Mark Anderson 4/15/09

My HIMSS Thoughts

Traditional buzz around vendors’ products with not much substance behind their claims. Most vendors were talking about how great sales were going and that the HITECH portion of the ARRA bill was going to really help explode sales. However, when I asked them what was in the HITECH bill, they had no idea of the details.

So the big buzz was HITECH, but …

Many intellectuals and government officials have been convinced that technology cost is the major factor for slow adoption of EHR technology. As we read in the August 2008 article in the New England Journal of Medicine, only 4% of physicians are fully utilizing EHRs in their practices today, with an additional 13% using parts of an EHR. In the hospital setting, HIMSS Analytics estimates that less than 2% of hospitals are using an EMR based on the seven levels of hospital technology adoption.

In reality, cost is a factor, but maybe a minor factor. With over 400 vendors in the marketplace, physicians have numerous opportunities to adoption EHR applications that cost less than $1,000 per year. This equates to less than 0.00033% of a physician’s annual gross income. We believe the real barrier to adoption has been twofold:

1. Physician data entry time increases by 7X over the paper based system, and
2. Physicians are not paid for data entry time.

Therefore, if we cannot decrease the physician’s data entry time, EHR adoption will never take off.

But wait — that’s where HITECH saves the day. The HITECH Act requires data sharing and interoperability between all care providers, thus potentially reducing physician data entry time by up to 75%. Finally, someone in the government figured out that the value of the EHR is in the data sharing between the primary care physician and the specialist, and between the specialist and the hospital, and even more importantly, between the patient and their care providers.

We predict that actual sales will not begin until after the economy turns around, and maybe not until January 2010 when "meaningful use" is is clearly defined.

When the bill was first announced, many organizations were excited to hear that the government was going to help fund EHR adoption. At first glance, most healthcare providers believed they were going to receive funding to purchase an EHR. They were wrong. Physicians who have already adopted EHRs were excited that they were going to receive funding to help reimburse them for their EHR. They were wrong. 

Funding is going to providers who meet “meaningful use” criteria, can report quality indicators to the government, and most important, can exchange patient-specific clinical data with other providers in the community.  Funding will not go to providers that have pre-existing EHRs unless they are connecting to a community HIE. One of the government’s primary goals is to eliminate the silos of patient information within an individual provider organization.

Therefore, the vast majority of the funds within the HITECH Act are assigned to payments that will reward physicians and hospitals for effectively using a robust, connected EHR system.

Mark Anderson is CEO and healthcare IT futurist with AC Group, Inc.

News 4/14/09

The Rhode Island Department of Health releases two reports showing that almost 40% of the state’s physicians have an EMR, with 58% of those report using it more than 60% of the time. In addition, 25% use e-prescribing at least 40% of the time.

AirStrip Technologies receives FDA clearance for its AirStrip OB application for use on the iPhone. The software allows OBs to access virtual real-time and waveform data on mother and baby, direct from the hospital’s labor and delivery units.

AMA President-Elect J. James Rohack, MD sends a letter to USA Today, saying "physicians are eager to embrace new technologies" and that it’s "imperative that there are widely recognized interoperability and security standards in place." Good to know that he believes doctors are on board, even though most are still resisting today’s current technology. At HIMSS last week, we heard the word "interoperability" over and over again, as well as security and privacy. Everyone agrees they’re a necessity, though everyone has a slightly different spin on what interoperability is all about. How long will it take us to get there?

A New York Times article profiles the use of an EMR (from e-MDs) of a rural doctor, who summarizes as follows: "I’ll never go back to the old system. I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.” For years, Mr. HIStalk has been saying that the main value of electronic records is being able to review and create electronic data from anywhere. Just getting data into an electronic form is where the payoff lives. HITECH should have rewarded providers for sharing data on a national framework such as NHIN, paying them per patient (or, even better, per record type). Using technology is one form of "meaningful use," but making data available to other providers is more so. The power is in the network, not the desktop, but paying for the former will encourage the latter.

A West Virginia doctor and a moonlighting medical resident are the subjects of an HHS search warrant, triggered by a tip that a local pharmacy was "handing out drugs like candy," including the dispensing of 3.2 million hydrocodone tablets in one year in the town of 200 people.

The Boston Globe exposes the potential inaccuracies with personal health records. The piece highlights some of the problems that occur with applications such as Google Health, which pull data from sometimes imprecise claims detail. The advent of ICD-10 codes will help, but don’t expect it to be the panacea. Meanwhile, doctors and patients may view such stories as a good excuse not to embrace PHRs.

BCBS of Minnesota and American Well announce an agreement to provide Online Care services in Minnesota. The program will provide BCBS’s 10,000 employees and family members the option for real-time live interactions with medical care providers via virtual clinics and will connect with HealthVault.

A local newspaper details some of the struggles facing South Carolina physicians as they move to EHR. Among those sited: costs, concerns about the long-term viability of vendors, and the current lack of standards.

The 80 physicians at Elmhurst Clinic (IL) claim it took several years to go fully paperless, but now say their monthly charges are up by more than $1 million. In addition, 2,700 square feet of space previously dedicated to paper chart storage is now office space. Physicians say the move to EHR aids in physician recruitment, facilitates research, and has allowed them to expand the practice.

A national survey of medical offices finds that 18% of offices are observing a 10-25% increase in accounts receivable over the last year. In addition, 28% of the offices are experiencing a 10-25% increase in bad debt expense.

A survey reveals that 67% of medical offices with four or more physicians do not use EMR software. The number drops to 60% without EMR for practices with 26+ physicians. Guess it’s a great time to sell EMR if you have a great product.

E-mail Inga.
E-mail Mr. HIStalk.

Docs on HIMSS

HIMSS: A Doctor’s Perspective
By Joel Diamond, MD

This was my fifth year attending the Healthcare Information and Management Systems Society extravaganza. In the past, this event has all but ruined the chance to spend Valentine’s Day with my wife (she insists that the name HIMSS was perfect for this guyfest). This year, they managed to overlap both Palm Sunday and Passover. Although it is tempting, I will try to refrain from the obvious clichés about techno geeks needing to get a life try to be respectful of the real world.

It is easy for a practicing physician to feel overwhelmed in this universe. Although this year was a bit more subdued, the amount of money spent by IT vendors is orders of magnitude greater than that seen at, say, the equivalent trade show of the American Academy of Family Physicians. I am told that it is exceeded significantly by the Radiological Society of North America conference. You can draw your own parallels to the priorities of dollars spent in actual healthcare.

The official conference was preceded by the Physicians IT Symposium, which was well attended and quite informative. There were similar symposia held separately for pharmacists and nurses. Unfortunately, the lack of integration into the greater conference seemed to reinforce a sense of segregation of real-world clinicians from the bigger community of “Healthcare Information and Management”.  Nonetheless, topics ranging from personal health records, Pay-for-Performance, and the Medical Home were timely and thought-provoking.

That said, the real world clinicians attending for the first time that I spoke with absolutely loved this conference. They told me that they had no idea of the immense amount of innovation and creativity that was out there. They were inspired to take this new sense of potential back to their organizations and push for meaningful change.

I have to agree with them.  Every year I discover my own new perspectives on the possibilities of what can be. The dream of improving patient care through the application of correct technologies becomes much more palpable.

Oh yeah, did I mention that the HIStalk Reception was awesome? Free drinks, great food, the Trump Tower, and a chance to network with some the industry’s real leaders of change. Unfortunately, the event was marred by the truly horrendous choice of emcee for the HISsie awards (inside joke).

Although the mysterious Inga did not reveal herself, the knowledge of her presence was the stuff that dreams are made of …

Clinically speaking.

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.

Thoughts on HIMSS
By RegularDoc

Physician IT Symposium
A one-day event that all docs in IT should consider attending.  Dr. Peter Basch’s talk in the morning was fantastic — the top eight things in IT that need clinician leadership. Another highlight was CIO/Dr. Martin Harris’s presentation about how Cleveland Clinic is using IT and their EMR to expand their ability to take care of patients nationally and internationally.

Dennis Quaid Keynote
I appreciated Quaid starting a foundation to increase public awareness, but he should have focused on that and not started talking about “his vision” of how IT could help (we all know the vision, DQ — stick to your strong points). But then I felt sorry for him when the post-speech questions were actually real IT questions! Maybe you could have a contest for best question one would have asked DQ. For example, I might have asked, “Are you now considering starring or working in a movie that deals with medical errors?" or “If you were Mr. HIStalk in a movie, whom would cast as Inga?"

George Halverson Keynote
I really admire what he and Kaiser have done and agree when he says all we need do is: (1) follow medical best practices; (2) improve caregiver coordination; and (3) have consistent follow through to close any loops. But he knows they have been able to create this “Medical Home” type of environment due to their economic model (one entity owning everything). So, he should careful in making it sound like everyone else just has to try a little harder and use more IT. In other words, the majority of us working in a FFS environment want to do these things, but as we all know, we need to have our reimbursement model change before we can really pull together around this concept.

Alan Greenspan Keynote
Well, he’s very cute in those glasses, but wow — did he think he was in front of some economics professors? Most of what he did was read off a prepared speech that was hard to fully grasp. But it was better when he did occasionally look up and address the audience and when he did the couch interview with Lieber.

Networking
Great, lots of people there — old and new. But, not nearly as many social events as in the past for obvious reasons, thus making it less likely to meet random new people.

Exhibit Hall
I  actually liked that there were not mongo-size booths, although I hated the floor layout — the numbers were just not consistent. On the other hand, I got a good workout walking around and stumbled onto a few booths I might not have otherwise seen.

Other Thoughts
On one hand, there was great excitement about the stimulus package and concern about “meaningful use” and whether CCHIT will be the required standard for EMRs. On the other hand, users in the know (e.g. doctors who use and implement EMRs) focused more on concerns about the usability of EMR systems (or really, the poor usability of most EMRs that create inefficiencies and quality risks).

Said another way, we will get so much more clinical and economic benefits from these systems as they become more usable, either via vendors listening to their current users (rather than prospective users) and/or vendors opening up their systems to allow for more user-defined user interfaces that sit on top of their systems.

RegularDoc is a regular doc.

Intelligent Healthcare Information Integration 4/10/09

HIMSS from a Grunt’s Perspective

“Healthcare Information and Management Systems Society” We all know our worlds of healthcare and technology have become bloated with cryptic acronyms, but this is one I appreciate. Pronounce “HIMSS” and then try the extended version. Pretty much trips on the way off your tongue, eh? So, thank God for acronyms, overused though they may be. (One issue: HIMSS does have a slight odor of male testosterone-laden bigotry – they could have gone with HIRSS, Healthcare Information and Restructuring Systems Society, right, Inga?)

I’ve attended numerous conferences in my time and, while I have known of HIMSS for years, this was the first time I have attended their annual event. The good Mr. HIStalk and the lovely Inga helped inspire my drive to attend with a kindly invite to the HIStalk reception at the Trump Hotel. (Thanks, guys, and more on that in a bit.) From the recently deceased TEPR (I may be premature on that, but life signs are difficult to detect … as is their Web site) to the American Academy of Pediatrics as well as other assorted groups, I have to say, HIMSS in Chicago this year outdoes any I’ve seen. As a lowly solo pediatrician from a small Midwestern town, I’d like to offer up a few “grunt-in-the-trenches” observations.

First, though I hear the attendance numbers were down, it is still a pretty massive crowd. Second, though I hear the vendors’ booths were also down – fewer, smaller, and with decreased booth babes – it is still a heap of ground to cover. Third, comparatively, many more folks were dressed for business , including business footwear, than in other events I’ve seen which is impressive considering all the ground that needs to be trodden from ‘miles’ of booths to the far distant lecture halls. I’m still limping a bit. (Spot any highlight-able footwear, Inga?)

A note on the keynote (1 of 4): I know many of the cynical sort have pooh-poohed the inclusion of Dennis Quaid as a keynote speaker, but I would contend he is a loving father who encountered a frightening flaw in our medical system and cared enough to try to help others avoid a similar scenario. Not as smooth addressing us as you might expect an actor to be, his non-verbal language suggested authenticity behind his words. His impassioned description of his emotional trauma lends a human face to the problems we are all attempting to address. His (perhaps overly-stated) appreciation for medical and HIT peeps, to me, seemed genuine. As a pediatrician, a father, and an HIT fan, I liked him.

Speaking of the keynote, I’d also offer props to the production crew. I used to be a sound engineer (big time rock-n-roll-n-such like the Eagles, Linda Ronstadt , Charlie Daniels, Randy Newman, Funkadelics, Stylistics, B.B. King, Pure Prairie League, etc.) and from the basis of my experience, I think the audio and video production teams deserve a big back pat. Well done, guys! I did hear one suggestion: they might consider some big screens about halfway back as the hall was so long it was tough to see from the cheap seats. (I sat near the camera guys as their chosen area was the audio sweet spot. Old habit.)

Now, granted, I couldn’t be in a tenth of the talks or spend prolonged time at any of the booths, but it seemed the overriding topic on virtually everyone’s lips was how their particular project/product/process was THE thing that Obama bucks should back to bolster the beleaguered HIT behemoth beyond the bipping point. (I know, tipping point, but I needed another “b.”)

My personal favorite, besides discussing the nude beach, “Moonstone,” with Rhode Island Senator Sheldon Whitehouse, was a discussion of Health Record Banks (HRBs, for those keeping acronym counts) given by Drs. Deborah Peel and Bill Yasnoff. Love the community aspect and the patient-centricity. Worth a look here; their first banks are now operational in Washington State.

I also LOVE the new partnering of Eclipsys with Medicity to create the Eclipsys Health Xchange solution. I see big winds blowing up from this. I was fortunate enough to get one of their blue backpacks emblazoned with “Meaningful Use?” Thanks, guys. (Full disclosure: I use, and love, Eclipsys’ PeakPractice– have ever since the old Bond CLINICIAN days. A nod and a tip o’ the hat to Travis Bond.)

Another intriguing offering I enjoyed is Doctations and their “online healthcare community.” I like things which “empower the doctor-patient relationship” while minimizing the silo effect. Their founder, Dr. Louis Cornacchia, is an unassuming neurosurgeon with great enthusiasm and an enjoyable vision.

Dr. Eric Fishman was around with his camera crew recording new segments for his EHRTV.com, sort of a steroided YouTube for EHRs. Very high quality video briefs, all about EHRs. Kudos, Eric.

I was fortunate enough to watch athenahealth’s Jonathan Bush give his acceptance speech for the HIStalk “Healthcare IT Industry Figure of the Year” HISsie Award as well as watch him record a moment with Dr. Fishman. I’ve seen lots of legitimate ADHD in my day, but I give, hands down, all honors to Jonathan for making extreme hyperactivity an honorable, perhaps even desirable, brain chemistry imbalance. He’s a riot!

I don’t drink, but I enjoyed OnBase’s sports bar/Cheers booth. A Norm and Cliff-ish home away from home booth when not at Epic’s digital-fireplace-toasty-home booth. Plus, besides my blue backpack, they had the only other freebie I gathered: an OnBase hardball. My eight year old said, “Yeah! Cool!”

A quick shout out to my pediatric pals, Drs. Feiten, Loveys, Schneider, and Marcus. More brave grunts at HIMSS from the pediatric HIT trenches of this brave new world.

Last, but most definitely not least, I believe I may have identified the illustrious Mr. H, though I would NEVER, EVER tell. The seductive Inga, however, remains elusive even though she is BFF with one of my favorite people, Amy Gleason. Amy looked lovely in her official green “Inga’s BFF” sash. I looked and looked at all the ladies’ feet, figuring the nicest female footwear would be a drop dead giveaway, but to no avail. Inga and Mr. H do throw a nice shindig, but I may need to offer up my old sound engineering skills for next year. For two otherwise workaday grunts, they’ve had a pretty impressive impact on the birth of this new industry. (I wonder if Jonathan Bush’s extreme Inga fantasies may have even had an impact on his marital status?)

To Mr. H and Inga, and to all who continue to push the HIT stone uphill, I offer a tip of the elbow and a bold "Na Zdorovie!"

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 4/9/09

We’ve spent the last few days at HIMSS in Chicago, learning about all things HIT and are happily back to our respective homes. Even though HIMSS traditionally draws mostly hospital IT folks, the conference included a physician EHR track and many ambulatory EHR vendors were represented.

Probably our favorite booth was NextGen’s, which had somewhat of a outer-space feel to it. During HIMSS NextGen announced the development of NextGen EHR Mobile, an add-on to NextGen’s EHR software. The new module will run on mobile devices, including iPhones, but won’t be available for a few more months. NextGen was also recognized as a winner of the MSHUG 2009 Innovation Awards in the area of ambulatory care clinical care, along with its client Elmhurst Clinic (IL). And, NextGen announced a new “Money-Back Guarantee” program that includes a promise their solutions will continually evolve to meet the federal government’s requirements for stimulus reimbursement.

Assuming NextGen maintains CCHIT certification, honoring that guarantee won’t be too difficult. Sitting in on a CCHIT Town Hall, it’s clear that the CCHIT folks believe  that as a minimum, their certification requirements will be the basis for the final federal standard. Over 200 new applications were sent to CCHIT in the last month, suggesting that more vendors than ever are viewing CCHIT certification as a necessity.

The Allscripts booth was right by a major exhibit hall entrance and they leveraged their premium location by making major product announcements each day. Their space was constantly hopping as clients, prospects, and the curious spilled into the aisles to check out their various offerings. One big draw was the new Allscripts Remote product, which gives doctors the ability to access their EHR via iPhone or iPod Touch.While watching a demo of the product, Inga overheard a doctor say, “Here is my credit card! This is exactly what I’ve been wanting!” Music to a sales rep’s ears.

Other Allscripts news:

• A partnership with data exchange platform vendor dbMotion. Allscripts will offer the dbMotion solution to its health systems and hospital clients to connect with providers. Both Allscripts and Misys had similar data exchange offerings, so we assume that Glen Tullman and company viewed dbMotion’s product superior and a better fit for their long-term goals.
• The unveiling of Allscripts Patient Kisok, a solution that integrates Allscripts’ EHR with Fujitsu PalmSecure biometric authentication and facilitates the patient check-in process.
• The introduction of Allscripts Prenatal, a stand-alone and EHR-integrated SaaS solution to address prenatal care workflow.

We also snuck into the pre-conference Healthcare IT Venture fair and observed a number of companies pitching for VC dollars. Most were startups, though we observed e-MDs’ Michael Stearns and David Winn present their case for new funding.  e-MDs indicated that they are looking for $5-$10,000,000 to advance development and beef up its infrastructure.The company has grown at an impressive rate since Dr. Winn founded it in 1996, and today 17,000 users across 49 states are using their applications.

And speaking of e-MDs, we are pleased to welcome them aboard as our newest HIStalkPractice platinum sponsor.We appreciate their support of our young HIStalkPractice site.

Overheard while standing in the shuttle line: The relaxation of Stark laws has not driven EMR adoption as quickly as everyone had hoped. Hospitals don’t have enough access to capital to support the physicians and physicians are not satisfied with the current product offerings.

eClinicalWorks and Sam’s Club release details of their new EMR program, which is targeted for the one to three provider space. ECW and Sam’s did a nice job of including all the details of the package directly on the Sam’s Club website. The basic hardware package using Dell equipment is about $12,000; the software purchase price for a solo doctor is just under $20,000; additional providers increase the price by about $10,000 each; SaaS options begin at $12,000 a year. Is it the cheapest solution out there? No. Is it pretty smart marketing on ECW’s part? We think so. Right now the offering is only available in three states, though it will be rolled out across the country by the end of the year.

Greenway Medical Technologies announces a strategic deal with Detroit Medical Center to provide PrimeSuite EHR to physicians across Detroit Medical’s nine hospital network. Greenway had a nice size booth at HIMSS, and while they might not have been as busy as some of their competitors, they appeared to have a constant stream of people checking out their solutions.

athenahealth made a few HIMSS announcements as well, including its launch of a national Clinical Intelligence Team as part of its athenaClinicals and athenaNet PM offering.The team will be responsible for monitoring various stimulus programs to ensure delivery of the maximum allowable benefits for clients. athenahealth also released word that their e-prescribing service just received additional Surescripts certification. athenahealth also shared news of the successful implementation of athenaCollector at the 130-provider Hudson Headwaters Health Network (NY). Kudos to athenahealth’s CEO, president, and chairman for winning HIStalk’s Healthcare IT industry figure of the year award. Bush and other athena folks attended our HIStalk/Ingenix reception Monday night and Bush was busy snapping photos of the whole event.

Speaking of the reception, the ehrTV.com crew were also on hand taping the HIStalk awards presentation.We had a few audio issues but hope Dr. Fishman and team were able to capture a bit of it. Of course we will let readers know when they can see highlights of that very fun evening.

iMedica names former Allscripts sales manager Martin Cody as a regional VP of sales.

Inga attended a session featuring the 2008 Davies award winners in Ambulatory Care. The practices varied in size from solo physician to 85 doctors, but the three presenters shared a few consistent messages. All agree that picking the “right” company to partner with is important, that implementation success depends on energetic leadership, and that in the end, EHR is just another office tool. Each shared stories of how paperwork was reduced, workflow was re-assigned across their practice, and overall efficiencies gained. On the HIMSS website you can review manuscripts that detail more specifics on each practice and the implementation process. If you are looking to add an EMR, the documents are worth a read.

As noted above, everyone seems to be jumping on the iPhone wagon with Epocrates clearly making its mark as one of the most widely used iPhone applications for physicians. More than 10% of US physicians (about 75,000) are using the tool just nine months after its introduction.

Not surprisingly, the overriding theme this year was the economic stimulus package and how you could get your piece of it. Both vendors and industry professionals stressed the need to move sooner than later, so it will be interesting to see what type of momentum shift we see over the next few months. Questions still linger over the definition for “meaningful use” and “certified” products, but we do know that interoperability and e-prescribing will be key requirements. If you attended, let us know your impressions.

Email Mr. HIStalk.

Email Inga.