Intelligent Healthcare Information Integration 9/10/10

EHR Mountains and Molehills

Way back in days of yore, when I was but a naïve EHR pup looking into systems which might be suited for me and my one-doc practice, I clearly remember thinking how I wanted to be certain that whichever system I ended up choosing, I wouldn’t end up as a corporate afterthought. Once the big boys (or girls) had my money, I worried I might become but a faint, far-off voice, more of a gnat when I had a problem than a lion whose roar could not be ignored.

Not only had I read and heard tales of just such woes, I had experienced the uppitiness of some of the bigger vendors’ sales reps first hand. I had many a demo in my office or at various events where the “show” had a constant underpinning of “see how wonderful we are” followed by a slightly upturned nose as they sat back in their chairs with a smug sense of “there’s no way a little, one-horse doc like you won’t be hyper-impressed by our magnificence.”

Not that I was, or am, any great shakes EHR reviewer, but I knew just as much then as I do now about what looks good to my eyes and about what made medical workflow sense. Frankly, most of the big systems weren’t very small-user-friendly, plus, they looked kind of ugly. (And, to top it off, I detest smugness.)

I was on a quest; I wanted to find a good-looking system (at least one that suited my eyes) and I wanted to find a company which I felt would value me as much after I had paid the price of admission as they did before. I finally settled on a system and a company which I thought fit that bill to a proverbial “T.” The system was very high tech, very customizable, very attractive, and very workflow-centric. The company was small, but the people were phenomenal, the kind of people I’d want my children to emulate. They promised to keep me, and pediatrics as a whole, as primary considerations. And they did.

I believe our partnership was mutually beneficial. I helped their company grow and helped them flesh out some important elements of their system’s design. They kept my concerns addressed just as if I were their only client. I felt well-matched and well-considered.

But, then … then came the mergers/acquisitions. Up one step, up another step, and now, up into the Himalayas (or, at least, the high Sierra Madres). What I worried about with each step was whether I would continue to have the feeling that I was still a valuable client despite my Nowhere, Ohio, address. I was fortunate that along each step up, my little guy concerns continued to be considered. Up step one, up step two, each seemed to value little trench grunts (or at least they made me feel that they did).

Getting noticed when you have an issue among molehills is one thing; it concerns me that no one will hear my screams if I fall in the midst of the mountains. So, Glen, while I doubt you’ll have the time to be reading my measly blog submission, I sure hope someone on your (our) new team still notices us little guys and realizes that, en masse, we have a lot to offer that is distinct from all the large groups and institutional players with their colossal checks. (Ours will also be colossal; you just have to cash a whole bunch of them to attain colossal-ality. Sort of like Seinfeld with all of his twelve-cent royalty checks from a Japanese TV show appearance.)

From the molehills…er, mountains…er, still in the trenches…

“It’s the sides of the mountain that sustain life, not the top.” – Robert M. Pirsig

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 9/9/10

The Association of Alexandria Radiologists (VA) chooses McKesson’s Revenue Management Solutions for radiology billing and practice management for its 26-physician practice.

MedLink International collaborates with HIE vendor Thrasys to market a cloud-based HIE platform to RHIOs and hospital groups. This is the same MedLink that was originally formed in 1997 as an answering service for doctors. A few years later, MedLink expanded its offerings to include VPN services to medical communities, as well as an EHR and PM solution for physicians. Management appears to be paying attention to market trends.

meridianEMR and PM vendor MedEvolve announce plans to share technical resources and integrate their products.

Greenway Medical Technologies says it had a record 1,300 attendees at last week’s customer conference in Atlanta.

The Massachusetts eHealth Institute (MeHI) REC releases a list of certified EHR vendors and Implementation and Optimization Organizations. Ten companies make the EHR vendor list, which pretty much encompasses all the major players. Eighteen vendors are named certified implementers.

Meanwhile, I could not find a list of any certified vendors for the South Florida REC, though Mitochon Systems says they’re now an Approved EMR Provider. Mitochon offers a free HIE/EMR/PHR system.

Nuance Communications introduces Dragon Medical Enterprise Network Edition for  large practices and hospitals. The new release includes a centralized management console and enhanced support for Citrix-based EHRs.

The American Society for Gastrointestinal Endoscopy will offer Welch Allyn’s EHR Prep-Select service to its 11,000 members.

Three in ten Americans say they would use their cell phone to track and monitor their health and 40% claim they would pay to use a remote monitoring device that would send health details to their doctor. Most physicians support remote patient monitoring as long as there’s an option for exception reporting, rather than just supplying raw data. Forty percent of physicians believe that a combination of e-mail, text messaging, and mobile health technologies could reduce office visits by as much as 30%.

Hill Physicians Medical Group (CA) brags that its IPA now has over 1,000 private physicians in the San Francisco area, plus another 1,200 practitioners that are part-time, faculty, or provide services through hospital-based positions. Across northern California, Hill has more than 3,500 physicians.

US Oncology selects PatientPoint as its patient portal solution.

A public radio station in Tampa looks at EMR adoption in the region, finding at least two physicians who aren’t big fans. A family practice doctor complains that consult letters from specialists with EMRs run four pages long, compared to one-page notes from non-EMR docs: “You’ve got this mass of uncoordinated data. Even though it’s all there it’s agonizing to try and go through this information, so you become inefficient.” A second doctor who’s had an EMR for four years says, “It really cut down the number of patients we were able to see as we were learning to use this. It probably took about a year for us to get comfortable with the system.” Ouch.

MedPlus and the eHealth Initiative release results from a benchmark survey on the role of RECs in EHR adoption. Some key findings:

• Of the 46 RECs responding to the survey, 30 said price and total cost of ownership will be the most important criteria for selecting a preferred EHR vendor, with other factors being Meaningful Use guarantees, local implementation presence, and availability of system hosting.
• Only 14 RECs said they had signed contracts with primary care providers.
• 30 RECs intend to change their fee structure in order to sustain themselves once stimulus funding ends.
• 28 RECs will conduct an RFP process to select recommended vendors, with 13 planning to choose five or more vendors.

Compulink Business Systems announces it is providing an unrestricted educational grant to the Joint Commission on Allied Health Personnel in Ophthalmology to develop online courses on EHRs for ophthalmic medical personnel.

A professional magician-turned doctor finds that a bit of magic helps put patients at ease and builds rapport. Magic has worked so well for Dr. Lalit Chawla that he’s written a manual (which includes 20 tricks) to help other health professionals incorporate magic into their professional work.

E-mail Inga.

HIStalk Practice Interviews Lisa Martinez, Applications Manager, Staten Island Physician Practice

Lisa Martinez is a applications manager at Staten Island Physician Practice of Staten Island, NY.

Give me some background on your practice and the technology you are using.

We are a two-location, multi-specialty group of about 90 to100 physicians.We’ve been using NextGen since 2006. It was our first experience using an electronic medical record. We also use their practice management system, so we’ve use both ever since then.

In the sense of using the system for the pay-for-performance enrollments, we enrolled with NextGen due to their HQM, their Health Quality Measures, that they set up. We moved forward with NextGen. We were not previously reporting until NextGen created the HQM.

Which was how long ago?

This was last year that we enrolled.

So that’s essentially how you got into the ehearts program?

Exactly.

What made you decide to participate?

It was actually brought to us as a NextGen client. Obviously we were interested in the pay-for-performance initiatives. At that point, especially knowing that it was just on the reporting end that we were enrolling as a beta site for their new application or utility, we enrolled.

Since we are a New York-based group, we enrolled in the eHearts and we also enrolled in PQRI. We reported for both of those for 2009.

How did you do on the PQRI? Have you gotten those results yet?

We have not heard back from PQRI yet.

What type of data are you capturing?

That was one of the great things with the HQM is that the physicians were already documenting into the electronic medical record. Say it be specific information for the patient while they’re doing their documentation for the day, or it can be information that’s coming through an interface. For example, lab results.

Through all the different measures, they’re actually going into the back end of our database and pulling those fields for the patient. The physicians don’t have to change their way of documenting. They continue to document the same way. We brought it to their attention, obviously, that we were reporting off of specific fields, but they were already using those fields, so it worked out well for them.

What sort of data are they looking for?

It depends on the measures. For example, in the measures that we do with eHearts, they’re looking at their medications, their blood pressure control, cholesterol control, and their smoking cessation.

All that type of data was already in your templates?

Exactly, yes. It could be even a drop-down field. It could be coming from an interface from their vital signs that they’re taking. For example, their blood pressure check on a daily basis, and their cholesterol also, would be from a result.

Did the physicians have to make changes in workflow? For example, were they necessarily testing cholesterol levels on a regular basis or did you they have to add those protocols?

No, luckily we actually already had it in place through our case management where they are following up with those patients before we even enrolled in eHearts or PQRI. The providers were already being informed of their patients, their high-risk patients, or any other case management that they were following. So luckily, this is a very popular scenario with the eHearts. We were already doing that for our patients.

How long was the reporting period?

It was for a year.

Did you do monitoring during the year to make sure everybody was capturing what they were supposed to be capturing?

We did, internally on our end. We pulled reports. NextGen didn’t have the capability to do that. I know that they’re working to do that, but they gave us a yearly report on the information.

We also can pull a breakdown, through NextGen, of exactly where our physicians stood that year, and where the patients that were missing the information were. We provided that to our physicians, but we also have our own internal reports that we pull.

What was involved in creating the reports?

That was all taken care of on NextGen’s end. They set up the utility. It was just in a sense, an afternoon of programming where they connected to our database. They informed of us the fields that they were going to be pulling, and at that point, we just did some basic data structure to make sure that the fields that we have are the same as what the reporting was of, and the fields’ names are the same so they’re not missing anything.

We went through that a few times back and forth until we made sure that we had everything 100%. I would say a couple of weeks to have everything set up and completed.

Where’s the practice in terms of meeting Meaningful Use objectives?

At this point, we are not enrolling with the Meaningful Use objectives until we go to the next version that’s offered by NextGen. That’s probably in 2011.

Any particular reason for that?

I’m sure there is. I just don’t know.

Anything else you can add to clarify what you are doing and how the physicians have embraced this? I guess they’re probably pleased as punch to get $100,000 not having to do any additional work.

Exactly, that’s the key piece. They didn’t have to do anything additional because asking anything additional is always an issue as it is.

But with that said, and seeing that there was a true payment that was given … because that was another piece, that we were in the thoughts of, “Oh, well they’re saying this is going to happen, but it’s probably not going to happen.” Once we said that, it did happen.

It’s great for the physicians to actually see that their follow-through with their patients is also giving them a benefit through NextGen, through using the electronic medical record, because it was a great investment — a very big investment on their end — for the group.

News 9/2/10

HIE vendor Availity acquires RCM service-provider RealMed. No terms were disclosed, though Availity says RealMed’s operations will remain in Indianapolis.

Allscripts-Misys and Eclipsys are now Allscripts Healthcare Solutions, as the merger is finalized. To celebrate, Glen Tullman, Phil Pead, and a dozen others rang the opening bell on NASDAQ. Familiar name, but new logo, new color, and a  new leadership team, with Allscripts-Misys alums taking most of the top spots.

Southwest Kidney Institute (AZ) selects athenaCollector, athenaClinicals, and athenaCommunicator for its 50-provider practice.

Speaking of athenahealth, I see they have added an amusing 2-minute video to their site called “Tame the Beast.” Jonathan Bush’s larger-than-life personality is one of the company’s best assets, in my opinion, and this clip highlights JB’s ability to effectively deliver his message with deadpan humor. It’s worth a look, even just to see the cameo of his beautiful daughter.

Jonathan Bush’s cross-town competitor, Girish Kumar Navani of eClinicalWorks, is named as one of 16 recipients of a Mass High Tech 2010 All-Stars Award. The award recognizes “dynamic and influential leaders of New England’s innovation economy.” He took top honors in the Health IT category.

The number of readers tuning into HIStalk Practice continues to grow. In August, we once again exceeded 10,000 visits, which is up 52% from a year ago. Thanks for stopping by and telling your friends. Of course, thanks to our sponsors, especially those very first ones a year and a half ago who took a gamble that HIStalk Practice would make it past the first couple of slow months! Their love helps fund my shoe budget, which in turn contributes to world beautification.

The local business journal says the 281-provider Austin Regional Clinic (TX) is shopping for its first EMR. Austin-based e-MDs is said to be in the running, though the clinic is working to create its short list of just three or four vendors.

More evidence that text messaging is effective way to help kids follow their doctors’ orders: the Pediatric Health Transplant Program at NY-Presbyterian/Morgan Stanley Children’s Hospital reports that its two-way texting program significantly decreases the likelihood of organ rejection due to medication non-adherence.

Weno Healthcare applies to be an EHR authorized certification and testing body (ATCB). Weno, which already has an EHR testing and certification program, also offers a free SaaS-model EMR (or $1,000 for a "government certified version”) and an e-health community to connect providers. A quick tour about Weno’s Web site left me with the impression that the company runs a much smaller operation than CCHIT or Drummond Group.

The ambulatory EHR market will double from $1.3 billion in 2009 to an estimated $2.6 billion in 2012, according to a new Frost & Sullivan study. By 2013, the market will peak at $3 billion and fall to $1.4 billion by 2016. More details here.

E-mail Inga.

Intelligent Healthcare Information Integration 9/1/10

EHR Songs

– sung to EHR vendors, regulators, and users in the modern “elevator pitch” time

If you have more glass and steel and shiny art nouveau
In your headquarters and offices to and fro
Then it’s time to reconsider
And maybe be a quitter
Cause you’re more a drain than help for healthcare’s woe
——–
You need retoolin’, baby, I’m not foolin’
We gonna send you back to design schoolin’
Way down inside, honey, you need it
We gonna get you to share
We gotta get you to share
Whoooa…
Wanna whole lotta share’n (X 4)
——–
App me, app me, app me, baby, please
Let me pick and choose what suits my needs
Never underestimate my cred inside my head
I know which tools I think are best of breeds
——–
Payment-O, I need you
MU, yes, we’re trying
Payment-O, I need you so
Could you ease it in?
Workflow mess, assorted tasks
Sleepless nights, you bring
And all to prove, we’re on the move
And complying
Payment-O, I need you so (X 2)
——–
Please allow me to introduce myself
I’m the tool of wealth and means
I’ve been around for a long, long year
Broke many an org’s money schemes
I was round back when Hendrix sang
Brought many a doc doubt and pain
Made damn sure CIO guy
Shook my hand and sealed his fate
Pleased to meet you
Hope you guess my name
——–
You can app if you want to
You can leave old code behind
Cause compet’s don’t app
And if they don’t app
Well, they’re no friends of mine
——–
Please release us, let us go
For we don’t love you anymore
To waste our practice seems a sin
Release us and we’ll EH –R again
——–
This ain’t no party, this ain’t no insco
This ain’t no PQRI
No time for waiting, or getting ready
I ain’t got time for that now
——–

Props (or, better yet, apologies) to Englebert, T. Heads, Stones, Zep, Cars, and Men At Work.

From the trenches…

“When the music changes, so does the dance.” – African proverb

 

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.