Readers Write 4/13/11

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

The EHR Herd, Part I: Is Certification a Helpful Credential for EHR Purchasers?
By Reefdiver

Would you buy a refrigerator that hasn’t been certified by UL? Would you buy a cut of meat at the supermarket that lacks the USDA stamp of approval? Would you purchase an automobile if it was not certified as meeting the minimum government standards for safety?

On the other hand, does the UL certification tell you which refrigerator is right for your kitchen or family? Does the USDA stamp tell you whether the skirt steak or the filet mignon is a better fit for the meal you are planning? Does the EPA approval tell whether the Smart Car or the Durango XLT is better for your vehicle needs?

As of today on the ONC site, there are 375 EHR products certified by all of the ATCBs combined for the ambulatory market alone, of which 262 are Complete EHRs. (Note: I started writing this two days ago and both of these numbers have gone up by significant amounts in the interim, with no apparent end in sight).

Does anyone else find it absolutely astonishing that that many products can pass the certification criteria that meets government specifications for allegedly being able to help providers meet Meaningful Use (MU) criteria? And that the number continues to grow each week? How hard can these standards of certification be if every product passes?

More than 30% of law school graduates fail to pass the law boards each year. Series 7 exams for new stockbrokers have a pass rate that is less than 50%. CPA exams are notorious for being difficult to pass, with the national average being about an 85% failure rate. Years ago, more than 50% of the pilot trainees in my military flight training class failed to earn their wings during the 15-month training program – they were washing out right up to the last weeks of training.

Is EHR certification getting to be like passing the UL test? As long as the product doesn’t produce a massive shock, it passes? A urine test must be statistically harder to pass than EHR certification. 

EHR certification is almost becoming a rubber stamp. Shouldn’t there be some failures with this many product applicants? Or, does certification not measure some critical differentiators, like usability? Given the 50% implementation failure rate so commonly quoted, maybe it’s just a demonstrative example that with technology, it’s much easier to certify functionality than it is to certify usability or practice-appropriateness.  

What other industry can you think of where this situation — hundreds of software vendors with government-certified products for one single class of end users, medical practices — is possible? Software for airline reservations? Enterprise software? Financial planning, spreadsheets, word processing, inventory control, hotel management, software for law firms, tax preparation software?  

Most of these huge software segments have no more than a handful of competitive software products. More than 300 certified software products for EHR, with more coming each week. Sure seems like a lot. Will probably lead to consolidation problems later!

Should the herd be thinned out, or is it better to have so many products certified? The number of choices is daunting for providers, like the cereal aisle at the market. It will be hard for the EHR market to support this many vendors, but a free enterprise system can often result in two doctrines that come into juxtaposition: survival of the fittest (vendors) and caveat emptor (providers). Does certification help either party more?

The other half of this delicate equation is the providers and practices. Their role is to pick an EHR and show Meaningful Use. Most vendors guarantee the desired outcome, but what is the fine print saying and are providers aware of it? 

With more than 300 certified products to choose from, how do providers pick one that is really right for their practice and specialty? The advice being given out there is pretty bland and not very useful for decision makers as far as I can see. Big vendors are not necessarily better than small ones. I’ll offer some thoughts on that later in the week in Part II of this, should anyone be interested.

For now, I hope some providers will respond to my comments. I’d love to hear how you feel about all the EHR products that are being certified and how is it helping you to choose whether and if to purchase one. And,  how you are going about finding one that really fits your practice and workflow best.

News 4/12/11

Capario partners with Data Media Associates to offer customers customized patient statements and mailing, plus a  payment portal.

An analyst with Avondale Partners notes that Emdeon is tracking more than 20 potential acquisitions. The analyst predicts Emdeon will “focus on adding solutions that monetize data from payment integrity, clinical messaging, business intelligence and decision support, and look to expand its RCM suite, and clinical information exchange.”

The State of Hawaii Public Safety Department contracts with eClinicalWorks to provide EHR to the 4,200 inmates in its correctional facilities.

eClinicalWorks, by the way, announces the pending availability of its MAQ Dashboards, which gives practices the data required to illustrate their Meaningful Use of the ECW EHR.

McKesson’s Practice Partner, ABELMed EHR, CureMD, and NCG Medical are named preferred certified EHR vendors by the Ponce School of Medicine REC (PR).

MinuteClinic, the healthcare division of CVS Caremark, partners with Advocate Health Care and Advocate Physician Partners to serve as medical directors for 23 MinuteClinics in Illinois.

The AMA says there are currently about 8,000 health-related apps available through the iTunes store. Wow. The AMA believes that’s not enough, so it  is sponsoring an App Challenge to find new apps. Since first announced March 30th, the AMA has received 60 submissions from physicians, residents, fellows, and medical students.

Please help me in welcoming Julie McGovern as a new contributor to HIStalk Practice. Julie is CEO and founder of Practice Wise, an eight-year-old, Wilsonville, OR-based consulting firm based that focuses on clinical and financial services for ambulatory practices. Find her debut Practice Wise post here.

US adults are strongly in favor of physician EMR use and the electronic exchange of data between physicians, according to a Commonwealth Fund survey. Though only 14% say they can access their records online, 34% can order prescription refills online, 22% can schedule appointments online, and 21% can email their physician.

Of the first 13 states to launch their Medicaid meaningful use programs, only six have issued incentive payments. At least 18 states don’t expect to open their programs until the second half of the year and nine have not yet indicated a start date.

Chartwise Medical Systems partners with consulting firm H.I. Mentors to provide ChartWise customers preliminary reviews of their clinical documentation improvement process, as well as training.

A GAO report finds that when physicians and patients appeal denied claims, reversals were made 39% to 59% of the time. Miscodings and incomplete information on claims were common causes for automatic claims denials.

Nearly 70% of physicians view information from drug company reps as useful in making prescribing decisions, according the Pharmaceutical Research and Manufacturers of America. The results of this survey remind me of a conversation I once had with a physician about the overall product knowledge of drug reps compared to EMR/PM reps. His opinion: EMR reps would be far more successful if they took a few lessons from drug reps. Drug reps tend to be well versed on the specifics of their products and able to articulate their advantages and disadvantages over the competition. Generally they were excellent with follow-up and regularly asked physicians for feedback on their products. I have to admit being irritated by that remark at the time, since I always viewed those of us selling EMRs as one step above the former cheerleaders and football players that moved into the pharma world.  On later reflection I decided the observation had (and still does have) merit.

Modernizing Medicine, makers of documentation software for dermatologists, raises $7.1 million, including $4 million from Speedo swimwear owner Pentland Group. The Electronic Medical Assistant application was designed by a practicing dermatologists and costs $650 a month, plus a onetime fee of $6,000.

E-mail Inga.

Practice Wise 4/11/11

Be Your Own Consultant!

So you’re trying to convince your bosses that they need to purchase an EHR because Meaningful Use makes it so. It feels like Y2K all over again. You know, back in the day when we all used a PM system on dumb terminals (ah, but the UNIX platform was so stable!) and you had to convince your doctors that it was time everyone got a PC and Microsoft Office and the new PM software that could give you four-digit years and save the world.

Déjà vu! You’re in this terrifying role where you have to learn the lingo, understand all the bells and whistles of products that make your head spin. Then, convince a single owner or a board of partners that you understand everything you are presenting to them, and your recommendation is …

Who do you trust to educate you on all of this technology? And to help you not lose your job by making a colossal mistake and costing thousands of dollars and jobs and possibly the meltdown of your practice? I know it sounds like doom and gloom but admit it — this is the stuff that keeps you up at night.

I say trust yourself. You can hire a team of free experts, be one yourself, and thrive in this experience. Admit your terror and reach out to the other terrified individuals in your community. How? Start a user group!

1. Don’t wait. You don’t have to be users of anything to start a group. Don’t wait until you get your software and then decide to start or join one. Start a group of almost-EHR users who all know a little about a lot of things or a lot about some things. Share your knowledge.
2. Invite vendors to present to your group. This is easier than attracting dogs with top sirloin. Trust me, you will need to devise a method for a waiting list.
3. Be selective. Even as a group of users, you don’t have a lot of precious time to waste. Research your vendors and invite those who you think will give you the best bang for your buck. Which is zero, but don’t let that be the rate limiter.
4. Ask the non-EHR vendors. You know, that whole group of support consultants and third-party vendors that are like little seedlings in the spring of EHR adoption. They usually see most of the products as they interface. Better yet; they talk to the end users and hear the complaints and praise of everything. Boy, don’t we love to share our experiences with anyone who will listen?
5. Give them the lunch hour for presentation. Make sure they provide the lunch.
6. Invite real (EHR) users to your almost-users group. They will be your deepest resource (see above, don’t we love to share…). From them you will learn what not to do, who not to waste your time on etc. They’re like parents and you should learn from their experiences.
7. Have different members of the group host your meetings. If your office won’t accommodate the crowd, check out hospital conference rooms (can be reserved in advance), the local medical society (should willingly lend to their participating providers), or the presenting vendor (don’t think of this as giving up the upper hand – you get your needs met, they do their presentation, and nobody is worse for the wear).
8. Don’t limit your group to EHR discussions. This kind of change management doesn’t happen in a vacuum. Your entire practice operations are going through electro-shock therapy. Open up to the whole discussion and ways to help each other through this evolution.
9. Keep it free, short, and worthwhile. You will build an amazing panel of experts that are now part of your team. The president runs the superpower of the free world and even he doesn’t know it all. He has a cabinet of experts who advise him. You can, too.
   

Julie McGovern is CEO of Practice Wise, LLC.

News 4/7/11

Less than 14% of practices with EHRs believe they meet all 15 core criteria to receive incentive payments, according to MGMA’s 2011 EHR study. Other key findings:

• The main barrier for EMR adoption is expected productivity loss.
• 29% of the 4,588 respondents say they are selecting an EHR.
• Of practices that had adopted EHR, productivity reportedly increased for 27%, decreased for  31%, and stayed the same for 43%.

athenahealth is named a supported EHR vendor by HealthInfoNet, the organization that operates the Maine REC.

e-MDs is named an EHR vendor partner by the Medical Society of the State of New York. Five other EHR vendors were also selected, though I could not find details on the MSSNY Website.

Nuesoft introduces a nine-minute video that provides a high-level overview of Meaningful Use, including how to find certified products, how to apply for funds, and the role of RECs.

Practice Fusion closes $23 million in Series B financing, bringing the company’s total funding to $30 million. This round was led by Founders Fund, an initial investor in Facebook whose managing partner is PayPal founder Peter Thiel. CEO Ryan Howard says the cash infusion will help the company “reach every doctor and practice in the country in our market.”

EMR vendor GloStream will add up to 40 jobs this year and will invest $1.4 million in expanded operations.

AAFP publishes a resource to help physicians understand how they can earn an e-prescribing incentive from CMS and avoid penalties. The guide includes an explanation of the code G8553, denominator codes, qualified e-prescribing systems, and program exemptions.

Navicure and the American Academy of Professional Coders form a partnership to develop educational resources to help practices practices transition to the HIPAA 5010 standard and ICD-10 code set. Some of the initiatives include a dedicated Website (www.icd10hub.com), regional dinners around the country, and, a Webinar series.

In a random sample that included both clients and non-clients, Kareo finds that practices’ top concerns are reductions in Medicare payments and patient payment collections. The average days in A/R was less than 40 days for 39% of the respondents and only 17% reported a net collection rate of 92-96%.

Phreesia introduces an autism screening tool for its patient check-in technology. Using the PhreesiaPad, parents are able to complete an automated version of the M-CHAT screening tool for assessing the risk for autism spectrum disorder in toddlers.

Please join me in welcoming  Capario as HIStalk Practice’s newest Gold sponsor. Capario offers a revenue cycle portal that works with existing PM and billing systems and provides a validation engine that gets claims paid on the first payer submission 90% of the time. The company was named the highest rated indirect clearinghouse in KLAS’s 2010 ambulatory clearinghouse report and  processes almost one million transactions a day. The Santa Ana, CA-based Capario offers a dashboard view of the revenue cycle and provides a number of analytics tools to improve cash flow. Capario works directly with providers, as well as with a number of partner vendors. We ran an HIT Moment with CEO Jim Riley a few weeks ago, who offered practical information about RCM vendors, 5010, and ICD-10. Capario is also sponsoring HIStalk, so a double thank you to them!

Sutter Health (CA) announces its $50 million Sutter Community Connect program to provide Epic EMR to qualified independent physicians. Sutter will subsidize up to 85% of the EMR software and implementation costs for physicians in over 100 Northern California communities.

E-mail Inga.

News 4/5/11

Todd Rothenhaus, MD joins athenahealth as chief medical officer. He most recently served as SVP and CIO of Steward Health Care (formerly Caritas Christi Health Care).

Physician offices added 7,600 jobs in March, representing a 0.3% gain. Total physician office employment is 2.3 million.

Webahn announces that its Capzule EMR is available to solo practices free of monthly charges. Capzule EMR does not display advertisements and does not require revenue sharing, so what’s the catch? The Capzule Web site says the EMR is not (yet) ONC-ATCB certified and does not offer e-prescribing. Also, the EMR does not come pre-loaded with ICD-9 or CPT codes. The “free” option is limited to solo practices, includes only one additional non-physician license, and it includes limited templates and customization options. The standard package costs $150 per month per physician and $10 per month for non-physician users.

The newest generation of doctors want salaried jobs, fewer working hours, and specialties that are conducive to family life, according to a New York Times article. At the same time, doctors are not revered by their patients like days of old. In fact, patients today are more likely to see doctors as interchangeable.

The 80-physician Doctors Clinic (WA) goes live on Sage’s online patient portal.

The Child Guidance Center of Southern Connecticut implements CareLogic Enterprise EHR by Qualifacts’. The purchase was partly funded by a $100,000 private foundation challenge grant.

About 56% of practices have not scheduled testing of the 5010 transaction set, according to MGMA. Less than 4% said they had begun testing the transaction set with health plans. Most disturbing: 23% of survey respondents didn’t know what needed to be done to their software to implement 5010.

I noticed that AAFP opened its annual EHR satisfaction survey survey. AAFP members using commercial EHRs can participate here. It’s not the most scientific survey out there (results are based on physician self-reporting rather than a random sample). Still, the results are interesting and give certain vendors the chance to brag a bit.

AAFP also posts a special report EHRs, which includes a number of articles on EHR use in family practices, details on the EHR incentive plan, and more. I’m not sure there is much new, but the section includes a nice variety of information all in one place.

HIT consultants say practices often underestimate the amount of training required for EHR or reduce training to save money or time. When calculating the amount of time required for training, practices and vendors should keep in mind the amount of data being abstracted from previous systems; integration needs; introduction of new hardware, especially end-user devices; and existing computer skills.

And from a different group of consultants: if you have physicians resistant to structured data capture, find a hybrid approach that blends the ability to capture required structure data elements and provides the physicians the flexibility to document in their own personal manner. The result will be increased physician adoption and better data for reporting and exchanging with other providers. Evan Steele swears he didn’t write the article, but he could have.

There’s still a lot to process about the recently proposed ACO regulations, but one thing is clear: ACOs will need solid HIT infrastructure. The regulations call for ACOs to report on 65 quality measures, so systems will need to be in place to churn out those numbers. In addition, at least 50% of an ACO’s primary care providers be EHR Meaningful Users. Another takeaway: consultants are going to win big, as providers turn to them to determine their needs and assess the value of their potential ACO participation.

E-mail Inga.