Intelligent Healthcare Information Integration 8/22/09

The Over/Under of EHRs

If you be a betting man or woman, you know the over/under is a wager made relative to some predicted number or stat for a given game, series, team, or player. The bettor guesses whether the actual result will be higher or lower than the predicted number, wagering accordingly. The classic example is the combined score for a particular game, say a football game, where the bookmaker predicts the combined final score for both teams and gamblers ante up on either a higher or lower alternative. (Just one of so many great ways to bet your booty away!)

While considering an Over/Under for EHRs, I realized that many EHR vendors have an entirely unrelated set of “overs” and “unders.” Thus, the Over/Under of EHRs:

• Overpromising: EHR sales folks are known far and wide for promising that their system will not only meet your every EHR need, it’ll clean your windows and some will reportedly make toast.
• Underdelivering: Many EHR end users have dirty windows and their bread grows mold waiting for the heat.
• Overcrowding: Crowdsourcing is a powerhouse for innovation and development, best by invitation, not demand. It is not a replacement for first solidifying a product for an optimal end user experience. For EHRs, it should be used to create finesse, not rework clumsy development.
• Underdeveloping: See “Overcrowding.”
• Overestimating: The real pace of “go live” for many practices is far slower and the time to “fully live” often far longer than vendor rep guesstimates.
• Underestimating: Tech heads think their in-depth understanding of the geek world somehow elevates them above the lowly techno-illiterati. The illiterate can learn; the arrogant will find humility a much steeper learning curve.
• Overasking: EHRcos, break your molds! Stop asking only each other what works. Ask outside your boxes.
• Underasking: Don’t EHR developers want to know what motivates and inspires the not-yet-adopted, their largest market target? While it’s always easier to ask those who speak your language, it doesn’t always lead to the insights of “cross-culturalism.” Talk to non-users, not just the techheads. (Also, see “Overasking.”)
• Overextending: More installs means more profit, regardless of the actual support personnel per user ratio. VC pressure may often have a role.
• Undersupporting: Take a lesson, EHRcos: Call Godaddy.com support. Bob Parsons may be rather sexist and not everyone’s cup of tea, but the man understands how to take care of customers.
• Overcharging: Just as so many gripe over the excesses siphoned from our healthcare dollars by insurance company middlemen, many EHRcos seem bent upon oversucking the same marrow.
• Undereducating: With all the grand tools available for training these days (live web conferences, “easy bake” high def video creation, eReaders, etc.,) it amazes me how many providers will agree to a week or two of onsite “education” for something as complex as total workflow redefinition.

OK, time to play bookmaker. Using the 80/20 Rule, if we say 80% full adoption of 80% of available digital utensils, I’ll propose (somewhat from my hiney) the Over/Under for EHRs: 2015. Ladies and gentlemen, place your bets.

I think that only daring speculation can lead us further and not accumulation of facts. – Albert Einstein

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 8/20/09

Healthcare IT coordinator David Blumenthal e-mails a letter promoting EHR as a critical element for healthcare transformation and urging support for the ONC’s work. “As a primary care physician for over 30 years, I spent the first twenty shuffling papers in search of missing studies and frequently hoping, during middle-of-the-night emergencies, that I knew enough about patients’ medical histories to make good decisions.  All that changed when I began to have access to patients’ electronic medical records.  It made me a much better doctor.  I would never go back, and neither would the vast majority of American physicians who have made the leap into the electronic age.”

Over 2,500 GE Healthcare employees from the Milwaukee area are volunteering to help paint, clean, organize, and provide landscaping for local schools. This is the 15th year GE has participated in this single-day volunteer event.

Iowa physician Dr. Jim Selenke offers this sound advice for physicians installing EHRs: become your own technical specialist. “Any physician who has used a computer and is patient and willing to watch and listen to instructions can easily maintain a system.”

Marshfield Clinic (WI)  receives a $13.8 million Medicare bonus after demonstrating significant savings in a CMS Medicare demonstration project. Marshfield showed it was able to improve quality of care at a lower cost than other other regional providers. The clinic’s medical director claims EHR was one ingredient necessary for success.

MD-IT, a provider of medical documentation software and services, acquires the medical transcription unit of Moretti Group. MD-IT now has 12 offices across the country and serves 6,000 physicians nationwide.

Former A4/Allscripts executive David Bond gets out of healthcare to develop a social networking site for teen athletes, earning kudos from former boss John McConnell (who did the same, now running his string of high-end golf courses).

Practice management and RCM provider Avisena announces a 148% increase in quarterly profits, compared to the same period last year.

Caritas Christi Health Care (MA) sells off its physician-office laboratory business to Quest Diagnostics. The deal includes an agreement to link Caritas’ EHR to a shared information exchange so physician practices can access Quest-processed test results.

United Healthcare and the state of Colorado introduce a new telehealth program to help physicians connect to rural and underserved areas.The Connected Care program anticipates facilitating 4,800 specialist visits per year, using a combination of audio and video technology.

MDeverywhere plans to market provider credentialing services, coding audits, and related consulting services from DoctorsManagement.

Tenet Healthcare contracts with physician rating service DrScore.com to provide patient feedback on 185 of its doctors. Dr.Score will collect and analyze online data from patients across three physician networks. Tenet may bring on an additional 185 doctors in the fall.

PM/EMR provider Sajix announces its own “STIMULUS INCENTIVE” program for existing HIT providers and physicians. The company provides few details in their press release, other than to say it provides an “incentive” to the doctors replacing current PM/EMR products with Sajix’s products. However, since the company uses all caps when referring to the program, you have to assume it’s a great deal.

HealthGrades claims it’s the #1 doctor-ratings Web site by an “enormous” margin. The site receives more than seven million individual visits each month and currently includes more than 900,000 patient surveys of doctors.

3M introduces an electronic stethoscope that uses Bluetooth technology to wirelessly transfer body sounds to software for further analysis.

The AMA offers tips for reducing the expense of accepting credit and debit cards. Physicians are encouraged to shop rates, negotiate lower rates, and pay attention to added fees. With typical rates around 2% to 5%, practices can keep costs at the low end by having processors bid for their business.

Americans are living longer than ever, according to the CDC. In 2007, the average American lived to 77.9 years, up from 77.7 the year before. Women still live longer than men (80.4 years versus 75.3 years for men) but the gap is narrowing (7.9 years for difference is 1979 but only 5.1 years today.)

NextGen Healthcare reports that over the last few months 12 community health centers have selected NextGen’s EHR and PM solution.

E-mail Inga.

News 8/18/09

HealthPort files for a $100 million IPO under the Nasdaq exchange. HealthPort was formed two years ago with the merger of SDS and Companion Technologies and last year merged with ChartOne.

Atlanta Women’s Specialists promotes its on-line services that include patient access to their personal medical records. The 11-provider group also encourages direct e-mail access with its physicians. The practices utilizes Allscripts Professional EHR.

Pediatrician Dr. Wendy Frieling joins IT service company PHNS as a regional account executive supervising the delivery of the company’s IT and business process services.

Ophthalmic Imaging Systems posts $2.9 million in net revenues for the 2nd quarter, compared to $3.2 million a year ago. The net loss for the quarter was $4 million, compared to last year’s $400,000. The company blames the revenue decline on lower sales and the loss on increased debt following its merger with MediVision.

A Florida medical magazine covers the history of EMR vendor DoctorsPartner, which says its PM offering was Best in KLAS 2007 and its EMR #2.

Dartmouth College plans to use a $3 million federal grant to develop a telehealth system to monitor patients through mobile phones and wearable wireless medical sensors.

Cielo MedSolutions selects Medfusion’s patient portal solution for use with its disease management patient registry. Cielo will integrate Medfusion’s portal solution to notify patients they are due to schedule a preventative or disease management appointment or to follow-up on a ordered test or procedure.

Over 600 participants traveled to Austin, TX last month to attend e-MDs 5th annual User Conference & Symposium.

You knew someone was bound to offer a “Cash for Clunkers” program for EHRs. MedPlexus offers a stimulus package that grants payments for $3,000 to $5,000 for doctors who replace their previous EHR and/or practice management platform with MedPlexus’ SaaS solution. Creative marketing (sort of) though I wonder if the program really offers pricing that is all that special.

Senators Mark Udall and Kay Hagan introduce a bill to address the shortage of primary care doctors in rural communities. The Rural Physician Pipeline Act would give medical schools resources to establish or expand rural training programs, including recruiting students from rural areas who desire to practice in their hometown or other rural communities.

The Oregon Health & Science University is addressing the physician shortage problem from a different angle. OHSU’s Physician Re-Entry Program is designed to help doctors coming out of retirement re-qualify for licenses. A dozen doctors have completed the program since its inception in 2006.

It’s clear from Friday’s excellent recommendations to HHS by the Certification and Adoption Workgroup of the HIT Policy Committee that they want major changes made to EHR certification. Some of the high points:

• HHS certification (notice they didn’t call it CCHIT certification) is not intended to be a seal of approval.
• A new certification process should be developed that focuses on Meaningful Use rather than specific functionality points (that change will let specialty EMR vendors certify their products).
• Certification should include all privacy and security policies that are in ARRA and HIPAA.
• New highly detailed interoperability and data exchange specs should be created.
• “Test harnesses” should be created so that providers can test their own software.
• Multiple certification organizations should be allowed, with NIST accrediting them.
• ONC should define certification criteria, not the organizations performing the certification testing.
• Certification criteria will be updated no more frequently than once every two years and certification should be good for four years.
• “Lock down” requirements should be eliminated to level the playing field for open source systems.
• Since Meaningful Use definition is imminent, HHS should create a preliminary certification that would be valid through 2011.
• Interesting quotes: “There has been criticism that CCHIT is too closely aligned with HIMSS or with vendors. While we did not see any evidence that vendors were exerting undue influence on CCHIT, we also understand that the appearance of a conflict is important to address … Most vendors advocated for a minimal approach to certification, complaining that CCHIT has ‘hijacked their development effort’ and that they are developing features/functions that nobody will use.”

The takeaway: if the recommendations are accepted, CCHIT’s role will be diminished and shared with other certification bodies, none of which will be allowed to create certification criteria; certification will move away from a detailed product design to focus instead of how EHR products are used; and CCHIT cannot shake its reputation for being controlled by a few big vendors and HIMSS. It’s pretty clear that CCHIT may well have an ongoing role in the government’s HIT policies, but not at the level of influence it has enjoyed until now. Finally, someone says no to HIMSS.

E-mail Inga.

News 8/13/09

As many as 45,000 office-based physicians who participate in Medicaid and use EHRs could collect as much as $63,750 through the ARRA stimulus plan, according to a new report. The researchers recommend that if you can qualify for the Medicaid funds, you are probably better off. You must have at least 30% of your patients enrolled in Medicaid and use your “certified” EHR in a “meaningful” way. The Medicaid program allows physicians to collect $21,250 in 2011 at the program’s start, then earn an additional $8,500 annually for the next five years. That’s a better deal than Medicare, which rewards early adopters, then pays smaller incentives in subsequent years.

MGMA members say their top concerns and struggles are dealing with operating costs rising faster than revenue, maintaining physician compensation despite reimbursement declines, and selecting and implementing an EHR. Interestingly, medical practice managers ranked these same three issues at the top of last year’s survey. Other big concerns centered around patient collections, uncertain Medicare reimbursement rates, recruiting physicians, and negotiating payer contracts.

Health Care Partners, an FQHC in South Carolina, adopts Visionary Healthware for its EHR, PM, and LIS solutions. Health Care Partners is a 12-provider practice with four locations.

RelayHealth partners with Identity Force to help clients comply with the FTC’s upcoming Red Flags rule. Identity Force’s software identifies suspicious activity involving Social Security numbers and other identifying information.

If you are a  community health center, Happy National Health Center Week. Who knew that such a thing existing? Sage Healthcare obviously did as they are offering volunteer assistance at community health centers throughout the country. Sage employees are lending a hand at six different health centers this week.

Family physicians now have their own social networking site, thanks to the AAFP and their subsidiary TransforMED. Delta-Exchange is a virtual, online learning community that is available to primary care doctors for $30 a month. The site includes online discussions, interactive Webinars, practice improvement articles, and customizable policy and procedure forms.

What to do if a you are a doctor and your patient wants you as a friend on Facebook? What is ethical? What follows HIPAA guidelines? Information Week discusses the dilemmas healthcare providers face as social media become more mainstream. Here is an insightful comment: “We had these same conversations 10 or 15 years ago about the Internet. As the Internet became ubiquitous, people wrote articles about whether medical groups should have Web sites, and whether doctors should have e-mail. Now, it’s taken for granted, as they should.”

A Minnesota chiropractor is sued by the state attorney general for fraudulently pushing high-cost credit cards onto patients, then pre-billing them for thousands of dollars in treatment. The clinic may have obtained high interest credit cards for as many as 150 patients, a good number without patient consent. The clinic is also accused of inflating patient income figures in order for them to qualify for the cards.

The medical profession is not recession-proof, at least according to this Ohio State Medical Association study. The report found that 70% of the 559 medical professionals surveyed claim their practice had seen either a decrease in business, or, an increase in the number of cancellations. A whopping 92% said they seen an increase in patients having lost their health insurance from the period of October 2008 and June 2009. Most practices also noted that more patients are having trouble paying their bills.

Suncoast Medical Clinic (FL) selects Learn.com to deliver online courseware and managed training services to its employees and customers. Suncoast is comprised of over 50 physicians serving six locations.

Individual and family health savings account balances increased in the first quarter of 2009, which is the first time since Q2 2008. Employer and employee contributions to HSAs nearly doubled quarter-over-quarter. Individual and family account holders age 51+ hold the highest average account values.

Get ready for the deluge. The pharmaceutical industry authorizes lobbyists to spend about $150 million on TV ads supporting healthcare reform. To give you an idea of what $150 million will buy, consider that the Obama campaign spent $236 million on TV advertising during the election, and McCain spent about $126 million. Obviously the drug makers stand to gain millions of new customers and millions more dollars if healthcare coverage is expanded.

E-mail Inga.

News 8/11/09

Patients with cardiac disease  who kept in touch with their doctors via electronic health records were able to maintain healthy blood pressure and cholesterol two years after being discharged from a risk reduction. This Kaiser Permanente study concluded that electronic reminders and direct physician counseling were equally effective in maintaining healthy cardiac risk factors.

Last week we ran an excerpt of a letter from a physician frustrated with his EMR implementation. Since that time, we’ve heard from the EMR vendor, who was thankful we filled them in on the situation. Here is what the vendor shared with us: “We have been in contact with the customer and have been told that the project as a whole is doing well. In fact, 80 percent of the implementations are complete. We are committed to our customers and we work closely with them  to make sure they can optimally utilize the system.” Kudos to the vendor for trying to address the issue quickly. As to the critics who suggested we were siding with the vendor and blaming the victim, let me re-iterate my comment that just about any vendors’ name could be inserted into the letter and, sadly, the story would be similar. There is not one EMR on the market today that addresses workflow issues to the satisfaction of all uses. Almost all practices suffer productivity losses for several weeks after going live. Salespeople, of course, don’t like to highlight the negatives. If there were a vendor who had figured out all the issues, that company would surely dominate the market. Instead we have hundreds of vendors and just a handful at the top.

Noteworthy Medical Systems adds Louisville, KY-based MedX12 as a sales and service partner.

Digital consults are on the rise, especially as insurers like Cigna and Aetna agree to cover their costs. About 20,000 physicians now use RelayHealth’s webVisit and typically receive $25 to $35 per online visit; patients also pay a co-pay of about $10. Patients with no insurance usually $25 to $45 for the service.

Mr. H recommends checking out this interview in the Journal of New England Technology. eClinicalWorks president Girish Kumar Navani predicts his company will see a 20-25% impact from the economic stimulus, and that it will take 5-6 years to evidence itself. Great answer to the question of whether he wants to take the company public: “No. There is no question about it. There’s no way I would kill my freedom to be shackled by reporting to Wall Street every quarter … I think going public is like the hangover after a night out. You really feel good about it the day you go public, and then after that it feels like a hangover — and it never stops.”

Healthcare employment grew by 20,000 in July, including 9,600 new jobs in the ambulatory care sector. The national unemployment rate, by the way, is a dismal 9.4%. Over the last past year, the number of health care jobs rose from 13.3 million to 13.6 million.

EHR Scope explores why EMR adoption is still slow, despite the HITECH Stimulus Act. The primary issue seems to be that doctors are taking their time researching vendors because they don’t want to risk purchasing a system that won’t qualify for stimulus money. Of course it doesn’t help that we likely won’t know until January 2010 the final definitions for “certified EMR” and “meaningful use.” The author of the article suggests physicians purchase a simple, flexible, and inexpensive EMR that fulfills their needs and conforms to meaningful use requirements, and to avoid unnecessary features. Perhaps. Then again, I wonder if physicians who are on their second or third EMR would agree that this is the best strategy.

Interestingly, this study finds that EMR adoption is ramping up as a result of the stimulus plan. Providers are increasing their focus on implementing systems in time to qualify for funding.

Nuance Communications, the maker of Dragon Medically Speaking and other speech technology products, beat analysts’ expectations for its fiscal third quarter. The company posted a quarterly net loss of $1 million, compared to a  $9.9 million during the same time period last year. Total revenue grew 11% over last year, led by a 27% increase in Nuance’s healthcare and dictation revenues.

E-mail Inga.