News 9/23/10

From InfoGard: “Re: ONC-ATCB. InfoGard Laboratories will complete the mandatory ATCB training conducted by ONC this week (week of 9/20). We are required to make any changes to our testing procedures and process for EHR testing after completing the mandatory ONC training.  We expect to be able to start the testing process the week of October 4. We will begin providing testing process information and taking applications the week of September 27.” No word yet on pricing.

Carilion Clinic (VA) and The Everett Clinic (WA) deploy Humedica’s clinical analytic and benchmarking tool to compare care delivery among its physicians and across other medical groups. Sounds great for prepping for ACO participation.

A third of office-based providers are now e-prescribing, according to Surescripts. However, only 12% of all prescriptions were written electronically last year. The number of providers using electronic prescribing grew significantly from 2008 to 2009, from 74,000 to 200,000, while the total number of e-prescriptions jumped from 68 million to 190 million. Massachusetts had the highest e-prescribing rate at 57%, followed by Rhode Island and Delaware.

The Association of Northern California Oncologists selects Via Oncology Pathways as the preferred cancer treatment protocol option for its 400 members. The Pathways Portal application is Web-based and enables oncologists to apply the pathways at the point of care.

Practice Fusion announces its first-ever user conference, to be held November 5th in San Francisco. Just like their EHR software, there’s no charge for the one-day Practice Fusion Connect 2010 event.

HCA-owned Ocala Health System (FL) buys Family Care Specialists, a 27-provider practice with seven locations. As part of the deal, HCA will provide the practice with resources to implement an EHR.

CapSite releases a new analysis of the ambulatory EHR and practice management market, based on insight from over 2,000 practices. Key findings include:

• 2010 EHR sales are expected to double 2009’s results.
• Over the next 24 months, the projected EHR/PM market opportunity will exceed $3 billion.
• Allscripts and Epic each hold 13% of the ambulatory EHR market, followed by eClinicalWorks, NextGen, and GE.
• Allscripts, eClinicalWorks, NextGen, and McKesson are the most-considered EHR vendors.
• GE has 9% of the practice management market, followed by McKesson, Cerner, Allscripts, and Meditech.
• Epic, eClinicalWorks, NextGen, Allscripts, and McKesson are the most-considered PM vendors.
• Most practices don’t plan to purchase a new EHR or PM solution for another 12-24 months.
• Despite the increased popularity of hosted models, 44% of practices prefer the traditional software license purchase option.

The AMA introduces a set of self-auditing tools for developing and evaluating fee schedules and billing safeguards in preparation for billing and payment audits. The Practice Analysis Tools for Healthcare includes tools to develop a practice-specific fee schedule and compare it against national average billed charge amounts. Physicians can also analyze their coding and billing patterns and compare them against national averages by specialty.

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A malpractice insurer finds that 35% of physicians aren’t aware that by 2015 the government plans to penalize practices that haven’t implemented EHRs. However, more than half of those who were unaware say the penalties won’t cause them to implement EHRs. As usual, cost was the top concern for physicians, followed closely by staff training.

E-mail Inga.

News 9/21/10

CHRISTUS Health selects athenahealth’s EHR, Collector, and Communication for its 150 providers and 40 clinics. They’ve been an athenahealth client for several years, having run athenaCollector at several sites. Interestingly CHRISTUS owns and operates multiple clinics within Walmarts, which at one time required its in-store clinics to run eClinicalWorks.

A janitor makes $40 selling 14 boxes of patient records to a recycling center. Unfortunately, he apparently stole them from the ambulatory care center where he worked and now faces felony commercial burglary charges. Officials say the records contained no personal medical information.

HHS approves a third ONC-ATCB: InfoGard Laboratories, which has extensive certification experience in a number of areas. InfoGard will compete with CCHIT and Drummond Group in the race to certify EHRs. No word yet on the company’s pricing or procedures.

Speaking of certification, Addison Health Systems, Inc., developers of the EHR WritePad, says it has applied for accreditation with The Drummond Group. The company points out that its e-prescribing partner will be CCHIT-certified, so WritePad will have certification from both Drummond and CCHIT. While technically I’m sure it’s true, I hope the company doesn’t spin the certification story in such a way as to confuse the average buyer.

Meanwhile, CCHIT opens its ONC-ATCB application process. The cost for complete EHR certification and testing: $34,300 for eligible provider products and $32,500 for inpatient software. I think it would be fun to compare the pricing model for all three of the selected ONC-ATCBs; I’ve reached out to them for details. Stay tuned.

Here’s a new dictation tool for the iPhone. MD-IT releases iConnect, an app that allows physicians to select patients from an appointment scheduling list and dictate directly into their iPhone. Recordings are electronically uploaded to the MD-IT platform for transcription.

Covisint acquires DocSite, a developer of clinical decision support and quality performance management tools. The acquisition will strengthen Covisint’s offerings for ACOs and HIEs.

Speaking of ACOs, as doctors wait for the government to clarify particulars on this new model of care, ACO experts recommend that physicians consider which providers with which they would prefer to align and begin tracking their own utilization and quality of care. An EMR helps in this area, but may not provide enough details to assess costs and quality or track patient ER visits and hospitalizations. At a minimum, practices should consider tracking some of this information in a spreadsheet and to monitor quality metrics.

TriageLogic introduces Office Triage Solution, a Web-based application to help practices manage incoming calls using decision-tree support tools.

Despite an overall decline in patient visits, physician offices continue to add more jobs. The Bureau of Labor Statistics says 5,300 jobs were added in August. For the summer, 9,300 new positions became available. Some theories for the counter-intuitive trend: practices are ramping up for potential increases in patient volumes as a result of health reform; they are betting that additional clinical staff will attract more patients and thus generate more revenue; and, as the threat of Medicare cuts loom, physician offices are hiring now in anticipation of spending freezes later in the year.

Deloitte Center for Health Solutions provides a comprehensive overview of several medical home pilots and offers insights into the future of the model. Researchers conclude that health IT plays a big role in the medical homes model and say it’s an essential front-end investment. Overall physician adoption will be a challenge, in part due to physician resistance to the use of health information technology in diagnostics, treatment planning, and routine patient interaction.

E-mail Inga.

News 9/16/10

From Spice Surfer: “Re: Mark Young. I noticed that Mark Young, Sage’s SVP of IT and CIO is no longer on the Sage website. Is he gone?” The folks at Sage sent over confirmation: “Mark Young left Sage to pursue other opportunities. Though his experience and insight will be greatly missed, we wish him the best in future endeavors.”

The New Jersey HIT Extension Center (NJ-HITEC) selects PatientPoint to provide health IT consulting to practices deploying EHRs and trying to qualify for Meaningful Use.

Hillside Avenue Family and Community Medicine (RI) says its use of McKesson’s Practice Partner EHR enabled them to reduce patient ED visits by 10%, decrease the average glucose levels of diabetics by 5%, and increase rates of screening for depression and smoking. The practice attributes the improved outcome to Practice Partner’s tracking tools and the ability to keep patient health information updated. By the way, the charming artwork above is direct from Hillside’s Web site.

Here’s another argument in favor of EHRs: the Federation of State Medical Boards (FSMB) says that EHRs could help state medical boards assess a physician’s clinical competence, which could one day be required for license renewal. The FSMB’s “Maintenance of Licensure” (MOL) framework says that physicians should continually engage three types of activities: reflective self-assessment, the assessment of knowledge and skills, and the demonstration of performance in practice.The FSMB believes the use of IT and EHRs in particular will be “of value” to doctors as they fulfill professional obligations and demonstrate their ongoing clinical competence.

Physician rating sites take note: few publically available characteristics of individual physicians make good indicators of physician performance or clinical quality measures. The only factors found associated with higher overall performance were gender (females did 1.4% better than males), board certification (3.3% better than non-certified,) and graduation from a domestic medical school (1% better than international). Malpractice claims were not significantly associated with performance. This study, published in The Archives of Internal Medicine, looked at 124 quality measures for 10,408 Massachusetts doctors.

Medical billing provider AdvantEdge Healthcare Solutions appoints Lahey Clinic (MA) CEO David M. Barrett, MD.

The Physicians Foundation is handing out 15 HIT-related grants, worth almost $2 million, to promote the use of HIT to improve physicians’ practice environment and quality patient care. Projects winning support include a Meaningful Use Achievement Toolkit, an HIT in Practice program to support EHR implementation in small practices, and grants to help physicians implement EHRs. The Physicians Foundation, by the way, was founded in 2003 through the settlement of a class-action lawsuit brought by physicians and medical associations against private third-party payers.

Dell continues its efforts to be a player in healthcare, announcing plans to integrate healthcare applications with its new Streak 5-inch Android-based mobile device. Dell says physicians will be able to buy the Streak as an integrated component of its EMR technology bundle, which I assume means its software partners (Practice Fusion, Allscripts, eClinicalWorks, and Meditech/JJWild) will soon announce Streak-compatible options. Dell is emphasizing the device’s size and weight, which they say make it easy for a physician to carry in a lab coat pocket. To me, that sounds as if Dell is positioning the Streak as an alternative to a tablet PC rather than a smart phone.

However, I was curious how the Streak compared to the iPhone. Here’s one recent review:

The iPhone has an advanced 3.5” screen with a resolution of 960 x 640 pixels, the Dell Streak has a larger 5” screen with a lower resolution of 800 x 480. The Apple excels in resolution, the Dell in size.  However, if you actually have to read something you generally have to expand it on the iPhone, that happens less often on the Dell, because the screen is so much larger. Whether it is using the screen keyboard, reading from the Kindle application that both now have, watching a movie or sharing a picture, or just browsing the web, the bigger screen is better. In terms of portability and phone use, both devices are substantially larger than the cell phones we used to carry and the Streak likely hits the upper limit. Both also look a bit dorky when held up to your head so both should have headsets.

NaviNet hires Shari L. Zedeck as VP of product management. She has served in similar roles with other software vendors, including Chordiant Software and Mindreef. NaviNet also mentions plans to roll out a unified patient information management system that integrates PM and EMR capabilities.

E-mail Inga.

News 9/14/10

Affinity Health System chooses GE Centricity EMR for its 22 multi-specialty clinics. GE will host the software for Affinity’s 220 doctors.

MPM selects PracticeSuite EMR as the EMR option for its MPMsoft billing software. PracticeSuite EMR is a “free” EMR for providers, though the company charges $35/month for each non-provider. MPMsoft is also a lower-priced alternative (their Web site says a “complete billing system” is $2,998). From MPM’s owner Jim Muschetti: “Our practices don’t have millions to spend on EMR systems like Allscripts or eClinicalWorks; our clients are small and they watch their pennies. They’re reluctant to spend a dime frivolously even in the best of times.” I have no doubt there is a demand for less-expensive alternatives (although “millions” is hardly typical even on the upper end), but, I wonder how many will have the financial means to certify products.

Speaking of the cost of EMRs, we didn’t have too many participants in our poll (to the right) indicating the monthly fee for a hosted solution. However, the small sampling indicates $500 to $999 is the most popular price point.

RCM provider PracticeMax acquires eClinicalWorks reseller Medinomics. PracticeMax already offers implementation and training for NextGen and SequelMed.

Medical billing software provider Kareo says it has raised $9.5 million, which it will use to enhance customer service, expand its product offerings, and add sales, marketing, and management personnel. Kareo targets small practices and offers its software via a hosted, monthly subscription model.

Here is a legal case to watch. The California Medical Association sues Blue Shield of California, saying its online rating system is inaccurate and misleading. The site recognizes providers who meet national standards for quality care. However, the medical association alleges the ratings are based only on claims data and do not consider details from medical records.

When it comes to EMR adoption, the most likely indicator of doctors’ interest and use in EMRs is whether their friends (and not just peers) use them. That’s the conclusion of a study published in the Journal of American Informatics Association. Researchers recommend that practices train the more popular doctors to be physician champions rather than doctors who are simply techies.

The government predicts that community health centers will double their capacity by 2014 and treat 20 million additional patients.

In the retail clinic world, Target increases the capacity of its in-store clinics, adding eight new locations in Chicago and the Palm Beach, FL area.

Aprima Medical Software announces DEVsource is its newest reseller.

RadNet announces its intention to acquire Image Medical Corporation, the parent of eRAD, for $10.7 million in cash and promissory notes.

SRS partners with Medstrat to integrate its PACS system with the SRS Hybrid EMR. SRS will implement and support the new “SRS PACS, powered by Medstrat” product.

The Gulf Coast REC at the University of Texas Health Science Center at Houston opens its enrollment for eligible providers, with a goal of 2,855 primary care providers in the first year.

Drummond Group, the organization that is CCHIT’s only official certification competition, says they’ve been hit with such a high volume of questions from vendors that they’ve set up a FAQ on their site.

Amednews.com chats with a few consultants about IT and the need for regular “checkups.” Recommendations include working with a vendor that has a proven track record and having hardware and software monitored twice a year. Especially important: a working backup, up-to-date security, and current software. As one consultant points out, “Information technology is no longer just a little component of somebody’s business, that a little nerd comes by and fixes your problem and moves on.”

I am all about spicing up life with a little humor. Kronos, a developer workforce management solutions, apparently likes mixing wit with work and  introduces a new weekly cartoon called “Time Well Spent.”  The above reminds me of just how much of a challenge this whole EMR thing might be for the industry.

E-mail Inga.

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.