News 5/7/09

From Marie Curie: “Re: clinical trials. GE with the Centricity Business solution offers an integrated clinical trial and billing management solution called Patient Protocol Manager. This is a new solution and fully integrates the access, billing, and revenue pieces between clinical trial and billing management with Centricity Business (formerly known as IDX). Albert Einstein post refers to the need for a solution.” Thanks. I would be interested to hear from any users actually using clinical trial software solutions.

The executive manager of the Center for Bone and Surgery (FL) details his practice’s transition to an unnamed EHR. Since implementing the EHR three years ago, patient encounters have grown 25% annually, with administrative and clinical costs rising only about 5% a year. The leader of the nine-doctor group also believes the EHR has enhanced their quality of care.

A new report from the office of the HHS Secretary suggests that the 50 million Americans living in rural areas have difficulty accessing healthcare, higher poverty rates, more health problems, and less insurance. Rural communities average 55 primary care physicians per 100,000 people compared to 72 per 100,000 in urban areas. With one in five Americans living in rural areas, the Secretary’s office is calling for comprehensive health reform that addresses these disparities.

An HHS report on National Healthcare Quality paints a pretty dismal picture of the quality of care being provided patients, or, at least the quality of reporting information. For example, 40% of diabetics don’t receive prevention exams and only half of obese patients are given appropriate advice on exercise and healthy eating. The use of HIT and standards-based data may provide better tools to capture data and report on quality measures.

Texas Medical Associations makes EMR selection easier with a new tool designed to help physicians in the selection process. The program provides side-by-side comparison of eight of the top products used by Texas physicians and helps estimate costs.

RelayHealth’s PatientCompass earns the “Peer Reviewed by HFMA” (Healthcare Financial Management Association) designation for the third straight year. To attain the designation, RelayHealth had to undergo an 11-step screening process by a panel of current and potential customers and expert HFMA peer review board members.

The National Institute on Drug Abuse offers a new online screening tool for physicians that will help them assess patients’ tobacco, alcohol, and illicit and non-medical prescription drug use. NIDAMED includes an online screening tool, a clinician resource guide, and a quick reference guide.

There is the medical care that most of us get, then there is the concierge model, and then there is Guardian 24/7. Founded by physicians who formerly served in the White House, Guardian provides “white-glove services” including immediate access to physicians and on-the-spot treatment, fully equipped hospital rooms built into homes and planes, and detailed medical emergency plans for officials, and dignitaries during their travels. The annual rate for most medical service plans is $25,000 a year. “Ready-rooms” for your home (or jet) can run from $175,000 to $1.25 million.

In an attempt to expand its pharmacy market, Wal-Mart begins testing free mail-order delivery of generic prescription drugs. Michigan will be the only state participating initially. Good news for consumers who can now call toll-free numbers to order generic medications for $4 to $10 each.

Sixty-two percent of Michigan physicians say their practices are full or almost full, which is 20% more than claimed the same in 2005.

To help alleviate the growing issue of physician shortages, three Congressmen introduce legislation to increase the number of Medicare-sponsored training positions for medical residents by 15% (about 15,000 slots). In 1997, the Balanced Budget Act froze the number of Medicare-supported resident training slots in hospitals at 1996 levels.

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How does someone fake a complete medical clinic? A Florida man pleads guilty to conspiracy to commit healthcare fraud after officials discovered he had leased space in the name of other medical clinics, opened bank accounts, filed corporate documents, and received Medicare billing numbers. Meanwhile, officials found that the organization had no operations, employees, or equipment. In less than a year, the man filed more than $12 million in Medicare claims and received payment of about $3 million. He is now ordered to pay $3.9 million in restitution and serve four years in prison.

E-mail Inga.

News 5/5/09

From Mr. Cleanjeans: "Re: infection. Next time after a flight, linger to see how well the post-flight clean-up goes. Some airlines (e.g. SWA) pride themselves on everyone pitching in to clean up to turn around the planes faster. What you see sometimes are people with gloves on to protect themselves. What you DON’T see is people with gloves on using antiseptic wipes on the seats, arm rests, tray tables, etc. I put a Purell or similar in the baggie and send it through the scanner!" 

From Albert Einstein: "I have noticed that there is rarely any mention of clinical trials IT vendors on this site. I am not associated with Clinical Trials nor any vendor or consulting group but keep bumping in to the problem of how to manage trials from patient access, revenue cycle and clinical IT integration perspectives. Can we get some help here?" Anyone have any insight on this? We asked Dr. Joel Diamond to share his thoughts on the topic and he replied: "There are some clinical trial vendors—they mostly help with administration of trials. The problem is that the pharma companies still insist on using rooms and rooms full of notebooks and paper to document everything. Some of the companies have some electronic capturing tools for reporting, but they tend to be proprietary for each trial and cumbersome to use. To date, there has been no significant tie-in to EMRs or any kind of standards for reporting and documentation. In my humble opinion, there is an incredible opportunity for EMRs to help with the inclusion and exclusion criteria for selecting patients for trial, and to monitor their follow-up."

The NY City Department of Health and Mental Hygiene wants to integrate a new substance abuse screening tool into the city’s eClinicalWorks EHR program. The interactive program would guide primary care providers through a series of questions and provide a substance abuse involvement score.

Christus Health votes to provide St. Vincent Regional Medical Center and La Familia Medical Center (NM) $300,000 to digitize their medical records.

Doctors’ Administrative Solutions (FL) signs a sales and marketing partnership with iMedica to offer iMedica’s Patient Relationship Manager 2009 and Transition EHR system.

The developers of TurboTax and Quicken introduce Quicken Health Expense Tracker to help consumers monitor their medical bills and payments from insurance companies. The online tool allows patients to view insurance payments and track their portion of medical costs. Wonder if any web-portal companies want to provide any Quicken-ready billing information for patient use?

Allscripts and Edge Health Solutions announce that Edge will offer Allscripts MyWay solution for Mac as part of its portfolio of solutions for Apple hardware.

The owner of a Las Vegas medical spa files a lawsuit against a former employee and her retired cosmetic-surgeon husband after discovering the couple were running an after-hours, cash-only cosmetic procedure business. The former employee used her key to open the spa in the middle of the night and on Sundays. The husband and other plastic surgeons would perform cosmetic procedures that included everything from Botox injections to breast augmentations. The owner claims she knew nothing about the unauthorized after-hours business, which operated for several years and generated as much as $30,000 a night.

Researchers suggest that doctors should spend more time writing and editing Wikipedia on medical topics in order to improve accuracy. Wikipedia has become a major source of health information for consumers, but its editing policy allows anyone to submit or make changes to articles. More physician input could lead to increased credibility of the online encyclopedia.

Practice management billing company TRACT Radiology (OK) selects AMICAS to provide financial software for its billing operations.

McKesson releases its fourth quarter earnings for the period ending March 31, announcing total earnings of $281 million, or $1.01 a share. This is  down from $307 million, or$1.05 a share for the same period last year. The technology solutions segment saw a 2% drop in earnings and flat revenues. McKesson attributes the lower earnings and flat revenues on delayed technology purchases due to the slower economy.

MGMA publishes a list of five reasons why practice administrators should use social networking tools for themselves and their practice. The professional organization recommends the use Twitter, Facebook, and similar tools as a way a free way to gain personal or practice exposure and to help patients find medical information and details on your doctors. Other reasons mentioned include the ability to provide instant communication and to help advance one’s career. Interestingly, the article makes no mention of blogging for social networking.

Readership for HIStalkPractice continues to creep up each month, so thanks for reading. If you haven’t already, take a moment to register for email updates to ensure you never miss a post. And a special thanks for our sponsors who help pay the bills.

E-mail Inga.

Intelligent Healthcare Information Integration 5/4/09

Step 4: Equalizing the Playing Field
(“Open” is not a Four Letter Word; Systems That’d Suit)

If open-sourced crowdsourcing hasn’t shown you its formula is successful, you’re not paying attention. Look at Apache HTTP Server, look at Linux, look at Mozilla Firefox, Java, MySQL, Thunderbird, OpenOffice. Open source and crowdsourcing enhance innovation; support of open source allows profit. Healthcare needs such public/private cooperation to stimulate the innovation necessary for its salvation.

Of the open source EHRs currently available such as OpenEMR, OpenMRS, VistaA & Vista-Office EHR, FreeMed, tkFP, and Care2x, thus far, they are unusable for the masses. Still typically Windows 95-ish, very boxy with lots of columns and rows, their support sites are often heavily laden with tech-head jargon and formatted such that perusing them is laborious. Documentation is usually cumbersome or scanty, often difficult for the lay person to assimilate.

Wouldn’t it be great if a polished, open source EHR could incorporate a “best practices” approach for included elements/design? Everyone’s got their favorites, but from down here in my trench, standouts include:

• Eclipsys’ Peak Practice – best visual candy, great customizability
• Jay Parkinson and his creative Hello Health – Web 2.0 style, “intuitivity”
• Doctations – online implementation, share-the-sandbox inclusivity
• TeleAtrics – little known with one of the best physician or patient/parent visit summary note formats – not too big, not too small, juuuuust right
• Medicomp’s new CliniTalk – simpler, yet far more powerful coded data collection via voice, type, or pen click
• athenahealth’s athenaCollector – exudes billing and practice management power
• Medicity’s Care Collaboration Platform – share, share, share

Why hasn’t some clever bizhead figured out that the potential for a really slick open source EHR/PM, marketed and supported correctly, is astronomical? Vendors say up front fees are not the moneymakers, that ongoing support services are what generate profit. Still, the majority of my non-tech physician colleagues cringe far more at initial EHR cost figures than at the support fees. Lower the threshold for entry; make a visually pleasing tool designed for normal peeps, not gadget geeks; provide education and support par excellence – these would seem a recipe for sweeping adoption and profit.

Small community docs and hospitals could certainly use a truly functional, low entry threshold product to help them cross the digital divide for their two-thirds of U.S. healthcare provision. They need a playing field equalizer, because current vendor offerings are built mainly for the big boys. It’d be nice if some bIg BeheMoth-sort would see the value in thousands of small community sales globally, but if not (and not meaning to be insensitive) then come on, all you out-of-work developers and designers out there…wake up!

During the current economic slump: 1) band together; 2) steal a few from column A, a few from column B, etc.; 3) put together an EHR that really will help the befuddled medical masses with a healthcare tool we could all actually use; and 4) create yourselves some jobs while helping save the entire U.S. healthcare system – hell, the whole global economy – to boot!

Still to come:
Step 5: Verdant Health (Lush, Full, Eco-friendly, Yet More Jobs – “Green” in Every Sense)

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.

Dr. Lyle on Information Overload 5/1/09

One thing you said the other day caught my attention – you said all that Twittering left you dazed and confused from information overload. I think we can all understand that feeling, and I would apply that analogy to the risks of interoperability. In other words, we better be careful what we wish for! Because if I get every piece of data for every patient, I will never get through my day.

As a primary care physician, I usually have about 10-15 minutes with each patient. Depending on their main complaint, I only need selected information. If I’m seeing someone for an acute sinus infection, I usually just need to know their active allergies and meds. If I’m seeing someone for a follow up to their three chronic diseases, I want the above, plus recent labs, tests, and recent specialty reports if relevant. If I’m seeing a brand new patient with a complex illness and I have an hour to work with them, then I would want all of the above, plus (maybe) notes from all past evaluations, drug history records, lab trends over many years, etc.

As you can likely see where I’m going, most outpatient care visits don’t need “everything”, and in fact, those visits would be ridiculously long and confusing if I had to wade through every piece of information ever accumulated on a patient. With that said, I can see a future what a computer might even intelligently summarize for you. And I have no problem with interoperability as a nice long-term goal.  

We really need to prioritize our resources with respect to EMR adoption. If interoperability helps make local interfaces easier, then I am all for it! But it seems like those interfaces are reasonable enough already, and that the focus on interoperability is a much grander scale. I think the forces behind that movement (“grand interoperability goals”) need to better justify why that is more important than other things to help make a local EMR project work (e.g. more usable systems, more consistent clinical decision support knowledge, quality metrics defined and reimbursed, …) Are others talking about this, or am I going after a sacred cow?

Lyle Berkowitz, MD is an internist and healthcare informatics expert. He is Medical Director of Clinical Information Systems for a large primary care group in Chicago. He also blogs at Change Doctor.

News 4/30/09

From Evan Steele: "Re: SRS and CCHIT. Just a clarification regarding the post where you mention that ‘SRS is taking a strong anti-CCHIT stance…’ Although it sometimes appears as if that is our stance, there is a place for CCHIT software in lower patient volume settings (e.g. primary care and academic practices). That market represents a huge opportunity for the CCHIT vendors. SRS is designed for the high-volume, high-performance market segment and has built a large national network of such practices over the past 12 years. I like to view SRSsoft’s positioning as not ‘us versus CCHIT’ but ‘SRS for high-performance physicians’ and ‘CCHIT for lower-volume physicians.’" SRS, by the way, just announced it signed up Cascade Orthopaedics, a 15-doctor practice in Washington. Perhaps it is a coincidence, but the latest press release makes absolutely no mention of CCHIT.

From EMR Vendor: "Re: ACP conference. I think most vendors will echo the fact that the attendees were knowledgeable physicians, who came looking for solutions, and know they need to buy. Physicians attend this show for the education and the exhibit hours are really in 45-75 minute increments. ACP arranged for a vendor shootout/demo of four different products. Seems like everyone is in the queue for CCHIT 2008 certification, if they were not already certified. Some EMR vendors were overwhelmed with traffic and others looked pretty desolate. We were consumed by prospects as well as reps from other companies pitching their resumes." EMR Vendor exhibited at last weekend’s American College of Physicians Internal Medicine 2009 meeting in Philadelphia, which was attended by about 6,000 internists.

From Spicy Girl: "Re: Miami and Medicare fraud. OMG, this line made me laugh out loud: ‘These are probably not the kind of things the visitor’s bureau talks much about.’ Thanks for the smile! I needed it!"

EHR vendor MedLink International and Clinical Laboratory Management (CLM) enter into an affiliation agreement that includes CLM’s promotion of MedLink’s TotalOffice EHR and Medlink EHR Lite products. In addition, MedLink users will be able to interface with CLM for lab ordering and results reporting.

McKesson promotes Randy Spratt to the newly created position of Chief Technology Officer. Spratt will also maintain his current role as executive VP and CIO.

Within hours of winning confirmation as the country’s HHS secretary, Kathleen Sebelius was thrust into the middle of the public health emergency involving swine flu. Her confirmation had been swirling in some controversy, but those issues likely took a back seat to the more pressing need for a permanent leader to take charge. Baptism by fire hose, perhaps?

Sunset Medical Practice Group (OR) and Diagnostic Imaging Solutions (CO) select Digital Healthcare’s Retasure solution to assess the retinal health of their diabetes patients.

The JPS Health Network (TX) moves forward on plans to build a clinic dedicated to treaty the Fort Worth needy, including the homeless. The planned clinic would provide medical services plus offer "wrap-around" services targeted at reducing homelessness and moving people to permanent housing.

Executives from the EHR Association testify at this week’s National Committee on Vital and Health Statistics hearings to help define "meaningful use." During his testimony, Justin Barnes, the chairman of the HIMSS-sponsored EHR Association and VP for Greenway Medical Technologies expressed his support for building "on the successes of CCHIT, HITSP and NQF."

Most US physicians have a positive attitude toward the electronic promotion of pharmaceutical companies, with three-fourths believing the approach is equal or superior to face-to-face communication (which is likely good news if you want to get into the pharma business but don’t have the looks of a college cheerleader). It would be interesting to know if doctors (and their staff) feel the same way when selecting electronic medical records or practice management tools. Will the bag-carrying sales rep be replaced by a remote demo expert pushing product over a high-speed connection? Or will practices still desire the more personal, onsite approach that gives a sales rep a better understand all that is unique about their clinic?

The 150-provider Polyclinic (WA) signs a contract with Swedish Medical Center to implement Epic EHR. Swedish Medical Center already uses Epic across its four campuses.

The AAFP, AAP, ACP, and AOA release a Guideline for Patient Centered Medical Home Demonstration Projects, which includes a set of endorsed guidelines for any project testing a medical home model. Included are recommendations on who should collaborate on projects, how participating practices should be chosen, what type of support should be provided, how practices should be reimbursed, and how results should be analyzed.

The AMA and the Michigan State Medical society partner with Compuware’s Covinst to provide Michigan physicians increased access to HIT tools and information. Some of the initial programs include e-prescribing and EHR/PM options.The AMA will use feedback from Michigan physicians to build on its upcoming nationwide portal project.

E-mail Inga.