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.

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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.