News 3/18/10

RCM provider Emdeon reports that Q4 revenues grew 9.5% over 2008 numbers and net income jumped 12%. For the full year, revenue increased 7.6% to $918 million; income grew 18% to $14 million.

Providers with Jordan Physician Associates (MA) implement MedAptus Inpatient Edition to capture and submit charges while on service at Jordan Hospital.

Score one for e-prescribing. In an AHRQ-funded, researchers find that primary care practices using e-prescribing systems reduced prescribing errors almost seven-fold over one year. The study compared prescribing error rates between six practices using e-prescribing and six using paper. While the paper-based error rates remained relatively constant (about 37%), the e-prescribing error rates fell from 42.5% to 6.6%. All the e-prescribing practices used the same e-prescribing tool (MedAllies.)

Physicians at Dreyer Medical Clinic (IL) sign an agreement with OPTIMIZERx to implement its SampleMD solution. I’ve never heard of SampleMD before but am intrigued by their offering. The system facilitates electronic searches for sample vouchers and prescription co-pay offerings, plus electronically dispense drug samples through a national pharmacy network. It also eliminates the need to manage and store physical drug samples in physician offices.

The FTC releases its plans for expanding broadband Internet connectivity and boosting HIT connectivity. Healthcare-specific plans include allocating $29 million a year for Indian Health services for broadband services and increasing federal funds and reimbursements for telemedicine and underserved areas.

Wayne State University Physician Group (MI) contracts with NextGen Healthcare to deploy NextGen Practice Solutions. The 540-physician group already uses NextGen EHR.

Speaking of NextGen, we welcome them to HIStalk Practice as our latest Platinum sponsor. NextGen Healthcare Information Systems has long been one of the ambulatory HIT industry’s most respected vendors, offering a suite of practice management, electronic health records, and HIE products. Last month NextGen announced the acquisition of Opus Healthcare Solutions and Sphere Health Systems, increasing their presence in the hospital IT space. Almost three years ago they became one of HIStalk’s first non-hospital specific sponsors and we appreciate their expanded support of our efforts.

The AMA launches a new managed care contracting resource to help physicians analyze and negotiate contracts with insurers. The National Managed Care Contract (NMCC) and database includes a searchable database and provides model contract language

McKesson adds a number of new practices using its Practice Partner EHR, including Consultants in Gastroenterology (RI), Virginia Nephrology, and Paradigm Medical Group (CO.)

A local Indiana paper examines one practice’s transition to EMR, including possible effects on patient satisfaction and the doctor-patient relationship. One of the practice’s doctor, who still handwrites and dictates his notes, believes that EMR will ultimately save time, but worries he might alienate patients as he concentrates on the computer screen. Others acknowledge the transition will be difficult, but will save patients time and money, reduce redundant tests, and increase safety when prescribing medications. Says like concerns raised by every doctor when transitioning from the paper world to an EMR, regardless of the practice or EMR.

E-mail Inga.

Intelligent Healthcare Information Integration 3/16/10

“HOST YOUR EMR LOCALLY!” the Web Yelled Today

Here I sit, typing away between patients, grateful that we haven’t had to yank the old pens and papers from their dusty shelves. We’re still seeing patients, still point-and-clicking away, capturing data and making appointments with ease, but not because we’re just so darned connected. Actually, we’re not.

I just got off the phone with our high speed DSL provider, a company with whom I’ve been well-pleased these past four years. After the expected interminable on-hold time, I was told by the very first rep with whom I was connected that she had just received word of a large area problem affecting our service. We had been issued a “Level 4” status (as if I’m supposed to know what that signifies) and the repair worker bees were busy getting to the problem. “They have three days to correct the problem,” she told me.

Not knowing just exactly who had granted them those three days and uncertain as to what little old me could do if the problem persisted beyond the allotted period, I gratefully thanked this pleasant rep, realizing she was just another worker bee who had no more she could offer. (She was likely on her way to many more calls about the very same issue and I didn’t envy her at all.)

Four more patients seen and digitally scribed since that last paragraph, four more who won’t need to have their info re-entered at a later time nor scanned in and, thus, essentially worthless, digitally speaking. Seven patients scheduled for follow-up or for a new appointment, work which won’t need duplicated once we rejoin the Web. In the meantime, the ISP home page which I had opened twenty minutes ago is about two-thirds loaded. (Dialup was never so slow.)

My EHR is Web-based. We could have gone the ASP route. Personally, I love the “cloud” concept and see real value for many “softwares” as a service. But, perhaps it is the geek in me who wanted his own servers, perhaps I’m more of a control freak than I care to admit, or perhaps I just knew I’d be happier with locally hosted speed and reliability. Any which way, I chose to host at home and, especially right now, I’m really happy with that decision.

Full disclosure here: Yes, we’ve had problems with our servers. Yes, we’ve had down time from RAID failure. The difference, and why I’m still a fan of local hosting for our purposes, is that when those occurred, I had some control. I could call for help, boots on the ground, and see what needed to be done, swapped, or replaced. Today, I just sit and wait while the worker bees are hopefully buzzing their way to the honeycomb cell which is the source of our hive’s disruption. I have no clue if three days will pass without being hotwired to the Web. Hector’s pup, I can’t even get my daily news jolt! That’s almost as bad as a lack of coffee. (Maybe I want to restart my daily newspaper subscription?)

Interestingly, Google searches still work like a charm, fast as ever. Score one for the cloud. Still, I’m listening to the Web yell, “Keep your hosting local!” while I handwrite another prescription that I am unable, today, to e-prescribe.

From the trenches (wondering when, or if, this will get through to the Web)…

Who cares about the clouds when we’re together? Just sing a song and bring the sunny weather. – Dale Evans Rogers

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 3/16/10

CCHIT files its comments on the Interim Final Rules and warns that the currently proposed standards might slow the pace of EHR adoption. Dr. Mark Leavitt points to the omission of standards for receiving lab results and for exchanging clinical standards, even though widely support standards already exist. CCHIT also says that some of the proposed functions are too microscopically defined, while others are still undefined.

Meanwhile, CCHIT says it is suspending any initial or incremental modular testing until it has an accredited Stage 1 ARRA test script to use. A note on their website also indicates that CCHIT is “confident” about its prospects for becoming accredited.

And, Drummond Group re-affirms its desire to be certified as a authorized testing and certification body. The company is making internal preparations and plans to be ready for EHR testing later this year.

The Senate passes legislation that would allow certain hospital-based physicians to qualify for incentive payments under ARRA. The amendment excludes ER physicians or those furnishing substantially all their services in an inpatient room. However, the legislation would make eligible physicians working in ambulatory facilities owned by hospitals. The provision was part of a jobs bill that now moves to the House for further consideration. If you recall, the House had included similar wording in a bill a couple weeks ago, but it was stripped at the last minute. Don’t spend those stimulus pennies yet.

After delaying the release its numbers, athenahealth posts a decline in profits and jump in revenue for Q4 and 2009. athenahealth restated its financials going back to 2005 as a result of an internal accounting policy review, initiated by the company, and related to the timing of amortization for deferred implementation revenue. For Q4, revenue grew 33% over 2008’s numbers, to $54.4 million; for the year, revenue jumped 38% to $188.5 million. Reported GAAP net income, however, fell 84% to $4.3 million in Q4, compared to $26.8 million a year ago; annual net income fell from $31.5 million to $9.3 million. The $.17/share earnings were in line with analyst expectations.

Vitalize Consulting appoints Tim McMullen its executive VP of sales. McMullen most recently served as a VP at maxIT Healthcare and was a national VP and partner with First Consulting before that.

Sales types be warned: physicians report that their offices are visited by up to 20 sales reps each week from the pharma or medical device industry. No wonder doctors have no time to hear about your best-thing-since-sliced-bread EMR. Half the physicians say they require or prefer reps to schedule one-on-one appointments.

Edge EHR Corp. announces plans to acquire Goal Software, a provider of practice management software for the eyecare industry. Edge is hoping some of Goal’s 700 providers add its EdgeEHR application.

One hundred percent of primary care doctors in Denmark use EMRs and almost all medical communication between providers, specialists and hospitals is electronic. The government made EMR use mandatory in 2004, and in 2009 doctors were required to use email to communicate with patients. To spur adoption, the government used financial incentives to physicians, including faster re-imbursement and payment for patient-doctor email consults.

Marquette General Health System plans to deploy McKesson’s Practice Partner EHR to its 140 employed clinicians across 30 owned physician practices. In addition, the hospital expects dozens of independent affiliated practices to adopt Practice Partner as well. The hospital will integrate the EHR with its Paragon HIS.

BCBS of Western NY and Blue Shield of NE-NY are the latest carriers to agree to cover telehealth services for patients connecting to providers via the American Well Online Care platform.

AdvancedMD hires William H. Stone as its VP and GM of Billing Services. Stone joins AdvancedMD after 11 years at MED3OOO where he served as corporate VP of Business Development.

A Gerson Lehrman Group report suggests that EHR adoption is growing faster than once predicted. Physicians have finally begun to realize that they will have little choice but to go electronic in order to maintain a viable professional existence. Physicians are now concluding that if they must do it, they might as well get as much from the federal government as possible. The report suggests we will soon see a “tipping point” toward widespread adoption of EMR. Perhaps, although it seems the “experts” have been saying we’ve been on the verge of a tipping point for the last 10 years.

CapSite sent over a copy of their very juicy 2010 U.S. Ambulatory EHR Study, which looks at the market’s response to the HITECH component of ARRA. The company sees an opportunity of more than $1 billion in net new business in the 1-10 provider space and $2 billion across the whole ambulatory EHR space. In other words, when we hit that tipping point, it’s going to be mighty big. The report is a good read, if you want to get a handle on today’s market.

E-mail Inga.

Intelligent Healthcare Information Integration 3/12/10

EMR. Cart. Horse.

Outcomes and quality reporting and meaningful use – cool.

I mean, really, is there a doc out there who doesn’t think improving patient outcomes or obtaining and sharing useful data or using any tool in their arsenal “meaningfully”  isn’t just plain, old, common sense, good stuff?

However, all these sound just about as logical to a physician as “you need to eat your vegetables”  sounds to a child. Sure, we all want to grow big and strong; we get that. But, if the veggies don’t taste good, if they aren’t presented in an eye-friendly way, if they make a medical practice “gag,” how many docs are going to be enticed to “eat what’s good for them?” Seems a lot like trying to inspire six year olds to eat plain Brussels sprouts.

What started out in with Dr. Larry Weed taking his POMR (Problem-Oriented Medical Record) and SOAP Note brilliance and extending it to digital “data acquisition and retrieval systems” which would extend the brains of physicians helping them make more accurate diagnoses and more effectively deliver “proper care” has gotten completely kerflobbled.

Instead of using computers to do what they do best in helping medical care providers do what they do best, we have skipped right over the logical progression that the good Dr. Weed envisioned some 40 years ago. We wonder why we are now trying to figure out why HIT isn’t being devoured by doctors. We’ve placed a plate of barely warm Brussels sprouts before the healthcare child; now we’re trying to bribe and even threaten punishment if he doesn’t eat.

Instead of keeping the healthcare provider providing healthcare and extending his mental powers onto peripheral brains with tremendous storage and retrieval strengths, we’ve twisted the focus toward turning doctors into mere data input devices. Instead of empowering physicians, we’re eviscerating their strengths and training and minimizing their cognitive clout. Instead of using digitization to maximize our doctors’ capacities, we have seen it used to detract from their mission and delimit their mentations.

In 1997, Larry wrote:

“The meteoric shower of medicine’s scientific achievements can overwhelm a doctor’s mind. A patient has no assurance that his or her doctor is able to take into account all relevant scientific knowledge and integrate it with detailed data about the patient’s own condition. Yet few doctors, patients, or policy makers recognise that modern information tools can become the loom for weaving these two bodies of knowledge into a fabric. In fact, few recognise the dimensions of the problem.”

Recognizing “the dimensions of the problem” and righting the course we now follow won’t be easy, by any means. But, at least for the foreseeable future, computers won’t be able to make the myriad of associations and subtle nuance recognitions required for accurate medical diagnoses on a per patient basis. The brains of our healthcare providers still outshine the petafloppiest supercomputer.

You have a chance of getting a child to eat Caramelized Brussels Sprouts with Pistachios and Red Onions just as you have a real chance of broad EMR adoption if you present something attractive, tasty, and “good for them” if you keep the focus upon enabling doctors’ strengths, not detracting from them.

Before we start reporting, measuring quality, and worrying about outcomes, how about we enable the doctors’  mental machinery and figure out how to make their data capture requirements unrestricting of their abilities to continue to care for us as we go about gathering enough data to meaningfully use?

From the trenches…

“It is the good horse that draws its own cart.” – Irish Proverb

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 3/11/10

From: Phased “Re: Dr. Alexander and Meaningful Views. I was excited to read your blog post about Meaningful Views, and helping physicians delivery better quality care, by providing tools and rich data that is easy to digest, accessible, and fast to access. From my perspective, it seems that the main focus for a majority of companies and industry folk, is simply revolving around the “Meaningful Use” buzzword, and the reimbursement incentives. Not so much around helping the ACTUAL population responsible for making the healthcare system better!!”

The ONC officially publishes its proposed rule establishing two certifications programs to test and certify EHRs. Organizations wanting to qualify as an “ONC-Authorized Certification Body” for the “temporary” program would be required to submit an application and demonstrates its competency to test and certify EHRs. CCHIT has not been granted grandfather status for testing, though they will likely be one of only a few organizations ready and able to qualify under the new program. Creating the temporary program would allow EHR programs or modules to be certified as early as this summer, and thus eliminating uncertainty as to whether or not a particular product is “certified” for incentive programs. The temporary program would expire the first quarter of 2012 and replaced with a permanent program that would designate an outside agency to certify organizations.

Quest Diagnostics and Surescripts team up to form an integrated service that combines lab and prescription information available to connected physician. On the surface the announcement doesn’t sound like much, but when you consider that Quest has 150,000 connected physicians and Surescripts has 170,000 active subscribers, that’s a lot of providers that will now have electronic access to both lab and prescription data.

Annapolis Pediatrics selects Sage Intergy suite to automate its clinical and financial operations. Annapolis Pediatrics is a four-location, 21 provider group.

Physicians Practice Organization (IN) implements MedInformatix Enterprise Practice Management and EMR to 14 of its 17 affiliated clinics.

By 2012, 81% of physicians are expected to use smartphones, according to a Manhattan Research study. Of those smartphone users, half will utilize the devices for administrative functions, learning, and patient care.

The Ohio House of Representatives passes a bill that would create and test a patient-centered medical home. Participating physicians could be eligible for reimbursements up to 75% for any HIT system purchased for the project, including training and technical support required for the medical home conversion. The bill now goes to the Ohio Senate for consideration.

Here’s some fuel for the naysayers who claim automation doesn’t improve quality of care. Canadian researchers find that computer reminders sent to physicians during routine electronic ordering or charting improve yield smaller improvements than expected. A review of 28 clinical trials yielded a median improvement of only 5.6%.

ASG Software Solutions and CTG Healthcare Solutions form a partnership that leverages CTG’s implementation and training expertise to install the ASG-MedAppz EMR.

Ingenious Med announces a new application for BlackBerry smartphones that will allow physicians to access the charge and data capture applications within their IM Practice Manager software.

CNNMoney takes a look at the EMR field, pointing out that the industry is ripe for consolidation. Of today’s 300 to 400 vendors, look for some of the bigger players to purchase smaller companies. Often the large vendors are not interested in catering to smaller practices, which works in favor Internet-based EMR vendors who typically  can offer providers a lower-priced alternative. None of this is particularly new news if you been in the EMR world awhile. What is interesting is that the main stream press is focusing attention on our space like never before.

CMS posts additional public comments to the proposed meaningful use definitions. The public still expresses concern that the bar is set too high, especially in the early years. Other comments suggest the government needs to re-think such areas as interoperability, the definition of eligible provider, and specialist requirements. Here is a sampling:

The requirements for meaningful use are too restrictive to be of any value to most specialty physicians. Only a complete EHR will provide the value we are all looking for. Primary care physicians are about the only ones that can take advantage of the incentives and therefore will be the only ones adopting EHR’s. Specialty practices all have something to contribute to a complete and comprehensive EHR; leaving them out will only result in a lot of money spent with very little gained. I think there’s still a lot of work left to do to incent all necessary groups to participate.

The incentive is flawed when you consider that the current EHR technology is built on the current healthcare business model, which most agree is suspect and requires reform. Change the business model first, then adapt new EHR technology with incentive.  Meaningful use objectives and measures for EP’s are unrealistic and if they are anything like PQRI are meaningless. Therefore the incentive is likely not achievable for many physicians.

As a community hospital employing 150 outpatient PCPs who utilize hospital-based billing, we find the ruling of our ineligibility for the outpatient EHR incentive program non-congruent with the stated objectives of this program. Conceptually, hospital-based billing is a separate and unrelated issue from the capacity to develop and use outpatient EHRs in a meaningful way to improve patient safety and quality. We strongly urge a reconsideration of this issue in order to align the incentives of our institution with the goals of the Office of the National Coordinator.

E-mail Inga.