Intelligent Healthcare Information Integration 6/8/10

EHR Data: Privacy vs. Publicacy

Lately, there’s a whole buncha buzz about on this digital healthcare data ownership versus sharing stuff. You know the issue of which I speak: Dr. Deborah Peel, et al, reminding us that the road to healthcare data integration is strewn with personal privacy landmines galore, and then, the NHINers and other data gatherers, like Jonathan Bush’s athenahealth with their recent touting of “athenaCommunity” as one arm of their mission “to make healthcare work as it should.”

This is a tough one, no matter which knife you use to slice it. On the one hand, Dr. Peel is correct that healthcare data once released to the digital winds is “like a sex tape that lives on in perpetuity in cyberspace.” People, especially us rootin’ tootin’ ‘Mericans want our personal privacy protected at virtually any cost. I don’t think any of us want our personal health histories “Paris-ized.” (Although, Ms. Hilton seems to have parlayed her randy exposure into a personal triumph. Regardless, I doubt that’ll work for any of us if our hemorrhoidal or high colonic histories get similarly YouTubed.)

J. Bush is also on the mark, though. Our personal healthcare information needs to be shared in order to be of value. Gone are the days when you have one doctor who spanks your butt when you’re born and follows you through “till death do you part.” We move, change providers, have multiple providers, use Minute Clinics and ERs — i.e., we roam. It is impossible to fathom our healthcare histories making it in timely fashion to the many destinations we do in any version of the old, tattered, paper chart. (Lord, just try to get a faxed report from another provider during the fifteen minutes you have a patient in your office!)

If we didn’t have such cultural issues as racism, ageism, sexism, and “sicko-ism,” maybe we wouldn’t care who sees our psychological or proctological profiles. If we had fully socialized medicine or if we had complete private pay healthcare sans insurance companies, maybe it wouldn’t matter who got what gross genital germ or mental misfire malady. If you get sick, either we all pay (socialized) or you do (tough break, buddy…them’s the cards you’re dealt.)

But, we live here in the land of the free and the home of the individual. We hold our privacy sacrosanct (unless we want to see what Paris has been up to and then the paparazzi have full sway.) We hold many of our prejudices, and the fears we have about others’ bigotry, nearly as holy. Yet, we also live in the land of the insurers/CMS and the home of McDonald’s medicine. We want our healthcare delivered on demand — done right without needless repetition or avoidable error and with minimal co-pays.

I was asked to write about this issue by a friend who’s a muckety-muck at a big EHR vendor. I was really hoping I could give him some unique, big toot piece. I’ve thought and thought about it and the wow-ness I’d hoped for seems less like a grand toot and more like an SBD. The eventual solutions for healthcare data privacy versus “publicacy” will be hard-fought and counter-punched for years.

This I know: I have met both Deborah Peel and Jonathan Bush. I’ve listened to each speak on multiple occasions. I like them both and think both are brilliant. I also think both are intimately and ultimately concerned about doing what’s best for patients, providers, and all of healthcare. In this very sticky wicket of personal privacy versus grand communal good, I’m very glad to see both are engaged in this battle, guarding opposite flanks of our healthcare ranks. Our vanguard is well-manned (-womaned.)

From the trenches…

“When it comes to privacy and accountability, people always demand the former for themselves and the latter for everyone else.” – David Brin

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 6/8/10

The New York eHealth Collaborative names Greenway Medical Technologies, Sage Healthcare, Eclipsys, eClinicalWorks, and NextGen as preferred EHR vendors.

New data from MGMA shows that 65% of established physicians were placed in hospital-owned practices last year, as were almost half of physicians just out of residency or fellowship. One likely factor is higher first-year guaranteed compensation with hospital-owned practices compared to private practices. First-year guaranteed income has fallen 2% for specialists since 2006, but increased more than 17% for primary care physicians.

Steve Jobs introduces the iPhone 4, complete with a thinner profile, a 5-megapixel camera and flash, and video chat (FaceTime). Though the FaceTime feature will only work between iPhone 4s for now, I’m sure it will eventually be huge in healthcare. Time for some creative type to develop an app that translates video chat to a CPT code and passes the code to a physician’s billing system (if you steal this great idea, I’ll expect you to send me wine or shoes when you hit the big time).

UBMD (NY) selects Allscripts EHR for its 450-physician practice. Physicians in the 18-practice multi-specialty group also serve as faculty at the University of Buffalo School of Medicine and Biomedical Sciences.

Health Informatics Consulting will provide implementation assistance for ambulatory surgery centers adding SourceMedical’s Vision and Vision EHR.

Partnerships like the one mentioned above reminds me of a prediction I shared with a friend not long ago. Perhaps this isn’t terribly profound, but I believe we’re going to see a marked increase in collaborations between ambulatory EHR vendors and third-party consulting firms. As stimulus-hungry physicians demand quick but thorough implementations, look for more vendors trying to secure alternative implementation resources, at least for the next couple of years. Hospital vendors have relied on third-party consultants for years, but it’s been less common in the ambulatory world.

Spectrum Health Medical Group (MI) will spend up to $60 million on EHR technology over the next five years as part of a master plan to dramatically grow the practice. The 90-physician group anticipates growing to 700 providers by 2014, a process that may cost more than $150 million in physician recruitment and support costs. Spectrum says the goals for growth include recruiting faculty for the MSU College of Human Medicine and building its research capacity. No doubt Spectrum also believes that tighter physician alignment will help keep its four hospitals full.

Proof that security and privacy blunders are not unique to the good old US of A: an employee at a Welsh medical practice mails an unencrypted USB drive that never makes it to its final destination. Unfortunately, the memory stick contained data on 8,000 patients. Lampeter Medical Practice was called out for the incident, though not fined.

Speaking of data breaches, 3M Health Information Systems releases a breach notification tool with new versions of 3M ChartRelease and 3M DisclosureTrac software. The functionality provides a template for creating breach notifications, plus saves the details for reporting purposes.

An HHS advisory workgroup recommends that EHRs be enhanced to deal with needs of unique populations, such as children and victims of domestic abuse. The AHRQ and CMS are already working on a pediatric record template for children enrolled in Medicaid or CHIP that includes such nontraditional factors as literacy, language and cultural barriers, domestic violence, and crime.

For about $3,000, a small practice can purchase a EMR solution that includes Dell hardware and free Practice Fusion software. The Dell/Practice Fusion bundle is available through both companies. Dell has similar marketing agreements with Allscripts, Meditech, and eClinicalWorks.

athenahealth makes some changes in its executive team following the resignation of David Robinson as COO and Nancy Brown as SVP corporate development. Ed Park is promoted to COO and Derek Hughes will take over the SVP role. After talking to one athena insider, I don’t think the changes are an indication that we are  about to see big shifts in the company’s direction. Meanwhile, athenahealth stock continues to struggle, falling 13% in the last month.

E-mail Inga.

News 6/3/10

The Retina Group of Washington (DC) selects the SRS hybrid EMR for its 20 specialists.

MED3OOO founder Pat Hampson is profiled in Smart Business. He advocates a culture based on strong relationships to foster growth. He suggests that employers value and recognize the contributions of each individual, nurture two-way employee communication, and empower employees. His approach seems to have worked since he started out 15 years ago: the company employs 1,760 and earned $137 million in revenue last year.

Practice Fusion and Kareo launch an integrated EHR/PM solution that includes Practice Fusion’s web-based EHR and Kareo’s medical billing software. Both companies will market the products.

Medical billing and A/R management company Medigistics selects CPU’s MED/FM Medical Billing and Practice Management software. The company provides services for over 300 physicians and CRNAs.

Over 40% of private practice physicians are connected to hospital systems, according to a new Beacon Partners study. The most common connection is via a patient/physician portal (35%), followed by a  results reporting interface (20%). Half the hospitals and practices surveyed have had to cut back on IT investments due to the economic climate and reduced access to credit markets.

The Ohio General Assembly passes legislation to establish 44 existing primary care practices as training centers for patient-centered medical homes. They will be reimbursed up to 75% of  their costs for HIT products, including EHRs, HIEs, e-prescribing, and decision support tools.

CHHIT extends full 2011 certification to Allscripts Professional EHR 9.1 and Medicat 2011 10.0. That’s a total of 19 products, if you are counting.

I haven’t mentioned any stats on HIStalk Practice in awhile, but traffic and subscribers continue to grow steadily. May readership increased 11% over last year and our subscriber base has jumped 28% since the beginning of the year. Confirmed e-mail subscriber count is now 774. Thanks to everyone who takes the time to read and sharing the site with your friends. And of course, a big thanks to our sponsors for their great support!

US Oncology announces its new iKnowMed platform for community oncologists. In 2004, US Oncology purchased iKnowMed and its oncology-specific EHR and has since added a revenue cycle management inventory management component.

In what appears to be a fairly comprehensive review of the HITECH Act’s implementation status, Manatt Health Solutions concludes that many eligible health providers will have difficulty achieving proposed Meaningful Use criteria. This is especially true for small and rural practices and certain community health centers. As a result, EHR adoption rates will be less than anticipated. The report is also critical of the HITECH’s approach to interoperability, saying it is unlikely to yield quality improvements and cost efficiency gains. Other key points:

• There need for stronger policies that would encourage practices to follow evidence-based treatment guidelines for improving patient health outcomes.
• All currently excluded health care providers need to be included in the program to enable true coordination of care across all care settings.
• Regional Extension Centers may face sustainability and operational challenges; alternative approaches should be developed to ensure ongoing EHR adoption and implementation support.

E-mail Inga.

News 6/1/10

From: Apple Doc “Re: iPad. Is Sage/Intergy going to be iPad compatible? That would be good news for us few with new iPads.” I asked the folks at Sage and a spokesperson provided this response: “Using Microsoft Remote Desktop Service or Citrix XenApp, Sage Healthcare software can be used from many different devices, including iPad. We began testing immediately upon the release of the iPad, and will continue testing for the next several weeks.”

mPay Gateway secures an additional $1.55 million in funding from new and existing investors.

Healthcare South (MA) selects Allscripts EHR/PM for its nine pediatric and family practice offices.

Sevocity offers regional extension centers and educational organizations free access to its Internet-based EHR, setting up as a demo clinic for up to 20 users and requiring them to have nothing more than PC with Internet access.

AHRQ releases a report on practice-based EMR usability and concludes that vendors are not performing adequate usability testing, following user-centered design principles, nor getting real usability experts involved in product design. Mr. H provides a great summary here.

The American Academy of Professional Coders names Daniel Schwebach VP of practice management initiatives. Schwebach most recently served as a manger with Pricewaterhouse Coopers, overseeing daily practice operations for over 400 faculty physicians.

Spurred by physician shortages and improvements in technology, the interactive telemedicine business is now growing almost 10% annually. The $3.9 billion industry includes home monitoring devices, teleconferencing, e-mail interactions, and healthcare applications on smartphones. Of course now that more insurers are agreeing to reimburse providers for many of these services, look for more physicians jumping onboard.

Enforcement of the Red Flags Rule is pushed yet again. The FTC set December 31, 2010 as the new deadline, giving Congress time to consider legislation that would affect the scope of covered entities. One proposed bill would exempt healthcare practices with 20 or fewer employees.

NextGen parent Quality Systems reports Q4 numbers: revenue up 19%, EPS $0.45 vs. $0.40, falling short of consensus earnings expectations of $0.49.

E-mail Inga.

Intelligent Healthcare Information Integration 5/30/10

Boomers’ Usurpers

We Baby Boomers have long thought we invented pretty much everything. If we didn’t actually invent sliced bread, we at least identified which side needed to be buttered. From the cultural and sexual revolutions of the Sixties with our hippie dippie, free love, free speech, flower power, no plastic, “Who needs more ‘stuff,’ man?” anti-establishmentarianism to the Eighties’ New Materialism where our mantra did a one-eighty to “Whoever ends up with the most stuff wins” to the New Right, Silent Majority, neo-conservatism, Family Values of the late 20th and early 21st centuries, we have always felt empowered to promote “our” values as “the” values.

God bless ‘em, our kids seem to have figured out to ignore our inflated mass sense of self importance.

While computers did come into their own on our watch, the powers of mass social networking were, whether we Boomers want to admit it or not, discovered and developed by our prodigy. They MySpaced out, friended up, and YouTubed down the mighty River Internet. They even seem to have evolved the species with a new developmental feature, TTA (Text Thumb Ambidexterity.)

OK, they blazed the trail, but B.B.s don’t like being out-maneuvered on social movements. So, we’ve jumped aboard the Facebook, et al, bandwagon full force. We’re all a-Twitter as we StumbleUpon Classmates who are LinkedIn to Slashdot and who Digg Xanga as we Friendfeed LiveJournal entries from Bebo that were Tagged on Ning as we Hi5 each other over that Delicious Last.fm recommendation once we’ve Reddit. A study on Pingdom posted in February showed a full 32 percent of social networking site users are undeniable Boomers with another 25 percent of users being from the Boomer “cusp” (ages 35 to 44).

So, Boomers and their close associates are hitting the Web hard for social interaction. Granted, it’s those Boomer-cusp Middle-Agers (who were 20-somethings when the Web truly hit World Wide “wowness” in the 1990s) who are leading all packs for online sociability. But, they’re kin, not kids, to us full-bore Boomers. Together, we account for more social internetting than our tech-brained children.

But, dagnabbit, them young whippersnappers are up to their rascally shenanigans again. After they scooped us with social media savvy, they are now securing their online profiles much more aggressively than we. The recent Pew Research Center report, “Managing Your Online Profile,” finds that Boomers are far more lax about managing their Web “face” and less likely to guard their privacy and manage their online security than those 18- to 29-year-old rapscallions. How dare they outperform us again!

Well, gang, we better get a grip or these young punks are going to trot us out to the old revolutionaries’ pasture right quick. We need to take heed, secure up, and get our Web acts together or they’re going to out-revolutionize us again. We obviously followed the lead of the kids to Web-based socialization. It looks like they’re scooping us on the need to look both ways as we cross the Information Highway, too.

Eh? What’s that you say, sonny? I need to watch my healthcare data as it goes digital, too? Clementine, call Dr. Peel…I think I need to have my “privates” examined.

Now, where’d I leave my cane?

From the crotchety, old trenches…

“Civilization is the progress toward a society of privacy. The savage’s whole existence is public, ruled by the laws of his tribe. Civilization is the process of setting man free from men.” – Ayn Rand

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.