Intelligent Healthcare Information Integration 8/10/09

Drink To Me Only With Thine Eye(s)
or The Window to the EHR Soul

I’ll betcha Ben Johnson, back in 1616, never dreamed his sweet, though somewhat melancholic “To Celia” would ever become the basis for the musings about a relationship with a machine. Yet, here it is almost 500 years later and as I stare into the giant baby blue of the EHR with whom I have become so enamored (or at least familiar), that is the love song I hear swimming betwixt my ears.

It isn’t just the soulless machine or LCD whom I find myself adoring in virtual and intellectual romance; it is the essence within which drives my love and from which her true beauty derives. It is her spirit, her life force, her anima, her élan vital. It is her software GUI, from her EHR underpinnings, which inspires my adoration and supplies the muse to my mental poetry – for she, her eye, is beautiful.

The first thing that attracted me to her was her eye. Beautiful blue with gorgeous splashes of color, clear whites with few lines, and an aura of serene simplicity which almost belied the wonderful depth of her inner complexities. She was stunning. Still is.

She is still the only eye I want to look into every working day. She still fulfills most of my manly medical needs. The soul I see within as I am constantly drawn to her never-wavering gaze each day is still one of passionate concern trying to be my all, to meet my every desire. Her countenance still pleases my gaze, her eye still beauteous to mine.

But, just as with every great love, time and familiarity reveal undeniable cracks in the veneer of loveliness which first bedazzled completely. Not that she isn’t still beautiful and not that there is another out there who has caused my eyes to wander; it’s just that all of the promise, both implied and assumed, never quite matches fully with time-revealed reality. The talents presumed and the best-foot-forward finesse of the early infatuation days yield to the actuality of the true.

Will this beautiful eye, this rectangular optical window to the true soul of my EHR machine, ever fulfill all of my desires? Will she grow with the refinement of age and experience into the dream with which my mind’s eye beheld her when infatuation first flowered?

Or, will I join the ranks of the unfaithful, becoming enamored by the sultry lines and sinuous curves of a younger, newer beauty? Will one with the flexibility of youth and the promise of new love distract my eye from my first, now aging, love?

Frankly, I don’t know. Our cohabitation, after all, is solely at my discretion. I do know that it was love at first sight with my first EHR love. The beautiful GUI, her “eye,” drew me in helplessly. Her understanding of my needs was deep, but her visual splendor captured my soul. This was an eye I knew I could gladly gaze into daily for many, many years to come. (Others before – and most, so far, since – appear lifeless and cold and uncaring of my visual happiness.)

While many are perhaps far more pragmatically oriented, I believe beauty engages us all. If you’re going to spend years, perhaps a professional lifetime, gazing upon a quadrangular “eye” to your EHR machine’s soul, it should be a gaze returning pleasure and visual “vavoom.” Superior EHR GUI design can lead to love.

Talent hits a target no one else can hit; genius hits a target no one else can see. – Arthur Schopenhauer

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 8/5/09

Salinas Valley Memorial Healthcare System (CA) selects e-MDs to provide PM/EHR systems for its 200 affiliated physicians. The healthcare system will supplement a portion of the costs of the software, training, and support expenses for its community physicians.

RealMed is named exclusive clearinghouse provider for Adventist Health System’s physicians.

The State of Mississippi contracts with Shared Health to implement and operation an EHR and e-prescribing solution for the state’s 600,000 Medicaid beneficiaries. The free, Web-based EHR will be automatically populated with Medicaid data, including lab results, medications, immunizations, and allergies.

TrialX will release an iPhone application that gives doctors and patients the ability to search for various clinical trials.

Salesforce.com takes a minority stake in PracticeFusion. PracticeFusion also announces plans to offer a new PHR offering using Salesforce.com cloud computing platform. PracticeFusion’s EHR software is Web-based and offered free of charge to physicians, as long as they are willing to put up with advertising on their systems.

Consumer Reports, the granddaddy of rating services, is now supplying patient satisfaction ratings to hospitals and physicians. The Consumer Reports Health Ratings Center rates the overall patient experience, including doctor and nurse communication, room cleanliness, and hospital staff attentiveness.

Cuban-trained physicians are fleeing their country in record  numbers and settling in the Miami area. By some estimates, as many as 6,000 medically trained professionals have moved to the South Florida area in the last six years.

More physicians are asking patients to pay out-of-pocket costs at the point of care, versus weeks later after insurance pays. Physician offices are taking advantage of various software tools that calculate the patient-responsible portion based on deductibles and insurance plans. While many patients appreciate the convenience of point of care payment, this article cautions patients to compare their payment amount to the actual EOB in order to catch any inaccuracies.

Welch Allyn introduces an online tool to educate doctors on the benefits of device connectivity. New site here.

SRS announces that the 12-provider Chestnut Hill Cardiology (PA) has selected the SRS hybrid EMR for its practice.

We were forwarded a letter penned by a doctor who is frustrated with the transition to his new EMR. To summarize, the physician has been live for six weeks and is still seeing fewer patients; they don’t have time to enter all the past history information required; he and the other doctors are spending numerous hours working with the vendor to figure out glitches. He feels the vendor misled him about the system and its capabilities. He questions whether his experience is unique or if other practices feel the same way. We didn’t see the need to mention the vendor because frankly you could insert just about any vendor’s name and it very well could be applicable. Perhaps an enthusiastic salesperson skipped over some of the details — it’s been known to happen. On the other hand, moving to EHR is an overwhelming process and many of the smaller details are incomprehensible until you are actually in the midst of a go-live. It’s easy for assumptions to be made on the front end. It’s easy for buyer’s remorse to set in when things don’t seem to be working the way you envisioned. No one has created the “perfect” EHR and every vendor has room for improvement. However, I would tell this doctor to give the transition more time. Six weeks is not enough time to feel comfortable with an upheaval as huge as a move from a paper to digital office.

athenahealth reports its second quarter results, which included a 9% increase in profit compared to a year ago. The company reported $3 million in profit ($.03/share) and revenue of $46.7 million (a 42% increase.) athenahealth attributes the positive results to better sales, including an increase of athenaClinicals EMR users from 498 to 1,034 active providers. Results were in line with analyst expectations.

Featherstone Informatics Group is named the exclusive vendor for the American College of Cardiology’s practice-based quality improvement program, IC3 (Improving Continuous Cardiac Care.) Featherstone will coordinate the program’s EHR interfacing and data extraction process for practices across the country. Data will then be analyzed in order to report logarithms for benchmarking physicians and practice clinical performance.

Durham, NC internist Esther E. Poza, MD joins TSI Healthcare as the company’s chief medical officer, tasked with leading the company’s efforts help physicians adopt EHRs.

Proteus Biomedical Inc. is testing a miniature digestible chip that can be attached to conventional medication, sending a signal that confirms whether patients are taking their prescribed pills. A sensing device worn on the skin uses wireless technology to relay that information to doctors, along with readings about patients’ vital signs. Sounds way too big brother-ish to me.

E-mail Inga.

Intelligent Healthcare Information Integration 8/4/09

The Elegant Palm Pre Cereal Box Top EHR

Yep. Pretty happy with the new Palm Pre. Simple, nonetheless powerful. Stylish, yet practical. Hip, though perhaps not iHip. Zen, and so much so, that I quit maintaining my motorcycle.

But, regardless of the number of contemplatory eggs gracing Palm developer desks, it isn’t perfect. Battery life is abysmal unless you keep all the apps closed. This kind of diminishes the glamour of being able to keep a bunch of ‘em open and switch in and out at will. Of course, if you have a bunch of chargers scattered around, you can keep up and the new magnetic grab-n-go charger helps this. (Thank you, yet again, Mr. Tesla.) Still, I’m used to having my digital six-shooter on my hip and jumping about at will. Remembering to grab the little beauty when I run off to an emergency or bathroom break proves challenging.

Also, the Palm Data Transfer Assistant could use some work. You’ll find lotsa online tales of woe about Palm Desktop or Outlook data migration. (Thank you, Chapura PocketMirror.) Another noticeable weakness is Sprint’s cellular coverage, at least here in my little burg. Verizon had me covered and I could always hear you now. Sprint doesn’t want me getting calls in the surgery center or even sitting at my office desk. (I won’t bore you with why Sprint doesn’t want new business customers to have AIRAVEs to enhance their signal, but will freely give them to established customers – I have to endure crap coverage until them deem me worthy, I guess.)

Still, challenges and foibles aside, I realized the other day that I could pretty much do every common little computer thing I need from wherever I happen to be (within cell tower range.) This is phenomenal! The integrative nature of the Pre and the beyond-iPhone-friendliness of my new pocket-sized phone-calendar-contact database-camera-GPS locator-weather center-web browser-videocam-pager-planner-game system-younameit tool made me realize the future had hit. This was a, “Wow, I can actually do what I’ve always wanted to do,” light bulb moment.

Then, this morning, I was putting my Raisin Nut Bran cereal box away when I noticed the box top. Remember how cereal boxes always had that little semi-cut-out slit you had to punch open to stick the opposing flap’s tab into? Remember how it invariably would not be well cut and your attempt to pop it apart would, also invariably, lead to the little connector piece tearing such that the tab would never hold the flaps closed as intended? Well, some cardboard engineering whiz kid has figured how to cut the tab and its opposing flap indentation such that the punch is eliminated and my little box top stays untorn and closes right every time. Genius, though it took decades to discover.

So, a two-and-two flash strikes. That’s what I want from my EHR. I like my system well enough; it has lots of the gadgets and gizmos I need. The problem is it isn’t Pre slick yet. Close. Kind of like the difference between the Palm Treo and the Pre. Functional, but kludgy. Close, but still not quite brass ring worthy. Missing the box top simple solutions for functionality. I’m guessing many EHR users feel similarly. We know what we need, but no one has the truly elegant answer yet.

I would like to know if anyone out there knows the “Geniuses of the Box Top” and a couple of Palm Pre developers who might be interested in constructing the new Palm Pre Cereal Box Top EHR? To make the next generation EHRs, the ones we really need, it’ll take these types of Zen master geniuses, those who can make all the work underneath appear simple and elegant. Maybe I should ask Fred Astaire.

Where all think alike, no one thinks very much.   – Walter Lippmann

Postscript : Since submitting this piece, I came across a tremendous article, The EHR ‘killer app’, by Jeff Marion on EHRWatch.com. If you haven’t seen it, it is well worth a read.

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 8/4/09

Todd Park, co-founder and board member of athenahealth, is named CTO of HHS. He will resign from athenahealth’s board on August 10 and will divest his ATHN stock position to meet government service requirements. Park will report to Deputy HHS Secretary William Corr and will start on the job later this month. An athenahealth press release quoted him as saying, “My entire professional career has focused on developing technologies and services that can help our health care system work the way it should. I am extremely excited about the opportunity to help the Administration explore and catalyze new ways to improve the health status of the United States through the power of data, technology, and innovation.”

PracticeOne partners with the Connecticut State Medical Society-IPA to provide e-prescribing solutions to its members with no up-front costs.

Family practice physician Sterling Ransone testifies before the House Small Business Committee’s Subcommittee on Finance and Tax, asking them to consider legislation that would provide loan guarantees for physicians purchasing HIT systems. HR 3014 would guarantee 90% of loans up to $350,000 for individuals and $2 million for group practices, plus allow for a loan repayment deferral period of one to three years. Ransone, who was speaking on behalf of the AAFP, told committee members that without such a program, many family practice physicians would be unable to afford the upfront cost of EHRs.

Allscripts hosted its user conference last week in Orlando. The Allscripts Client Experience (ACE) brought in a  record 2,700 registrants for the event, which combined Allscripts clients and former Misys clients.

Speaking of Allscripts, Merge Healthcare announces that Allscripts has selected its Cedara WebAccess software application to “image enhance” Allscripts EHR solutions. The Cedara WebAccess portal will provide users a zero-footprint method of distributing medical images and reports.

Meanwhile, Merge Healthcare announces net income for $400,000 for the quarter ending June 30th. This compares to a $18.2 million loss during the same period last year. Second quarter 2009 revenues rose more than 15% to $15.4 million.

NextGen’s parent company QSI releases its earnings, which were below analysts’ expectations. The company reported a 21% increase in quarterly revenues compared to the same quarter last year, but net income declined 7%. Quarterly revenues were $66.6 million. Like other companies in this space, QSI says their sales have been impacted by delays in purchase decisions related to ARRA uncertainties.

I bet all these HIT companies are wishing they had some sort of cash for clunkers program that would spur providers to drop billions of dollars in less than a week.

Memphis Health Center and Church Health Center (TN) receive a $290,000 donation for telehealth equipment. The funds come from AmeriChoice, the TennCare branch of United Healthcare Services. Both clinics serve the under- and uninsured.

HHS Secretary Kathleen Sebelius announces that the Office of Civil Rights is now in charge of the enforcement and administration of HIPAA. Previously HIPAA oversight has been the duty of CMS, but Sebelius believes the change eliminates duplications and increases efficiencies in how privacy is protected.  Remains to be seen if the change will affect much of anything.

Officials from Medicare admit that Arizona senior citizens have been slow to enroll in a federal program that encourages them to store their medical histories on Google, Healthvault, or similar websites. Medicare and the Arizona Health-e connection say that adoption has been less than the estimated three to six percent of consumers nationwide using some type of PHR. Now officials are wondering whether or not to extend the $2.5 million project. One problem seems to be lack of EMR adoption by physicians: if the doctors aren’t using them, why should patients?

Larsen Billing Service, the country’s largest midwifery billing service, selects CollaborateMD to provide its hybrid SaaS practice management and billing software.

MD-IT cements its position as the largest company providing transcription services to physician offices with its acquisition of Transcription Prescription. MD-IT provides medical documentation services and software to 5,500 physicians nationwide.

The Boston Business Journal profiles the open business approach of eClinicalWorks founder and CEO Girish Navani. Long before social networking was hip, Navani encouraged an open and uncensored Internet site for users, which is now used by 5,000 doctors. My favorite quote, “You can go on our social network and write, ‘eClinicalWorks is terrible, the CEO is a moron’ and we say, ‘Thank you very much!’”  Gosh, I’m not nearly that tough, so please don’t post any comments like that on our sites. The article also notes Navani vowed six months ago to add 500 jobs over the next two years, although the company has only added 100 so far.

E-mail Inga.

Joel Diamond 7/31/09

More About Controlled Medical Vocabularies

I remain an advocate of structured data. I believe that it is the foundation for connected healthcare. As I have pointed out in previous posts, the art of medicine often rests on the nuances of communication. The patient’s chief complaint and the physician’s history of present illness can often tell a much richer story than drop-down lists and templates. We were taught in medical school to use the patient’s exact words whenever possible.

When I was in training, my fellow residents and I would often debate about the very best encountered chief complaint. Many of these involved malapropisms of medical terms used by patients in overcrowded emergency rooms.

It was not uncommon for women to complain of problems related to the “fireballs in my Eucharist” (fibroids of the uterus). Sometimes I think the gastrointestinal complaint of “die-a-rears” is more descriptive than the actual term (diarrhea), and certainly “sea roaches of the liver” seems more ominous that “cirrhosis”. One of my favorites, though, was a mother who was afraid her son might have a case of “smilin’ mighty Jesus”. It took me awhile to realize that she wanted me to rule out “spinal meningitis”.

The perennial winner chief complaint contest goes like this. An 85-year-old woman once presented to the clinic with “leaves growing out of my vagina”. Shockingly, physical exam confirmed this as true. Further history revealed that the poor lady had suffered from severe uterine prolapsed. For those less familiar with medical terminology, a pessary is a device that is inserted to hold up the cervix and uterus in order to keep it from “falling out”. This enterprising octogenarian decided to improvise and use a potato for this purpose. Potato… dark place… sprouts…. you get the rest.

My all time favorite (and true) encounter documentation would be completely lost of meaning (let alone humor) if it was documented with structured data.

Two seemingly unrelated traumas arrived within minutes of each other: a man with a severe laceration to his penis and a woman unconscious due to head trauma. The history of present illness is similar in both charts. The man and his girlfriend are “involved” on his kitchen table. Unfortunately for him, her poorly controlled epilepsy results in a grand mal seizure and unrelenting jaw-clamping. Frantic, he grabs a nearby cast iron skillet and whacks her on the head to make her stop. .. you get the rest.

Continuity of care and a patient-centered record are the holy grail of connected healthcare. Accurate and timely access to patient data is the foundation, but clinicians should not abandon essential storytelling just because of IT adoption. Documents, with appropriate free text, must be preserved, but … only when intelligently associated with overall workflow, can the art (and humor) of medicine endure.

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.