News 6/16/09

Allscripts and Henry Schein enter a strategic partnership to market Allscripts Professional EHR. Under the exclusive agreement, Henry Schein will utilize its national medical sales force to market the solution nationwide. Henry Schein will also refer other Allscripts solutions on a non-exclusive basis.

Maine Governor John Baldacci signs a bill requiring health insurance providers to cover telemedicine services, including those provided via interactive audio, video, and other electronic media.

A Delaware man walks out of his doctor’s appointment, taking the doctor’s computer with him. A few hours later police arrest the patient after finding the computer in his basement. No word on whether or not patient paid his bill.

GE Capital announces a $100 million commitment to extend no-interest loans to providers and hospitals purchasing GE’s Centricity EHR. The program allows providers to defer payment until receiving government stimulus money, likely in 2012.

Several consultants point to EMR adoption as one of the keys to keeping a practice solvent through the recession. Though the up front expense is high and implementation can be overwhelming, EMRs are required to create the quality reports necessary for P4P. Perhaps, but plenty of doctors will still remained convinced that the costs outweigh the benefits.

VirtualHealth Technologies finalizes an agreement with Silk Information Systems to provide web-based EHR, RCM, and billing solutions with no up-front costs to its base of 1,500 medical practices, through VirtualHealth’s subsidiary Medical Office Software.

In Virginia, large medical groups continue to increase in size, as more doctors give up their independent practices. The trend is not unique to the area, nor are some of the reasons for joining bigger groups: more stability, less responsibility for day-to-day business operations and thus fewer hours. Lower overhead as costs for such things as billing, EMRs, and administrative functions are also a draw. Opponents of the trend fear quality may suffer.

An Indiana ophthalmologist and his wife are found dead at their practice, victims of an apparent murder/suicide. Dr. Philip Gabriele and wife Marcella were indicted last week on federal charges of health care fraud, wire fraud, and criminal conspiracy. The indictment claims the doctor falsely and fraudulently diagnosed cataracts in patients and performed unnecessary cataract surgeries. False claims were then submitted to Medicare, Medicaid, and private insurance carriers. The Gabrieles denied the charges and were suppose to turn themselves in the day they were found dead. No winners in this story.

President Obama addresses the AMA Monday, stressing the need for reform. Some of the speech covered old ground: the need for a comprehensive upgrade to EMRs, more focus on preventative health, and emphasis on cutting costs. Obama stressed he was against caps on malpractice awards (likely not popular with the physician crowd) and discussed his proposed “Health Insurance Exchange” program for the uninsured or for those that don’t like their current coverage.

Sixty-one percent of American adults now look online for health information, compared to 25% in 2000.

A physician shares her thoughts on how social media can expand the physician/patient relationship, as well as help patients and physicians widen illness support networks. A good read if you are already a social media-savvy doctor, or, one wondering if it is worth the investment in time and energy.

The Mayo Foundation for Medical Research and Education and former employee Dr. Peter Elkin are in the midst of a legal battle, with each suing the other party. At the heart of the issue is ownership rights and royalties for natural language software developed by the physician while in Mayo’s employ. The story involves a web of companies, including LingoLogix (a company we profiled on HIStalk) and Cerner (who later bought LingoLogix and has now filed its own lawsuit.)

Next year we hope to make this conference. Last week 350 medical experts and computer game professionals came together for the fifth annual Games for Health Conference. Highlights included games specifically focused on improving cognitive health and the use of gaming to change behavior. It’s just a matter of time before doctors begin handing out prescriptions for Halo 3 and Call of Duty.

An HIT Moment with … Steve Schelhammer

An HIT Moment with ... is a quick interview with someone we find interesting. Steve Schelhammer is CEO of Phytel.

Proactive Patient Outreach is a Web-based service that includes an electronic patient registry, a protocol engine based on nationally recognized guidelines for preventive and chronic disease care, and an automated messaging system that contacts patients who need services. Phytel provides a variety of management and physician feedback reports, and it helps practices qualify for pay-for-performance, PQRI, and medical home incentives. We also have a medical economics team that works with customers to help them analyze their patient population and improve the quality of care.

In contrast, practice management software merely reminds office staff when to contact particular patients for follow up, and those reminders are entered in the system only when physicians order it. What we’ve done is to systematize physician-driven population health management and to make recalls automatic instead of hit-or-miss. In that sense, we’re offering more than technology; we’re providing a health improvement service built around compliance, outcomes, and extending the influence of the physician beyond the visits that patient initiate themselves.

Last year CMS named Phytel a qualified patient registry for PQRI reporting. What does that mean for your average physician client?

What it means is that we can now submit PQRI data automatically from our registry, without physicians having to do anything or worry about which patients they should be collecting data on. It also saves staff a lot of time entering CPT II codes in their billing systems.

The administrative burden on practices was the main reason why only 16 percent of physicians reported PQRI data in 2007. They just didn’t feel it was worth doing the extra work to get the incentive. But in 2008, Medicare raised the incentive from 1.5 percent to 2 percent of charges, and it also provided an alternative method of submitting the data. If you use a CMS-approved electronic registry like Phytel’s, you only have to send in data on 30 consecutive patients with a specified condition—and only two of those need to be Medicare patients.

We extract most of the necessary data from practice management systems and electronic health records, including lab data if a practice has an EHR or a lab interface. Where required information is not in the available fields, our program prompts users to enter the missing data, such as whether a diabetic patient has had an eye exam.

What impact does the ARRA have on Phytel, both good and bad?

ARRA will be highly favorable to our company’s strategic direction in the field of population health management. The legislation requires “meaningful use” of EHRs to qualify for financial incentives, and it’s clear that part of that will be the ability to capture and report quality data. Today, few EHRs—including those with the latest CCHIT certification—have robust registry functions. So physicians will have to combine EHRs with outside services like Phytel’s in order to report performance data, unless they want to devote a huge amount of staff time to data entry or pay for custom reports to show meaningful use.

Also, EHRs do not include automated outreach and patient self-management capabilities. Even if they were combined with a commercial technology solution, they would still lack the ability to tailor the messaging to clinical protocols. It’s instructive that the majority of our customers have EHRs, yet had difficulty in reaching out to noncompliant patients before they used our service.

Physicians don’t need an EHR if they want to use Phytel to bring in patients for needed services. But to the extent that ARRA’s incentives encourage more physicians to adopt EHRs, I believe that it will increase the impact of Phytel. By enabling us to populate registries with more granular clinical data, the spread of EHRs will help physicians pinpoint the patients who really need help and get them to make appointments before their conditions worsen. And that will contribute to better outcomes for their patient population.

What trends are you seeing in regard to provider reimbursement and evidence-based medicine and where does Phytel fit in?

Physicians will increasingly be paid on the basis of their quality and their patient outcomes rather than the volume of services that they provide. While fee for service is still the predominant method of reimbursement, pay for performance and the medical home trend are already shifting a significant chunk of physician income to quality-based incentives. For example, California health plans paid out more than $200 million in P4P incentives to medical groups and IPAs from 2003 to 2007. And Blue Cross and Blue Shield of Michigan recently launched a program that will pay physicians who create medical homes a 10 percent bonus, starting in July.

A key requirement of both P4P and medical homes is that physicians must follow evidence-based-medicine guidelines. Most physicians think they’re doing that, but a broad body of research, including the Dartmouth Medical School studies on variations in care, shows that it just isn’t so. The study that really woke up everybody up a few years ago was the RAND report that revealed patients were receiving only 55 percent of recommended care, on average.

What the RAND study failed to point out is that many patients don’t receive the care they should because they don’t comply with their physicians’ treatment plans. This is a problem that Phytel can help physicians alleviate. By strengthening the physician-patient relationship, by helping doctors optimize the value of each patient visit, and by extending the communication between physicians and patients beyond the walls of the office, we give doctors vital tools for improving patient health.

Phytel is very interested in participating in the emerging patient centered medical home health improvement initiatives. The AAFP’s TransforMED project endorsed Phytel, and I’m on the board of the Patient Centered Primary Care Collaborative, which is promoting the medical home concept at a national level. The PCPCC has more than 400 members, including major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, and physicians.

Many health plans are doing medical home pilots, and some are rewarding physicians who have been recognized by the NCQA as medical homes. For example, Dr. Joseph Mambu, a Phytel customer who qualified for the top level of NCQA recognition, expects to receive a medical home incentive of more than $40,000 through a statewide initiative in Pennsylvania. Judging by the NCQA criteria, we believe that many other Phytel clients could use our service as a building block to qualify as medical homes.

What are some of the more unusual ways your clients are using Proactive Patient Outreach?

Many of our clients are focusing on particular chronic conditions, such as diabetes or congestive heart failure, that generate a lot of morbidity, complications, and costs. And some practices are customizing our protocols in very specific ways. For example, the Holzer Clinic, a multispecialty group in Ohio, has scheduled bi-annual callbacks for older patients with certain conditions, rather than using the four-month intervals recommended by some national guidelines. Holzer’s physicians are doing that because they recognize that for a lot of elderly patients, noncompliance is related to their inability to come in frequently for appointments.

A Midwestern healthcare system gave us very specific parameters to increase the number of patients who were getting recommended flu shots. The practice targeted higher risk populations, including children, adults over 50, and individuals with chronic conditions that would make them vulnerable to influenza complications. Phytel was instructed to contact these patients between Oct. 2, 2008 and Jan. 22 of this year. As a result of this intervention, the system saw a 15 percent increase in the number of patients getting flu shots compared with the previous year. The power of this approach was also shown by the fact that 15 percent of the older adults who were contacted received flu shots, versus only 4 percent of those who did not respond to our phone calls.

The customizability of our protocols is important to physicians. They don’t usually change very much in the national guidelines, but they like the ability to tailor the protocols to their own practice styles and the community standard of care. Pay-for- performance measures also vary somewhat from one insurer to another, so the ability to customize protocols to patients in different plans can help physicians obtain the maximum P4P rewards they’re entitled to.

The most important thing we do, however, is to enable physicians to do population health management at a very high level without diverting scarce resources from their other objectives. Health care is badly in need of technology that can automate the repetitive, time-consuming aspects of preventive care and longitudinal disease management, and that is what we provide.

Intelligent Healthcare Information Integration 6/12/09

Ficos and Inscos and Autocos and EHRcos

I don’t drive an American-made car. Sorry. Kind of wish I did as I’m a big fan of supporting the local economy, whether it’s that of my little community or that of my country. But, with the recent Detroit disasters, I’m not exactly feeling like the town idiot for my automotive purchasing decisions.

GM, Chrysler, and pretty much the whole gamut of American automobile companies are reaping their sown seeds of self-interest, self-righteousness, and strong-handedness. From the arrogance and disrespect shown as they invented and promulgated “planned obsolescence” to the shortsightedness of designing for short-term profit versus sustained planetary and population well-being, the U.S. car manufacturers (the autocos) are just now getting a taste of the comeuppance which they have for so long unwittingly (and perhaps dimwittingly) sought.

Too large, too little insight at the top, too light on listening to the real needs of the world around them has left many of these automakers reeling from real reality. (Didn’t you just love their scolding for flying in on private jets to ask for handouts?)

Looking at the US healthcare mess, a certain parallelism appears to be brewing. Healthcare insurance companies, inscos, have also grown too large. They are dictatorial in their manipulation of healthcare monies, Their lobbyists have long been far too powerful an influence upon our nation’s elected leaders. Their roles as guardians and watchdogs of healthcare monies have devolved into self-perpetuating protectionism. Their top-heavy, middleman, leech-like drain upon true healthcare priorities is becoming increasingly, obviously, unsustainable.

We’ve seen what this did for finance (ficos). How long before the healthcare inscos’ bailout funds become the Twitter topic du jour?

Well, if my eyes don’t deceive me, there appears to be another TBFTB (too-big-for-their-britches) phenomenon a-brewing. When it comes to healthcare dollars these days, probably only second to the inscos in financial watercooler conversations are EHR vendors, the EHRcos. (Indeed, they may be the top conversation piece as the inscos seem to be trying to keep their collective heads down.)

In the midst of the early stages of the predicted EHR industry consolidations, acquisitions, and small player demises, the ARRA/HITECH funds have promised to fertilize the growth of yet more egoistic behemoths. And, some of these large EHR vendors are starting to show signs of forgetting that, in the end, it’s the little people for whom they work, it’s the individual customer whose support and favor they ought to continually seek and curry.

Lest the bigger EHR players forget, behemoths are not indispensable. Remember such relative giants as TWA, Pan Am, Circuit City, Enron, Egghead Software, Coleco, Pullman Palace Car Company, RCA, and the Coca Cola Corporation? (I’ll let you look up that last one).

Just as the inscos started out to help consumers obtain affordable healthcare and keep care costs controlled, EHRcos started as grand ideas to help healthcare providers provide better care. If they are not careful, they will also follow the unfortunate footsteps of the TBFTB inscos and turn away from their genetic principles.

I really don’t want my grandkids having to also pay for the bailout of the NexEpiMisyCentricMcKeGEclipeCliniCernitech Conglomerate while still paying off Ficos, Autocos, Inscos, et al.

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 6/11/09

From Skeptic: “Re: industry growth. We’ve been hearing the pundits predict 20-30% annual growth for the last 10 years. As of the end of last year, only 4% of physicians were using a fully functioning EMR. So maybe vendors are selling more and the market is ‘growing,’ but I am waiting for proof that physicians actually have the real tools they need to reach an adoption tipping point.” Meaningful use, perhaps?

From iPhone fan: “Re: upgrade to the 3GS. You said you just upgraded to the 3G model. Apple has a 30-day return policy so you should just take it back and get the new one.” I spent 20 minutes today holding on the phone to speak to someone at Apple about my options and finally hung up. Guess I am going to have to drag myself over the Apple store and ask one of the geniuses there. Meanwhile, other iPhone users are angrily blasting Apple about the unfair upgrade pricing.

Dr. Chris Rangel, who blogs at www.RangelMD.com, details an EMR disaster story that resulted in the loss of several months worth of medical records. The short version is his three-doctor practice bought an EMR and an in-house server. The selected EMR “looked good on the outside but was a pile of feces on the inside.” Training was inadequate and IT support was incompetent. Ultimately the practice lost data because the backup was set up incorrectly. Dr. Rangel is now using an on-line EMR, which he thinks is the way to go if you are in a small or medium sized practice. He suggests that the main reason some doctors “set up complex in-office software and hardware configurations” is because they want want maintain control. Says Rangel: “Having a stand alone system will make as much sense as building a minipower plant in your back yard to provide your home with electricity instead of taking it off the grid.” His piece is humorous, in a tragic sort of way. However, I think he falls short with his recommendation that using a Web-based solution is the automatic answer. Software can be “a pile of feces” whether it is an in-house or on-line solution. Both type vendors may provide poor training and support. Regardless of the infrastructure, make sure you do plenty of due diligence, including talking to current and former clients.

Peter Orszag, director of the Office of Management and Budget, shows strong support for HIT at a conference earlier this week. Orszag stresses the need for more information tied to medical systems so that doctors and hospitals know what works and whether additional procedures are warranted. He believes IT is a requirement for delivering the necessary data.

iMedica’s EMR/PM solution wins an endorsement from the Physicians’ Organization of the University Medical Center at Princeton, a PPO with 500+ physician members.

A former hospital employee is sentenced to a year in prison for her unauthorized access of the medical records of an AIDS patient who was feuding with one of the woman’s friends. She posted the information on her MySpace page. The woman was only 20 at the time, but it’s a pretty sad to think how many stupid (and mean) people are running around in this world.

Vermont strengthens its already tough stance on gifts to doctors from pharma and medical device firms. No more free lunches, as all meals and travel expenses are banned. Gifts to prescribers are no longer allowed and any payments to doctors – regardless of the amount – must be reported to the state.

The Southern California Orthopedic Institute selects SRS EMR for its 51 providers.

Former Eclipsys CFO Bob Colletti is named CFO for e-learning vendor Learn.com.

New Jersey-area HIT vendors claim EMR interest is surging. Businesses anticipate a positive economic impact by the end of the year as ARRA reimbursement details are finalized.

Another Kaiser Permanente employee (a nurse) is accused of wrongfully peeking into the medical records of her son’s second grade teacher. The nurse claimed the teacher said something derogatory to her son, her husband sent a letter to the school board claiming she was unfit to teach, and (according to a tipster) the nurse then pried into the teacher’s medical records. The teacher is suing the nurse and Kaiser, charging conspiracy, negligence, invasion of privacy, and emotional distress.

The use of electronic clipboards at the Iowa Clinic has reduced patient check-in time from nine to three minutes, according to the practice’s CEO. Patients update their information using a stylus and computer screen rather than a pen and paper. Administrators at the 140-physician practice also believe the new process has resulted in more complete patient data, especially insurance detail. Each tablet costs about $3,000.

E-mail Inga.

News 6/9/09

On the rise: the number of immediate-care clinics. The trade group Convenient Care Association estimates that 1,200 such facilities are now operational across the country. This is in addition to clinics located in retail pharmacies. Meanwhile, many of the drugstore health clinics are expanding services to include injections, care for strains, and treating chronic conditions such as asthma and osteoporosis. Physician groups continue to voice skepticism.

The VA announces plans to allow researchers to use de-identified, aggregated data of veterans to pinpoint the most effective treatments for specific conditions, including post-traumatic stress disorder and antibiotic-resistant staph infection.

This study estimates that the 2008 market for EMR data transfer equipment and applications was $575 million, but will reach $1.6 billion in 2013. That’s over 23% a year growth.

Genesis Physicians Group (TX) signs an agreement with revelationMD to provide clinical integration to its 1,460 member physicians. Genesis will invest over $100,000 to implement the exchange technology. Between 60% and 70% of the providers will be able to access the service for free, while others will pay between $100 and $200 a year.

Last week we mentioned the medical billing specialist/community college medical billing teacher who was arrested for allegedly bilking her employer out of $157,000. Now a second practice has come forward and claims the biller, Catherine Yount, stole nearly $54,000. In both cases, Yount is accused of depositing insurance company payments into her account, rather than her doctors’.

Center Pointe Sleep Associates selects the ZMR software from SleepEx for its EMR and sleep lab management system. I had never heard of SleepEx, but it claims its Web-based EMR and lab management solutions are the most widely used by sleep diagnostic and therapy providers, installed in over 150 locations.

Apple announces its new iPhone 3GS, which includes some spiffy new enhancements over the previous 3G version. Now available: a digital compass, video, and voice control, plus a more speed and a longer battery life. The $199 price tag is the same as the 3G had been (although reading the fine print, I think the $199 price is only for brand new AT&T clients — existing clients will pay $499 for the same phone, which hardly sounds fair.) Meanwhile, the 3G version (which I upgraded to just TWO weeks ago) just fell in price from $199 to $99. Apple also released details of its new 3.0 software for the iPhone. Cut and paste, a landscape-mode keyboard, and improved search capabilities are some of the nicer enhancements. The update is available June 17th and free for iPhone users. Finally, Apple notes there are now over 50,000 applications available on the iPhone, with medical applications the fastest growing category. Likely the biggest barrier to widespread clinical adoption will be the iPhone’s limited battery life.

Claims clearinghouse MD On-Line acquires competitor Medical Claim Corp.

Most healthcare providers believe ARRA funds earmarked for HIT will have little or no success in encouraging EHR adoption. Sixty-six percent think EMRs could positively affect their bottom line and 75% believe EMRs could positively impact healthcare as a whole. Most also believe P4P could lead to improved patient outcomes, but 79% fear the increased reporting and record-keeping would increase the costs of doing business. Budget concerns continue to be the biggest barrier to adoption.

RelayHealth wins Target Corporation’s 2008 Partner Award of Excellence for demonstrating “innovative leadership, superior business practices and commitment” to Target’s core strategies. The award was presented at the recent National Council on Prescription Drug Program’s annual conference.

A New York doctor claims that his use of technology and streamlined processes has enabled him to offer more personalized care to fewer patients while maintaining the same income level. Dr. José Batlle uses online appointment scheduling, EMR, electronic prescribing, and virtual visits by phone and e-mail. He says he spent about $25,000 to buy the technology and estimates it saves him close to $100,000 a year in salaries and billing costs.

Alta Bates Medical Group (CA), a 600-physician IPA, agrees to settle FTC charges that it violated anti-trust laws by fixing prices charged to health care insurers. Alta Bates agrees not to collectively negotiate fee-for-service reimbursements and engaging in similar anti-competitive conduct.

This Boston Globe article points out the potential inaccuracies of online doctor rating services, such as Angie’s List, RATESMDS.Com and DR.SCORE.COM. Over 40 different sites now allow patients to rate their doctors, but ratings and the posters cannot always be verified. While some doctors are irritated or try to game the systems, most seem to recommend the old fashioned way of finding a doctor: asking friends and relatives.

Affinity Medical Group (WI) selects Phytel to identify treatment opportunities and augment its patient-centered medical home initiative. Affinity will first implement Phytel’s Proactive Patient Health Management tools for its primary-care team, before rolling out to all 200+ providers.

E-mail Inga.