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.

HIT Vendor Executives on HITECH and EHR Innovation

We asked several EMR and consulting executives the following question:

What will be the effect of the HITECH Act in terms of short- and long-term EHR innovation?

Victor Arnold, Managing Partner, AsquaredM

What I am hearing from clients is that they are just doing their best to get an EHR up and going, let alone worry about innovation. That means to me the impact is going to be long term — once people figure out what they have, what it *really* does, and then, what they need to do. This will probably take a couple of years to settle in, by my estimate.

Clinical processes are extremely variable, even within a given institution. And the “need to do” is going to be a problem for everyone. I am sensing that people are just now realizing how “one-off” their clinical processes are internally and what a monumental job they are going to have in figuring out, and then deriving, a “common” clinical work flow.

This is the next great hurdle for the EHR. Once they get past congratulating themselves for implementation (clients) and sales (vendors), then they have to make is sustainable. That means some level of standardization. That will drive the innovation.

A counter force that will dampen innovation will be the mainline vendors. This is not to say they aren’t willing to be innovative, but rather they will be in a “guns or butter” situation with R&D versus support budgets, once they get their sales to the point of revenue recognition. This may leave room for an agile vendor that is capable of rapid development to grab a place, or more likely, innovation will come from third party firms that cover the space between vendors and clients and can offer services to clients that address needs that vendors are able to handle. This has been common in the HIT space for years and will probably be in play again.

Rob Culbert, President, Culbert Health

In the short term, EHR vendors will focus on two primary activities: developing functionality to support Meaningful Use and client implementations. The reality is that resource constraints will hinder innovation over the short term. 

In the long term EHR vendors will benefit from having product developers heavily involved in the implementation process and will have a much better understanding of clients needs to drive future development. 

As more practices achieve MU, best practices and advanced informatics capabilities will drive a new wave of transformative innovation focused on clinical quality and outcomes management.

Girish Kumar Navani, CEO, eClinicalWorks

The HITECH Act will probably have a bigger impact on adoption than innovation. We believe that companies will, and should, continue to listen to their customers and build their products accordingly, so with or without the HITECH Act, companies will continue to innovate and make their products more affordable and easier to use.

Tee Green, President, Greenway Medical Technologies

As electronic health record software providers, we have always used our research and development capabilities, both in terms of funding and priority, to drive innovation. And I feel I’m speaking for most of the industry here as well. It’s a matter of seeking the competitive edge and of course advancing healthcare outcomes.

I believe that in union with public health agencies and federal standards boards we have led innovation and paid attention to standards to the point that innovation has made the goals of the HITECH Act realistic for individual care providers and for the creation of a national health information network.

Within the current and anticipated CMS and ONC proposals as well as deadlines and timetables it’s important to remember that the HITECH Act is a foundation for an unlimited potential. In terms of future innovations either short- or long-term, as the HITECH Act provisions take hold, the research and development Greenway is undertaking will continue to utilize customer communication avenues to collaborate on advancements in interoperability, usability, and reporting methods, all to improve point-of-care efficiencies and patient safety. That’s where we see the overriding points of continued innovation.

Greenway’s integrated platform for clinical, financial, and administrative workflows is designed as an innovative foundation allowing for rapid customization of customer and industry requirements. From that foundation comes the ability to add data points and expansion. Within our PrimeSuite EHR  comes PrimeResearch, which advances clinical trials and research and therefore better medicine. Innovations in genetics and mobility and revenue cycle management are also being realized in the short term.

I think the greatest long-term innovation is going to come from within the sensibilities and experiences of care providers. As we drive more and more important data capabilities to them, providers will want more, and together that will fuel collaborative and innovative thinking. It’s a dynamic we’ve realized since our founding by practicing physicians, and I know that the HITECH Act is providing unlimited horizons for innovative leadership.

Hayes Management Consulting, Peter J. Butler, President

The HITECH Act will have a positive impact on EHR innovation in both the short and long term. Providing financial incentives to implement EHRs will speed up EHR adoption. In order to stay competitive in the marketplace, EHR vendors will need to provide innovation solutions and product offerings now that can achieve meaningful use.

With new projects like the Strategic Health IT Advanced Research Projects (SHARP) Program, funded through the HITECH Act, organizations including Harvard and the Mayo Clinic will receive $60 million in cooperative agreements to perform advanced research in healthcare information technology.  Projects under SHARP will help address some of the barriers facing organizations when implementing EHRs and will foster data sharing and collaboration which are essential components to improving healthcare.

Jay R. Anders, MD, CMIO, MED3OOO, Inc.

This is a very interesting question. The HITECH act has a lot of vendors scrambling to both monitor regulations as well as develop functionality that will be needed to certify under Meaningful Use.

In the short term, EHRs will have to adapt quickly to an ever increasing bar proposed by the Meaningful Use regulations. Some vendors will not survive this rapid transition. Innovation functionality will be limited to meeting regulatory requirements and will focus will be placed on truly long range innovation.

In the long term however, focus will shift from meeting regulatory requirements to actually creating products that physicians can use to not only reduce their workload but augment the quality of medicine. Advances in physician decision support and evidence based population health management will start to appear. Also, technology advance in speech recognition and parsing medical text into codable data will mature to the point of being useful.

So the bottom line is: short term, get it installed and paid for. Long term, make it something physicians can really use.

Scott Decker, President, NextGen Healthcare

In the short term, all EHR vendors have to make adjustments to their products to ensure they meet the criteria for meaningful use (MU) – it’s the degree of change required that varies across vendors.

Providers should take note of the amount of work their prospective EHR partners still have to do before choosing one to help them demonstrate MU. NextGen Healthcare has already been helping customers with efforts to achieve MU on time and I am confident the feature sets and flexibility of our software will be able to meet the standards. NextGen EHR version 5.6 is already a CCHIT Certified 2011 Ambulatory EHR and our ePrescribing product holds the highest level of certification available. We have also already demonstrated exchange of data as described in the criteria.

Over time, more regulations will arise and further innovation will inevitably be required of all EHR vendors. Those that are continually innovating though, outside of the latest incentives, will have a head start and be able to start helping clients early. For example, to augment our existing Healthcare Information Exchange product, we developed HIE Connect, so that providers can plug their NextGen EHR into any established HIE and share patient data in real time. At the same time, our NextGen Patient Portal already enables interactive care between the patient and his or her doctor, helping to meet several of the patient access and information exchange criteria for meaningful use.

Betty Otter-Nickerson , President, Sage Healthcare

HITECH is driving physician interest and slowly beginning to drive adoption rates of EHR products, which will in turn make additional investment in those products possible. HITECH also places emphasis on how physicians use EHR.

Our industry’s challenge will be to continue innovating its products so that they become easier for customers to use and less obtrusive to implement, while providing services that make for a seamless integration of information technology into the patient care process. Providing a seamless transition for customers is our primary focus, and should, I expect, eventually, drive any remaining hold-outs toward adopting an EHR.

However, in the short term, HITECH may improve the effects of CCHIT, which historically seem to have stifled innovation to some extent. CCHIT certification has required building features and function for which there is not necessarily a demand in every case, but, nevertheless, must be built to "pass the test".  Also, certification has leveled the playing field to a certain extent since all vendors must offer a number of the same core features.

HITECH should provide opportunity to drive technological innovation as vendors continue setting themselves apart from the competition and add value for improving patient care. Innovation requires investment and resources, which we’re continuing to apply even as we maintain our CCHIT certification, and look toward supporting Meaningful Use.

Evan Steele, CEO, SRSoft

The answer depends on how you define innovation. If you define it as finding new and better ways to help the end-user (i.e., the physician), there is no question that meeting the demands of HITECH will sap innovation in the EMR industry for a long time. As vendors chase increasingly stringent—and ever-changing—government criteria, they will have few resources left to enhance their products in ways that address what physicians want, and really need.

Under the HITECH Act, the government defines what sort of innovation is needed. There will certainly be innovation by EMR vendors as each tries to find a way to align its software with the HITECH criteria.

However, this type of innovation, which is not accompanied by improvements in workflow and productivity, does not help physicians in their daily delivery of patient care. Unfortunately, finding innovative ways to meet these criteria will consume the lion’s share of vendors’ development time and resources, with little or none left over for the innovation that is sorely needed — innovation that would transform failure-prone EMRs that obstruct doctors into user-friendly ones that actually help them.

Physicians are clamoring for products that are easy to use and increase their productivity, letting them provide better care to more patients for higher total revenue in the face of growing demand and declining reimbursement rates. Coming up with those products will require real innovation.