DOCtalk by Dr. Gregg 7/12/11

Still Stupid Simple

In my continuing quest for a new EHR, I’ve been seeing lots of demos, reading lots of brochures, and gawking at all kinds of PR stuff. Recently, some of it caused me to reflect upon my old friend, Stupid Simple.

I’ve developed such an adoring admiration for Stupid Simple that I have actually adopted his name for my personal mantra. Usually this works quite well as I sit in Padmasana (full Lotus pose) chanting, “Stupid Simple, Stupid Simple, Stupid Simple…” I typically find mindlessness with relative ease and have actually levitated on an occasion or two when invoking his powerful mantric name.

Today, though, evil forces must have been wafting through the ether of my meditation zone. Far from nearing Nirvana, I found my consciousness most vilely preoccupied with thoughts about health IT Marketing and Sales… ack! Talk about a meditative letdown.

I tried Siddhasana and even Swastikasana poses, but I could not evade these disruptive mental intrusions. Thus, I silenced my Stupid Simple-ness and listened to an internal dialogue rage within my head. What I heard was Stupid Simple taking on the unnamed evil forces of crappy HIT Sales and Marketing. (I’ll call them “S&M” for now.) It went something like this:

S&M: “Customers can’t recognize the reworked diatribe we use and/or steal from all the others like us. We all use the same regurgitated crap just wrapped up with different branding. HIT customers are too stupid to know.”

STUPID SIMPLE: “HIT customers are not stupid. Just because you try to fluff your way to a sale, doesn’t mean customers won’t eventually realize that your vaporous claims and “best of breed” assertions won’t eventually be seen for what they are…or I should say, for what little they really are.”

S&M: “Oh, yeah? Well then how come we keep making sales? How come people keep coming to look at our products?”

STUPID SIMPLE: “If you only give your dog slop to eat, he’ll eat it. But, you’ll lose him if someone starts handing out prime rib.”

S&M: “But, they are sooo dumb. They keep asking the same dumb questions like, ‘What does SaaS mean? What does ASP mean? What’s the difference between SaaS, ASP, and a cloud offering?’ They are sooo slow!”

STUPID SIMPLE: “Just because you throw a bunch of acronyms around doesn’t make you smart. Heck, most of the time, when someone well-versed in a particular vernacular or jargon uses such acronyms or industry-specific terms when talking with people less well-versed, it’s to make themselves feel as if they’re smarter or to make the others feel inferior.”

S&M: “Oh, yeah? Well, AAMOF, IMNSHO, you’re just a collocated de-acronized quip. You’re FOS, a WOBTAM, and a PONA.”

STUPID SIMPLE: “Yes, and your fecal encephalopathy is showing your SBI.”

S&M: “Huh?”

STUPID SIMPLE: “See? While it may help to facilitate internal communications, jargon and industry-specific acronyms don’t help endear customers. Nor does ‘biz speak.’ Corporate communications are fine if it makes you feel professional, but we are all still people. If you’re trying to reach out to others who may not be so familiar with your world, translate. Use real language, common terms – ‘people-speak’.”

S&M: “So, you’re saying I need to dumb myself down to the level of the ignorant masses?”

STUPID SIMPLE: “Not at all. I’m saying that to meet the needs of your customers, help them ease their pain points, stop talking down to them, and start talking with them. Help them understand how you can help them by helping them feel less helpless. (Notice the accent on the word “help”?) Oh, and can the huff and fluff stuff. Get real.”

S&M: “What?! Are you nuts? This whole industry is built upon useless white papers and collateral crap. We’d collapse if it weren’t for overpromising and underdelivering.”

STUPID SIMPLE: “Nuh uh. I mean, nuh uh, it won’t collapse. You are correct that HIT has a long and almost legendary history of providing vastly less than it promises. S&M teams have built entire companies that have very little worthwhile product behind them. But, this house of cards is just waiting for the wrong breeze to blow. Lord knows, if HITECH hadn’t come along…”

S&M: “Yes, indeedy! HITECH was a major boon for us blow-hards! Plus, it’s helped drive a stake into the hearts of the real innovators! Long live ARRA!!”

STUPID SIMPLE: “But, ARRA funds won’t last. People will eventually start to find that underdelivered products don’t work. How many times do you think you can get away with saying ‘We’ll help you deliver better care and make more money’ before people see that you aren’t capable of either? How long before those who are truly innovating create the ‘real deal’ and show just how vaporous you’ve been for so long?”

S&M: “Don’t know. Don’t care. I’m getting’ mine now and I could care less about the end users long-term woes. Don’t care if it doesn’t deliver. Don’t care if it makes their lives harder. As long as my razzle dazzle befuddles them long enough to get the sale, I’m ka-chinging my way to the bank.”

STUPID SIMPLE: “Such a waste. I’m outta here. I’m gonna go find a real EHR with honest marketing and sales folks who want to talk to me like a real person. I need a company that understands the value of me, Stupid Simple. AMYOYO, pal.”

S&M: “Yeah? Well…you are “stupid simple” aren’t you?”

STUPID SIMPLE: (Proudly) “Yes. Yes, I am.”

As the two foes drifted out opposite ears, I felt proud of my buddy, Stupid Simple. I know the challenge of finding those who understand him. But, I believe that he’s right and that there are folks out there who really do get the value of our version of the KISS Principle: Keep It Stupid Simple. Many S&M-ers, just like many HIT developers, however, just don’t get it. It’s wonderful when you find those who do.

From the trenches…

Postscript: I just found hard evidence of the suspected intrusion of those aforementioned evil forces: someone – or more likely something – scribbled “Extormity Rocks” in the sand of my desktop Zen garden!

“I want that they should bury me upside down, so my critics can kiss my ass.” – Bobby Knight

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 7/12/11

From Micki Tripathi “Re: Massachusetts E-Health Project. Thought you might find this interesting.” Micki is the president and CEO of the MA e-Health Collaborative (MAeHC) and a noted HIStalk Practice contributor. He forwarded a link to an AHRQ-funded study on the physician use of clinical registries before and after the implementation of EHR. The study found that physicians who participated in MAeHC’s EHR implementation initiative increased their ability to generate registries for lab results and medication use. The authors conclude that Massachusetts’ 4-year, $50 million HIT program may be a viable model to improve the quality of care.

MGMA names Susan Turney, MD its president and CEO, succeeding the retiring William F. Jessee, MD. Turney, who is an internist, has served as CEO of the Wisconsin Medical Society since 2004 and founded and chaired the Wisconsin Statewide HIE.  I’m planning to attend MGMA’s annual conference (late October in Las Vegas) and I look forward to hearing more about Turney. I must admit I’ll miss Dr. Jessee, who I have always found to be very insightful and articulate.

In case you are feeling Meaningful Use-challenged, CMS is offering a teleconference for providers July 14th to walk through the basics of the program. The call will cover eligibility, calculating incentives, attesting, and Q&A.

Greenway Medical reports that of the 40 RECs with established operations, more than 80% include Greenway’s PrimeSUITE EHR as a solution of choice.

Allscripts business partner CHMB pays $2 million cash for the assets of Davis & Associates, a provider of medical billing and technology to physician practices.

Telepsychiatry is not catching on as fast as other telemedicine offerings and money may be the reason. Insurance companies, including Medicare and Medicaid, typically pay less for Web-based mental health counseling than in-person therapy, meaning patients must pay more out-of-pocket. And, some carriers do not offer any reimburse for telepsychiatry services. Craziness.

Physicians in private practice are twice as likely to practice defensive medicine than their federally-employed peers. Unlike physicians in private practice, the Federal Tort Claims Act protects government-contracted physicians against personal financial liability. Makes you wonder how much healthcare spending could be trimmed if private physicians were better protected against lawsuits and didn’t feel compelled to order all those CYA-type services.

Health IT Services Group announces that over 1,000 nephrologists now use its Acumen nEHR.

Practices with less than 20 physicians on average use about 20% of the care processes that are considered required for medical homes, including care coordination, electronic disease registries, e-prescribing, and online communication with patients. In general, the smaller the practice, the less likely it is to have implemented HIT processes. I noticed, however, that the data for this Health Affairs-published study was compiled between July 2007 and March 2009. Perhaps it’s overly optimistic to assume that today a much larger percentage of small and medium-sized practices are embracing HIT processes.

Fun facts you can share with folks around the water cooler and look really smart (or nerdy):

• The Medicare EHR incentive program has paid over $94 million in incentives through June 30th
• Over $166 million in Medicaid EHR incentives have been paid through June 30th
• There are over 68,000 active registrations of EPs and hospitals for the Medicare and Medicaid EHR programs.

E-mail Inga.

News 7/7/11

National Coordinator Farzad Mostashari MD concurs with the HIT Policy Committee’s recommendation to push back the start of Stage 2 Meaningful Use by one year. Reason: the rule includes a January 1, 2013 start date for Stage 2, but the Stage 2 requirements won’t be finalized for another year, leaving EPs, hospitals, and vendors insufficient time to prepare.

Symantec and Allscripts partner to offer an online privacy and risk assessment tool that allows practices to identify potential gaps for complying with HIPAA rules and HITECH. The application can be deployed with any EHR and not just Allscripts products.

No surprise here: a study of HIT implementations in small practices concludes that not early all adopters believe the investment was worth the time and money. The biggest problems cited by providers include technical difficulties, lack of training offered, lost productivity, and the inability to get systems to talk to other EHRs.

Primaris, Missouri’s Medicare QIO, collaborates with e-MDs to provide free assistance to e-MD users interested in earning PQRS incentives for 2011 and 2012.

Premier Purchasing Partners awards SuccessEHS a 36-month contract to offer its group purchasing members special pricing on its EHR, PM, and billing services.

OptumInsight partners with RemitDATA to offer the Web-based Remit Advice Professional service, which gives practices access to analytics of remittance notices from health plans, along with coding and reference tools. OptumInsight (formerly Ingenix) is part of United Healthcare’s Optum business unit, which just named Larry C. Renfro its new CEO. Outgoing CEO G. MIke Mikan is leaving to head up a private equity fund.

CMS issues its proposed fiscal 2012 Medicare payment rule, which includes a 29.5% pay cut for physicians. The drop in reimbursement reflects the current SGR formula, which CMS administrator Donald Berwick, MD says must be fixed to avoid “serious consequences.” The proposed rule also expands CMS’s misvalued code initiative to update codes that over- or under-paying providers. If CMS’s proposed changes to telehealth services are approved, telehealth access and the types of eligible services could be expanded:  the proposed rule places more emphasis on telehealth’s clinical benefits, rather than requiring a telehealth visit to provide all the same exam elements as an in-person visit.

AHRQ and the University of Wisconsin-Madison’s Center for Quality and Productivity Improvement develop a toolkit to help practices in workflow analysis and redesign before, during, and after HIT implementation. There seem to be a good number of toolkit options available, ranging from benchmarking, checklists, and flowcharts, to interviewing, risk assessments, and usability evaluations.

EHR and PM company ACOM Health buys billing service provider Contract Medical Billing. The service will be rebranded as ACOM Medical Billing.

Aria Health (PA) selects Allscripts Community Record to enable data sharing between the Allscripts Ambulatory EHR used by its employed physicians and Allscripts Sunrise used by its hospitals. The community record technology is powered by dbMotion and will also tie in other regional providers who use non-Allscripts EHRs.

E-mail Inga.

News 7/5/11

The top struggle for medical practice managers: preparing for reimbursement models that place a greater share of financial risk on practices. Other pressing concerns, according to the results of MGMA’s annual member survey, include participation in the Meaningful Use incentive program, dealing with rising operating costs, selecting and implementing an EHR, and implementing or optimizing an ACO.

A report in JAMIA concludes that the error rate with e-prescribing is similar to that of handwritten scripts. Mr. H weighs in on the study on HIStalk, pointing out that the data came is a bit dated (from 2008); researchers could not make any conclusions on particular e-prescribing or pharmacy systems; and,  the study did not assess how practices implemented the technology or how physicians were trained to use them. I haven’t seen the full study so I will defer to Mr. H and his lukewarm assessment, though I wouldn’t mind seeing a similar study based on today’s  ever-growing use of e-prescribing (68 million e-rxs in 2008 versus 326 million in 2010.)

Wisconsin Health Information Technology Center identifies six Value Vendors for its REC program, including athenahealth, Cerner, eClinicalWorks, e-MDs, Greenway Medical, and McKesson.

Please join me in welcoming and thanking Bulletin Healthcare as HIStalk Practice’s newest Platinum Sponsor. Bulletin is all about providing medically relevant news to healthcare professionals, including 400,000 physicians a day. The company sends eNewsbriefings on behalf of two dozen medical associations, as well as to the President, the majority of US cabinet members, and a whole lot of Fortune 500 execs. If you are a vendor interested in connecting with Bullentin’s large healthcare audience, check out the company’s advertising opportunities. We appreciate their support of both HIStalk Practice and HIStalk.

gloStream adds Health Network Solutions as a certified partner to sell and support gloStream’s EMR and PM software.

NextGen parent company Quality Systems wins three Stevie awards in the following categories: Investor Relations Campaign/Program of the Year; support staffer of the Year; and, Live Event: Best Internal Recognition/Motivational Event for the NextGen Users Group Meeting. CEO Steven T. Plochocki (left) looks pleased.

Happy Independence Day, if you are still celebrating.  It’s obviously a slow news day, as evidenced by the fact that the only HIStalk-related e-mail I received today came from one of our Canadian sponsors. I found this photo I took a few years back when I celebrated the holiday in DC. Definitely the best fireworks display I’ve ever witnessed and the best city to be in if you prefer to reflect more on Independence than on hot dogs – and don’t mind sticky, hot, humid weather. Wherever you are and whatever you are choosing to celebrate, have fun and be safe.

E-mail Inga.

From the Consultant’s Corner 7/2/11

Workflow Diagrams Improve Customer Satisfaction and Cash Flow

In the business of healthcare, missteps and wrong turns can be disastrous. Workflow diagrams are a proven way to help make sure your organizational strategies are headed in the right direction.

Many organizations don’t see the need for documenting business and clinical workflows, but failure to do so can hurt both the facility’s bottom line and patient retention rates. When a facility takes the time to create workflow diagrams and supporting documentation, there’s nothing left to chance.

By diagramming workflow, healthcare organizations can improve customer satisfaction scores and boost financial performance. Sometimes it’s the most obvious things that can get overlooked, such as having a solid check-in process to collect co-payments and outstanding self-pay balances.

One of our clients, for example, was getting complaints from patients about the fact that they were left standing in the hallway after appointments, trying to figure out for themselves what to do next. The problem: there wasn’t an operational workflow for check-out. Once we documented and evaluated the operational flow, we quickly made the necessary adjustments. Patient satisfaction has greatly improved.

Workflow diagrams can also remedy many puzzling financial problems. For example, it’s not uncommon for a healthcare organization to get discrepancies between actual deposits and amounts posted to the system. When you create a workflow diagram, it’s easy to spot the missing step: posting the co-pay, for instance. By documenting workflow, a facility can improve cash flow and accurately reconcile system information to deposits.

A couple of tips for diagramming workflows successfully:

Keep your eye on two workflows

I recommend creating two separate workflow diagrams, operational and functional. The operational workflow identifies all the steps needed to successfully complete a process from start to finish. A functional workflow shows your employees exactly what to do to accomplish the operation in the most timely, efficient manner.

Let’s use patient check-out as an example. An operational workflow might conclude with a step like, “Nurse escorts patient all the way to check-out.” The functional workflow might include a step that says, “Nurse tells patient, ‘Follow me, and I’ll escort you to our check-out area.’” By documenting this step, the nurse doesn’t have the option to say, “Go down this hall and make a left to get to check-out.”

Document everything!

It’s usually not enough to document one or two problematic operations. Your facility can see major improvements by documenting a wide range of operations, including:

• Registration
• Appointment scheduling
• Co-pay collection and posting
• Eligibility requests and results
• Encounter form documentation and charge posting
• Coding and collection
• Denial management
• Credit card processing and posting
• Return appointment scheduling
• Collecting insurance data
• Third-party payment posting
• Collection agency processes

There’s an old saying in science: “Anything you document will improve.” Once your operational and functional workflows are documented, you can use them as blueprints for even greater improvements down the road. Organizations that implement workflow diagrams have a better chance of consistently outperforming those that don’t in terms of quality, compliance, cost containment, and patient satisfaction.

Rob Culbert is president of Culbert Healthcare Solutions of Woburn, MA.