DOCtalk by Dr. Gregg 4/25/11

Brilliance Makes It Look Easy

Gene Kelly. Fred Astaire. I wish those guys were leading the charge for HIS development.

No, I don’t think that EMRs need to sing in the rain or that practice management systems could benefit from dancing on the ceiling. What every HIS system to date could use, though, is the “duck on the pond” effect that these two pros had completely mastered.

You know the “duck on the pond effect”: the appearance of gliding smoothly and serenely across the pond while little webbed feet are paddling along furiously below the calm, still waters. Those who provide that effect, no matter their profession, make it look like anybody could do what they do. They make it look so easy and effortless.

Astaire and Kelly always made it look so simple. Yet, both were the ultimate in “efforting.” They were relentless in their pursuit of perfection, working themselves, and their co-stars, into blistered and bleeding toe exhaustion when trying to nail down a routine. The end result of all this blood, sweat, and (I’ve read) tears was unparalleled mastery of their craft and brilliance in their performances. Kelly’s muscular machismo and Astaire’s suave elegance were the result of tremendous under-the-water paddling.

There just simply aren’t many EMR or EMR-related systems out there that really have this Kelly-Astaire idea down. Most of them do a whole lot of stuff under the covers, sure, but their dance isn’t smooth, their “paddling” is evident. On top of their waters, it’s choppy.

On the EMR stage, this lack of behind-the-scenes work and the shoddy showmanship is manifested time after time. We have many, many EMRs which are like back-up dancers: they can do the basics, but that star finesse is just not there. If the developers don’t put in the relentless pre-show effort, the audience (the end users) will have to suffer through the performance. We’ll get through it, but it is rough and uninspiring.

Some developers do seem to have started to “get” the power of this pursuit of perfection. Instead of sending out an understudy, they have seen how much is gained by putting a truly well-trained star on stage. They’re creating tools with the simplicity of use that all end users, medical or otherwise, crave. Some of the new iPad-savvy EHRs are showing some of this refinement. So are some of the new iPad / iPhone / Android medical apps.

Here’s a perfect, specific example: Medicomp and their new Quippe tool. They certainly understand how much you can do under the covers while making it look so danged simple on top. Their experience, though, may show just how unready much of the industry yet is for such superstars. I’ve heard technorazzi say, “Oh, it’s just a bunch of XML-tagged text.” End users might not see how hard it is to make it look so easy, but once we see how smooth the surface show is, we want more. It surprises me that any EMR technico wouldn’t see how much goes on, and has gone into, making the “dance” look so smooth. Maybe they, too, don’t see the power, the feet furiously paddling, under the surface.

But, that’s just the kind of power I’m praying for in my next EMR – the kind that seems like anybody could do it, a system with those Gene and Fred work ethics, grace, and “it looks so easy”-ness. I want this super paddling below and an EMR “glide” on top.

For NHIN success, we need many more such “stars.” Despite my “I want it now” angst, I think it’s inevitable that we’ll start to see these traits begin pervade the whole of the HIT industry. I’ll even wager real money that those vendors who don’t clue in to this concept sooner will come to envy those who do.

Once these ideals are more widespread in the EMR realm, just think how far we might be. Even more, imagine once all HIS tools are empowered by those same qualities, but from Ginger Rogers. She, as you probably know, could even do it all backwards – and on gorgeous, high-heeled, Inga-esque footwear!

From the trenches…

“Some people seem to think that good dancers are born.” – Fred Astaire

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 4/20/11

CMS says it paid physicians more than $234 million in Medicare incentive bonuses for the 2009 PQRS  program and an additional $148 million in 2009 e-prescribing incentives. The PQRS bonuses averaged $1,956 per provider and $18,525 per practice, while the average e-prescribing bonus was just over $3,000 per provider and $14,051 per practice. CMS reports that participation in PQRS has grown 50% per year since it first began in 2007.

Practice Fusion hires Paul Willard as VP of marketing and Liz Meyerdirk as senior director of business development. Willard was most recently VP of marketing for Coupons.com; Meyerdirk was associate VP of corporate strategy and business development for MedeAnalytics.

Radiology & Imaging (MA) and Seacoast Radiology (NH) select McKesson’s revenue management solutions for billing and coding. I mentioned Seacoast Radiology a few months after hackers breached one of their servers. The likely culprits were said to be “rogue gamers” looking for bandwidth to play Call of Duty: Black Ops.

AMA rolls out its AMAGINE platform nationwide. The subscription-based offering ranges from $20 per month per physician for e-prescribing to $300 a month for EMR. AMAGINE includes access to over 20 HIT solutions, including Allscripts, CareTracker, QuestCare 360, and NextGen.

Beacon IPA (NY) partners with Sequel Systems to offer its members discounted pricing on SequelMed EMR and PM products.

Patients perceive that the use of EHR increases the quality of care and provides a more accurate health record. Eighty-percent of patients have a positive perception of EHRs, though only 62% of physicians feel the same way. Patients are more concerned about privacy and security (81%) than doctors (62%). Both groups agree that the biggest benefits of EHRS are real-time access to records and  the ability to share information among providers.

Allscripts opens registration for its ACE 2011 conference. This year’s big event is August 29-31 in Nashville. If I am reading their graphic correctly, Allscripts expects its ambulatory EHR clients to outnumber the Sunrise customers by about two to one.

The Missouri HIT Assistance Center selects SuccessEHS as a Group One vetted EHR vendor.

Physician offices are better at retaining RNs than hospitals or health systems, likely because of the better work environment. RNs work an average of 3.3 years at a physician offices before changing jobs, but only 3.1 years at general hospitals. Average compensation is higher in hospitals than physician practices, but offices tend to  offer more stability and better culture.

Odd: Physician’s Computer Company issues a press release chastising payers and clearinghouse partners for their “lack of readiness” to test the new 5010 transaction standards. PCC says it has validated its own readiness with its direct-to-payer connections, but is waiting on more than three dozen carriers and clearinghouse partners to get up to speed. I can’t figure out what PCC has to gain from issuing the release, other than a few ticked off partners.

American Well launches Online Care for Providers, a new service that enables physicians to offer telehealth to patients. The offering includes the ability to conduct two-way video, secure text chats, and phone calls. Encounter records  may then be then download into the provider’s EMR.

Most physicians that are considering hospital employment expect to be paid one to five percent more than they are now. Employed physicians believe doctors should be more involved in executive leadership and hospital management, including service on the board of directors. On the other hand, hospital executives aren’t ready to hand over the keys yet and say they’ll need to find funds in order to pay physicians more. Train wreck, anyone?

E-mail Inga (who is visualizing the weekend a bit early)

News 4/19/11

Anyone attest today? CMS opens its Meaningful Use verification period  Monday, marking the first day hospitals and eligible providers can start their 90-day attestation period. EPs wanting to receive a Medicare incentive check by the end of the year will need to start their attestation period no later than October 1.

Ingenix says that family practice physician Douglas Foreman, DO will be among the first physicians to attest. He uses the Ingenix CareTracker EHR.

Meanwhile, ChartLogic announces that 26 of its customers across 19 states plan to start the attestation process as early as April 18.

Greenway Medical announces the integration of its EHR/PM product PrimeSUITE with Cognify’s Participant Tracking System for monitoring care plan continuums.

A big thank you to the folks at Dodge Communications who forwarded their critique of the AMGA exhibit hall. Brad Dodge gave GE Healthcare’s booth Best in Show and recognized MED3OOO for Best Food (one of my favorite categories). Humana won honors for The Booth Most Likely to Be Confused with a DippinDots Stand. Plenty of other fun categories, should you feel the need to cackle. AMGA, by the way, says about 2,000 people participated in their 20011 conference last week in DC.

Also from AMGA: the percentage of physicians practicing part-time is on the rise. A reported 13% of males and 36% of females work part-time, compared to 7% and 29% in 2005. Results from an AMGA-sponsored survey also found that 83% of medical groups plan to hire more primary care physicians this year; 79% intend to hire specialists.

Thomson Reuters releases Micromedex Drug Interactions, a new iPhone app to monitor drug interactions. The $50 app allows physicians to check up to 50 patient medications simultaneously.

Northern Illinois Physicians for Connectivity names Sage Healthcare a preferred partner.

Healthcare South (MA) signs a three-year, Level 1 application support service agreement with Beacon Partners to support its Allscripts EMR system.

Physicians are five times more likely to own an iPad or similar device than the general population. About 27% of primary care and specialty doctors use some sort of tablet computer.

HealthGrades launches a new Web application that enables physicians and administrators to verify and modify their online information.

MD-IT announces the official release of its MD-IT EMR.

A new report predicts that 75% of providers will use e-prescribing over the next five to six years and that the US e-prescribing market will reach $204.6 million. I assume that means providers will spend $204.6 million a year for e-prescribing, but the press release is a bit unclear and I wasn’t curious enough to pay $4,800 for the full report.

athenahealth CEO Jonathan Bush chats with Peter Johnson of Fox News about curbing Medicare costs. Gotta love Fox’s prominent reminder of the Bush’s family ties.

E-mail Inga.

DOCtalk by Dr. Gregg 4/17/11

Pediatric Tar Pits

Way back in the day when dinosaurs first dreamed of computers to solve their workaday needs, I’ll bet some pterodactyl envisioned that computers would one day actually take the drudgery out of their calculational quandaries and let them focus upon doing the dinosaury things that they really wanted to be doing.

Well, that day is finally, really, honestly here – at least for us dinosaurs who deal with pediatric and neonatal drug and parenteral nutrition. I just enjoyed an hour-long webinar (how often can you say you actually “enjoyed” a webinar?) on the new digital tools that Thomson Reuters has just released: Thomson Reuters Pediatrics and Thomson Reuters Neofax.

Any of you familiar with neonatal care have likely heard of Neofax, a great book – pretty much a “must have” for neonatal care providers – chocked full of drug and nutritional information and complex calculations. It has been updated yearly since 1986 and has grown into a rather thick little paperback tome. (Ugh. Paper.)

Any of you familiar with pediatrics know how frequently drug dosages must be calculated – like virtually every single time on virtually every single child – based upon their specific weight (i.e., weight-based dosing.) And then there’s rounding. Do you round off to the closest milliliter or teaspoon? It’s not as simple as “Take a pill twice a day and call me in two weeks.”

Weight-based dosing rises to new levels of head-scratching complexity when it has to be applied to the multiple components of parenteral feeds (infant formula and TPN).

Many EHRs don’t help with this much. Some do, especially those that really “get” pediatrics, but most either ignore this calculation component, say they have it on the “to do” lists, or do some smaller portion of the process.

What Thomson Reuters has done is not just kick it up a notch; they knocked it into a whole new sphere of computer helpmate-dom. They have provided some heavy duty calculational tools to a robust database of drug monographs (Micromedex) using evidenced-based data to provide one of the best little tools any pediatric or neonatal provider could ever hope for. It is easy to navigate, displays information and alerts cleanly, and has some great tools for incorporation into hospital pharmacies and CPOE processes.

They offer “Basic” versions of each via the Internet which have fewer tools and require a little more end-user input and “Premier” editions which are “Intranet-based” with more bells and whistles and patient-specific capabilities.

The only downsides I have seen are: (a) you can’t get a look at it online without a webinar or a demo; (b) I wasn’t able to get any pricing info yet; and (c) it isn’t the prettiest user interface I’ve ever seen.

Despite these minor issues, it is clean, powerful, easy to understand, full of evidenced-based help, and it will probably knock any pediatrician’s socks off regardless of the GUI. It does just exactly the kind of things computers should do to help us pediatric dinosaurs get on about being better dinosaurs without being mired in antediluvian data and calculation tar pits.

From the tar pits…

“I’ve been drawn into your magnet tar pit trap.” – Kurt Cobain

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 4/14/11

From Kelpie: “Re: the EHR Herd. With regard to the Readers’ Write article posted by Reefdiver, KLAS just published a report focused specifically on how prepared each ambulatory EMR vendor’s clients are for MU. I think it would be very useful to your readers that are looking for some sort of help in ‘thinning out the herd,’ as the article says.” Kelpie is with KLAS and is willing to give providers a free executive summary of the report if they are able to spend 15 minutes participating in KLAS’s research. That sounds like a pretty sweet deal, given the standard provider price is $980. If you are interested, e-mail me and I will forward you Kelpie’s contact information.

The new KLAS report, by the way, finds that nearly 80% of ambulatory care providers are confident they will meet Meaningful Use criteria this year. However, KLAS also notes some significant gaps, including the absence of electronic record sharing for two-thirds of the providers and the lack of clinical decision support rules for almost half the surveyed physicians. Epic and Greenway clients are the most prepared to achieve Meaningful Use.

Nuesoft Technologies launches Nuesoft Mobile, a free app for users of Nuesoft’s NueMD medical billing solution. The app includes charge capture functionality, an appointment viewer, and the ability to attach voice notes and images to patient records.

AMGA starts today in Washington DC. That’s one event I’ve wanted to attend for a number of years, but the timing has never been right. If you are there, I’d love an update and/or photos.

The Montgomery AIDS Outreach (AL) selects SuccessEHS as its PM/EHR solution.

The AMA sends a letter to CMS outlining the federal regulations that physicians find most burdensome. Topping the list are unfunded federal mandates, elimination of Medicare payment for physician consultations, and incompatible and inconsistent quality initiatives.

Epocrates introduces a new mobile drug sampling service, Epocrates Mobile Sample Closet. Pharmaceutical companies will use the service to offer physicians custom samples via their mobile devices.

The Alabama Primary Health Associates (APHCA) partners with Arcadia Solutions, which will provide EHR training and support to APHCA’s 15 community health centers.

Speaking of community health centers, The National Association of Community Health Centers estimates CHCs serve 20 million people each year. That number is expected to double by 2015, in part due to increased funding from ARRA and healthcare reform legislation.

The National Hispanic Medical Association partners with DrFirst to offer its clinical and financial products.

WebChartMD, a transcription workflow provider, integrates its platform with M*Modal’s Speech Understanding technology.

Big Sandy Health Care (KY) receives $255,000 in Meaningful Use incentives from Kentucky Medicaid. Its five community health clinics use Meditab clinical software.

The American College of Surgeons launches an online community to support surgeons practicing in rural areas. The resource will allow remote surgeons to seek advice and collaborate with peers.

Radia (WA) signs a five-year agreement with Zotec Partners to manage the 80-physician practice’s accounts receivables.

After reading this study, I vow never again to apologize for allowing my fashion enthusiasm to occasionally overflow to HIStalk. An Archives of Dermatology-published study by a group of dermatologists finds that 20% of adult patients believe their doctors should wear ties. Furthermore, most patients favor the traditional white coat (the doctor’s “badge of authority.”) And, one third of the patients say their trust in their doctor is influenced by his/her attire. Which is crazier: that patients care what their doctors wear? Or, that doctors actually asked patients for fashion advice?

E-mail Inga.