News 4/15/10

From John “Re: EMR for neurology. I am looking for a practice management solution, to include EMR/EHR for a neurology clinic … ideas please.” If you have suggestions, please forward them directly to me. I will compile comments into a single post.

Physicians from more than 860 practices in remote and underserved areas of California will soon be able to connect virtually with specialists in larger hospitals. The University of California, which is overseeing the initiative, just awarded AT&T a $27 million contract for the telecommunications infrastructure that will serve as the backbone for the California Telehealth Network.

Speaking of telehealth, American Well launches Online Care Team Edition, which brings live, on-demand specialist care consults into primary care physician exam rooms. Hawaii Medical Service Association will be the first health plan to deploy the technology.

Greenway Medical Technologies announces a meaningful use guarantee which has a slightly different twist from others we’ve seen to date. Greenway guarantees that its PrimeSuite EHR meets the reporting functionality and requirements necessary for providers to achieve meaningful use and qualify for stimulus funds. If providers fail to qualify for stimulus dollars, based on concerns with PrimeSuite’s certification or reporting standards capability, Greenway will fix the problem and in the interim pay customers an amount equal to any stimulus funds lost.  Different twist, but the onus is still on the physician to use the EMR in a meaningful way.

e-MDs announces it has increased its employee count by 36% over the last year. The company has also grown organic sales 36.5% since the beginning of the year.

Only 7% of US residents use personal health records, but that’s up from 2.7% last year. Younger individuals with more education and higher incomes are more likely to use PHRs. About 40% of PHR users are more likely to ask their their doctors new questions, and, about the same number say that PHRs made them feel closer to their doctor (the sweetness of that finding makes me smile.)

SourceMedical launches SourceTherapy Billing, a billing service specializing in outsourced revenue cycle and consulting services for physical therapy. The billing service is enabled by SourceMedical’s acquisition of Advanced Patient Financial Solutions.

Medical billing company HealthPac Computer Systems partners with AssistMed to integrate AssistMed’s data capture technology with HealthPac’s patient accounting and control system. The integration supports the use of a digital pen and custom forms and will automate charge capture and billing.

MDeverywhere releases a Web-based practice management offering for all its mobile hand-held devices, giving physicians the option to captures and view schedules via any smart phone or other Web-enabled hand-held device.

The Florida Medical Association selects Galen Advisors as its sole supplier of revenue cycle management services. Association members will be eligible for one month of free billing services for each 24 months of service.

Revenues from remote patient monitoring using mobile network will rise to $1.9 billion globally by 2014, with heart-related monitoring applications driving the initial growth in the sector. Also predicted to be big: healthcare smartphone apps that link to sensors worn on the body. Time to buy some stock, perhaps.

E-mail Inga.

Readers Write 4/14/10

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

From the “Other” Trenches
By Camus

I find the “In The Trenches” pieces intriguing. I only wish I had more time to author some counter thoughts to the good doctor. 

I had a physical exam with my GP last Monday. This physician is a member of a 30+ doctor group across the street from a MAJOR medical center in a major city.  He’s been my GP for seven years. Upon checking in I received a clip board with sheets of paper to complete. Each sheet starts with name, address, phone number, and SSN — the usual demographics the office has laying around on fifty other pieces of paper in my chart. (This was after I waited seven minutes on hold to schedule an appointment as they have no online appointment request and four minutes on hold while I verified my own insurance eligibility because they lack this ability themselves).

Physical exam is fine, usual blood work, history questions, and then an EKG. My reason for the visit was both a physical and concern over a near syncope event two days prior. Something’s not right in the EKG and there’s mild concern of an electrical block from the SA node. GP suggests making appointment with cardiologist in practice. Check out. Lab work promised later in week.

Walk down practice hallway to cardiologist office. Inform the receptionist I’d like to make an appointment as I’m a referral from my GP down the hall. There’s an open slot two days later at 1:00 pm and I grab it. Validate parking ($10 instead of $20) and depart.

Wednesday, two days later, arrive at cardiologist’s office 15 minutes early and check in. Receptionist hands me clipboard full of “new patient” forms. There’s five forms and each begins with the requisite name, address, phone number, DOB, SSN, etc. Filling this out is a waste of my time, so I do it once and write “see previous form.” One form seeks extensive personal and family history, which also resides in my chart some 75 feet away but that no one bothers to forward. One form seeks information on why I’m there, which would be obvious if they had an electronic system and the order from my GP who’s in their practice. No worries, I’m difficult to upset. 1:15, back to cardiologist’s exam room.

Dr. Cardiologist walks in, introduces himself, sits, and asks, “So, why are you here to see me?”

Somewhat bewildered, I answer “Because my GP in your practice suggested I do after a Right Bundle Branch Block readout on my EKG from my appointment Monday, two days ago.”

Dr. Cardiologist: “You have a doctor here?”

“Yes, I have for seven years.  He suggested I see you after the EKG.  I also have a very slow heart rate, with a resting pulse of 42-45. Normally my heart rate’s around 50. I went to see my GP for both a physical and because of a near syncope event last Saturday.”

Dr. C: “You had an EKG here?  Ok, we need to get that. Hold on a minute….”

Dr. C rotates in chair and presses buttons on wall mounted speaker phone. Four rings, voicemail. He hangs up, presses more buttons. Four rings, another voicemail.

Dr. C: “It would seem everyone’s out to lunch. Sit here while I go get your results.”

Question 1: Why aren’t the results in front of him?

Question 2: Why isn’t my paper chart in front of him?

Question 3: Why isn’t the order from my GP sitting in front of him with my GP’s comments surround the RBBB?

As he’s departing, I tell him,“You may wish to get a copy of the stress echo I had five years ago.”

Five minutes pass and Dr. C returns with chart notes, EKG, and stress echo results. A much better dialogue ensues and I joke with the good doctor I can make his life much easier and not have his office waste the patient’s time.

“Why don’t you have an EMR, Dr. C?”

“We’ve been looking a long time. It’s very complicated. Anything we get must communicate with the hospital and their system.”

And I dig further, “Yes Dr. it MUST communicate with the hospital. And there’s over 50 systems that will do that. I know my Dr. GP was on the committee to select a system three years ago. What happened?”

Dr. C: “We’ve seen so many systems, I don’t even remember how many. You should really speak with the hospital.”

Clearly Dr. C wasn’t in a hurry to solve the paper, process, workflow, lost revenue, lost charts, and patient inconvenience nightmare. That was fine as I was more interested in getting to the “heart” of the matter for my visit.

We’ll see how efficient this week’s visit is when I check in for my stress echo. I wonder if there’s a form waiting for me to write my name, address, phone, and SSN.

And, this happens every day, thousands of times around the country.

News 4/13/10

From Valley Gal: “Re: e-MDs. Why didn’t you mention e-MDs in the body of your discussion about the KLAS report? Only Greenway and athenahealth were mentioned. I have noticed that HIStalk Practice seems to avoid e-MDs. Why?”  The omission of e-MDs was definitely an oversight on my part, but they don’t make as much “noise” as some other vendors. They’ve issued five press releases since September. During the same time frame, Greenway had 14, athenahealth 32, and Allscripts 47. Press releases are the not the only way we get information on vendors, but there there is a definite correlation between vendor mentions and the output of their marketing team.

From Caymus: “Marketing and public companies. It’s fascinating to see the posturing among publicly traded companies as they influence the RECs and spend millions getting the message out, while behind the scenes, they’re settling lawsuits from previous partnerships mentioned in press releases. If we focus on improving healthcare first and market share second, both can result. I spent some time with (an unnamed vendor) and despite the rhetoric espoused by senior management, the customer isn’t first. When there are intense communication policies on ‘who’ is allowed to speak with anyone, and internal communications regarding appropriate ‘talk tracks’ for media, then the customer is not the focal point.”  I have worked for both private and public companies and I will agree that public companies tend to be much more focused on the financial metrics and driving market share. I definitely recall occasions when certain actions seemed more about making the numbers than doing the right thing by customers. That being said, I like the financial transparency you have with public companies. There’s value in knowing the financial strength (or weakness) of a company before investing thousands of dollars on its products. As for posturing with RECs, it’s the way to play the game right now, regardless of whether you are public or private.

CCHIT names Karen M. Bell, MD as its chair, replacing the retiring Mark Leavitt. Bell most recently served as SVP of HIT Services for Masspro. Her other roles include director of the Office of HIT Adoption and acting director of the ONC.

Hospitals, be good to your doctors. The average net annual income generated by physicians last year was over $1.5 million, with neurosurgeons bringing in almost $3 million revenue per doctor. With numbers like those, doctors have the upper hand when asking hospitals to subsidize their EHR purchases.

Good news: women are not ready to replace their physicians with the Internet. An online Harris Interactive survey finds most women feel more comfortable discussing private health concerns with their doctor than with an online community, spouse, friend, or family member. However, half of the women surveyed said the first place they research a health question is online.

Inadequate technology is blamed for poorly translated and potentially hazardous prescriptions, according to this study in Pediatrics. Half of Spanish-language prescription labels contain errors, causing confusion and possibly life-threatening situations if misinterpreted. Pharmacy leaders believe HIT needs to step up and improve the way pharmacy prescription software translates drug instructions. Debemos mejorar.

The administrator at the nine provider Cokingtin Eye Center (KS) claims their MedInformatix practice management software has helped reduce the practice’s A/R to 17 days and enabled them to collect 99% of collectible fees.

A Kalorama Information study suggests that relaxing meaningful use standards could lead to double-digit growth for the EMR industry. The requirement for 80% of orders to be completed via CPOE by 2011 was noted as one of the biggest concerns. The report suggests gradual adoption would be a more way to achieve widespread EMR adoption.

E-mail Inga.

Intelligent Healthcare Information Integration 4/10/10

Sir Don and the CMS

The pediatrician in me says, “Wahoo, one of us!”

The primary care physician in me says, “Yeah, someone who believes in reinvestment in general practice and primary care and that reimbursement should be based upon value, not volume!”

The small community advocate in me says, “Cool, a guy who believes in strengthening ‘local health care systems – community care systems – as a whole.’”

The doctor-geek in me says, “Yes, I like a healthcare leader who isn’t focused upon the technology; the tools need to return to where they belong, in the tool chest, not as the centerpiece of health care provision.”

The patient in me says, “Wow, his primary focus, keeping the patient at the ‘absolute center’ of the health care system, is heartening.”

The pragmatist in me says, “OK, he has some experience running a large bureaucracy, but nothing as huge as CMS. Maybe that’s not such a bad thing given the brain sludge which often accompanies those who become too mired within bureaucratic traditions.”

The worrywart in me says, “Well, perhaps the critics correctly warn that his propensity for idealism over EBM (Evidence-Based Medicine) needs tempering.”

The empathist in me says, “Sir Dr. Don Berwick has one helluva mantle to shoulder at CMS. Congress, insurers, lobbyists, lawyers, HIT vendors, providers, patients, and, of course, the entire healthcare blog world will all be nipping at his hide. Hope his is thick enough.”

From the trenches…

“A true knight is fuller of bravery in the midst, than in the beginning, of danger.” – Sir Philip Sidney

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 4/8/10

A new KLAS report suggests that physicians are considering an increasing number of EMR vendors, though Allscripts, NextGen and eClinicalWorks remain on the short lists of most practices. Among small practices (five doctors or less), 72% are considering options outside the best-known vendors. Companies like Greenway and athenahealth that have traditionally served the smaller market are now being given more consideration by larger practices. Another interesting data point: one-third of providers planning an EMR purchase are replacing an existing solution, often because their existing EMR lacks the functionality or certification required to qualify for ARRA funds.

I notice the study examines what EMRs that doctors are “considering” rather than actually purchasing. I recently had a conversation with a small vendor who caters to small practices. He agreed there is a flurry of interest right now. However, plenty of physicians are not pulling the trigger because the docs are waiting for the CMS final rulings on certification and meaningful use. I’m not sure I blame them, given that a solo physician carries all the burden for the EMR’s cost and must dedicate a significant amount of his/her personal and professional time for implementation. The investment is far less risky for a bigger group that’s able to share the costs between providers and to pay staffers to coordinate the implementation.

RelayHealth earns certification for its Payor Connectivity Services from the CAQH Committee on Operating Rules for Information Exchange (CORE) Phase II. The CORE certification means that RelayHealth’s provider customers can securely process electronic queries within 20 seconds and receive consistent patient administrative information.

Mercy Health Systems (PA) plans to implement NextGen EHR for its 70 providers. Late this year Mercy will also deploy NextGen Health Information Exchange. The physicians already use NextGen’s Practice Management software.

Allscripts announces a number of new deals:

• AnMed Health (SC) picks Allscripts EHR for its 60 employed physicians and 40 affiliated physicians. AnMed currently provides Allscripts Tiger PM in a hosted model for the physicians and will offer the EHR through a similar setup.
• Parkview Health (IN) selects Allscripts EHR/PM and RCM for its 170-member physician group, plus Allscripts’ EDIS for its six hospitals.
• The 200-provider Sacred Heart Medical Group (FL) chooses Allscripts PM and Payerpath RCM solutions

Allscripts also releases its third quarter numbers: revenue of $179.9 million versus $160.7 million a year ago, which beats analyst estimates of $175 million. Profit came in at $18.5 million versus last year’s $13.3 million. Bookings grew 25% to $105.5 million.

EHR vendor SuiteMed announces that it will give free licenses to MediNotes e clients through the end of the year. MediNotes, which is owned by Eclipsys, will not be supported after December 31, 2010 and plenty of vendors are coming up with great offers in an attempt to woo MediNotes e clients.

Physician compensation in 2009 averaged $156,218 for primary care docs and $238,587 for specialists. Doctors in private practices earned more than their academic peers.

Physicians say that EMRs both help and hinder physician interpersonal communications with patients and other clinicians, according to this study. EMRs give physicians immediate access to information, which helps communication during office visits. However, some clinicians see EMRs as a distraction and rely too much on EMRs for information gathering, rather than gathering information through real-time communication. The study’s co-author, Ann O’Malley sums it up well:

“Electronic medical records are a double-edged sword when it comes to communication with patients and other clinicians.”

A HealthAffairs study concludes that between 75 and 85 percent of physicians with EHRs already use functions that meet some of the proposed criteria for demonstrating meaningful use. While that sounds promising, you have to remember that providers must meet all of the criteria for each stage in order to qualify for funds (in other words, using “some” of the criteria doesn’t cut it). Another interesting tidbit in the study: less than one in five of the surveyed physicians had at least a basic EHR. Nineteen percent of primary care physicians had a basic EHR and 17% of specialists. In other words, more confirmation that EHR adoption and utilization still have a long way to go.

E-mail Inga.