Intelligent Healthcare Information Integration 7/8/09

KISS, Please

Simplicity. As complex as healthcare is, if we try to add the density of technology to it, perhaps it is counter-intuitive to think of ‘simplicity’ as a key operating principle of the NHIN construct. However, I believe this is the must have nuclear core for the successful initiation of the broad masses of both consumers and providers to the adoption of healthcare information technology. It is also key to their subsequent and sustainable utilization of these tools.

Everyone who has been listening to the widely broadcast cachet attributed to HIT has at least some appreciation for the extensive list of advantages we all envision for our future digitally-enabled healthcare provision. Seeing what tech has done for shopping, banking, communications, social networking, political campaigns, and general information sharing, it is virtually impossible to imagine that such benefits would not also transcribe well into the realm of healthcare. Indeed, it is the very complexity of healthcare that makes it seem such a likely candidate for technology enhancement.

Therein lies the rub: We know what technology can achieve, yet we are seemingly overwhelmed by its application to so complex an arena as healthcare. We want all the benefits which we know it can provide, yet we are stymied by the vastness of healthcare as well as the currently available information technology solutions, most of which have trouble working and playing together.

I propose we let the big players continue to duke it out over who shares what with whom and how they’re going to solve their big center issues. I mean, while they have helped to push HIT along the past quarter century or so, they’re also the ones who have enabled the ‘silo-ization’ with which we are now hamstrung. They have oodles of money and should be the ones to fix the dilemmas they’ve enabled.

In the mean time, for the rest of us (consumers, small providers, ancillary healthcare delivery providers,) let’s do simple. Already familiar tools. Real, immediate value. Attractive, intuitive user interfaces. Internet as the backbone, no silos. Easy-to-use cell and smart phone push-pull data collection and dissemination apps. Work with the individual end user in mind, both consumer and provider – together, not separate. Important pieces first, add complexities as mastery grows. Small sips to start; avoid the overwhelming drink-from-a fire-hose phenomenon.

As John Gaule said, “A complex system that works is invariably found to have evolved from a simple system that works.” Couldn’t agree more.

Keep it simple, stupid? No…Keep it stupid simple.

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 7/7/09

From: Handy Man “Re: Should CCHIT-certification be required for EMRs? Perhaps the analogy ought to be that when I hire a contractor to build a house, I don’t mandate what tools they use…. Do I really care whether they use Craftsman hammers or 10 oz or 16 oz hammers? Or, do I care that the house stands up straight and level? I.E, let’s focus on goals of medical care, not just having technology to say we have technology.”

Executive Solutions for Healthcare, a developer and manager of ambulatory surgery centers, selects ProVation MD and EHR solutions for two of its facilities. Trinity Plaza Surgery Center and The Endoscopy Center of Lodi (CA) will utilize the ProVation solutions from Wolters Kluwer Health.

JL Software announces the release of The Handbook of High-Risk Obstetrics for use on Phones and iPod Touches. The $49.99 application covers all aspects of perinatal practice.

The Tennessee Medical Association sues a collection agency, alleging the company is fraudulently trying to take back reimbursements paid to doctors. Health Research Insights is demanding repayment from physicians, on behalf of its insurance company clients. The collection agency is demanding repayment for claims that in some case date back several years. The company accuses the physicians of coding visits at too high a level, a charge based on claims data and not actual medical records.

Metropolitan Health Networks (FL) selects eClinicalWorks for its nine internal medicine clinics.

A New Hampshire nurse files a class-action lawsuit against three Obama administration officials, claiming that the health IT provisions in the ARRA violate patients’ rights to privacy and violates HIPAA privacy rules. The suit seeks an injunction to prevent the distribution of the $22 billion earmarked for HIT.

The 12 providers at North Oaks Obstetrics and Gynecology (LA) select Sevocity EHR.

David Brailer says that the government’s lack of specificity about how stimulus money will be paid out to providers is hurting EMR adoption as potential customers wait and see. He also predicts that meaningful use criteria will be loose even if that dilutes the whole point of having them. “They’ll go for the big tent as opposed to a narrow solution. That’s not good policy, but that’s the politics of the matter.” The CNN article mentions EMR licensing expense and the potential use of VistA, quoting Medsphere CEO Mike Doyle in comparing the $9 million the State of West Virginia paid it for eight hospitals vs. the $90 million West Virginia University (which he incorrectly called the University of West Virginia) paid Epic. “If Obama is serious about this, he won’t be able to do it $90 million at a time.”

The AMA offers some strategies for practices wanting to reduce their carbon footprint. For example, turning off computers when not in use, offering follow-up consults via phone to reduce driving, and replacing film x-rays with digital.

Omega Medical Solutions (SC), a medical billing and consulting agency, selects Allscripts Practice Management and Payerpath solutions for its physician practice clients.

A St. Louis-area practice launches a program aimed at helping the uninsured and stimulating the local economy. The seven employees of Baker Medical Group were given $300 work of $2 bills they could spend on anything. Employees can also give a $2 bill to an uninsured or unemployed patient, who can then redeem it for a free office visit. By the end of June, 20 patients had taken advantage of the program.

E-mail Inga.

News 7/02/09

The State of Texas will spend $7 million over the next two years to establish 30 telemedicine sites that will give Medicaid patients access to pediatricians.

About 6,000 patients of the Buffalo Medical Group have signed up for online access of their medical information in the past year. Epic MyChart costs the practice twenty cents per patient per month. Administrators are fans because they believe it provides patients better control over their health.

The folks at InteGreat let us know their EHR version 6.3 just received CCHIT 2008 ambulatory EHR certification. CCHIT bestowed 2008 certification to 14 products in June, bringing the total number to almost 70. Just suppose that the ONC does not make CCHIT certification a requirement to secure stimulus funds. Will there be as many products seeking certification for 2010?

Pentucket Medical Associates (MA) rolls out GE Centricity EMR in a remotely-hosted environment utilizing virtualization applications. Global Data Systems is hosting the Centricty software using InstallFree Bridge virtualization technology. Pentucket is a 400-provider, five-location multi-specialty group.

The AMA notes that more and more doctors are Tweeting, typically to extend their Web presence, enhance patient communication, expand their marketing efforts, and/or to communicate with their colleagues. Like most users, physicians tend to stop regular Tweeting within 30 days of creating an account. Will Twitter become a standard aspect of practicing medicine in the 21st century, or is it just a fad? The jury is still out.

A week-long computer glitch at Ohio’s state medical board kept 5,000 physicians from renewing their licenses online by the June 30 due date, forcing them to drive to Columbus to avoid having their licenses lapse. The medical board has extended the deadline by a week for those who weren’t able to renew.

I had my own computer glitch Tuesday. We are working on several new interviews with interesting HIT folks for HIStalk Practice and HIStalk. My recording software failed me in a very compelling interview with a physician who offered some excellent insights on using technology to improve quality of care. I’m hoping he’ll forgive me and give me a chance for a “do-over” so readers can learn his views on software usability, making better use of practice management software tools, and CCHIT certification (hint: he thinks it is irrelevant and unnecessary).

Three western NY health insurers hire HEATHeLINK to implement a program to get 500 physicians on EMR within the next three years. HEALTHeLINK will help select the vendor software packages that physicians can choose from and guide them through implementation.

In New York City, over 1,100 physicians are now participating in the city’s Primary Care Information Project (PCIP). Over $20 million in city, state, and federal monies have already been spent to subsidize eClinicalWorks systems for doctors serving Medicaid patients and the uninsured. Several hundred providers more are in the pipeline awaiting implementation.

Here’s a new service that leverages the growing telemedicine trend. DoctorsonDemand.com allows patients to connect with available doctors for short virtual visits via phone or the Internet. Patients are required to have an initial in-person visit with a participating doctor before being eligible for a Tele-Consult. Patients are billed $35 for each virtual visit.

The Children’s Hospital of Denver names Navicure the exclusive clearinghouse program for its PedsConnect program. PedsConnect is an integrated EHR/PM solution offered by Epic for use by pediatric providers in Colorado.

An overnight security guard at a Dallas orthopedic clinic is arrested for hacking into one of the practice’s computer and downloading malicious code in hopes of launching a massive computer attack by July 4, which the guard calls “Devil’s Day”. He goes by the nick “GhostExodus" when presiding over his hacker group, “Electronik Tribulation Army”.

The hacker actually seems pretty sane compared to this guy. I’m all for DIY projects, but the obvious question here is, “why?”

E-mail Inga.

News 06/30/09

The AMA and over 80 other physician organizations send David Blumenthal a letter expressing concern over the proposed timeline to demonstrate meaningful use. Some of the challenges noted are the lack of certifiable EHRs for certain specialties and the length of time it requires to fully implement EHR. Also at issue is the migration to HIPAA 5010 transactions and ICD-10.

Rep. Kathy Dahlkemper, chairman of the House Small Business subcommittee on health care proposes a bill to create a new SBA loan program to help doctors in small or solo practices to buy and maintain EMRs. The program would rely on private sector loans of up to $350,000 and $2 million for groups and be 90% backed by the SBA.

The local paper highlights Walla Walla (WA) Clinic’s conversion to Allscripts’ EHR. The 39 physicians paid more than $1 million in start-up costs but believe it is “the right thing to do.” The clinic CIO admits the EHR transition is difficult, saying, “It’s like changing the motor on the car while its driving down the road … and keeping it running good.”

A former business manager is sentenced to 40 months in prison for stealing almost $1 million from her ophthalmologist employers. The Pennsylvania woman submitted bogus payroll information, including claims of working 22 to 32 hours a day, seven days a week. She spent the proceeds on a $1.6 million home, luxury cars, and private college tuition for her children.

Small medical practices provide almost three quarters of the the ambulatory care in the US, according to a recent NCQA report. Smaller groups are more likely to lack the resources to improve quality of care, implement EMRs, and serve an increasingly diverse population.

EHR provider Sevocity announces the the availability of a no-charge interface to Austin Radiological Association’s (TX) radiology reports. In what appears to be a creative strategy to gain market share, Sevocity is offering the free interface to any of its clients. Austin Radiological operates 14 outpatient radiology clinics in central Texas.

The Wall Street Journal highlights the growing use of online communication between patients and physicians. RelayHealth and Medfusion are mentioned as companies offering interactive questionnaires that automatically generate follow-up queries based on the patient’s symptoms.

Two doctors and the former owner of two medical billing companies plead guilty to a money laundering, tax evasion, and fraudulent medical billing scheme to defraud no-fault insurance companies that provide medical benefits to motorists involved in collisions. Among other charges, the group pled guilty to concealing $1 million in income from the IRS.

Diagnostic Center of Medicine (NV) selects Allscripts PM as a replacement for its Misys practice management system. The 16-provider, three-location practice is also adding the Allscripts EHR.

The AHRQ considers the development of an electronic toolkit to assist small and medium sized practices change their workflow when adopting HIT. The AHRQ just issed an RFI to gather information on how clinics and physician groups redesign their workflow when adopting technology.

HIStalkPractice readership continues to climb, so thanks for tuning in. Make sure that you sign up for e-mail updates so you don’t miss a thing. And, if you have an interesting EMR story to share or know of a physician using technology in a creative way, let us know.

E-mail Inga.

Intelligent Healthcare Information Integration 6/27/09

A Willing Suspension of Magical Thought

Actors and playwrights know that “a willing suspension of disbelief” is essential for the successful acceptance of any fiction. Such faith allows us to enjoy the greatest of entertainment, be it Samuel Beckett’s “Waiting for Godot” or Matt Groening’s “The Simpsons.” Without a willingness to forego our skepticism and socially inculcated, rules-based orientation, we would forever be ingrained in a world of columns and rows and formulaic drudgery.

This is the essence of “magical thinking.” It allows us escape from our cubbyholed, preconceived mindsets. It enables flights of fancy, free association, and the perception of the possible. It is enabled from birth (genetically programmed?) as evidenced by watching any child at play. It allows us some of our greatest kidhood fantasies and fears. (Think: Santa, Tooth Fairy, Easter Bunny, Boogey Man, and all those monsters under your bed.) Magical thought allows magicians to amaze us and artists to enthrall us.

Unfortunately, that same ready power of mental delusion is what also allows us to believe that politicians really do mean what they say this time, that bankers really can self-regulate themselves adequately, that insurance companies are there for our protection, that technology can solve our healthcare crisis. It permits the fantasy that ARRA money will wind up helping heal healthcare and not just bulking the bankrolls of EHRco bigwigs and bolstering Insco bottom lines.

I love my fantasies as much as anyone. I would absolutely love to believe that information technology will put a period to my pen-and-paper-based problems, end my seemingly ineluctable non-electronic errors, provide instant access to the information I need as I need it, give me gobs of great evidence-based new brain power, and stop the shrinkage of my already skinny sliver of practice profit. However, I am unable to relinquish the disappointing deduction that the current rush toward IT as the “end all, be all, cure all” for healthcare is poorly planned at best and an impending catastrophe at worst.

For those who live and work in highly technical worlds, where the people you see daily are digitally oriented and adept, it is probably not an unreasonable reach to assume all things digital are possible. But, when I drive around my little corner of middle America, I see loads of folk whose electronic skill sets are likely limited to TV remotes and ATMs…at best. Where I work, I encounter colleagues who would love the aforementioned techno-advantages, but who barely have enough time to unravel the mysteries of CPTs and ICD-9s, no less the quandaries of an entirely new EHR-demanded workflow. Where I practice, I live the daily dilemmas of bringing the non-techno-literate along as we endeavor to navigate our way across the digital divide.

In considering this piece, I Googled “magical thinking” which brought me immediately to a great article by Gilles Frydman with comments and links to related pieces by such HIT notables as David C. Kibbe, Sarah Greene, John Halamka, and e-Patient Dave. Agree or not, all are worth a read, though perhaps the best, from the view of a grunt in the trenches, was a shorty by e-Patient Dave where he highlights the neglect of the everyman in this HIT stampede. 

I want this brave, new, digital world for healthcare as much as anyone, but authentic and concrete, with real value for everyone, not just the fat cats and CEOs. Let’s suspend the magical thought and deliver truly “meaningful use” to my neighbors, Joe and Josephina Sixpack, not just the technorati.

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.