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.

Intelligent Healthcare Information Integration 4/29/09

The Creatively Maladjusted

One of the most famous doctors of all time – a true visionary and a tremendous healer – once offered what I believe to be one of his finest insights:

“Human salvation lies in the hands of the creatively maladjusted.”

Personally, I know very few creatively maladjusted folks. I know a slew of the maladjusted, and a peck or two of the creative, but rare is the convergence of the two. If information technology is to “save” healthcare, there is no doubt that it will be HIT’s creatively maladjusted who bring about its salvation.

Let me flesh that notion up a mite:

• “Healthcare” is a mess – way too many middle men who have way too little “care” for health between me and my patients
• Healthcare information technology has become pretty much a similar mess – way too many “solutions” which only seem to broaden the chasms between me, my patients, and good healthcare provision
• For one mess to rescue another mess, it’s going to take people from beyond the pale who are free of institutionalized bias and restraints to deliver us to the HPL (Healthcare Promised Land)

Sadly, the business of HIT has now been around long enough to have become institutionalized. Sad, this is, because instead of becoming a functional, helpful, advancement that delivers powerful new tools for improving people’s lives, it has become more like a writhing swarm of locusts all looking to feed upon the crops of our lives and our economies. And, the Stimulus monies are essentially a non-pesticided entire Corn Belt of fresh feed for these ravenous grasshopper hordes.

Historically, the use of electronic technology to advance healthcare was envisioned by some pretty smart people for some pretty durn good reasons. I’ve been fortunate enough to have met a few of these pioneers, like Drs. Larry Weed and Ron Pion. Larry early on saw the value of the “peripheral brain” for doctors and Ron enabled patient education via television. They “got” the value of technology in improving the provision of healthcare. Unfortunately, many since have seen fit to merely “get” the “value ($)” portion of HIT. Thus, the institutionalization (and degradation) of originally noble ideas began.

A similar institutionalized situation used to exist until the above-quoted famous doctor (and a few others of his ilk) brought forth some seriously creative maladjustment to dislodge acceptance of the then accepted norms. Those normative notions, most of now see, were pretty seriously twisted despite their widespread promotion. However, “normal” has never been synonymous with “correct.”

Racism was once a major institution, in both thought and deed. But, in living up to his famous quote, Dr. Martin Luther King, Jr. helped us see through his creative maladjustment that a better way was possible. Healthcare now needs some maladjusted creators to step up and call out the institution of healthcare IT.

There are a few of these miscreants, these heretics, around. Again, I’ve been lucky enough to have met a few. But, in the deafening drone of the institutionalized swarm, their visionary voices are hard to hear. Occasionally, I read some other blog brat promote attacking the walls of the HIT establishment as they discuss some of these innovative disrupters, but they, too, are small voices amidst a roar.

I suppose the important thing for the small voices is to keep talking, keep envisioning. To again quote the good Dr. King:

“Our lives begin to end the day we become silent about things that matter.”

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.