment models shift from fee for service, EHRs will prove invaluable for documenting quality care.
• Don’t expect the Stage 2 deadline to be pushed back.

Mostashari also took several questions from the audience. Based a few of them (regarding ICD-10, for example,) some audience members didn’t fully understand what the ONC really does. A few points from the Q&A:

• CMS would like to “harmonize” various quality initiatives to reduce administrative burdens.
• Progress has been made in establishing standards and protocols for information exchange, but work remains.
• In developing new clinical measurements, the priority is establishing those that matter across a wide range of specialties rather than for single specialties.

As a presenter, Mostashari is engaging, personable, and quick on his feet. It was definitely my favorite session of the conference.

Tuesday morning’s keynote speaker was Eric Dishman of Intel’s Digital Health Group. I am going to try to track him down because I think he’d be a great interview for HIStalk. His presentation was billed as "Home and Community-based care Technologies for Independent Living,” and he went into a fair amount of detail about various emerging technologies, such as kinetic motion monitoring, implantable medication compliance devices, and tools to automate the documentation process. Dishman made a great case for the need for technology that shifts patient care out traditional settings and seems confident that we’ll see a flood of innovation over the next 10 years.

I spent about 10 minutes in a remedial session on technology. Its content targeted individuals who were not IT experts, but were perhaps responsible for taking care of the office’s IT needs. I suppose it’s a great topic for certain office managers running small offices, but I walked out when the presenter began to explain the difference between a server and workstation.

As I walked down the hall looking for an alternate session on patient interaction technologies, I noticed a standing room only crowd for a session on building successful physician/hospital relationships. Obviously the average administrator is far more interested in that topic than the HIT stuff.

In the exhibit hall, I sat through a couple of 20-minutes sessions on PQRS at the Healthcare Innovations Pavilion, where I think it was only vendors presenting. The ones I saw were well done and perfect for my 20-minute attention span.

I’ll be doing a meeting wrap-up tomorrow, but here are a few more pics.

My collected swag. Best giveaway: the free flu shot from Passport Health.

athenahealth hosted a fun event Monday night at the Tao in the Venetian. I think the event was billed as the Opening of the Kimono, starring the kimono-adorned Jonathan Bush. After a few opening remarks, Bush opened his kimono and an image of athena’s Meaningful Use Dashboard was displayed onto the kimono (the picture on the right.) It was a tongue in cheek representation of athena’s push for EHR vendors to be more transparent and reveal their customers’ level of success fulfilling Meaningful Use requirements. Only Bush could get away with such a presentation.

MED3OOO and Phytel co-sponsored a reception for the Primary Care Assembly. Guests had an opportunity to sit in front of a green screen and videographers created a music video of them singing different hit songs. This pair was lip synching to Sweet Home Alabama for their personal video.

I also stopped by Greenway’s party, which was in a dueling piano bar at New York New York. The music was great and everyone seemed to be having good fun. I even had the opportunity to shake hands with CEO Tee Green and the dashing Justin Barnes.

Nice shoes AND nice calves.

E-mail Inga.

From MGMA 10/25/11

Monday

At the suggestion of a reader, I walked through the exhibit hall this morning, intent on identifying what HIT vendors may be talking about this year in addition to EHR and Meaningful Use. So, in no special order:

• Connecting. For example,  connecting physicians to each another; connecting physicians with hospitals, labs, pharmacies, and payers; connecting providers with patients.
• Improving EHR adoption. Obviously the EHR vendors were talking about this, but so were document imaging vendors, transcription services, and companies that offer ancillary tools that feed information into EHRs (speech recognition, card scanners, automated charge and code capture technologies, and HIE type offerings.)
• Patient communication tools. Examples include kiosks, patient portals, personal health records, and automated patient reminders.
• Revenue enhancement tools. Definitely not the sexiest of topics, but practices still care about products and services for RCM, code scrubbing, and ICD-10 conversions.

Most annoying entertainer: the singing Elvis on stilts at the Sage booth. I think he was at least as old as the real Elvis would be, but I doubt he ever had Elvis’s voice. I pitied the vendors surrounding Sage’s booth.

Speaking of Sage, an employee told me the company is changing its name. He says it won’t be Medical Manager.

I was pleasantly surprised by the morning keynote speaker, Marcus Buckingham. He has written a few books, including First Break All the Rules and Now, Discover Your Strengths, and was scheduled to discussed what the world’s best managers do differently. He covered the topic well and was very funny and entertaining. I thought he was a great pick for MGMA’s target audience.

I am in a bit of a time crunch, so I am unable to cover all the highlights of my day (including the presentation by the bowtie-adorned Dr. Mostashari) but a few highlights in pictures:

Before I gave it all back to the Hilton.

John Hallock (on right) is director of communications for athenhaealth. He assured me that his boss, Jonathan Bush, hadn’t been drinking when he selected today’s outfit.

That’s me on the right, posing with a George Clooney lookalike. Wish I had been smiling.

In the hotel gift shop. I wonder if Mr. H will notice if I happen to add this to my expense report?

I find this knight creepy, regardless of the marketing message it’s suppose to be sending.

E-mail Inga.

From MGMA 10/24/11

If you saw Elvis, then you must in in Las Vegas. Dueling Elvises (Elvi?) were on hand to entertain the MGMA crowds on the opening day. Personally, I thought the younger Elvis was way hotter than the more senior and rotund version. Young Elvis gave me his card, saying, “If you ever need an Elvis, I can hook you up.” Since HIMSS is heading to Vegas in February, I intend to keep his contact info, since one really doesn’t know when you might need an Elvis

.

MGMA made a big push this year to get the crowds in the exhibit hall on the first day. There was very little competition in terms of educational speakers and the first 1,000 folks to enter the hall got “special” gifts. I must have been #1,001 because I got nada. The hall opened at 1:00 and free drinks and appetizers were on hand beginning at 3:00. Bribery apparently worked, as the traffic did appear heavier to me than in years past. Cirque du Soleil acrobats were also floating about, including this magician. They were fun and entertaining, even though I found the masks a bit creepy.

Plenty of magicians, money-grab booths, and massages were available to attract attendees into booths. My favorite entertainer was the chef at Zirmed, who was mixing up some bruschetta and juggling tomatoes, while also giving a spiel on Zirmed’s “recipe for success.” Now that’s talent.

I also enjoyed the balloon maker at the IDS booth (that’s an octopus above.) Creating balloon animals is also an enviable talent.

Sage is donating $5 to a cancer research organization for anyone who signs on their wall. And, Gateway is giving $5 to the Susan B. Komen for every card they swipe.  Thank you Sage and Gateway.

Another good cause: United Healthcare has markers, crayons, stickers, and all those other fun things you enjoyed in kindergarten and is encouraging attendees to create cards for service men and women. I made a little Christmas card that I thought was quite cheery.

Today’s shoe winner: these little alligator skin beauties worn by a doctor. Angela with CTG was a close second in her knee-high black patent leather boots (I’m sorry I didn’t get a picture.)

I mentioned that Sunday afternoon the exhibitors didn’t have much competition from the standard education sessions. However MGMA did offer 20 minute education sessions in  the Healthcare Innovations Pavilion, which was set up at the far end of the exhibit hall. They appeared to be pretty well attended.  I had intended to sit through a couple but by the time I found the Pavilion (did I mention it was at the far end of the hall?) I had already missed the sessions that most interested me.

I saw a good number of sponsors were displaying their “Power HIStalk” signs, including e-MDs, NextGen, Accusis, Culbert, and Gateway. If you see one of our signs (which are autographed by me, Mr. H, and Dr. Jayne), please join me in thanking the vendor for supporting HIStalk.

Speaking of sponsors, last year Mr. H bought me a monogramed lab coat to wear to our sponsors’ luncheon at HIMSS. I am now kind of wishing he had gotten me this sparkly silver coat instead. It also came in gold, which I think would look lovely on my BFF, Dr. Jayne.

Every HIT vendor was pitching its Meaningful Use certified status. Even the transcription companies were touting how their offerings could help practices achieve Meaningful Use.

In terms of technology, the best new offering I checked out came from Patient Point. The company has a care coordination platform that integrates clinical data from health plans, pharmacy benefit managers, and PM and EMR systems. The data can be used to create customized care plans, coordinate care, identify gaps in care, and monitor quality measures. The company also offers a point of service kiosk and online portal. It may not be the stuff the average practice is quite ready for, but as more organizations move towards PCMHs and ACOs, I can see increased demand for many of the tools they are introducing. Good stuff.

The opening reception was well-attended, which is not unexpected when the drinks are free and the food is good. The food choices were diverse, from sushi to pasta to chocolate-covered strawberries.

My picks for Tuesday: Farzad Mostashari leads a session on Meaningful Use and at least one of the many sessions on transitioning to 5010 and ICD-10. I have multiple party choices for this evening (thanks for the many invites) so I’ll be pacing myself (that’s my plan anyway.)

And finally, lest anyone forget, Vegas is always a excellent place to observe great fashion. As you can see, a girl can never go wrong wearing garter stockings with short shorts.

E-mail Inga.