Intelligent Healthcare Information Integration 5/8/10

EHRs and Molecular Gastronomy

I like cooking, though I’m no chef. Something has always fascinated me about chemistry, though I’m certainly no chemist. I’ve been a gadgety, geek freak who loves his PCs pretty much since birth, but I’m definitely no computer engineering or programming guru. But, watching Chef José Andrés whirl his amazing gastronomical wand on 60 Minutes recently led me to realize that my somewhat diverse fascinations have a heretofore unrecognized common, sort of covalent, bond.

In cooking, one of the most important features is the presentation. The Gestalt beauty, the interplay of colors, the mingling of aromas, and the artist’s eye for movement in the interplay of textures all combine to build an experiential expectation for the taste sensation which is to come.

Molecular gastronomy throws an understanding of chemistry into sauce pan, examining the “transformation of ingredients, as well as the social, artistic and technical components of culinary and gastronomic phenomena in general,” per Wikipedia. In the hands of Chef Andrés, it turns eating into romance.

As I droolingly watched Anderson Cooper prepare to delight in a “bagel with lox” which appeared more like a mini-ice cream cone made of a crêpe “bagel,” cream cheese “ice cream,” and (my personal all-time favorite sushi ingredient) salmon roe “lox,” it occurred to me that the next big thing for HIT might just be an incorporation of a similar approach for EHR development, sort of an EHR molecular gastronomy.

I mean, good Lord, it’s been decades now since folks started to apply technology to the art of healthcare information management. If you look around at the hundreds of EMR and EHR solutions out there, you’ll see oodles of great ideas and clever ways to address certain elements of the HIT dilemma. The “molecular” underpinnings of EMRs are becoming clear. The problem remains that these ingenious solutions exist in disparate products. None of them have the all-in-one, melt-in-your-mouth, taste explosion phenomenon of a José Andrés creation. I think I now know why.

Pretty much across the board, EMRs and EHRs have all taken the TV dinner approach: you got your meat, your potatoes, your veggie, your sliver of cornbread all plastic-wrapped into one “complete meal,” if you want to call it such. It’s edible, but…

I’m starting to think the trend toward all-inclusive, “integrated” solutions may have been as deceptively misleading as the “amazing convenience” of the TV dinner.

How about we start creating José Andrés-style culinary laboratory mini-bars (development centers) where those creative “chefs” (HIT developers and programmers) can concoct their clever individual bitefuls of component EHR “dishes” (molecular apps) and let the provider “gourmets and gourmands” (end users) pick and choose the “taste sensations” (tools) which best enthrall our “taste buds” (practice needs)?

The new Helios platform by Eclipsys is a step toward this molecular EMR diner. Personally, I’d like to see the trend continue. I’m anxious to taste more molecular EHR gastronomics.

From the trenches…

“Anybody can make you enjoy the first bite of a dish, but only a real chef can make you enjoy the last.” – François de la Rochefoucauld

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 5/6/10

The administrator at Gulf Coast Orthopedic Specialists (FL) claims his practice’s full utilization of MedInformatix EMR and practice management system has allowed it to meet or exceed nearly every MGMA best practices index. In the last three years the five physician group has dramatically improved its A/R, grown the practice, and reduced billing staff from nine to five. In reading the short case study, it sounds like the administrator should also get some credit for recognizing the practice’s lack of full system utilization and for pushing the staff take advantage of the software’s capabilities. When the administrator joined the practice, MedInformatix had been installed for two years. He brought in more training and led the charge for better system deployment. Successful implementations require a champion (or three.)

ClearPractice, a SaaS-based solution for smaller practices, names Dr. Gary Ferguson CEO and president. Ferguson is the former president and CEO of NotifyMD. ClearPractice, by the way, is the former GenesysMD, so even though the name is fairly new, the company has about 4,000 provider clients. In addition to Ferguson, the company is hiring additional sales talent.

Over their career, cardiologists earn an average of more than $5 million, compared to $2.5 million for primary care specialists. While that’s quite a gap, even the primary care docs might feel some consolation knowing they still earn more than the average business school grad ($1.7 million) or PAs ($847,000) or regular old college grads ($341,000.)  Meanwhile, policy-woks need to figure out how to lessen the gap between specialists and primary care to make primary care a more attractive option for medical students.

Not only are primary care physicians not compensated as well as their specialist counterparts, their workloads are expected to increase 30% over the next 15 years. More for the policy-woks to ponder. Undoubtedly technology will be an underlying component of many of the proposed solutions.

Twenty-four Sadler Clinic (TX) physicians resign, forcing management to lay off 38 clinical and clerical staff members. The resignations, representing a quarter of the practice’s doctors, come after Sadler changed its policy for compensating physicians (to supposedly make payments more equitable between general practitioners and specialists, by the way.)  Messing with peoples’ money (in Texas or anywhere else) rarely ends well.

The athenahealth folks have a new blog that will be multi-authored, and include posts from Jonathan Bush. Bush’s first piece is entitled, “Ceci n’est pas un Blog.” Now who is not going to want to take a peek at a musing with such a catchy title?

Emdeon buys an minority stake in Enclarity, forming a new strategic alliance to develop tools that help payers identify provider data errors at the claim level.

Massachusetts internist Dr. Robert LeBow says he may forgo potential stimulus money because he’s not interested in adding an EMR, claiming they are too complex and controversial.  Other doctors worry that even if they purchase an EMR, promised savings from efficiencies will never materialize, or, computer incompatibilities will keep them from sharing records with other physicians. It will be interesting to discover just how many other Dr. LeBows are out there, choosing to accept Medicare penalties and lower reimbursements  over going digital.

merdianEMR launches a new patient check-in system that uses the iPad.

P4P studies could increase medical disparities experienced by racial and ethnic minorities and people of  low economic status. A new RAND study suggests that typical P4P payments are lower for practices serving vulnerable communities, creating an incentive for providers to deselect patients with poor outcome measures. In other words, P4P may have the unintended effect of diverting medical resources away from the communities that need these resources the most.

E-mail Inga.

News 5/3/10

e-MDs collaborates with the University of Texas on a summer internship program to promote health IT. The Health IT Summer Certificate Program will permit 50 students to work full time for nine weeks for e-MDs and other HIT companies. e-MDs likely hopes to find a few permanent candidates to fill the estimated 85 positions it plans to add this year.

A standardized claim form and a single set of submission and payment rules could provide physicians $7 billion in direct savings per year. Authors of this study estimate that if health plans standardized their rules, physicians could save on billing operations, as well as approximately four hours per physicians and five hours per practice support staff member per week.

MedLink introduces podiatry-specific modules and functionality for its TotalOffice ER.

Billing service provider Healthcare Billing Consultants (PA) selects Sage’s Intergy practice management and analytic tools for its 80 providers.

athenahealth’s Q1 results: revenue up 33%, EPS $0.01 vs. $0.04. News that spending was up 72% without immediate growth wasn’t taken well by investors, with shares dropping 21% on Friday and pretty much holding there Monday.

The CEO of Akron Community Health Resources blames implementation of its new EHR system for employee paycheck delays. The practice, which recently installed eClinicalWorks, is holding paychecks a couple of days while waiting for incoming insurance reimbursements to cover its $85,000 payroll. Ouch.

meridianEMR releases its mMobile iPhone application to allow providers to access and update patient information on their meridianEMR systems. Coming soon to the Apple iTunes store.

Peninsula Regional Medical Center (MD) selects eClinicalWorks EMR for its employed physicians at the Peninsula Regional Medical Group. The Medical Center will also promote eCW adoption with affiliated community physicians and implement eCW’s Electronic Health eXchange as its interoperability tool.

Thibodaux Orthopaedic & Sports Medicine Clinic (LA) and Sonographers-On-Site (LA) implement NovaPACS by NovaRad.

A five-physician primary care office used its EMR to determine how each doctor spent his/her day. In additional to seeing an average of 18 patients per day, each doctor received 24 phone calls, received 17 e-mails, and processed 12 prescription refills. In other words, physicians performed about three dozen tasks that were urgent, yet uncompensated.

I assume the writer of this article is a consultant, since it argues that physicians can eliminate inefficiencies and increase revenue by implementing an EMR. The items mentioned are not particularly original (EMR allows you see one more patient a day, improves coding, save time on chart pulls, etc.) Unfortunately, too few practices see the type of returns promised by this author (and EMR vendors). So, isn’t it time to either come up fresher products that make great ROIs achievable or at least come up with a fresher argument? Maybe I am feeling a bit Mr. H-ish today, but isn’t it time for the industry to improve its game?

Park Nicollet Health Services (MN) initiates a pilot with Zipnosis to offer patients an online diagnosis service. For $25, patients can complete a five-minute questionnaire and have nurse practitioners suggest treatment or prescribe medication. The response comes within an hour via text or email. Interestingly, CEO Rick Krieger is one of the founders of the precursor to MinuteClinic, suggesting that he’s convinced patients are tired of the traditionally time-consuming doctor office model, at least when in comes to minor illnesses.

E-mail Inga.

Intelligent Healthcare Information Integration 5/1/10

EMR Mythbusters

Last autumn, at the annual meeting the Ohio Chapter of the American Academy of Pediatrics, I had the tremendous good fortune of giving a talk in tandem with Dr. Andy Spooner, CMIO of Cincinnati Children’s Hospital Medical Center.

I’m not sure I’ve ever felt that being asked to give a talk was a blessed event, but this one broke the mold. Perhaps it was the topic, perhaps it was the meeting, but most likely it was the partner, Dr. Spooner. (I like to think maybe it was a mutual camaraderie and synergism, but I’m pretty sure Andy deserves most of the credit!)

We had been asked to sit on a panel discussing “Technology in Pediatric Practice.” This morphed from the panel to just he and I discussing some of our favorite rumors, half-truths, and misconceptions about EMR adoption and use. We borrowed/adapted the title from one of my favorite geek TV shows. (Props to Jamie, Adam, and all the gang at M5).

There was a pretty good sized crowd and the talk seemed well received. Audience participation was enthusiastic, and afterwards, folks asked us how many times we’d done this before, if our “routine” was fully scripted, or if we might be taking this on the road. (“First time”, “complete ad lib”, and “our agents are taking a meeting on it”, respectively.)

I think what made it so enjoyable for me was the lack of formality and the easy give-and-take rapport between Andy and me. Plus, it was an interesting tête-à-tête: his CMIO, larger center experience and my small practice, trench gruntness. Perhaps most significantly, Andy’s just a very fun person despite his brilliance and a curriculum vita that’s longer than most PhD theses.

Anyway, I bring this up here because we were asked to record our EMR Mythbusters talk for Nuesoft’s Monthly Podcast Series and it was just recently posted. As these hallowed pages are for the “Practice” side of the infamous HIStalk, maybe some of the readers might find our banter worth noting because, while I realize HIStalk Practice readers know all this stuff, there are loads of providers who are still considering EMR adoption and who are trying to fathom our brave new HIT world, especially with the nitrous boost currently being injected by HITECH. Maybe you know a few of them who might enjoy a sort of fun look at some of the HIT issues they’re trying to fathom.

Warning: It is a retake of the full meeting version, around 53 minutes. You may want to bring some popcorn!

From the trenches…

“The first myth of management is that it exists. The second myth of management is that success equals skill.” – Robert Heller

Addenda: 1) Neither Andy nor I have any financial relationship with Nuesoft. 2) There’s a bit of a volume level change several minutes in.

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 4/29/10

Regional extension centers may have difficulty finding staff with adequate experience in both software implementation and work-flow adaption, according to a new Health Affairs study. The authors also question the sustainability of RECs due to inadequate funding. Similar programs in Massachusetts and New York have spent $60-80,000 per physician; the proposed federal funding for RECs averages about $6,400 per physician.

Perhaps the Wide River Technology Extension Center in Nebraska has figured out a way to address the experience issue, as well as maximize training dollars. The HIE will offer physicians and staff discounted rates for online HIT and EHR training through Health IT Certification. Great way to train lots of folks at once.

The director of compliance coding at Hickory Cardiology Associates (NC) claims A/R days have dropped from 60 days to 45 since moving to ZirMed’s RCM solutions.

The Alaska EHR Alliance selects e-MDs and Greenway Medical as the “best choices” for the state’s healthcare providers. ACS Healthcare Solutions was the managing consultant for the selection process, which lasted eight months and started from a pool of over 250 EHR vendors.

Ingenix is integrating medical reference materials from Krames into its Ingenix CareTracker EHR system.

AdvancedMD Software adds Akamai Technologies’ Web Application Accelerator service to speed access of its Web-based solution across the Internet.

Three health clinics affiliated with Ephraim McDowell Health (KY) go live on LSS Systems’ practice management and medical records system. The clinics are also able to share data with the hospital’s Meditech software. The hospital plans to roll EHR to eight additional clinics by the fall.

The 58 employed physicians of Mercy Hospital of Portland (ME) are adding Allscripts’ EHR to run with the already installed Allscripts PM product.

The NYC Regional Electronic Adoption Center for Health names Greenway Medical one of its preferred providers of healthcare technology solutions.

Two Virginia practices, an internal medicine practice and a podiatry group, sign up for Benchmark Systems EHR.

Lourdes Medical Associates (NJ) selects athenahealth to provide its RCM services for over 100 providers in its network.

McKesson announces availability of 12 new templates for chiropractors for its Practice Partner, Medisoft, and Lytec MD physician systems. For the next 11 months,  McKesson is also offering chiropractors a rebate with purchase.

Sinai Medical Group (IL) is implementing NextGen’s EHR and PM products and expects to go live in August. Sinai’s faculty group practice includes almost 200 physicians.

A Practice Fusion-sponsored survey finds that patients see an average of 18.7 doctors during their lives. The 18-24 crowd averages a mere 8.3, while folks over age 65 have seen 28.4 physicians. Of course the point is that’s lot of clinical data, mostly on paper, in a lot of different doctors’ offices.

PHR vendor NoMoreClipboard partners with  Sevocity to offer Sevocity EHR clients an integrated patient portal option.

athenahealth celebrates Superhero Day, following the outcome of an employee bet. After being diagnosed with Type 2 Diabetes, a 360-pound athenahealth employee asks the management team for some weight loss motivation. The execs agreed to dress up as superheroes for a day if the employee lost 100 pounds within six months. Spiderman wins the bet and Jonathan Bush has the opportunity to wear Spandex.

E-mail Inga.