News 4/2/09

From EHR Guy: “Re: Rumors are flying. I’m hearing that (Unnamed Company) laid off their entire ambulatory HIT sales team. Are you guys hearing anything like that?” This note came from one of Unnamed Company’s competitors. We asked Unnamed for an official response and didn’t hear back. However, given the HITECH money headed towards this industry, why would a company pull out now?

From Procter Parkland: Re: Rumor. Not exactly a rumor per se but more a question that could become relevant in next few months: with the stimulus money coming and vendors positioning themselves for a piece of the pie, any idea how much pricing has come down?  It makes sense that the early adopters over the past few years have selected the more expensive vendors, but if you essentially tell everyone they have to adopt in the next few years, I would think that the majority would be drawn to lowest-common-denominator solutions that help them check the box and get the money(and avoid the penalty), without breaking their wallets (especially in this environment).  This would require more expensive vendors to price down to compete with the cheaper guys.  I’ve heard of MDRX and others offering ‘stimulus pricing’ that is 25% or more below where they used to sell – any other anecdotes of this happening?” We will defer to our readers to share their experiences.

Summit Medical Group(NJ) names Karen Graham COO for its 140 physician group. Graham previously served as CIO for Cooper University Medical Center.

McKesson announces that Pamela J. Pure, executive vice president and president of McKesson Technology Solutions, left the company as of March 30th. No reason given or replacement named.

Digital Healthcare announces that during Q1, primary care physicians utilized Digital’s eye health assessment technology to test over half a million diabetic patients. 

March was HIStalkPractice’s second full month and we were pleased by the 45% increase in views over the previous month. Thanks for reading and be sure to sign up for regular email updates so you don’t miss the scoop.

iMedica is now a member benefit partner of the Colorado Medical Society. The Society’s 7,000 member physician will be eligible for preferred pricing for all iMedica products.

A group of leading doctors and researchers are calling on their peers to sharply limit the funding they receive from the drug and device companies, the latest sign of the growing push to limit industry’s influence on how medicine is practiced. The medical associations recommend physicians refuse general budget support from the industry, though are okay with advertising in medical journals and allowing industry to sponsor booths at doctors’ conferences. The pharma companies are complaining, even though the measures would surely save them a bundle.

Greenway Medical Technologies announces its PrimeResearch solution is now integrated into Greenway’s PrimeSuite EHR/PM solution.

Jewson Enterprises, one of the original companies offering research and analysis on physician office software solutions, is now offering its services online. The 36-year old company headed by Vinson Hudson is offering a service named Y.O.U.R. S Online, which provides updated information on PM/EHR software and industry vendors.

Here’s another new on-line tool for technology-seeking physicians. The AMA launches a learning center to provide doctors information about e-prescribing alternatives. The site includes details on vendor prices and features, calculators to estimate time savings and Medicare e-prescribing incentives, and information on other federal and state incentive programs.

At the same time more baby boomers are reaching retirement age, more and more doctors are opting out of Medicare.

Walgreen stores offer free clinic visits to the unemployed and uninsured for the rest of the year. Patients will still be responsible for the cost of prescriptions. Walgreen runs 341 clinics across 35 markets.

New HIStech Reports posted: McKesson and its top-rated Paragon HIS, plus a spotlight on Wolters Kluwer clinical solutions. Both good reads.

Our next news post will be coming direct from HIMSS in blustery Chicago. Inga will be twittering if you care to follow. (IngaHIStalk.)

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An HIT Moment with … Michael Stearns

An HIT Moment with … is a quick interview with someone we find interesting. Michael Stearns, MD, CPC is president and CEO of e-MDs. 

Vendor executives have expressed their opinions on the best use of the proposed federal stimulus dollars set aside for healthcare technology, most of which align closely with the business interests of their respective companies. Is healthcare IT a good investment, is evidence adequate to prove so, and what technologies would provide the biggest bang for the buck in terms of patient outcomes and cost savings?

Interesting question. The majority of healthcare policy makers, including the Institute of Medicine, feel that information technology will play an essential role in improving the quality and efficiency of healthcare in this country. The transformation of care at Veterans Administration hospitals, including a reported 80% reduction in medication errors since the implementation of their EHR system, is one of the most striking examples of the value of HIT (health information technology). Those of us who remember trying to care for very sick patients at VA’s during the “dark ages” of incomplete and often lost records can appreciate this transformation.

Patient outcomes will benefit the most from provider access to legible and complete information, clinical decision support tools, alerts and reminders, and improved coordination of care.

Cost savings should result from fewer hospitalizations of chronically ill patients through better care coordination, greater patient and family involvement in providing care, the reduction in medical errors related to information access and clinical decision support tools that guide physicians to choose low cost tests and treatments of equal efficacy. In the (hopefully) near future, it would be nice to see a level of medico-legal protection for care providers who demonstrate adherence to established clinical guidelines. In many cases this would free clinicians from ordering low yield tests as a defensive strategy.

Part of the federal investment in healthcare IT includes funding to research its effectiveness from the standpoint of patient safety and reduced costs. The value of this exercise is not so much proving that HIT is a good investment, but rather identifying areas where improvements in current systems can offer the greatest benefit. Smart vendors will use the knowledge gained from HIT research to create solutions for areas in greatest need for improvement.

What technical and standards work is needed to allow providers to exchange information effectively?

The CCD standard is a significant first step towards interoperability as certified ambulatory vendors have been compelled to support one unique standard that will markedly benefit the sharing of clinical data through health information exchanges. HL7, IHE, NHIN, CCHIT, and HITSP have all made significant progress; primarily through the efforts of volunteers. Hopefully the HIT Standards Committee that is being formed and the money committed to NIST will accelerate standards efforts. The additional funds that have been made available should allow stakeholders to thoroughly address the data integrity challenges associated with the use of HIEs.

A key element of most healthcare reform proposals is analyzing data to find opportunities for improvement. Do we have the right quantity and quality of data available and are we ready to use it with the appropriate privacy protections?

This is an area of particular interest to e-MDs given that several members of our senior management team have backgrounds in academic medicine and formal training in medical informatics.

In our opinion we need to greatly increase the amount of structured and usable data being captured in electronic medical records. SNOMED CT has proven difficult to implement in EHR applications, but its artificial intelligence underpinnings and canonical structure make it ideal for reporting and research. This has given rise to the development of interface terminologies that facilitate the use of natural sounding clinical expressions that allow data to be stored as concepts mapped to external vocabularies such as SNOMED CT or LOINC. We are taking what we believe is a leadership role in this area, including the development of our own interface terminology that we plan to make open source. It will be called the “Medicapaedia.”

Patient Privacy will be critical. The United Kingdom’s National Health Service lost the confidence of physicians when they learned that the government was not taking adequate steps to protect patient information. They have had to promise fairly draconian consent management policies and other measures in an effort to regain trust. We should learn from their experiences.

Is lack of EMR and e-prescribing adoption caused by inefficient system design, misaligned incentives, or physician resistance?

The majority of industrialized countries have far greater EHR adoption rates than the United States, despite the fact that their systems are in most cases markedly inferior to U.S. systems. A group from New Zealand visited us recently and said our EHR was significantly superior to their current systems. Despite the lack of highly refined EHRs 95% of their physicians use EHRs for all patient encounters. They could not even imagine practicing medicine on paper. Based on this, one would think that a lack of incentives and/or disincentives for not using EHRs is a big part of the low adoption rate in the US. Competition over EHRs is far greater in this country than anywhere else in the world and our systems have improved dramatically over the past 10 years. Nonetheless, to get our rather demanding physicians over the hump, EHR vendors need to embrace system design principles employed by software designers in other industries. We have invested heavily in a firm that specializes in what is referred to as “cognitive engineering,” and the results have been fairly dramatic. The “carrot and stick” approach outlined in the incentive package for EHR use will hopefully overcome physician resistance, especially as vendors get smarter, competition increases, and systems get easier to use.

The physician EMR market is heating up, with arguments about legacy vs. upstart vendors, CCHIT-certified vs. non-certified products, and EMRs designed for billing and malpractice defense rather than optimal patient care. What overview would you give about today’s market and what predictions do you have for the next 3-5 years?

That is a loaded question! Developing an EMR that is reliable, safe and secure and meets the usability and certification requirements is a major undertaking. Every vendor was an upstart at one time in their history. Companies with the right level of funding and prior experience in EMR design, implementation, and support have a decent chance of surviving, given the incentives that will be available. If this fosters disruptive innovation that benefits healthcare then everyone will benefit, in particular patients.

Certification will be important, however. Practices who do not see the writing on the wall and then decide to wait until next year to select and implement an EHR may find that established vendors have long waiting lists. This will create an opportunity for start-ups but there needs to be some level of protection or poorly designed systems that could compromise patient care will make their way into clinics. Any certification process needs to include testing of minimum feature sets for functionality, security and privacy, consistent with what CCHIT currently provides. However, it would be helpful if the certification process was expanded to include usability.

To reach the stated goals of implementation states in Mr. Obama’s plan, vendors will be required to make major investments in training personnel, training methodologies, support personnel, and technologies that allow EHRs to be installed and supported with minimal effort and cost. EHRs will need to be redesigned based on research and proven software design methodologies such as cognitive engineering. Hopefully specialists will finally get the attention they deserve. We fully anticipate that certification requirements pertaining to functionality, product ease-of-use, standards compliance, research, reporting, interoperability, adherence to evidenced-based medicine guidelines, and protecting patient privacy and security will be greatly expanded over the next 3-5 years. It is going to be a fun ride.

News 3/31/09

We are heading out to HIMSS this weekend, so if you would like us to check out any vendors on your behalf, let us know. The exhibit floor can be overwhelming, but we’re happy to squeeze in some field investigation time, especially if you are a physician looking for a new EMR or other office tools.

And if you are a physician, happy National Doctors’ Day. The AMA has set aside March 30th to call attention to the growing problem of physician shortages and its effect on patient care.

McKesson announces the availability of its Advanced Diagnostics Management solution to connect payors, clinical laboratories, and providers to help physicians order the most appropriate tests at the point of care. The solution leverages the RelayHealth network by allowing providers to access to lab test catalogs and health plan rules for eligibility, automatic pre-authorization, network coverage, and price estimation.

Columbus Hematology Oncology (MS) selects Oncology Partners to provide practice management consulting and medical billing services.

The founder of the walk-in clinic company that Walgreen’s bought and expanded to 700 clinics and wellness centers touts their convenience, nationally available EMRs, and $59 price for a doctor’s office visit with one day’s notice. He’s hinting at a major announcement Tuesday.

iMedica announces the availability of the its latest EHR/PM version, named Patient Relationship Manager 2009.

AT&T and Mednet Healthcare Technologies partner to help doctors and patients remotely monitor heart arrhythmia through personal mobile devices. Using Mednet’s HEARTRAK External Cardiac Ambulatory Telemetry solution, heart monitor data is transmitted via Bluetooth-enabled cell phones.

A Time editorial says EMRs are the Wrong Prescription. Quote: “In a digital system, doctors can’t simply write whatever they want: they generally must select from predetermined choices. That runs the risk of nudging them toward diagnostic decisions based on the computer’s choices. The structure of an EMR, in other words, can easily offer an open invitation to create hyped-up diagnoses and inflated bills.”

New York insurers are looking for 20 EMR-using PCPs to participate in a medical home project. They’ll pay start-up costs and cover the salary of a care manager.

The GAO gets IRB approval for a fake medical protocol involving pouring a liter of an unnamed product into a woman’s stomach after surgery to prove that it’s easy to fool IRBs. The independent IRB that approved it said it was “hoodwinked” but complained that the GAO violated federal laws. In another test, GAO successfully registered its own IRB with HHS despite listing its president as dog named Trooper.

Commissioners for Olympic Medical Center (WA) approve a $2.14 million contract with GE Healthcare to provide Centricity for its out-patient facilities.

Despite having paid contractors billions to create the DoD’s AHLTA military EMR system, it’s a fixer-upper, with the military rolling out a new plan to improve it and to make interoperable with the VA’s VistA.

For $5 a month, patients of Santa Cruz Medical Foundation (CA) can e-mail their physician for medical issues. Dr. Michael Conroy is a fan and says, “It saves patients’ time so they don’t have to wait on the phone.” Sign us up.

Regulatory filings reveal that Nancy-Ann DeParle earned at least $3.5 million in 2006 and 2007 from fees and the sale and awards of stock from healthcare firms. The business affairs of the new White House healthcare czar is leading some to criticize her potential conflicts, though others view her insider knowledge a plus.

St. Joseph Hospital (NH) selects GE Healthcare’s Centricity for its 70 employed physicians. Centricity will replace several other EMR systems across St. Joseph’s 19 locations.

EHR Scope has a new spring edition ready for download. It includes several articles on EHR selection and implementation and a free and comprehensive list of 323 different EMR/EHR solutions.

Kaiser Permanente substantially improves heart attack survival rates of patients participating in a pilot collaborative care program. KP found that when patients enrolled in the collaborative program within 90 days of a heart attack, they had an 88% better chance of not dying from cardiac-related causes. The pilot care program linked pharmacists, nurses, primary care physicians, and cardiologists using and an EHR and clinical care registry.

HHS is distributing $338 million to 1,128 FQHCs, using economic stimulus funds. The money will help create or retain 6,400 healthcare providers and expand care to additional 1.2 million patients over the next two years.

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Intelligent Healthcare Information Integration 3/28/09

The E-Generation

Get serious, people.

Turn off the friggin’ light switch. Change the daggone toilet paper roll … preferably, recycle the cardboard, too. Don’t throw your trash on my street … or anybody else’s.

And, while you’re at it, let’s kill off this virulent infestation of psyche that permits us to ignore the needs of others and focus only on the “Entitled Generation” and its abhorrent manifestations.

E-Generation examples:

• Corporate execs of failed or failing firms who have the audacity to accept bonuses for ineptitude. (Hey, man, it’s in my contract!)
• Sports stars who make 200 TIMES as much as the firefighter who rescues even family pets from burning homes or the EMT who daily helps obliterated people not feel so obliterated. (My agent says I’m worth it, man!)
• Medicaid and Medicare recipients who have no incentive, financial or otherwise, to make smart healthcare decisions. (Runny nose? Let’s go the ER. There’s an emergency. Don’t feel like getting up yet? Blow off the doctor’s appointment; it doesn’t cost us anything if we do. Who cares if they waste the doctor’s and their staff’s time and prevent other patients from getting a timely appointment?)
• Health insurance companies who have no interest in “insuring” people’s health, only healthy corporate profits margins. (Health insurance as a “benefit?” Seems more a burden these days.)
• EHRs, PHRs, HIEs, RHIOs, etc. too big from which to walk away yet with so many “functions” that they don’t function well for anyone. (Let’s throw more money into poorly designed gigundo systems because… well… just because they already ‘are,’ they’re some big companies, and there’s money being made. Where’s disruptive innovation when you need it?)

Me? I’m sick of the “what’s in it for me”-ness of modern America. Obama’s right, it can’t be just the leader, or leaders, who are going to right this listing ship. We all need to get serious and do the right things. Make better choices. Don’t do stuff just because “that’s how it’s always been done.” (God, I despise that one!)

Most people, I believe, have a fair idea of what’s right and what’s not. But, most choices are not made from an “Is it right?” perspective. Most moment-to-moment choices seem based upon expediency, greed, or entitlement. The impossibly large welfare system and the failures of the banking and home mortgage markets blossomed from the very same seed: entitlement. And, as the seed has a rotten core, so, too, the blossom reeks.

This isn’t an exclusive generation, by the way. Baby boomers, X-geners, Me-genites, et al – we are all apart of the E-Gen. It’s a generational association which is non-exclusive, crossing all age groups. It knows no socioeconomic or religious bounds. It doesn’t preclude gays, straights, or trannies. It is one of the most all-encompassing groups ever. Yet, it should be an extreme embarrassment every time any of us pays our E-Gen dues.

How much does it really take away from your precious TV or Twitter time to put the cap back on the toothpaste, pick up the canvas grocery bags on the way to the store, or give someone a meaningful thank you? Maybe next you could actually vote. Or volunteer. It’s a start. (And, you can Tweet about it!)

Stop grabbing and start giving.

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.

EMR Vendors on HITECH – Part Five of a Series

We asked several vendor executives a series of five questions related to the economic stimulus as it impacts electronic health records.

What will be the government’s ongoing involvement in healthcare IT?

Allscripts – Glen Tullman, CEO

The Government has three roles to play: providing leadership, standards, and incentives to spur utilization. So far, President Obama has accomplished all three, both through his words – highlighting the value and importance of Electronic Health Records – and through his actions – passing the Stimulus bill with the HITECH Act and substantial utilization incentives, along with a call to strengthen standards.

Healthcare reform is a front-burner issue within the Obama Administration and government in general right now. We believe that healthcare IT has a critical role to play in enabling our country to achieve many of the broad goals outlined in the Administration’s reform platform. We think of it as a necessary but not sufficient requirement for successful transformation. In other words, you can’t possibly achieve our national healthcare goals without technology and Electronic Health Records, but widespread EHR adoption alone also won’t do it – we need reform across the entire system.

We also believe HIT will continue to be central to the Administration’s forthcoming reform plans, which will be rolled out over the next few months. President Obama has indicated that, true to his campaign promises, this $19 billion investment is merely a down payment on what he sees as a large, comprehensive effort over the next several years. We look forward to being a part of his vision for improving our healthcare system with technology.

athenahealth – Jonathan Bush, CEO, President, and Chairman

I think we will continue to see various standards and functionality committees formed which is to be expected given the fast majority of the vendors in HCIT are legacy-based software vendors. That said, our hope is whatever policy is enacted wont stifle innovation, but rather create market dynamics that help further do away with the “Do-It-Yourself With Software Model” that we all know has not worked in HCIT just as we have seen software-only models in other industries parish. The software-enabled service (SeS) model should and we believe will be the dominate model in years to come – where the interface is simply the conduit by which the vendor delivers some kind of service. amazom.com writes millions of lines of code, as does your retail bank – but we pay for the book or access to the banks network not for the software.

eClinicalWorks – Girish Kumar Navani, President

It will be speculative on the part of eClinicalWorks to comment on the government’s involvement. We do not hire lobbyists or contribute to campaigns, so we are not directly involved in politics. We trust that the involvement of public and private sector will yield a balance that will be beneficial to healthcare as a whole.
 

Eclipsys – Tom Cooke, VP and GM of Eclipsys Practice Solutions

Eclipsys believes the government will continue to be the single largest payer and provider of healthcare in the United States. As the largest stakeholder, the U.S. Government will continue to invest in ways to create efficiency and quality. This stimulus package is not only welcomed for its financial support of HCIT, but also for fostering a culture of quality  and outcomes that will help accelerate healthcare technology adoption, interoperability and collaboration among stakeholders including health systems, suppliers, and consumers. We expect the bar to continue to be raised by Federal Mandate, and continue to believe this is a good thing for our industry, and our company.

  
eMDs – Michael Stearns MD, President and CEO

The governments of other industrialized countries have taken a more active role than the U.S. in healthcare, with mixed results. We can learn from these lessons and allow the government to have a positive influence on healthcare while not impeding innovation. I would personally like to see the government accelerate standards efforts and fund research and consumer/provider education programs related to HIT 

Greenway – Wyche “Tee” Green, President 

Our President and many members of Congress clearly see that health IT, specifically EHRs, must be the backbone of a 21^st century healthcare system and that these components are essential to implementing any type of healthcare reform. We see the government fulfilling this process and providing the up-front incentives that will fuel our country’s long overdue modernization of our healthcare system.
 

MED3OOO – Jay Anders, M.D., Chief Medical Information Officer 

For the foreseeable future, government will take an ever-increasing role in healthcare IT. There is just too much money at stake. Transparency in the form of physician and hospital ratings and rankings will be commonplace and available on the CMS website for review. Within the current language of the stimulus bill, physicians and hospitals that receive incentive funds will have their names, addresses, and phone numbers published on the CMS website. You will see CMS expand what they report on physicians and hospitals as they gather meaningful data on healthcare cost and quality metrics.And, of course, government will continue to set standards as to the functionality and interoperability of HIT systems. They will be the watchdogs of privacy, and will continue with oversight and standards relating to how patient identifiable information should be shared and communicated.  
Medsphere – Mike Doyle, CEO

At this point, we know that government involvement in healthcare is going to increase. And unlike the mood of roughly 15 years ago, when the Clintons attempted to overhaul healthcare, many in the industry are now amenable to and involved in trying to restructure our system. Medsphere views that as a good thing, and thinks the initial attempts by the Obama administration to involve stakeholders in the process have been positive.

How government involvement will play out exactly is unknowable at this point. However, it seems obvious to us that they should do certain things. Why waste the investment in VistA? Preserve that tremendously useful tool and propagate it to other sectors of the government–the DoD, for example. In our view, the use of VistA falls within the fiscal responsibilities of government. Beyond that, the government needs to ensure that the EHR systems in U.S. hospitals are interoperable, cost-effective and clinically proven to improve patient outcomes. This is a pivotal time in healthcare due to the critical mass regarding electronic health records and the Obama stimulus package. We can’t waste this opportunity.
NextGen – Patrick Cline, President 

Government money generally brings along with it some form of government involvement. Whether that means certification, process oversight, benchmarking or a more hands-off approach remains to be seen. We do feel strongly that government’s role is not to be in the business of healthcare IT, but rather to support healthcare IT by providing significant incentives to healthcare providers that implement the right systems.

We also feel strongly that significant care must be taken regarding how the stimulus monies are controlled and dispersed. Nearly every day, we hear of new “ventures” or schemes aimed at “getting at” the healthcare IT stimulus monies. Many will try to disguise themselves as “trusted third parties” that, if given significant sums of money, will do the right things with it. Our administration needs to be very careful here. Except for certain legitimate grants, the majority of funds directed toward the adoption of electronic health record systems need to go directly to healthcare providers for meaningful use of the systems.

We think NextGen Healthcare has consistently demonstrated an ability and eagerness to lead the industry with respect to compliance with government-supported standards and initiatives, from HIPAA to CCHIT certification and more. We intend to aggressively comply with every set of HIT criteria that the government determines it needs to promulgate.

 QuadraMed – Keith Hagen, President and CEO 

 We expect that the government will only become more involved in healthcare IT over time. First of all, there is still a great deal of work to be done on the standards front. The holy grail of semantic interoperability of data between systems is still way out there. The idea of sustainable Health Information Exchanges is not a reality today. That will take government involvement to try to get what is essentially a competitive market structure to behave more cooperatively. Finally, we expect cost pressures to only increase – we expect pay for performance regulations to only increase. Providers will continue to need IT to not only survive but thrive in the new regulatory environment. 

Sage – Lindy Benton, Chief Operating Officer

 The United States government is the largest healthcare payer and the healthcare outlay continues to rise. While levels of involvement may fluctuate depending on political will, it’s conceivable the government will play an increasing role in catalyzing the use of IT and analytical tools – significantly to unleash data necessary to manage the quality of delivery of care, reduce waste and errors in focused areas, and to assess the use and effectiveness of protocols and interventions.

SRSsoft – Evan Steele, CEO   

The government should encourage physicians to adopt healthcare IT that will provide them with tools to increase productivity and improve quality of care—tools that they will embrace. Otherwise, we will face backlash from doctors and continued disappointing EMR-adoption rates.The perfect storm is brewing—aging baby boomers, a greater number of insured individuals, retiring baby boomer physicians, and a shortage of physicians graduating from medical school. In the face of this increasing demand for care and decreasing supply of providers, we cannot push physicians to adopt old-school EMR technology that compromises their productivity.

Industry stakeholders and the government must reevaluate the EMR landscape to promote products that actually make physicians and, therefore, the entire health system more efficient. As President Obama said in his recent health summit, “Every voice has to be heard. Every idea must be considered. . . . I just want to figure out what works.”