Intelligent Healthcare Information Integration 12/9/10

EMR Hunting: 20 Questions (well…5, plus)

Q) Why is hunting for an EMR like looking for a new smart phone?

A) Because there are a ton of them from which to choose, most of them look and feel pretty much the same, they can all do a lot of the basics, there are some pretty cool features even in some of the less-developed ones, and even the best ones don’t do everything you might want.

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Q) Why is vendor EMR enhancement sometimes akin to moving from a pig pen to a mud puddle?

A) Because when a vendor gives their old users a new feature or a slightly better interface, the users will rave and crow about how cool the new feature(s) is/are, not realizing their lot in life has only minimally improved.

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Q) Why aren’t all vendors offering free online demo tool access where users can “test drive” an EMR?

A) Not sure. I only know that if I’m buying something to “drive” for the foreseeable future which may make or break my bottom line, I sure as heck am not going to pony up after a spin around the block with the salesperson doing the driving. Plus, I’m much more prone to appreciate a vendor who provides such access.

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Q) What makes for a great EMR demo experience?

A) Vendor reps who really know their product, who don’t assume that they know more than their customer, who take the time to try to deliver a personalized experience and not just a rote spiel, and who TRULY understand the value of time to a busy physician.

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Q) What can providers do to enhance their EMR product compatibility?

A) Look for a system “look and feel” that suits you, yes, but also look for a corporate philosophy and history that is compatible with your values. Glitz and sham abound; don’t be blinded by pseudo-science, salesmanship, or “the show.”

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Q) What about those products mentioned in the post of November 30th?

A) Not forgotten. (And by the way, I really appreciate the Comments and emails I’ve received suggesting products and features I may not mention or even be aware of – thanks, and please keep ‘em coming!)

SRSsoft’s Hybrid EMR – One of the things I like best about SRSsoft isn’t just their new “app store” which allows users to add new parts and pieces in the user-friendly fashion of iPhones and Droids (which I truly, dearly love!) No, perhaps the best thing about them is straight-shooter Evan Steele, company CEO and all-round good guy. Evan actually took the time to personally show me around the SRSsoft block and describe their tool, their new app store, and their pending new version features (very cool!) What really makes him unique in my book, though, is his honest, no BS approach. Case in point: Evan has been rather outspoken in his opinion of Meaningful Use certification and its lack of value to specialists (one of his special foci.) He has maintained a clear vision about wanting to provide physician-friendly tools which are “workflow-driven.” However, as this ever-evolving process has unfolded, he has re-evaluated their corporate stance and will now get on about obtaining an ONC-certified diploma. The value to his clients of such has changed and he is open and frank about seeing the need for providing this and changing his approach. As he gave me a explanation of his changed views, I sensed no sales guy schmooze, just a plain-spoken “I’ve reconsidered.” I like his lack of guile and straight up manner.

Medicity’s iNexx – Well, I’m not sure what to say now about Medicity and iNexx. I have gotten to know several of their corporate bigwigs and really enjoy and respect them. I like their primary product a lot and am very intrigued by their approach with the open source, app-able iNexx (though it’s really still in alpha and not yet ready for prime time.) The recently announced buyout by Aetna is something that makes the physician in me cringe. Nothing particularly personal to Aetna, but after years of aggravating experience after aggravating experience, my overall insurance company Gestalt is, well, probably pretty commonplace amongst providers and not all that wonderful. I do try to maintain the bigger picture view I espouse, but whether it’s Aetna or UnitedHealth Group or MomsAndPops Hometown Insurance, most physicians don’t really feel too good about having more insco involvement in between their patients and them. It’s a “once bitten, twice shy” thing. I read on HIStalk that Medicity would stay as a separate biz unit “under the company’s current management.” I hope so. I really like those folks – and their tools.

So many products, so little blog space. Next up: Fun folks (expanded,) excitement, a true helpmate, the power of views, plus.

To be continued, from the trenches…

“Dreams are today’s answers to tomorrow’s questions.” – Edgar Cayce

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

News 12/9/10

The 20-physician South Carolina Oncology Associates integrates its GE Centricity PM system with Kryptiq’s Online Bill Pay.

HealthPartners (MN) expands its online clinic services to Wisconsin. For $40 or less, patients in either Wisconsin or Minnesota have access to online consults with nurse practitioners using HealthPartners virtuwell.com program.

Berkshire Health Systems (MA) deploys Allscripts EHR and PM for its 108 providers and will offer a hosted and support option for 300 affiliated physicians.

Across the pond, a UK-based supermarket chain plans to add about 200 in-store medical practices. Sainsbury supermarkets will offer the space at no charge, though some GPs are critical. The chairman of the Royal College of Practitioners is quoted as saying, “Supermarkets should stick to selling fruits and vegetables.”

The Rhode Island RECs adds Ingenix CareTracker as a qualified EHR for doctors in its state. Ingenix, by the way, just  announced that its ClaimsManager software is available in a cloud-based version, targeting small and mid-sized physicians offices with fewer than 50 doctors.

Clark & Daughtrey Medical Group (FL) and Central Florida Gastroenterology contract with PatientPoint to automate registration through self-service check-in kiosks.

Just one month after announcing its pending purchased by McKesson, US Oncology tries to raise awareness for its iKnowMed practice management system with this recent press release. US Oncology stresses that iKnowMed is a customized version of Henry Schein’s MicroMD product, perhaps to emphasize it’s not offering an untested product. I find it mildly curious there’s no mention of the McKesson deal.

The great folks at Hayes Management Consulting sent me a virtual holiday greeting, saying they are making chartable donations this year in lieu of cards. I am sure Hayes’ contributions are much appreciated by the Toys for Tots Foundation, Massachusetts General Hospital Charlestown Health Center’s Pediatric Patients, and Susan G. Komen for the Cure.

Physician practice consulting firm Equation acquires competitor HealthCare Business Consulting of Baton Rouge, LA. The purchase expands the marketing reach of the Salt Lake City-based Equation.

McKesson says Practice Partner, Medisoft Clinical, Lytec MD, and Horizon Clinicals are all now ONC-ATCB certified. McKesson has its share of detractors, but I find it commendable that they seem to be trying to take care of their client base, even if that means maintaining multiple legacy systems.

Looks like the pending 25% pay cut from Medicare may be pushed back at least another year. Lawmakers are leaning towards a 12-month reprieve, giving the incoming Congress time to  come up with a new payment policy based on care quality.

The administrator at Birmingham Heart Clinic (AL) says its use of Greenway’s PrimeSUITE EHR helped the clinic earn a $70,000 PQRS bonus from CMS.

Adding  interactive forums to online health programs reduces member attrition while also saving program costs compared to face-to-face coaching. In other words, we’ve become a society that loves our social media and need our online world to motivate us, regardless if we are trying to improve our health, find a spouse, or raise chickens.

Physicians don’t really trust hospitals, even though they view hospital alignment as a way to relieve their administrative and financial burdens. Two-thirds of cardiologists and 48% of primary care physicians are interested in being employed by hospitals, citing an improved work-life balance as the primary draw.

E-mail Inga.

News 12/7/10

Healthcare communication provider NaviNet acquires Prematics, a developer of mobile clinical messaging and e-prescribing tools. NaviNet will integrate the Prematics mobile care management products with NaviNet’s Insurer Connect, EMR, and PM solutions.

Industry consolidation continues. The 23-doctor New Hanover Medical Group (NC) joins New Hanover Regional Medical Center’s owned physician group. The arrangement gives the New Hanover Medical Group access to the hospital group’s business support, including medical office technology, quality resources, and contract negotiations.

eDoctor and X-Med partner to integrate eDoctor’s ePrescribing into X-Med’s Linux-based PM system.

The 50-provider Ear, Nose and Throat Associates of South Florida picks PatientPoint’s RCM and self-service offerings to run with its existing PM and EMR.

The Eye Care Institute (KY, ID), completes its conversion to MedFlow EMR.

Sisters of Charity Health System (OH)  launches an IPA, designed to provide a platform to offer additional services to its independent physicians. The IPA will offer GE Centricity’s Practice Solution, billing and collection services, consulting, and managed care contracting.

In a study published in Clinical Transplantation, researchers finds that an electronic monitoring system and personalized counseling help improve medication adherence rates for kidney transplant recipients. Medication adherence jumped 40% when patients were given personalized phone counseling, along with prescription bottles that used integrated microcircuits to record when medicine was taken.

On other hand, an automated call-in system to monitor heart failure patients failed to show benefits, according to a NEJM study. Participation was apparently an issue, with 14% never using the telemonitoring system and only 55% calling in at least three times a week after six months.

The Department of State is hunting for an ambulatory EHR system to use in its medical offices across the world, including US embassies and consulates in 170 countries. Interested vendors must respond by December 15th.

I was intrigued by this press release, issued by the 800-physician member Brown & Toland (CA). Allscripts CEO Glen Tullman tells 100 Brown & Toland doctors that their organization is well positioned for success as an ACO, based on its early adoption of EHR technology. The release provides additional details of the Allscripts systems that is currently or in the process of being  implemented. I’m assuming Brown & Toland is targeting non-member physicians with this message in hopes of recruiting more providers. The San Francisco-based Brown & Toland is headquartered in a highly competitive healthcare market and likely needs plenty of troops, assuming it wants to hold its own in the ACO alignment race.

New technology alert: Mobisante is beta testing a handheld ultasound device that connects to a cellular network or Wi-Fi, allowing users to immediately send images to other providers. The company hopes the market will be drawn to the product, based on its flexible connectivity options and portability. Mobisante is waiting for FDA clearance and hopes to start commercialization in 2011.

Good news for family practice docs. Medicare allowances continue to rise for CPT codes 99213 and 99314, which represent 84% of all FP office visits by established Medicare patients. In 2006, 99213 paid $52.06; in 2011 payment is projected to be $74.85. Similarly a 99214 routine office visit earned $82.62 in 2006 and will pay $111.36 in 2011. Yes, good news, indeed, but still a lean living compared to specialists.

E-mail Inga.

News 12/2/10

Quality Systems, the parent company for NextGen, names James J. Sullivan EVP, general counsel, and secretary. Sullivan is the former SVP, general counsel, and secretary of The TriZetto Group.

Central Florida REC selects athenahealth as a preferred solution provider. Checking out the Central Florida REC’s website, I don’t see mention of any preferred vendors so I’m guessing they are finalizing details with their selected companies.

SuccessEHS makes its PM/EHR solution available for the iPad.

A new report suggests that providers implementing EHRs could see an increase in medical liability insurance, at least in the short term. While that initially sounds counter-intuitive, Conning Research and Consulting suggests that liability carriers are concerned that software failures and medical coding errors could occur more frequently in the early stages of EHR implementation. The report also predicts that the cost of defending medical liability claims could increase as more lawyers begin using data from electronic sources.

Northwest Primary Care (OR) contracts with Sage to provide the IMPAX PACS. The 25-physician practice already uses Sage Intergy PM and EHR. Sage offers IMPAX through an arrangement with Agfa Healthcare.

Most physician offices are turning to their vendor for help reaching Meaningful Use, according to our HIStalk Practice poll. That is pretty much consistent with a recent Sermo poll that concluded 45% of practices were looking for advice from their EHR vendor. A fewer number of practices will rely on RECs or their own internal resources. Meanwhile, our results indicate that consultants better focus their efforts elsewhere or increase their marketing efforts with physician practices. Our new poll to your right:  For practices: are you running an ONC-ATCB complete EHR?

I’m happy to report that traffic on HIStalk Practice increased 27% in November, compared to last year. Actually, I am more than just happy. I am ecstatic that more people keep stopping by. Dr. Gregg Alexander has pointed out to me that the site meter is about to hit 200,000 visits, and, in the next month or so I anticipate we’ll reach 1,000 e-mail subscribers. As a recovering sales rep, I love looking at numbers when they are going in the right direction. Thanks to all the readers, subscribers, and contributors (especially the prolific Dr. Alexander) who are helping ensure HIStalk Practice is trending the right way!

E-mail Inga.

Intelligent Healthcare Information Integration 11/30/10

Time for the Cheese, Please

“Thought provoking EMR comment. Don’t be sparing us the details of the cool features you’ve seen and which companies are providing the cool features you’ve found … show me the good stuff!”

That’s a compilation of a couple of quotes from John over at EMR and HIPAA after a recent post here where I mentioned I was starting to find some pretty cool pieces and parts amidst the waterfall of EMR/EHR demos I’ve been drenching myself within of late. I promised I would “stop the tease and show the cheese.” (John requested sharp, but it may be more along a Muenster.)

Four upfront caveats:

1. I am in no way receiving any remuneration from any of the vendors I will be mentioning.
2. I have really enjoyed many, if not most, of the people who have taken their time to show me their solutions. Part of me wishes I didn’t have to end up choosing but one answer / company for our office’s needs.
3. While I am certainly keeping self-interest at the fore, I try to consider the needs of my heretofore undigitized colleagues and what my understanding of their needs might include.
4. There’s only one of me and I have a day job (well, often a day and night job,) so I wouldn’t even begin to imply I’ve seen all there is to see – but I’m trying!

OK, here we go, and in no particular order of coolness…

Ultimate Usability

Unfortunately, there’s not a system in existence today that has this feature – yet — but the hands-down winner in my book goes to Medicomp’s CliniTalk and its yet-to-be-named Type / Write / Click cousin. Using their medical knowledge engine of “260,000 coded clinical concepts mapped to CPT®, DSM, ICD, LOINC®, RxNorm, SnomedCT®, and other billing codes and clinical reference terminologies,” this middleware allows truly smart data capture, integration, manipulation, and utilization. It’s coming very soon to some pretty good systems which it will help to make great.

I’m so enamored with this functionality that I’m doubtful I’ll be able to choose a new system that doesn’t have it incorporated – or at least one with plans to do so. Seriously, it does for clinical data what I’d always thought a computer should: it adds an intelligence and an level of association-making that a busy clinician really needs while helping to minimize the “Wow, I went to med school to become a data entry clerk for insurance companies” feeling. Unconfirmed, but I hear Sage Intergy will be one of the first to engage this hyper-enhancement.

Eye-Friendliness

This is one of my personal “gotta be there” criteria. It was a huge factor in my love at first site with Bond Clinician, the now life-support-plug-pulled Peak Practice. If my “blink” upon first view of an EMR isn’t one of “OK, that’s kind of pretty,” then I know the demo from there on out will likely only yield ideas for features or functions I might want to see in the other system I do eventually choose.

Prettiest faces in this category are all iPad-ian: Quest’s Care360 and ClearPractice’s Nimble. Right up there, too, is Dr. Chrono, but I admit to enjoying the warm feel of faux leather, even if only digital, which Care360 and Nimble use. This familiar view might even assuage some of the anxiety of docs who are still pen-and-paper bound. (I especially like the slightly askew desktop look-and-feel of Care360, perhaps because my desk is usually pretty askew, too.)

Desktop systems could learn a thing or three from these iPad implementations. I mean, really, isn’t there a whole science about HCI (Human-Computer Interaction) and how to make visual content appealing, productive, and efficient? My take: Many EMR vendors could use a few less chief marketing officers and a few more humanistic computer interface designers.

That said, I have seen a couple of desktop systems worth noting. SOAPware’s EMR has come miles from when I first remember its rather basic layout. athenahealth’s athenaClinicals also has evolved nicely since I joined Inga and John Smalling in a group demo about a year ago in an ill-fated jaunt into product demo reviews. (I liked it then; its look and feel is even better now.)

As this is a long, ongoing, often sleep-inducing process, I guess it’ll have to be a “to be continued.” But, before I go, here’s a few I’ll be discussing next time:

• We “get” the “App Me, Baby” idea: SRSsoft’s Hybrid EMR and Medicity’s iNexx.
• EHR vendor team who seems to have the most creative fun: Nuesoft.
• Most exciting new non-EMR EMR: Mitochon Systems mEMR.
• Best digital office preparation tool: Welch Allyn’s EHR Prep-Select.
• The value of views: DIS.
• Using exo-EMR stuff, mostly iPad apps, as really useful patient education and engagement tools: Blausen Medical’s Human Atlas, Pampers’ Hello Baby – Pregnancy Calendar, CHADIS, and Text4baby. (Pseudo exception to caveat #1 above: I also like start-up Health Nuts Media for whom I am the unpaid CMO). Heavy prejudice toward pediatrics, I know, but remember the source here.
• Vendor web sites: what attracts and what repels.
• “The Good, The Bad, and The Ugly” of demos and vendor/client connections.

So, while not meaning to continue the tease as I’m really trying to dole out the requested cheese, I’ll close here with the promise to grate some more fresh Parmesan soon.

From the trenches…

“The early bird may get the worm, but it’s the second mouse that gets the cheese.” – Jeremy Paxman

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.