News 11/4/10

Radiation Therapy Services, dba 21st Century Oncology, selects Sage Intergy for its 90 radiation therapy centers across 16 states.

The University of Wisconsin-Madison’s Center for Quality and Productivity Improvement takes a look at the effects of HIT tools on physician workflow in the outpatient setting, noting that previous studies have shown varied results. It’s a long read but here are a few conclusions worth noting:

• There is growing awareness that the analysis of workflow is necessary to ensure successful HIT implementation and to effect process improvement.
• When there’s a lack of integration of HIT into clinical workflow, quality and safety improvements suffer. HIT integration needs to support the cognitive work of the clinician and the workflows among organizations (e.g., between a clinic and community pharmacy), within a clinic, and within a visit.
• If HIT is to provide optimum performance, it must be designed to fit the specific context in which it will be used, specifically practice and patient types.

Core Solutions, which specializes in behavioral health software solutions, wins a contract to implement an EHR for 60 substance abuse providers affiliated with the Arkansas Office of Alcohol and Drug Abuse Prevention.

I’m glad the elections are over, along with the annoying political commercials and even more annoying phone calls. Over the next few weeks look for the lame-duck Congress to patch pending Medicare cuts before the 30% payment reductions kick in.

From the International Journal of Medical Engineering and Informatics: self-management of chronic disease can improve patient health and reduce hospital visits, and, PHRs and the use of the Internet have the potential to help patients better manage their diseases. Too bad no one wants to use PHRs.

Start-up company Avvo announces it will expand its free online ranking services to include rankings of physicians. Avvo debuts with listings for over 800,000 doctors, drawn from public records and company research into doctors’ backgrounds and experience. Any predictions as to whether or not they’ll be able to filter out the retired/deceased/imprisoned physicians?

I happened upon this commentary by a couple of attorneys who specialize in negotiating HIT contracts between practices and vendors. They point out that one of the key services that RECs can provide is educating providers on HIT contracts, including some of the important provisions to minimize risk and to improve chances of achieving meaningful use:

RECs have the potential to serve as a valuable resource, especially for remote and underserved paper-based primary practices. However, RECs could be doing a disservice to physicians by failing to advise or provide them with essential EMR contract negotiation skills.

I was surfing YouTube today and noticed a recently posted series of videos highlighting a presentation by McKesson Sales National Sales VP Tammy Eden of the Physician Practice Solutions division. Each of the 10 clips are three to four minutes each and overview the final rules of the HITECH Act, the requirements for qualifying for Meaningful Use, and how to actually apply for reimbursement. The information is generic enough to be a great tool for anyone needing summary information, regardless of your EHR, and definitely worth a peek.

E-mail Inga.

News 11/2/10

The eClinicalWorks 2010 Users’ Conference is in full swing at The Gaylord Palms Resort in Orlando with a record 2,500 participants. As part of the event, eCW introduced its Version 9.0 product and launched its new 100millionpatients.com portal solution.

digiChart and MDAdvantage Insurance partner to extend malpractice discounts for physicians who use digiChart OB-Gyn EHR. digiChart will also offer software discounts for physicians covered by MDAdvantage.

NaviNet, a company traditionally known for healthcare communication services, introduces a practice management and EHR solution that integrates with NaviNet’s Insurer Connect payer portal. The PM/EHR solution is based on CureMD’s platform, so I am guessing that NaviNet is putting its private label on the CureMD technology.

Meanwhile, CureMD launches discrete reportable transcription (DRT). Doctors who want to transcribe clinical notes can use CureMD’s overnight transcription service, then have the DRT technology directly populate discrete items into the CureMD’s EHR.

Quality Systems (NextGen) reports Q2 numbers: revenue up 14% to $81.5 million, EPS $0.46 vs. $0.41, with both revenue and earnings falling short of expectations. The Street was looking for $85.7 million and $0.49.

The Tri-State REC, based in Cincinnati, releases its list of five supported EHR vendors and products. The list includes Allscripts Professional, athenaclinicals, GE Centricity, eClinicalWorks EHR, and NextGen EHR. Supported vendors will extend special pricing and terms to providers working with Tri-State, but the REC’s director says Tri-State is “committed to working with any practice or provider, regardless of which certified EHR vendor they choose.”

No surprise here: primary care physicians, on average, have the lowest income of doctors in any medical specialty based on hours worked. Primary care docs earn about two-thirds of general surgeons, averaging $60 an hour compared to surgeons, who make $92 an hour. The top paying specialty is neurosurgery ($132 per hour), followed by radiation oncologists ($126 per hour). Primary care physicians averaged 51.2 hours a week compared with the 59 put in by surgeons, 57.9 by subspecialists, and 47.4 by "other" physicians.

The REC Ohio Health Information Partnership is working with Welch Allyn to offer providers the Welch Allyn EHR Prep-Select service, which helps practices pick their EHR  and achieve Meaningful Use.

Gateway EDI launches Patient Exchange, an online patient portal that includes billing statements and online pay options.

The AMA collaborates with Press Ganey to provide physicians with a Web-based tool for measuring patient satisfaction. Using an electronic survey, the RealTime solution collects and evaluates patient feedback and generates reports and summaries to identify satisfaction trends.

AZZILY will integrate MaxMD’s mdEmail service into is EHR/PM/PHR application. I chatted with the AZZILY folks last week at MGMA and they plan to official launch their product later this year.

Correction: I mentioned recently that an Allscripts exec told me that Travis Bond (founder of Bond Medical) is a new Allscripts MyWay reseller. I have since learned the executive was incorrect — he’s not.

October was another record month for HIStalk Practice with our highest number of visits ever (11,358). Views were up 38% over last October and overall readership is 24% higher for the year. Over 900 confirmed subscribers receive a handy notice in their inbox every time we have a new post. If you are not one of those confirmed subscribers, sign up for e-mail updates to your right. Also, share your love with our sponsors by visiting their sites and checking out their offerings. And if you think you’d like to be a sponsor, click on the sponsorship link at the top of the page. Thanks for reading and for telling your friends that they are unhip if they aren’t tuning in.

O’Brien’s Billing, a New York-based billing service specializing in mental health, selects Kareo as its billing software solution.

Speaking of Kareo, I’d like to welcome the company as our newest HIStalk Practice Gold Sponsor. Kareo offers a Web-based practice management and medical billing software that includes integrated electronic claims processing. Its pricing model is transparent, with options listed right on their Web site (starting at $69 per provider per month). The-six-year old company partners with Practice Fusion for its free EHR and integrates with other third-party EHR products. VC firm OpenView Partners recently invested $9.5 million in Kareo, giving the company the ability to further enhance its product suite and expand the company’s infrastructure. If you click on their banner to the left, you’ll see details a special pricing exclusively for HIStalk Practice readers (25% off Kareo’s Plus, Complete, or Max plans for the first six months). Mr. H and I appreciate their support!

Practice Fusion, by the way, announces a partnership with Microsoft’s Windows Azure MarketPlace to offer researchers de-identified health information at no charge. The clinical dataset includes insights on vitals signs, diagnoses with ICD-9 codes, medications with NDC codes, prescription events, immunization details, and allergic reaction details. Practice Fusion also just obtained ONC-ATCB 2011/2012 Certification through Drummond Group.

PM/EHR vendor American Medical Software selects Intuit Health’s patient portal solution for its physician clients.

A CompTIA study suggests that 34% of healthcare providers are using comprehensive EHRs and more than half of all providers use some form of EMRs. I haven’t seen the actual study, but apparently the survey sample included only 300 healthcare “providers,” which included doctors, dentists, nurses, PAs, and office managers (who are clearly not “providers”, but I’ll let that slide). CompTIA also surveyed 370 IT firms, of which only 40% did business in the healthcare sector. In other words, the methodology sounds questionable and I’d be wary of adding these statistics to my next EHR white paper. If you have read the report and have a different opinion, please share.

E-mail Inga.

From MGMA 10/27/10

Wednesday is officially the last day of the conference, but I am heading out bright and early.

I still have quite a few impressions to share, but I’ll start out by summarizing what I interpreted as the big buzzes this year:

• Financial matters worry practice administrators the most. Declining reimbursement, healthcare reform, and rising costs are all contributing factors.
• Hospitals are buying practices at a rate not seen for at least 20 years. Despite the failures back in the late 80s and early 90s, people are optimistic that alignment will work this time because physicians are tired of all the financial issues (see above) and evolving delivery models (ACOs) that support hospital ownership. Plus the new generation of physicians aren’t interested in working 80 hours a week and foregoing family life and other interests. These physicians are happy to work for a hospital for a guaranteed minimum paycheck.
• Meaningful Use is defined and products are being certified, but EHR adoption is still not surging, though growth is steady. Practices, at the least the larger ones represented by MGMA members, are moving forward, but no one I met is rushing to be the first in town to qualify for federal monies.

A reader suggested that maybe I should have thrown a shoe at the booth babe who pegged me in the head with beads on Sunday. With that in mind, I returned to the scene of the crime Tuesday. As you can see, Booth Babe is on a perch, giving her the ability to hurl the beads down onto the crowd. A nearby vendor told me that management banned her from throwing the beads into the aisle (which is how she pegged me). Instead, she had to sail the beads down to the people standing in the booth. A much more conservative, but far less dramatic approach. Anyway, all was forgiven after I noticed Booth Babe had on fabulous blue shoes.

MGMA hosted a general reception Tuesday night. Many attendees took the opportunity to adorn themselves with Mardi Gras trinkets. The facility for this reception was smaller than the one used Sunday night. It also had fewer food and bar stations, which resulted in long lines. The MGMA people must have felt a little guilty about the wait since I noticed a couple of employees handing out free drink coupons. Free drinks always makes waiting more bearable.

True story: as I left my hotel room Tuesday morning, the maid told me she liked the shoes I had left in the room yesterday. In fact, she commented that the shoes were her size. A bit creepy, but she swore she didn’t try them on. Obviously I am not staying at the Ritz (I have a hard time believing the maids at the Ritz would admit to looking that closely to my shoes). But, I have to love a maid who knows her shoe fashions.

If you are planning a trip to a convention in New Orleans, here is a tip. The Marriott Convention Center is right across the street from the convention center. There is a different Marriott about half a mile away. If you are going to an event at “The Marriott,” it’s good to verify exact which Marriott before walking half a mile in fabulous, yet not particularly functional shoes. It also may save you $8 on cab fare as you rush to go to the “correct” Marriott.

And here is a tip for vendors: don’t ever tell a practice that has over four doctors that they are “small,” especially if the practice is located a small town. I witnessed that conversation and I think the administrator (who actually had an eight-doctor group) wanted to smack the vendor guy, or at least throw some beads at his head.

Many vendors threw private parties Monday night. Some of my invites must have gotten lost in e-mail, but thank you Sage and Allscripts for making sure I was included. I missed both those affairs, but the Allscripts people tell me they hosted about 500 people. Given there are only about 4,600 at the convention (including 2,700 paid attendees), I’d say Allscripts won the big party award.

Speaking of MGMA attendance, I heard the numbers are up about 30% from 2009. MGMA said they “ran out” of space in the exhibit hall (the total number of exhibitors was north of 250). I’ll take these as signs that the recession is easing a bit.

I chatted with the McKesson folks for awhile (who or may not have not gotten word about the company’s re-org, but were tight-lipped about any changes, nonetheless). Among other things, they told me about several Practice Partner clients who were successfully using McKesson tools for Medical Home initiatives. I had an even more telling conversation with an administrator who implemented the Practice Partner EHR in September and was pleased with the progress. She said she decided on Practice Partner because it worked well with her Lytec billing software (which does everything she needs it to do) and the price was right. Her practice had nine providers and NextGen’s proposal EHR was about $250,000. Glostream, which the doctors really liked, was almost $300,000. Practice Partner was about a third of the cost. She said that the Practice Partner software is perhaps not as pretty as the more expensive options, but, so far it is getting the job done and the doctors are pleased.

Medicity was showing off its new iNexx product, which is an open platform for health information exchange. Providers that are tied in can view clinical data from all connected providers. Medicity, along with third-party app developers, is creating additional modular applications. While I’m sure it could be deployed on a large scale, it seems like a great option for communities that are not ready for a full-blown HIE, yet want to share data. I believe the connection fee is $99 a month per provider. To promote the idea that iNexx can replace fax machines for data exchange, they were handing out “Pet Faxes.”  As an aside, Medicity told me this is the first time they have exhibited at MGMA and are pleasantly surprised by how many physician offices are already aware of their company.

In some of the larger sessions, rather than opening the floor for questions, participants were encouraged to text their questions. This seems like a great alternative to queuing up at microphones (or shouting out questions that have to be repeated) and then having people tell some long story before actually getting to the question. The text alternative meant the questions were shorter and to the point. Thumbs up.

I also was a fan of the Healthcare Innovations Pavilion, which was set up in the exhibit hall. Vendors had 20 minutes to overview a topic and of course make a pitch of some sort. A couple that I sat through included Meaningful Use (MED3OOO) and patient portals (Intuit). MGMA strategically scheduled these when there were breaks in the exhibit hall and they were standing room only. The presenters I heard were solid and I think people like hearing what vendors have to say without necessarily walking into a booth and asking questions.

Remnants from my last dinner in New Orleans. Yum.

Heading out to the airport momentarily. MGMA 2011 in Vegas!

E-mail Inga.

From MGMA 10/26/10

If it weren’t for the above establishment, I would have posted an update a bit earlier.

Monday was a packed day, starting with an 8:00 a.m. general session highlighting health reform. MGMA CEO William F. Jessee, MD moderated a panel that included representatives from the Federation of American Hospitals, Humana, the AMA, and the National Business Coalition on Health. The discussion ranged from what is wrong with healthcare today (a lot) to what is wrong with the reform package (a lot) to physician shortages, ACOs, and the purchase of private physician groups by hospitals. Lots of great discussion and theories for how health reform may affect practices. No bottom line was reached (not surprising, given the diversity of the panel) but there were plenty of reasons for stakeholders to wish they had a crystal ball.

David Blumenthal spoke at a separate session that was apparently mired with microphone problems. Unfortunately, I had noted the time wrong time and missed it. Another attendee told me that if had ever have heard Blumenthal speak before, I’ve already heard what he had to say, which including all the great reasons for implementing EHRs.

I sat in on a couple of other sessions and must conclude that the trend for hospital/IDN ownership of practices is high on the buzz meter. A fellow attendee told me a session on physician/hospital integration was beyond standing room only, with people sitting in the aisles to hear Marc Haley of The Haley Consulting Group share his thoughts on the topic.

Another hot topic was lower reimbursements and the threat of cuts. Though the Medicare cuts (totaling about 30%)  will likely not occur, look for drastic reductions in staff and delays in the purchase of EHRs if Congress doesn’t take action by the end of the year.

MGMA released the results of a couple of surveys, including one that found better financial performance for groups with EHRs than those with paper records. Physicians in private practices averaged almost $50K per year higher revenue after operating cost per FTE. Hospital or IDN-owned groups with EHR reported an operating margin $42K more than those on paper records.

Also from MGMA: hospital-owned groups tend to have lower revenue figures than privately own practices, but, some of the differences can be attributed to variations in accounting practices. Specialists working in a hospital-owned group earned 20% less than their independent peers. Primary care physicians working in hospital-owned groups earned $192K, compared to $180K for physicians in private practice.

On a panel discussion about EHR certification, CCHIT seemed quick to point out that their traditional certification program is more robust than the standard ONC certification. Paraphrasing CCHIT Chair Karen Bell, MD, the ONC-only certification may not include everything a practice needs to provide quality patient care. Of course doesn’t CCHIT have to come up with an argument for why vendors should continue paying thousands to obtain various CCHIT product certifications?

Also heard more than once: after CMS starts handing out incentive monies, look for the agency to roll out an audit process to verify that providers are truly using their EHRs in a meaningful way.

athenahealth CEO Jonathan Bush and I had a chance to compare shoe fashions and discuss what was going on in the athena world. Last week athenahealth announced great third quarter earnings, which of course put smiles on the faces of quite a few athenahealth staffers. A few other notable items gleaned from the always entertaining Bush:

• “Cloud” is the buzz word right now and he says no one is in the the cloud like athenahealth.
• The cloud, by the way, means that 100% of athenaclinical clients are on the ONC-certified version. It also means that the transition to 5010 will occur seamlessly for athenahealth clients, he told me.
• In this age of vendor mergers and acquisitions, Bush says athenahealth is not currently a target. However, he believes that if one day a company were interested in athenahealth, it would be an entity that is a  “new entrant” to the healthcare IT vertical.
• Bush is the master of the analogies and points out that the difference between buying athenahealth versus traditional solutions is a lot like flying: you could build a plane, develop your own flight plan, and fly yourself somewhere, or, you could go with athena, which is like buying a ticket to fly with a commercial carrier. The commercial flight gets you where you need to go, it’s easier than the first option, and you leave the flying to the experts.

I attempted to hit quite a few more exhibit booths in between sessions. SimplfyMD showed me their EHR, which is heavy on scanning and pushing information to the doctor, rather than the doctor pushing information to the chart. The product does include templates for providers wanting to input their own chart notes, but I thought they looked a bit clunky compared to a number of other products. However, my impression is that they don’t push the template option as much as they do workflow alternatives that keeps the doctor performing too much data entry. The EHR-only product is $400/month/provider and the company does not have a practice management solution. SimplyMD is young (a couple years old or less) and has about 680 providers live.

More on this in a bit, but I was surprised by Cerner’s 10×10 booth, situated in one of the spaces on the outer edges of the hall. I consciously was keeping an eye out for Cerner and didn’t even notice their booth the first time I walked their row.

Thanks to the sponsors who prominently displayed their “I Power HIStalk” signs, including SRSsoft, e-MDs, Advanced MD, and iMDsoft.

Workflow.com had its same tired tiki-themed booth. Time for a refresh, I think.

As usual, NextGen had a great approach for getting prospects to their booth and listening to their elevator pitch. During a 5-10 minute overview of the company and products, two attractive artists worked together to create art. It was fascinating to watch because the pair were so in sync that it was almost like watching some sort of modern dance. Very fun.

Some of the many giveaways that I didn’t win included a lovely Coach purse (Ingenix), a few Wiis (Fifth Thirds was one I recall), a seven-day cruise (Tavoca), and plain old cash from a number of vendors. Eric Fishman of EHRtv won an iPad from Surescripts, as did a couple of his employees. Did I mention I didn’t win anything?

Quite a few vendors were tweeting throughout the conference. I was amused by one from Greenway which encouraged people to “see” its founders at the booth. I’ll blame the choice of the word “see” versus “meet” on the fact that was shorter to tweet; I assume Greenway didn’t place Tommy Green and Tee Green in some sort of display case.

The Cerner folks sent me a couple of personal invitations to watch demo of their ambulatory EMR product. As I mentioned, the booth was pretty small, so doing an inconspicuous over-someone-else’s-shoulder demo was a little challenging. I admit the demo I observed was limited and I didn’t get to ask questions. However, compared to other EHRs on display throughout the exhibit hall, Cerner’s patient summary screen looked comparatively “busy” and not particularly pretty. It didn’t appear to be as intuitive as some of the newer, sexier products on the market and certain features seemed user unfriendly. For example, I didn’t think the template charting function was very quick. If a provider were trying to find a particular item to select, they would have to wade through too many other options to find the preferred choice.

I have a few more impressions to share but I’ll pick it up on the next post. Meanwhile, thank you Gateway EDI for the invite to your party at the Gordon Biersch Brewery. I am blaming Gateway for kicking off a fun evening that ended too late at one of New Orleans’ most notable landmarks.

E-mail Inga.

Intelligent Healthcare Information Integration 10/25/10

Moving Ahead with Albert’s Axe

OK, not to be overly the drama queen, but after taking a little time to let the situation unfold and sink in a bit, I’ve now come to the realization that, at least for me, hearing the news of my EHR’s impending death has triggered the grief cycle cascade as defined back in 1969 by Dr. Elizabeth Kübler-Ross.

Denial, anger, and bargaining are done. Depression settled in, but has just now started to lift as I head into acceptance (though perhaps begrudgingly).

Whether or not you accept the Kübler-Ross five stages of grief theory, or even the newer “extended” seven-stage version, I think everyone agrees that the loss of a loved one, even the loss of a loved “thing,” can trigger a profound series of emotional effects. While very few providers would consider our EHRs an objet de l’amour, it is still something which becomes a very intimate and engrained part of the majority of our working hours, perhaps even of the majority of our waking hours.

The transition from pen and paper is traumatic, filled with many a “I’m gonna heave this this freakin’ thing right out the second floor window and enjoy watching it disintegrate on the concrete” moment. Learning a new way of doing virtually everything you do during a working day is filled with numerous episodes of “I wanna go home” whines and “I hate this” whinnies.

Once you’re there, once you’ve tapped into your never-ending source of adaptability and allowed it to overtake your nostalgic inertia, you get on into the groove. The new way, assuming you’ve made a smart choice in your new workflow direction, starts to become a part of you. The new habits, patterns, and work styles begin to light up with the promise which had originally enticed you to embark upon this new path. You start to get your mojo thang workin’ again.

Whether by choice or vendor decree, going to a new EHR and enduring another workflow overhaul may not be as grandiose a change as moving from paper to digital, but prior advantages have been lost. Before the paper-to-PC switch, you have dreams of how much better the world will be. Now, though, the anticipation of what is to come is muted by the awareness of what is to come.

Simply and honestly put, workflow overhaul is a major bitch. Innocence lost, you know what you’ll have to endure, at least to some degree. Thus, the dread of re-experiencing the frustration blues associated with major change is difficult to offset because the anticipation and excitement allowed by naïveté are diminished.

I don’t know if making such system and workflow changes are more or less difficult in a larger group, hospital, or other institutional setting where the advantage of more support personnel may be offset by more people needing to make the transition. My sense is that it is tough for all. But, for us one- and two-horse practices, it is not only difficult, it is also quite personal. The depersonalizing corporate-think is not actuated and there are zero degrees of separation between the decision makers and the implementers.

From several experiences now, it has become apparent to me that it is difficult for EHR vendors to maintain a balance in dealing with both the very large and the very small medical worlds. Just as quantum physics requires quite the different vocabulary from that of the Newtonian world, the needs and vocabulary of small provider practices are quite divergent from their larger counterparts. Same healthcare universe, but very different scales and quite different perspectives.

Seems a Grand Unifying Theory is a tough thing to find regardless of your universe of concern.

From the trenches…

"Technological progress is like an axe in the hands of a pathological criminal." – Albert Einstein

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 hisblog, practice web site or directly from doc@madisonpediatric.com.