HIStalk Practice Interviews Scott Decker

Scott Decker is president of NextGen Healthcare.

Do you believe that the HITECH Act will deliver the goods, both in terms of improving care and lowering costs through technology and for stimulating the economy?

I think those are two fairly dramatically different issues. I think it certainly is doing more than has been done in the 20 years I’ve been in the industry in getting attention brought to the value of automating electronic medical records and the processes and communication between systems. I think it’s still a little too early to tell. While the entire industry expects that it’s going to be the catalyst and it’s finally going to get everybody moving, it’s still too early to tell.

If it does what it’s intended to, which is get electronic health records in the hands of the vast majority of the physicians and vast majority of the hospitals doing physician order entry, I absolutely believe it’s going to deliver on higher quality care. I think that’s been intuitive to everybody in the industry for a long time, that if information shared across caregivers — I don’t think anybody, obviously, thought that wouldn’t improve patient care. So with that caveat, if everything happens the way the stimulus is intended to happen, yes, I think it’ll absolutely help improve care.

As far as being a stimulus, if everybody starts automating, I think you’ll see a short-term increase in healthcare IT spend. I don’t know that I’d consider that an economic stimulus. It certainly is a segment stimulus and certainly good for healthcare IT vendors. I don’t know if it’s the best use of dollars to stimulate our overall economy.

Do you think the technology’s also going to help lower cost in healthcare?

You go back once again to the intuitive things which are — will it take care of when people get testing and does it help improve the administrative flow? I think a lot of those things are going to happen fairly short term. I don’t know if it’s a major mover in the next five years on lowering costs.

In fact, it may actually increase costs in the next five years as everybody has to go through all this implementation work. Over time, I think if quality improves, lower costs go with that. I think we’ll actually see a short-term increase in costs and I think the long term is a 10- to 20-year horizon before you start to see improved overall cost in healthcare because of this initiative.

Do you have a sense of how many doctors will forego that HITECH incentives and stick with the electronic or paper systems they’re already using?

We don’t have a sense on that, so let’s just assume that 20%, maybe, of physicians have electronic health records. We definitely think this will be an accelerator. We definitely think it won’t force everybody to go off. I think it’s going to get up to the same point we would have gotten to anyhow, I just think it’s going to get up to it faster. Maybe the ultimate is 75 or 80% of physicians.

Two years ago, if we would have talked about this, you probably would have agreed it’s going to take 10 to 15 years. Maybe now we’ve changed the time horizon back to five to 10 years. I mean you still talk to them and say, “This isn’t enough to make it worthwhile.” Now maybe the pain at the end of this curve will be strong enough that even those will have to move, but I think there’s definitely a set who are still saying this isn’t enough to change my position on the value.

The HITECH legislation is aimed primarily at general medicine EMRs. Do you see anything changing for specialists?

I think if it’s successful in the primary care side in and of itself, it’ll help specialists, especially in the flow of information. You already have higher penetration of EHR on the specialty side. Those were certainly some of the more early adopters.

I have heard talk, people even revisiting the stimulus to say, “Do we need to put more incentive into the bill to apply to specialties?” I think yes, they are going to benefit maybe more than they currently perceive. Some of that’s direct, and I think some of its indirect; i.e. just the connectivity of primary care folks as they get online, I think, is going to be a benefit to them.

Hospitals and regional extension centers may eventually have a larger than expected role in which physicians implement which systems. Was that a surprise, and has NextGen’s strategy changed at all because of it?

It was definitely a bit of a surprise. I think we, and some of our peers in the industry, didn’t necessarily expect that move and maybe even scratch our head a little bit at “is that the best way to spend the money to help accelerate this”; i.e. put a middleman in the market between vendors and physicians, especially organizations that don’t exist today, that doesn’t necessarily have a lot of experience and skills implementing and deploying EHR.

But with all that said, it is what it is and yes, it has changed, rather dramatically, our strategy because it has the potential of being a key channel to getting physicians up and running. So we’re very aggressive in our planning on how to best work with the RECs and making sure they’re successful.

Clearly with hospitals, I see them much more aggressive in the last six months, also, in really solidifying their strategies on going after EHR. I was just at CHIME a couple months ago and did probably three focus groups, probably talked to 50-75 CIOs, and almost to a CIO, it’s now their top strategy. One of their top two strategies is now the deployment of EHR, certainly for owned physicians and a vast majority of the cases, to the community physicians having some sort of offering through the health system. So yes, we definitely stepped up the time we’re spending in the hospital segment and think that’s also a key distribution point.

Connectivity solutions include both HIEs and vendor-specific options, technology such as that offered by Epic. What should customers look for in planning for the future?

They definitely need what I would call a more generic HIE offering rather than a vendor-specific. I guess I would relate that comment more to our conversations with health systems, so it’s backlit from that side first. I mean, they need a solution that’s committed to connectivity, and I think everybody has come to the conclusion that you can’t dictate to your community a single EHR solution or even two or three.

Where I think connectivity is not even just about hospitals, it’s the physician communication — the physician and the hospitals, hospital to physician, and physician to physician. The health system probably ought to put in a system that facilitates that. Why need a multivendor platform to do that?

From the physician office side, you need to make sure your vendor has an open architecture and standard that’s going to easily communicate with a neutral HIE platform.

By the way, I wasn’t ruling out the fact that your vendor might have a neutral platform. So for instance, at NextGen, we invested heavily in building an HIE product. The number one criterion was it has to be open standard/open vendor model. Our clients are using a NextGen HIE solution to accomplish what I described as they need to be changing.

One of the things on the inpatient side that we’re seeing is that many vendors have seen customers satisfaction metrics drop after a big sales pitch because the vendor wasn’t able to scale up to hold all the hands of those new clients trying to implement simultaneously. Do you think that we’re perhaps creating a lot of unhappy customers because that HITECH window is so small?

Yes. I think everybody believes if things take off as we are anticipating they are, there are definitely going to be organizations that have trouble scaling. Just like you asked me what the criteria that clients ought to be looking for when they choose HIEs, probably this is an even more important one — whether to resource it to the company you’re looking at to help you with your EHR, and assuming the demand’s going to be through the roof.

What organizations are probably best prepared to scale with that and are going to be able to give you a quality installation and service and training — I think that’s going to become more and more an important criterion for selection.

Anything else you want to share about NextGen?

We’re obviously invested heavily on all the fronts you tapped on. We focused really heavily in the last 12 months on making sure we are prepared to address that scale issue. We’ve always been very focused on customer satisfaction. I think this just puts more pressure than we’ve ever had on making sure we’ve pre-invested to make sure we continue to deliver quality product implementation and clients at the end of it. You need a company that can scale, and there are fewer and fewer of us out there in the industry, I think, today.

The other thing we’ve invested really heavily on is this whole concept of HIE or interconnectivity. We’re pretty excited about the portfolio we now have between having an EHR and an EPM. They’re all on a single database that’s tied into an HIE that also has a patient connectivity piece to it so that we can really tackle what we think is going to be the ultimate game here, which is going to go quickly beyond just “how do I get my practice up and running EHR,” but “how do I get my practice up and running in a connected community.” I think that’s going to be the big game as the standards start raising. We’re real excited about what we have on that side and what we’ve already been able to do through the clients on building up that model.

News 12/22/09

MedLink International joins the ranks of EHR companies offering a guarantee that its “qualified” EHR products will meet meaningful use guidelines, even though though the final guidelines have yet to be published.

I am sure I am not the only one who is ready for the release of the final meaningful use definitions so we stop hearing everyone give an “expert” opinion of what will and won’t be included. Then we will be able to focus on hearing all the “expert” explanations on what it all means. If you are planning to attend HIMSS and aren’t already sick of the topic, there’s a one-day Physicians’ IT Symposium looks pretty good. Hopefully the individual sessions will be more inspired than the symposium’s title: “What it Means to be a Meaningful User.”

CCHIT announces that it has certified a total of 14 products under its Certified 2011 Comprehensive and Preliminary ARRA 2011 programs.

The CIO of the 300-physician Springfield Clinic (IL) claims its Allscripts EMR plus a patient kiosk system netted a $4.5 million ROI in the first year, thanks to staff reductions and reduced transcription costs.

Medical tourism numbers are down almost 30% compared to a couple of years ago. The decline is blamed on the recession, high travel costs, and overall discomfort with the idea of traveling to strange places for care that might not meet US standards.

A market research publisher says the 2009 EMR market will hit $13.8 billion, which is less the market’s full potential. To beef up adoption, vendors and health systems will need to provide additional financial incentives to financially strapped solo and small practice physicians who can’t afford the upfront costs or EMRs.

Karen Pletz, president and CEO of the Kansas City University of Medicine and Biosciences, was fired last week with no explanation from the school. During her ten-year tenure, Pletz has been credited with increasing endowments to $70 million and improving medical board passing rates to 100%.

Practice Fusion claims its user base grew 400% in 2009 and now includes more than 25,000 EHR medical professionals.

Practice EMR vendor DoctorsPartner offers the Sushoo independent HIE, free for DoctorsPartner customers or $2,500 upfront and $80 per month otherwise.

OptumHealth, a division of UnitedHealth Group, plans to offer virtual doctor visits nationwide next year. NowClinic will be available for $45, regardless of whether or not a patient is insured. The visit includes a 10-minute appointment with a physician who can file prescriptions, except for controlled substances. Providers will eventually be able to view patient medical histories.

PricewaterhouseCoopers’ Health Research Institute predicts healthcare cost controls as the top health industry issue for 2010. Also in the sector’s forecast: growth in technology and telecommunication; more hospital-employed physicians as providers seek greater stability and electronic connectivity; and greater emphasis on fraud and mistakes.

The Minneapolis paper highlights mPay Gateway, which offers a Web-based healthcare software credit card payment system. The four-year-old company serves 1,500 providers and predicts 2009 revenues of $300,000. mPay Gateway’s biggest distribution partner is Allscripts, which added 700 providers in 2009. We interviewed CEO Brian Beutner a few weeks ago.

The US Patent Office issues a patent to Practice Velocity for it PIVoT urgent care EMR. The company CEO says, “The patent recognizes the uniqueness of PiVoT and this gives the protection of the US Government for the intellectual property rights of Practice Velocity.” Sounds good, though I couldn’t comment on whether the product is truly unique or if the company is simply employing an unusual marketing ploy.

On the rise: business management programs designed specifically for physicians and other clinicians. Doctors can lug their backpacks across campus at such universities as Vanderbilt, the University of Pennsylvania’s Wharton School of Business, Harvard, and Duke.

I plan to take a bit of time off over the holiday, so maybe I’ll have time to download this new iPhone app. Death Panel tests users knowledge of healthcare reform in a quiz format. Can’t think of what would be more fun then snuggling in front of the fire with a glass of wine and musing over healthcare policy.

 Ho-ho-ho!

Intelligent Healthcare Information Integration 12/19/09

Feeding Those Who’ve Already Supped

From Healthcare IT News, Diana Manos, December 2, 2009:

Health and Human Services Secretary Kathleen Sebelius and David Blumenthal, MD, the National Coordinator for Health Information Technology, have announced $235 million in grants supporting non-profit organizations and local governments that can exemplify the positive impact of healthcare IT on population health.

From Grants.gov, Recovery Act – Beacon Community Cooperative Agreement Program :

Selected communities must already be national leaders in the advancement of health IT, workflow redesign and care coordination, or quality monitoring and feedback. In addition, successful communities must have advanced rates of electronic health record (EHR) adoption and health information exchange (HIE), and the readiness to incorporate health IT to advance community-level care coordination and quality monitoring and feedback.

Seriously? The way to advance healthcare for communities, to help “communities to build and strengthen their health information technology (health IT) infrastructure and exchange capabilities to demonstrate the vision of the future where hospitals, clinicians and patients are meaningful users of health IT…,” is to give more money to those folks who already have money and support? They’re saying the answer lies in encouraging those things that have trudgingly brought us to our current quagmire of NHIN limbo?

This then implies that those 2,000 or so small communities across the U.S. with their associated small community hospitals where 60-70% of American’s receive their healthcare, most of whom have little to no HIT and little to no HIT funding support, are again left standing beside the table, starving, watching those who already have been tossing down giblets and gravy get fed yet again. All the while, there they stand, hunger pangs piercing their bellies, as they watch another course of fat and feast go to those who’ve already eaten while the hungry wonder where they might catch a cast off crumb or two.

No consideration for a new way to advance community healthcare integration? No promotion of novel thinking and innovation for community HIT? No “let’s encourage some disruptive shake-up for this semi-stagnant industry” to encourage new adopters and new connectors?

Maybe in my little foxhole here on the frontlines I’ve missed something, but darned if it makes any sense to me to take ARRA monies and consistently push all of them out to the “already haves.” If they already “had it” sufficiently, wouldn’t we already be seeing the integrative fruits of their labors? With so few really grand success stories in the world of CHINs and RHIOs and HIEs, what is the logic that says throwing more free (i.e., taxpayer) money at them will provide them their long sought spark?

Kathleen, David, I hereby offer my two-cent suggestion: There are lots of small communities who could use that money and I know of several disruptively innovative, out-of-the-container thinkers who might really send HIT integration to new levels for all us little guys if somebody would provide them a seat at the banquet. (They eat very little and would even help with the dishes.) How about a helping hand for the “have nots”?

From the (hungry) trenches…

“I’ll be more enthusiastic about encouraging thinking outside the box when there’s evidence of any thinking going on inside it.”  – Terry Pratchett

PS – Thanks, Shabbir.

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 throughhttp://madisonpediatric.com or doc@madisonpediatric.com.

News 12/17/09

From Much Ado: “Re: free Cerner EMR. I got Cerner EMR ‘almost’ for free from my hospital. Less than a year into it, I realized that I couldn’t afford the inefficiencies of ‘free’ and ended up buying another system. Best decision I’ve ever made. I wish the winner good luck.” On HIStalk, Mr. H compares the giveaway to “free kittens” that no one wants.

KLAS announces the best healthcare IT software vendors. Epic is the big winner in multiple categories, including EMR and PM in the 100+ physician market. Other winners in the ambulatory world include eClinicalWorks and Greenway for EMR; and McKesson, Greenway and athenahealth for practice management. In addition to eCW, Greenway, and McKesson, a number of other HIStalk and HIStalkPractice sponsors made the list including Eclipsys, Wellsoft, Nuance, CareTech Solutions, and Hayes Management Consulting. Congrats to all.

A trio of healthcare IT companies announce new applications for mobile devices. 3M Health Information Systems releases 3M Mobile Dictation software for its Mobile Documentation System, giving physicians access to patient data on their smartphones. Amcom Software’s Mobile Connect application allows clinicians and staff to use BlackBerry devices for messages and critical codes. And, Halfpenny Technologies introduces ITF-Mobile, which allows physicians to securely access test results.

SynaMed announces a free HIPAA-compliant patient-to-doctor messaging system that works with its free EMR and PM systems. Reading the fine print on the website, it looks like in addition to the “free” stuff, SynaMed also offers upgraded packages that include software hosting (for $358 a month per provider plus $20 per staff member, you can get EMR/PM and hosting). Unlimited e-mail support is $1,500 a year and support “training” is $85 an hour. When you add it all up, it sounds a bit like getting four free tires, but needing to buy a car if you want more than a tree swing.

ONC accelerates its timetable for rolling out health IT regional extension centers (HITRECs), planning to announce 30 grants on January 21 and another 40 or so in March. Sounds like a good move, given the amount of work that needs to be done in short order.

The computer scientist who wrote the iPhone application iStethoscope says he did it as, “a bit of fun,” and has been astonished by its success. The app, which allows heart sounds to be recorded and e-mailed to other doctors, sells for $.99 and many cardiologists consider it superior to $3,000 digital stethoscopes. That being said, on the iTunes app store, users give iStethoscope an average of two stars out for five.

Culbert Health is conducting a series of EHR workshops on behalf of BCBS Massachusetts. Keith MacDonald, Culbert’s director of strategic services, is leading the sessions that are specifically designed for the needs of smaller practices and cover everything from funding and practice readiness to vendor selection and physician adoption. More details here.

Cerner says it will offer Certify Data Systems’ HealthDock appliance to facilitate bi-directional clinical information sharing between providers, labs, hospitals, and other care settings.

Next time a Pfizer sales rep is in your office, check out the company-issued tablet PCs. Reps will use the devices when requesting drug samples for doctors, choosing the doctor on the screen, which then displays a list of appropriate products for sampling. Pfizer has a mighty big meaningful use incentive: the company paid a $2.3 billion fine for illegally marketing its drugs to doctors, so Uncle Sam wants to keep an electronic eye on them.

Most physicians believe that HIEs would improve quality of care, reduce costs, and save time. Despite the benefits, this survey of 1,000 physicians didn’t find a single doctor willing to pay $150 a month to connect to an HIE. Half of the doctors believe access should be free.

A study of mental health professionals finds most believe electronic records were clearer and more complete than paper records, though not necessarily more factual. A whopping 83% said that if they were a patient, they wouldn’t want other healthcare providers to routinely access their mental health records.

Speaking of mental health, here’s a shocker: teens are more likely to talk to a computer than people. Adolescent patients using a hand-held device to input medical information were 24%  more likely to have a follow up medical visit and six times more likely to get care for behavioral problems like substance use or depression.

Daniel J. Kohl resigns as CEO of the struggling Spheris, a medical transcription service company. The company reported a 15% drop in revenue the first half of the year and ended its registration with the SEC in November. Likely adding fuel to the fire was the company’s poor showing in last week’s KLAS report on medical transcription service vendors. Amid customer complaints that Spheris was unable to resolve quality and technology issues, the company was ranked last in a field of 15.

Hanukkah Wishes.

News 12/15/09

From: D. M. Bennett “Re: Seeker of Truths Comments. Review of ARRA funds status will demonstrate that dollars are being dispensed by the Regional Health Centers, as widely publicized by Sebelius and Biden – the dollars seem to be going to pay for assistance in ‘selection’ and ‘infrastructure.’” And thus not exactly being handed over to providers to purchase EHRs, despite what a few unscrupulous vendors may be suggesting. Speaking of the RHCs, no one should underestimate the potential power these organizations will wield over the next couple of years. If I were an EMR vendor, especially one catering to primary care, I would want to become BFF with every one of them. Those vendors overlooked by (or out of favor with) the RHCs may find themselves struggling for survival.

From: Scrooge “Re: AMA concerns. I suggest you may be too ‘willing to believe’ in the ‘heart’ of the Physician – just wait until the Reform Bill kicks in with its full complement of ‘panels’ and some bureaucrat’s definition of P4P gets pushed down – there won’t be any time for that ‘heart.’”

Here’s an option for providers wanting an EHR but don’t want to pay for it. CDW Healthcare and Cerner are launching the Tech Rx Transformation Contest, offering physician practices the chance to win a $50,000 EHR solution, including implementation and support services. To enter, practices may submit a description about why their practices needs an EHR or PM system. Deadline is January 22nd.

Greenway, NextGen and Pulse all receive CCHIT 2011 Ambulatory EHR certification.

Business journalist and blogger Dana Blankenhorn predicts 2010 will be a year of serious buying for EHRs, lots of implementations, sector job growth and some big mergers. The experts (or optimists) have been saying that for years, but, this time I think it’s a pretty safe bet.

That being said, a new study concludes that EHR systems often fail to achieve expected gains in healthcare efficiency. A Milbank Quarterly report looked at EHR projects around the world and determined: EHRs do often increase auditing and billing efficiencies, but decrease efficiency in clinical work; full interoperability may never occur; paper records are more flexible for clinical work; and, small, local EHR systems tend to be more effective and efficient, compared with larger systems.

UCSF Professor Dr. Robert Wachter evaluates the health IT industry and gives it an overall C+ rating. Quality Systems (NextGen) and eClinicalworks were the highest-rated ambulatory-specific vendors, earning at least a B.  GE, Cerner and McKesson received the highest marks.

‘Tis the season to do good works, and the team at Hayes Management Consulting is doing its part. Hayes has opted to forgo traditional holiday cards and instead donate to the Toys for Tots Foundation and Susan G. Komen for the Cure. Far better than a card.

Meanwhile, CollaborateMD and its founder/CEO Douglas Kegler have led his company and employees to make donations to dozens of organizations this year. At the beginning of Q4, Kegler committed to make a donation on behalf of every single employee to the charity of the employee’s choice. In addition, CollaborateMD offered 100% matching gifts for all employee contributions. Well done.

The Healthcare Authority for Baptist Health (AL) purchases McKesson Practice Complete to handle physician billing and claims management for its employed physicians. Physicians will also use the McKesson-hosted Horizon Practice Plus PM system.

meridianEMR and LABORIE MEDICAL announce the integration of LABORIE’s urodynamic test results directly into meridianEMR’s urology-specific EMR.

The Justice Department says that healthcare fraud remains a key target of the federal False Claim Act, and the government is stepping up enforcement. A healthcare attorney warns physicians that going forward they may have to do more due diligence in their billing and business activities. For example, physicians now face false claims liability for failing to disclose or return overpayments promptly to the government. A reminder that despite all the buzz about EHRs, a strong practice management system remain essential.

E-mail Inga.