News 3/4/10

I’m back at home after an exhausting, fun, and educational few days at HIMSS. I have a ridiculous number of e-mails to wade through, but as far as I can tell, there were no earth-shattering announcements, such as company mergers or the like. However, many new product releases, new partnerships, and client success stories were shared. Over the next few days I will digest it all a bit and post more highlights.

In terms of offerings of interest to physicians, I had the chance to look at a few of the EMR vendors. The big name vendors had heavy traffic the whole time, but I have to wonder if the HIMSS experience is worth it if you are a small vendor in one of the small booths and low traffic areas. A lot of those folks looked lonely.

I got a quick peek at SRS and I finally understand its appeal. It does not offer every bell and whistle that you might find in a NextGen or Allscripts product. However, it’s very intuitive, the screen is not cluttered, and navigation is simple. If you want to chart the complete note at the point of care, this is not the product for you. But if you want something that gets your charts electronic, it’s not a bad option. It’s not the option if you want to do complicated data searches since it relies heavily on scanning and transcription. There are limited discrete fields, which also means you don’t have a whole lot of point and click in the documentation process. I knew the product had these limitations before seeing it, but it is strong enough in its design to be an attractive alternative for certain types of providers (especially specialists).

I didn’t see the Sage product in great depth, but it looks like one of the more comprehensive EMRs in terms of its ability to be customized and to accommodate a totally paperless workflow. However, it is not the prettiest EMR out there and a little window dressing might improve its appeal.

If you are a smaller start-up vendor, here’s a recommendation: hire an industry veteran to help you define what is different and unique about your product. This is 2010 and there is no need for a vendor to begin a pitch saying that what makes his EMR great is that it makes patient information available from anywhere and saves on transcription costs and reduces paper. I’m pretty sure that just every HIMSS attendee is aware of that every EMR has that same potential.  When a vendor starts telling their story in this fashion, their credibility is blown and their lack of experience in HIT is exposed.

Here is what seems to be a hot trend: products that can be bolted on to core practice management and EMR programs. The hospital world has been doing this for years, but not so much the ambulatory space. Of course there have long been claims clearinghouse that work with PM solutions, but now vendors are offering easy-to-use and customizable front-end solutions (like Salar) to work with EMRs, all sorts of RCM tools (RelayHealth is big in this area), and business intelligence tools to help doctors with PQRI reporting and the like.

Despite this not so pretty picture, VisualDX was a  pretty sexy product and one of dozens of applications that are newly available for use on a smartphone. VisualDX includes a database of images so a provider trying to identify a particular skin rash, for example, could search through a library of thousands (with pretty precise search options.) A consumer version is also available for all those nervous moms.

For me, the HIStalk party was the ultimate highlight. If you were there, thanks for attending. And endless thanks to Encore, Evolvent, and Symantec, our gracious hosts. If you missed it, I hope we’ll see you next year!

Short post tonight as I get caught up on life! I’m be sharing more, so keep reading.

E-mail Inga.

Intelligent Healthcare Information Integration 2/26/10

Hi Ho, Hi Ho, It’s Off to HIMSS We Go

The setting: Outside of a small, storybook cottage in fairy-tale woods.

Camera zooms in, from a group of frolicking woodland creatures, through a too-cute cottage window to the hand-carved, kitchen table where four elfin men sit sipping steaming mugs of morning blend.

Sleepy: (yawning) I just can’t seem to get excited about this whole HIMSS thing.

Happy: What!?! How can you say that? This will for sure be one of the best events ever!

Doc: I concur. Not only is the whole country abuzz with HITECH fever, but the world is watching to see if the U.S. can actually mend its fractured and dysfunctional healthcare system, especially the informational component thereof.

Dopey: Hyuck, hyuck. I never quite know what you’re saying, Doc, but it shore sounds fancy!

Grumpy: (walking into the kitchen with a gruff and grumbly tone) You fellows never let a guy sleep in!

Happy: (with just a tad too much cheeriness) Good morning, Grumpy! Aren’t you excited about our trip to the big city in the land of peaches and Coca-Cola? Even you must be keyed up with all of the hubbub surrounding ARRA monies and HIT investment that’s brewing.

Grumpy: Harrumph! I most certainly am not. I don’t think those promised dollars will ever hit the hands of the physicians…sorry, Doc.

Doc: Oh, Grumpy, that’s not what this is all about. That money is designed merely to flow THROUGH the hands of the physicians into the hands of the vendors and developers to stimulate the growth of our digital healthcare information system.

Sneezy: (entering, with an ACHOO!) That’s not what everybody thinks, Doc. (sniff) I saw Dr. Doolittle on my way to the mine yesterday and he said he was heading down to Woodland Bank to arrange his new EMR system loan because (sniff) his vendor swore he’d make a bunch of money by adopting now.

Happy: (with his chronic big smile) Either way, don’t we all benefit if healthcare goes electronic? Isn’t the goal really about the benefits to us, the patients, and not who gets what piece of which pie?

Sleepy: (wiping sleep from his ever half-closed eyes) Pie? We’ve got pie?

Happy: (chuckling) No, you silly, sleepy little elf. We’re talking about the big EHR vendor ARRA/HITECH “pie.” I was thinking about what Snow always said, (in a girlish voice) “If your palm itches, you’re about to come into money.” (grinning ever bigger) I’ll bet there will be a lot of palm-scratching CEOs walking around the Georgia World Congress Center!

Doc: Well, I don’t begrudge them a nickel if they can actually create systems to make treating Bambi’s bunions easier and my days in AR dwindle.

Grumpy: Well, I think that is yet to be determined, Doc. Hey…how can a hooved creature have bunions?

Doc: Figure of speech, my dear dwarf.

Happy: Well, regardless, HIMSS will have lots of parties and lots of freebies and lots of happy people excited about the future. I hear even Eric Fishman will be there filming for EHRtv.com. Hope I get interviewed!

Sneezy: I just wish more HITECH money was going (ACHOO!) to big pharma. None of my nasal sprays help anymore. (sniff)

Doc: With all the great data we’ll soon be able to accumulate, aggregate, analyze, and share, Sneezy, I’m sure we’ll figure out better ways to circumvent your rhinitic condition.

Dopey: Hyuck. There you go talking all purdy again, Doc!

Bashful: (standing in the doorway, sheepishly twirling his big toe into the earthen floor) Aww…I’m just thinking about Monday night at the HIStalk reception. You think there’s any way I might meet Inga?

From the woodland trenches…

“From now on, Snow White and the Seven Dwarfs will be known as Person of No Color and the Seven Vertically Challenged Individuals.” – Argus Hamilton

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.

News 2/25/10

No single EMR vendor is a clear leader in sales to physicians, according to Kalamora’s EMR 2010 Report. The study names Allscripts, Epic, eCW, athenahealth and NextGen among the top vendors but says no one company has even one fifth of the entire market. Kalamora also notes that brand recognition for EMRs is fairly low and no particular brands stand out when doctors are surveyed. That’s a disappointing observation if you are an EMR marketeer. In my experience its always difficult to figure out the best way to connect with ambulatory care physicians, so I suppose not much has changed.

Capario releases a new Web-based portal designed especially for physician billing services. The portal that includes real-time dashboard reporting, customizable work queues, and tools to manage parent-child relationships among customers.

KLAS launches a new HIT Buyers Guide just for HIMSS and it is free to providers, though not vendors nor consultants. The guide includes letter grades on over 700 software products and services that are offered to acute and ambulatory providers. If you are a provider and have downloaded a copy, let me  know your impressions. The KLAS folks will also be distributing the guide during HIMSS.

Island Orthopaedics & Sports Medicine (NY) purchases SRS hybrid EMR for its seven provider practice. According to one of the doctors, earning ARRA stimulus money is not a top priority:

“I am confident that the economic benefits we will receive from this system will far exceed any government subsidies that may be forfeited in just a few years.”

Thirteen of the country’s largest radiology practices form Strategic Radiology, an entity designed pool bargaining power with insurers and equipment dealers, as well as share expertise and best practices. The organization represents over 750 physicians.

This study finds the average number of hours worked by physicians fell 7% between 1996 and 2008, from 55 hours a week to 51. Physician residents decreased their hours even more, averaging 10% less work time over the time period analyzed. Coinciding with the decreased hours were physician fees, which fell 25% between 1995 and 2006.

Pulse Systems is one of the many companies launching new products to spotlight at HIMSS. Pulse is introducing an integrated patient portal and a self-service patient check-in solution which will be available stand-alone or integrated with Pulse’ Patient Concierge Suite.

PrimaCare Medical Centers (TX) claim that since installing MedInformatix’s practice management and EMR solutions, their insurance collections about increased about three percent. The 11-location urgent care network also uses ZirMed for electronic claims processing. So, is a three percent improvement in collections that significant? Doesn’t sound very dramatic to me, but perhaps collections weren’t too bad pre-MedInformatix.

Just published by The Huffington Post Investigative Fund: FDA is “moving closer” to regulating EMRs after receiving reports of six patient deaths and 44 injuries related to system malfunctions. Examples included an OR system whose lockups forced nurses to re-enter data from memory and another that didn’t display allergies correctly. An FDA official admitted that the agency has steered clear of regulating HIT, but says, “In light of the safety issues that have been reported to us, we believe that a framework of federal oversight of HIT needs to assure patient safety.” Reaction from vendor executives at the recent hearings was interesting: Epic’s Carl Dvorak was quoted as saying regulation wouldn’t necessarily ensure safer products or encourage innovation, while Cerner says it supports making voluntary safety reports mandatory because it’s “the right thing to do.” It’s not clear if the FDA is looking at all EMR’s or just inpatient systems.

I’m heading out to HIMSS this weekend so my next update will come direct from Atlanta. On the top of my list is checking out some of the lesser known EMR products, so stay tuned.

E-mail Inga.

News 2/23/10

From M.C. COO: “Re: it’s Hammer Time! Great posting. Lots of parts for sale, not many usable tools.” In case you missed this fun post, M.C. is referring to Dr. Gregg Alexander’s recent commentary, I Don’t Wanna Build the Hammer.

From EMR Machinist” “Re: Building hammers. Love the old hand tool (chisel and rasp) analogy.”

McLaren Health Care Corporation (MI) signs a $3 million EHR contract with Allscripts for its 150 employed physicians. Initiate Systems will build McLaren an enterprise MPI across its multiple systems and databases, which includes McKesson’s practice management system.

Pacific Medical IT signs on as a reseller for Aprima Medical Software. Checking out Pacific Medical’s Web site it looks like they also offer Practice Fusion EHR.

e-MDs President and CEO Michaels Stearns, MD agrees to serve as board president of the newly formed Texas e-Health Alliance.

Speaking of Texas, EMR usage in the state is on its way up, according to the Texas Medical Association. In November 2009, 43% of surveyed physicians said they used EMRs, up from 27% in 2005. Doctors age 40 and younger had even higher adoption, with 60% claiming EMR use. The overwhelming majority of doctors who already have EMRs say that electronic charting is the best part; the worst part is data input. Seventy percent of the physicians say they intend to implement an EMR in the next two years, which would be quite a boon if you are selling or implementing EMRs.

That 70% number is a bit higher than what Accenture has calculated, based on interviews with 1,000 physicians. The Accenture study (being released next week) concludes that 58% of physicians not using an EMR today plan to purchase one within the next two years.

In an article profiling his practice’s use of EMR, internist Eric Voth says, “The single greatest benefit is information management and simultaneous access." His 160-physician Cotton-O’Neil Clinic (KS) has been using NextGen since 1998.

Associated Cardiovascular Consultants (NJ) selects Sage Intergy, Sage Intergy EHR, Practice Analytics, and Practice Portal for its 38-physician  practice. I noticed that Sage Healthcare has its own channel on YouTube, which offers a number of customer interviews, including one with Associated Cardiovascular’s executive administrator.

I guess everyone is making predictions for the new iPad and wondering if it will be a passing fad or a healthcare staple. These folks conclude that 54% of medical professionals are likely to purchase some sort of tablet PC over the next year, with ease of use being the most important selection criteria. The iPad seems to be user-friendly, but (for now) lacks certain functionality that healthcare providers desire (RFID, camera, etc.) While I am at HIMSS, one of my top questions to the ambulatory EMR vendors will be what their plans are for offering solutions on the iPad.

Speaking of HIMSS, if you are attending, you will want to check out Mr. HIStalk’s Must See Vendors for HIMSS10. In addition to brief descriptions on about 50 companies and their offerings, you can learn more about all-important trinket giveaways and various free refreshment choices in exhibit hall. You can also download a PDF version to print and take to Atlanta if you like. I also recommend taking a look at HIT Vendor Executives on HIMSS10. Dozens of industry execs provide insights on what’s going to be hot at HIMSS this year. It’s a must-read if you want to sound like an industry insider while making small talk in the Starbucks line, before an educational session, or at a cocktail party.

A big thank you for everyone who took the time to participate in our HIStalk Practice survey. I feel kind of like Sally Field, here but it’s sure nice to know readers like what we are doing!  Mr. H and I haven’t had a lot of time to go through all the comments in detail, but I did note the suggestion that we do more coverage on men’s shoes (boring), provide commentary on Manolos versus Louboutins (Louboutins), and add a “STEALetto of the Day” section highlighting shoe bargains (love it!) We promise to thoughtfully consider the more industry-specific comments and do some tweaks over the next several weeks.

E-mail Inga.

Intelligent Healthcare Information Integration 2/19/10

I Don’t Wanna Build the Hammer

I build cabinets. They come in many shapes, colors, and styles. Each and every one is precious to me.

Despite how much I enjoy the art of cabinetmaking — yes, cabinetry is still far more an art than a science — I find building them has gotten harder and the process takes much more time and effort these days.

You see, I was originally trained with hand tools. I know how to use them and they feel very comfortable in my hands. But, I kept hearing about all these amazing new, modern tools and reading about how much more I could do with them than with my old chisel and rasp. I finally decided to try to keep with the times and convert to modern equipment. So, off to the hardware store I went to see what newfangled gadgets I could see.

Little did I know how many hardware stores there are these days: small mom-and-pop shops, national chains and megastores, even some which are strictly Web-based. Since I didn’t really know what there was to know about the new wave of tool design, I figured I better look at them all.

Holy crud! What an eye-popping assortment of doodads, doohickeys, thingamabobs, and whatsits! You can twist and turn and join and curl and polish and trim any which way you might ever want. It looked to me as if there wasn’t anything I couldn’t do with a little piece of wood if I had a modern shop full of these fancy schmancy instruments.

The salespersons all showed such finesse in using these gadgets. With my extensive training in fine woodworking, I knew I could do much more still with these in my hands.

I asked about pricing: pretty steep, compared to my simple hand tools, but not unaffordable. (After all, I make enough cabinets to generate a livable income.)

I asked about training: regular classes, ongoing support, and even Webinars were all available, though there were extra charges for some of these. (That was OK as I knew it would help me get up and sanding sooner if I had some personal instruction.)

I asked about productivity: as the sales people whizzed through their demos, they assured me I would be able to produce even finer cabinets at a similar rate, thus generating more income for similar effort. (My boys’ meager college funds would appreciate that!)

It all looked so good; I plopped down my plastic and went home to await delivery of my new, complete set of cutting edge woodcutting tools.

Now we come to the rub, the glitch in this whole, new high tech gadget gitalong. After the delivery crew had dropped the boxes off on my woodbench, I learned a sad truth: every one of my shiny new implements appeared to have been designed by an engineer, not a craftsperson. Their instructions were written in tech-ese, not English. They seemed to have started with the assumption that the end user already had an in-depth knowledge of modern tool design and understood their inner workings.

After wading through pages and pages of almost indecipherable and convoluted instructions which asked me to remember minute details from chapters and chapters before, I finally realized that putting my new tools to use was going to be a phenomenal challenge, but, not for the reason you might think.

I can digest details and manage minutiae. (You should see some of the woodcrafters’ trade journals.)

I can learn new skill sets. (I’ve spent my life learning new ways to wrangle wood.)

I can even build a hammer if I have to. (I don’t want to; I prefer to use the hammer to create cabinets.)

The biggest problem? My new tool set came as a kit. All the pieces and parts are there, but to use them, to get on about the business of making cabinets, I have to put the entire toolset together. Sure, they’ve molded the plastic and hardened the handle shafts, but I am supposed to put the pieces together in a way they say “will work how I want them to work.”

(Shoot, my little Palm Pre is pretty complicated, but it only took a day to get fully up and running with it. Sure, I had to put the battery in and run through some guided setup routines initially, but they were “pre-thought out”; I barely had to think at all, just follow some very simple, well-designed, and regular human-ese instructions. It works how I want it to just fine.)

I am committed to mastering my new toolset. Overall, I love it and we will end up creating beautiful cabinets together. It’s just a lot harder than I think it should be. It takes a lot more effort because I’m still figuring out how to put the tools themselves together, which is not really where I want to be spending my time. I’m pretty sure most other cabinetmakers feel the same.

I want to create cabinets. I don’t wanna build the hammer.

From the trenches…

“Follow the grain in your own wood.” – Howard Thurman

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.