Intelligent Healthcare Information Integration 5/27/09

Life in a Little Trench, or Supply Side HIT
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A “grunt in the trenches.” That’s a term I’ve used to describe who, what, and where I and thousands of healthcare providers like me are, occupationally speaking. It is probably a different perspective than many you’ll see on these pages. Please allow me a moment to offer a few descriptive moments to sketch out that picture a bit more.

• I’m a solo pediatrician in a small town (pop. ~9,500) in the rural flatlands of central Ohio.
• I’m on call for neonatal emergencies and C-sections 24/7/365.
• I love living in and serving my small community. I’m the medical director for the county health department, a member of the town planning commission, a local United Way board member, a Rotarian, a member of the local hospital Foundation Board, and have a spot on our town’s Bicentennial planning group.
• In the last three years, my true “vacations” have totaled 3 days.
• Our busy little practice serves a rural populace: about 65% of our families are Medicaid.
• I locally host our EHR on two servers. For IT for our office, I’m it.
• My three wonderful employees started off almost fully computer-illiterate. (OK, one knew how to turn a computer on, one didn’t, and one called the mouse a “duck.” Seriously.)
• I spent hours upon hours researching more than 200 EHRs, demoed scores of systems, and went into deep detail on the finalists before deciding upon an EHR for our office
• Life in my trench includes traffic “jams” of six cars and friends who know me before I’ve ever seen them. It allows for a trip to the post office, a bank deposit, picking up a prescription from the pharmacy, grabbing a forgotten paper from my home, and being back to the office, literally, in less than twenty minutes. There are Scout meetings, sports, school functions, and homework. I insist upon family time and some (admittedly brief) down time.
• I don’t miss big city life in the least.

I’m not offering this description to glorify myself nor anything I do. Rather, I am a very run-of-the-mill, small community, primary care physician. There are thousands more like me out there, working hard to care for our communities and families. We have wonderful, fulfilling lives and enjoy our labors.

There is, however, something missing from our great little lives. We need inclusion in this great big HIT discussion going on. With very few exceptions, nobody’s talking about us – even though we serve the majority of US healthcare needs. Systems and plans are almost completely focused upon the Mayos, the Clinics, the HIEs centered around giant centers, etc. Doesn’t anyone care about all us little grunts out in the frontline trenches?

It seems most everyone’s focused on the big guys and their bigger pools of money. Even the purported Keynesian liberals in political power now seem to be counting on the “Trickle Down Effect” (or its precursor, the “Horse and Sparrow Theory” from the 1890s) to spread HIT from the big centers to all us little guys. Last time it was the conservatives telling us grunts how well we’d all be served by supplying the big boys’ side and letting us little fellows feed off the crumbs that fell.

OK, so that was finance, not healthcare IT. I suppose it’ll work better this time.

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 5/26/09

A California eye surgeon uses Twitter to provide patients’ friends and families with surgery updates. His staff has set up a Mac notebook in the waiting room and he Twitters his patients’ status to a private Twitter account at the conclusion of a procedure. The 42-year-old doctor says that using Twitter is “just a different way to do outreach.”

A Florida ophthalmologist hopes the economic stimulus package will boosts the growth of his sideline EMR business. Dr. James Croley designed Quickview Medical Records, which is targeted for use by ophthalmologists and optometrists. Currently the product is being marketed across 20 states and costs about $14,000 for a typical office.

The Arkansas physician injured in a February 4th bombing hopes to return to his family practice in July. Dr. Trent Pierce, who is also chair of the state medical board, lost his left eye and hearing in his left ear after an explosive device went off in his driveway. No one has been charged with the incident, though officials say they have a person of interest.

AAFP subsidiary TransforMED signs a strategic partnership with EthosPartners to provide a customized analytics tool to integrate and track operational and financial performance in primary care practices. TransforMED’s client base will have the opportunity to use Ethos’ VitalStats to track RCM, physician productivity, and other practice measures.

Transcription service provider MxSecure plans to incorporate M*Modal’s Conversational Documentation Services and speech recognition into its MxTranscribe EHR document management software.

Physicians for uninsured African-American and uninsured/Medicaid Latino patients are less likely to use and EHR than physicians primarily treating privately insured white patients. In general, physicians in urban areas and in group practices utilize EHRs more than doctors in rural areas and solo practices. This article does not theorize why, but likely the cost of technology is the primary factor.

The sluggish economy is making physicians less likely to leave an existing practice, based on findings from an AMGA survey. Last year physician turnover was 6.1%, compared to 6.7% in 2006. In addition, 62% of physicians are delaying retirement due to economic conditions. In other words, physicians have found their 401Ks shrinking, just like the rest of us.

Montana physician Dr. Ron Bearss gives up his private practice for three months to care for soldiers in the Middle East. We thank you for your service.

E-mail Inga.

News 5/21/09

McKesson announces the availability of its Medisoft v15 version and its new Medisoft Clinical product, which includes the new version plus McKesson’s Practice Partner Patient Records. Medisoft Clinicals will be targeted to current Lytech and Medisoft clients and primarily sold through resellers.

A three-doctor family practice clinic in San Diego claims its automation tools are performing the work of one to two full time employees. Specifically, Del Mar Family Practice is using ReminderPro for automated appointment reminders and LabRetriever to deliver tests results. Both products are offered by Inphonite.

The Dartmouth-Hitchcock Clinic (NH) plans to roll out the MedAptus Professional application to 150 specialty providers. The clinic will deploy the MedAptus Practice Plus Edition to facilitate charge capture.

CCHIT approves its final 2009-2010 criteria, but says it will put the new certification process on hold until it can review the forthcoming ONC stimulus package requirements. The ONC has until August 26th to provide the requirements for ARRA reimbursement, including the government’s definition of a “certified” EHR.

When it comes to healthcare and medical records, what do patients want? A Beth Israel Deaconess Medical Center study suggests that patients are looking for full access to all of their medical records, are willing to make some privacy concessions in the interest of making their medical records completely transparent, and going forward, fully expect computers to play a major role in their medical care, even substituting for face-to-face doctor visits. Patients say they not only want computers to bring them customized medical information, they anticipate in the future to rely on electronic technology for many routine medical issues.

HEALTHeLINK negotiates special EHR pricing on behalf of its physician members. The Buffalo-area HIE says the agreements are with six EHR vendors.

E-nagging apparently works. That is, people receiving regular e-mail messages suggesting modest lifestyle improvements do increase their activity level and make healthier food choices, according to a Kaiser Permanente study. If physicians adopt this tool, how long will it be before someone wants to begin billing for it?

I like to think I am fairly technologically savvy, so I was frustrated that I had no idea what this athenahealth press release was all about. The company announced that “it has completed a Statement on Auditing Standards No. 70, as amended, (SAS 70) Type II examination, which was performed by Deloitte & Touche LLP (‘Deloitte’) over its service operations. Under the SAS 70 Type II examination, Deloitte examined athenahealth’s design of controls and tested the operating effectiveness of such controls related to the Company’s revenue cycle management service operations and its centrally-hosted software platform.” The translation from athenahealth spokesperson John R. Hallock is that the company is demonstrating that their RCM operations adhere to the same level of security and privacy standards that are required of commercial banks and other fiduciaries. Ahh … like a CCHIT certification for RCM providers. Which now leads me to wonder if any/all/no RCM vendors have received similar seals of approval?  Should they?

e-MDs promotes Christine Homer from VP of Client Services to COO. In addition, e-MDs hires Mike Maldonado as the new director of support and Jeff Falwell as director of training and implementation.

Citizens Memorial Healthcare (MO) claims its 15 outpatient clinics increased new patient revenues 23% as a result of implementing the Medical and Practice Management (MPM) practice management and EHR suite. The EHR provided improved documentation, which enabled code levels and helped contribute to a strong ROI.

An AAFP survey confirms the negative impact the recession is having on American’s access to healthcare. Fifty-eight percent of AAFP members have seen an increase in appointment cancelations and 60% have observed increases in health problems because patients are forgoing preventative care. Overall, physicians report seeing fewer patients today than in January 2008, but most claim the number of uninsured patients has jumped.

Patients with high deductible insurance plans can now refer to an iPhone application to estimate their costs for medical procedures. The Mobile CDH application estimates the patient’s costs based on public programs as well as some commercial carriers. Canopy Financial, which traditionally provides banking technology for health insurers, is the creator of the $4.99 application. Sounds like something a small physician office might want to check out as well.

E-mail Inga.

Joel Diamond 5/20/09

What’s Wrong with ICD

I suppose only geeky doctors amuse themselves like this: my medical partner and I used our EMR messaging to send ICD-9 related insults to each other throughout the day.

For instance, I pointed out that his E828.9 (accident involving animal being ridden) was undoubtedly due to his 302.1 (zoophilia arotica). This was after he accused me of frequent CPT 54450 (foreskin manipulation). Clearly this was one of the most flagrant examples of religiously-inaccurate coding, by the way. Besides, I told him that he should be so lucky with his 752.65 (hidden penis). All this led to a serious E960.0 (unarmed brawl).

Why is ICD-9 so rich in its expression of seemingly silly/worthless diagnoses, but falls so short in reflecting the realities and nuances of day-to-day medical care? No doubt, that it has been widely used as a tool for billing. I suppose that someone finds the need to accurately code for E928.4 (accident due to constriction by hair), and am fascinated by the ability to drill down to great detail, such as E910.2 (water activity injury without diving board). Much has already been written about the need to document E845.9 (spacecraft injuring another person).

What about the heralded switch to ICD-10? I’m not sure how the 318 codes for diabetes mellitus are going to be helpful, but I an so glad to know that there will be V32.22  (Occupant of three-wheeled motor vehicle injured in collision with two- or three-wheeled motor vehicle, person on outside of vehicle, nontraffic accident, while working for income).

Like many physicians, I didn’t worry too much about this before EMR adoption. I admit that I would scribble a single diagnosis on my superbill and let my billing staff “do the rest”. When I first used an EMR, I was shocked to find out that I needed to specify an ICD-9 code in order to complete my documentation. One of my earliest frustrations with adoption was the difficulty in finding the code that I needed. Fibromyalgia could only be documented as “myalgia and myositis unspecified” (729.1). I had to search for a long time to find a code for hemochromatosis—finally deciding it was 275.0, (disease of iron metabolism).

Despite the “geekiness”, controlled medical vocabularies and semantics will have to be tailored to the needs of “real” doctors as we move forward with HIT adoption.

In the meantime, I hope that you don’t get E905.4 today (bitten by a venomous centipede) or know anybody with the misfortune of a 929.0 or 937.0 (look them up yourself!)

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.

News 5/19/09

Specialists in the Phoenix area will soon be able to provide consultations via videoconferencing. St. Joseph’s Hospital and Medical Center is implementing Clinical InfoNET technology to enable specialists at the hospital to connect with referring doctors in the community.

The ONC releases its timetable to address the HITECH portion of the ARRA. Missing: details related to the “meaningful use” definition. Instead, the report says, “specific understanding of what constitutes meaningful use will be determined through a process that will include broad stakeholder input and discussion. HHS is developing milestones for major phases of the program’s activities with planned delivery dates.” Translation: we haven’t figured out what we are doing yet and aren’t ready to commit to anything. The good news is that we can expect a few more weeks of opinions from every “expert”.

Children’s Medical Center in Dallas has become the first hospital to tweet in real time during a transplant surgery. Can someone explain the value of this? Wouldn’t watching it and/or reading a summarized transcript be a better use of time?

Physicians spend an average of three hours a week interacting with health insurance plans, according to a study sponsored by The Commonwealth Fund and the RWJ Foundation. Nurses spend 23 weeks a year per doctor and clerical staff spend 44 weeks a year per doctor. Estimated total national cost: between $23 billion and $31 billion a year, which is six times more than the federal government spends on the SCHIP program. A second study found that clinicians spend an average of 35 minutes a day on billing and insurance-related tasks. After adding the cost of administrative staff to perform billing functions, the annual cost for these activities is over $85,000 per physician, or 10% of revenue.

Healthcare attorneys warn doctors not to automatically delete e-mails from patients, but instead archive them to maintain a complete medical record. In fact, using e-mail for doctor/patient communication should be a business decision that weighs the financial and liability risks and benefits. Opinions vary, but some attorneys recommend saving all patient-related e-mail in case it includes any personal health information that should be protected under HIPAA. Those lawyers always want to make everything so complicated.

A Virginia internal medicine doctor leaves her busy group practice to start her own “no-insurance” practice. Dr. Brenda Arnett only accepts cash or credit cards, leaving patients to file their own claims. She bills by the hour and because she is receiving payment up-front, she finds she can afford to provide each patient individualized attention. She also makes house calls (taking along her laptop).

Chicago-area physicians are finding their patient volumes are increasing as a result of extending office hours. For example, the outpatient clinics at Loyola University Medical Center (IL) now stay open later and many are opened Saturdays. After the first month, clinic visits grew 11%, compared to no growth in patient volume for several previous months. Retailers figured out a long time ago that if you made your services available during traditional non-working hours, you could attract more customers. The question now is whether physicians will continue to offer more patient-friendly hours once the economy rebounds.

Ecliplisys’ PeakPractice solution is now a conditionally CCHIT Certified 08 Ambulatory EHR product. PeakPractice is still pending completion of the advanced ePrescribing requirements.

RelayHealth’s Pharmacy Solutions Group is providing the CDC with antiviral prescription data to help monitor the spread of the H1N1 virus with tracking maps and infection timelines.

Last week we mentioned the thousands of patient charts found in a dumpster in Texas. This week’s chart dumping story takes place at a Tennessee recycling center, where thousands of patient charts were discovered, complete with Social Security numbers, personal health information, and before and after photos from a plastic surgery office. Does this happen out of ignorance, stupidity, or laziness?

E-mail Inga.