An HIT Moment with … Scott Anderson

An HIT Moment with ... is a quick interview with someone we find interesting. Scott Anderson is the president and partner of KIG Healthcare Solutions, Inc., a NextGen reseller based in St. Louis that covers Arkansas, Iowa, Kansas, Louisiana, Missouri, and Texas.

If I’m a doctor, why would I want to buy from a reseller?

We offer a local presence and flexibility as a smaller, privately-held firm. That allows us to "over-serve" our customers, by, for example, taking the time to step back and look at their practice before training begins. It makes no sense to take a bad paper process and make it electronic.

And we have a great partner in NextGen, while allows us to access their terrific corporate resources as well.

What’s the hardest thing about selling EMRs?

If we are in front of the right groups, of the right size and specialty, it is overcoming a physician’s reluctance to embark on the path to EMR. It is such a paradigm shift for them, and they are hesitant.

Thankfully, we have satisfied doctor/practice manager clients who are willing to step up and speak our praises and the praises of EMR in general. Frankly, there are some that won’t adopt an EMR until they are dragged kicking and screaming. We have learned to identify them pretty quickly and move on.

How does the market look for this year?

I feel better about our pipeline in this first quarter than any first quarter in our five-year history. We are seeing interest at most every spot of the market — small, medium and large. There are some that are stepping back and waiting to see what President Obama or their hospital might offer, but many more are realizing that there is no such thing as a free lunch. 

We have also been able to demonstrate a decent ROI if they commit to using the system as designed, although we have seen some troubling signs of the economy and how it has affected some practices.

What is your biggest challenge?

Finding good people, without a doubt. I spend 30 percent of everyday looking for talent and then nurturing the people we already have. This is a people business. 

Among the major players, the technology will continue to become more standardized and similar. It is our implementation and post-sale support that should separate us from the pack. And that begins and ends with motivated, well-trained, and happy people.

How do we keep them besides the work and the changes it can bring? Great benefits to start. We pay 100 percent of their healthcare coverage for the employee and their families. We work hard to limit the travel wherever possible so they don’t burn out on the road by making sure they are home on Thursday night and don’t leave again until Monday morning. We try very hard to convince them they have a stake in the business.

One more thing: I think we all need to do a much better job in terms of educating our audience. We need to listen more and talk less.

News 1/22/09

The number of physicians e-prescribing has more than doubled in the past year to about 12% of all office-based doctors. Between Medicare bonuses and assorted software and hardware incentives from other carriers, physicians are beginning to ease up on the use of pen and paper.

Medical malpractice provider The Doctor’s Company publishes a list of telemedicine best practices aimed at enhancing care and decreasing liability exposure. Some of the better advice includes providing patients with examples of the types of complaints that are adequately dealt with over the phone or e-mail vs. a visit to the ED. A few of the pointers make good sense for anyone e-mailing: don’t put in an e-mail something you wouldn’t say; be concise and check for spelling and grammar errors; and pick up the phone if the communication is taking more than 2-3 e-mails to explain.

Clara Maass Medical Center (NJ) provides new tools for its physicians to send and receive EMR data, selecting Axolotl to provide technology and services for its HIE. Clinicians will electronically receive clinical information via their existing EMR, Axolotl’s EMR Lite, or fax. Axolotl’s Elysium Virtual Health Record (VHR) will also compile information from disparate EMRs to provide a comprehensive view of the patient’s medical history.

Commonwealth Fund President Karen Davis calls for modernizing the country’s health information technology. "Medicare can do its share by joining with private payers in contributing funds to help those who cannot afford to purchase such technology on their own — especially safety-net clinics and hospitals serving uninsured and low-income patients. It can also create incentives for the adoption of information systems meeting approved standards, and help establish ‘health information networks’ that allow patients and the health professionals that care for them to have all relevant medical information available at their fingertips. While such a change requires upfront investment, it would begin to pay dividends after seven years and generate net savings of $88 billion over a decade."

Adena Health System (OH) rolls out a new e-prescribing initiative. The health system is sponsoring a pilot program and plans to implement the service system-wide by the middle of the year. Adena is using Pharmacy Health Information Exchange, which is operated by SureScripts.

Odd lawsuit: a retired Alabama doctor who collected $1 million from his lawsuit claiming a cemetery encroached on his 16-plot "estate lot" has the award reversed. He claimed the loss of a few square feet caused him mental anguish, although he admitted that he had not sought psychological treatment.

HIMSS, a founder of CCHIT, brags on adoption of CCHIT-certifed EMRs, coming to the oddly phrased conclusion that the market vastly prefers certified products (instead of the obvious, that pressure has cause the usual vendors to get their products certified and sales haven’t really changed). HIMSS thinks certification makes products easier to evaluate and less risky, but certified product vendors have gone out of business, sold doctors products that are completely unsuitable to their work flow, and sold products that are theoretically interoperable but definitely not interoperating. Plus, nearly every major product is certified, so certification still doesn’t provide a tie-breaker.

A survey finds that most physicians made more money in 2008 than the previous year, despite a weak economy. Specialists achieved a 4.4% salary gain and primary care doctors saw 4%  raises. Seventy-two percent of the 257 healthcare organizations surveyed reported increases in physician salaries, compared to 73% in 2007. Only ten percent of the doctors saw decline in salaries. The survey also found an increase in the use of incentive plans tied to quality measures and a decrease in plans paid per work RVUs.

In his inaugural speech, Obama promotes healthcare technology to "raise health care’s quality and lower its cost."

Crain’s New York Business/Health Pulse reports that New York University Medical Center has chosen Epic for a massive clinical systems project that includes its ambulatory sites and faculty practice office. The cost of the project was given as $186.4 million.

Revenue cycle and practice manager provider MTBC partners with healthcare collector Computer Credit to offer an ASP collection portal for healthcare practices and hospitals.

A couple of housekeeping details.  We are pleased vendors have already booked our two Founding Sponsor slots, so expect to see their banners soon. A couple of Platinum spots have also been committed. Vendors interested in one of the remaining spots should contact Inga. If you haven’t signed up for e-mail updates, take a moment to do so by putting your e-mail address in the Get Instant Updates box to your upper right. We don’t want you to miss any updates or one of the many interviews lined up for the coming weeks. And thanks for reading and sending in your comments.

A former health department billing clerk is charged with computer fraud after allegedly using an illegally obtained credit card with a patient’s name to make a $400 Wal-Mart purchase. The sheriff’s department found a handwritten list of 14 patients with names and Social Security number in the clerk’s home. The health department has warned 11,000 patients to be on the lookout for fraud.

Who knew that there was a National Medical Group Practice Week?  This is the sixth annual celebration of the MGMA-sponsored event, which is designed to promote awareness and understanding of medical group practice as the "premier form of healthcare delivery."  Next year, we’ll be more on top of it and send out "Happy Group Practice Week" cards.

A West Virginia county suspends its smoking ban less than three weeks after it went into effect after bar owners complained it was hurting business.

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News 1/20/09

The compliance deadline for ICD-10 is pushed to October 1, 2013. Stakeholders generally agreed that an October 1, 2011 deadline was inadequate time to prepare for the transition.

I love this quote from the administrator of a 12-doctor orthopedic group in Michigan: “One doc I know compares getting an EMR to going from outdoor to indoor plumbing,” he said. “It makes a huge difference eventually, but there’s a mess for a while.” This comment appears in a Crain’s Detroit Business article that highlights how practice administrators are struggling to manage practice finances without compromising patient care. Guarding costs and leveraging computer technology are key strategies at the moment.

If you’re a dermatologist in the DC area, you are probably too busy to be reading this. The upcoming DC festivities create a three-fold increase in the Botox and microdermabrasion business.

Allscripts Professional earns CCHIT Ambulatory 08 certification.

Physicians in Tomball, TX are receiving real-time patient updates via mobile devices. Tomball Regional Medical Center is providing its physicians with the Clinical Xpert Navigator solution to notify them of critical patient information. It’s the former MercuryMD MData solution that is now offered by Thomas Reuters.

Blue Cross Blue Shield of Michigan lays off 1,000 employees and wants average rate increases of 55% for individual plans, claiming it’s on track to lose $1 billion in the next three years.

Over 200 physicians at University Health Associates clinics (WV) switch to electronic medical records over the weekend, along with West Virginia University’s hospital sites. The health system has spent $90 million on the complete Epic EHR project.

In what appears to be a growing national trend, a rural, hospital-owned Colorado clinic prepares to close its doors. Doctors in remote areas find that lower patient volumes and lower reimbursement rates are not adequate to cover their rising insurance premiums and to pay off big student loans. Will the new administration offer these rural clinics additional funding to help them stay in business?

We’re hearing a few more specifics about what Congress is considering for the HIT component of an economic stimulus bill. House leaders want to set a December 31, 2009 deadline for a set of initial HIT standards and are promising up to $65,000 per physician in provider incentives. Hospitals that become fully wired would also be eligible for incentive payments. Penalties for those not adopting HIT would come into effect starting in 2016. The Congressional Budget Office believes such incentives would increase HIT adoption to 90% for physicians and 70% for hospitals over the next 10 years. One of the biggest potential road blocks continues to be how to address privacy concerns.

Here is a report that Congress and Obama might have missed. The results of a recent study by Kaiser Family Foundation and the Harvard School of Public Health indicate that most Americans don’t consider HIT spending a priority. Seventy-seven percent of the 1,628 surveyed recommended that HIT spending decrease or stay the same.

The Heart Group (PA) picks SRS for its EMR solution. The 37-provider group says they passed on the hospital’s EMR offering because they did not think SRS was intuitive enough. Goes to show you that free (or almost free) is not necessarily cheap enough.

South Jersey Healthcare (NJ) chooses Sage’s Intergy EHR solution for its affiliated physicians. The health system will subsidize the cost of the EHR, as well as interfaces to the hospital’s IS/HIE.

In Nigeria, identical twins Pam and Gyang Dareng give up their careers as medical doctors to take up professional golf. Seems like there should be some funny punch line in there somewhere.

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Intelligent Healthcare Information Integration 1/19/09

The Big “O”

"O." No, not Oprah. Not Overstock.com. Not even the big "O."

"O" as in Obama. A short jaunt around the web HIT postings, blogs, and news items these days quickly provides an overview of the impact of "O" on the current state of healthcare IT. For an industry that appeared to have become somewhat stalled with abysmal reports on EHR adoption; standardization that seemed be slowing product innovation; and CHINs, RHIOs, and HIEs (with a few exceptions) failed or failing, the promises of the great and powerful "O" were like a shot of B12.

The incoming "O" has made lots of promises about advancing HIT, including megabucks and another of those "chicken in every pot" type remarks to provide an EHR for every American by 2014. (Believe that one?) Fifty billion dollar promises and a president who wants us all to electronify has been like the jolt of lightning awakening Dr. Frankenstein’s lifeless monster.

While it is encouraging that the new administration will have a much greater understanding and focus upon the importance of IT for healthcare, it seems O’s broad HIT promises have many abuzz that HIT is now poised to become an “overnight” success. (Like so many “overnight” success stories, it has admittedly been some quarter century we have been trying to achieve HIT stardom.)

Don’t get me wrong – I am all for the impact of the O-factor. The almost unbridled optimism that seems to have developed (even in some die-hard, conservative Republicans) for what the new administration may bring is quite contagious. The fact that O isn’t even in office yet and has already begun to steer the course of our country is quite impressive. The fact that so many initiatives seem to be under consideration is (and I don’t use the word cavalierly) awesome. Our country — cripes, the whole world — needs this optimism. We have some pretty major messes and we need some can-do folks at the helm.

What concerns me is the little “o”s, the folks who take what the big O says and immediately apply it to their personal agenda. Everyone sees the glory road to success as being whatever route leads past their own door. At the recent eHealth Initiative 5th Annual Conference in Washington, D.C., many vendors, politicos, and HIT proponents seemed quite enthralled that the 50 Big Ones promised by O over the next five years was the stimulus needed to finally push HIT past the tipping point. Of course, most of them also had a pretty specific idea about where that money needed to go to achieve the tip, usually somehow related to their current ambitions or agendas.

So, do I have my own agenda? Am I another little “o”? Of course. But, I’m trying to maintain a certain amount of historical perspective, too. The past 25 years have shown us that pushing HIT on both physicians and the general public is somewhat akin to pushing mules. You don’t get too far too fast. Merely telling a mule why they must move doesn’t work too well, either. Changing people’s expectations, processes, and workflow requires carrots, not whips, and turning those changes into habits is a derivative of time.

Hopefully, O and his people know this and just won’t throw those ever scarcer dollars to the little "o"s in hopes that what they’ve done before will somehow now work just because there’s money to burn. Yes, oh yes, we do need healthcare information integration and the technology it requires. But, what we really need are some disrupters to take advantage of this opportunity, to provide some innovative thought and leadership, and to figure how to turn “pushing mules” into riding race horses.

Dr. Gregg Alexander is a grunt-in-the-trenches physician and admitted geek. He runs an innovative, high-tech, rural pediatric practice in London, OH, and can be reached at doc@madisonpediatric.com.

An HIT Moment with … Gregory Spencer, MD

An HIT Moment with ... is a quick interview with someone we find interesting. Gregory Spencer, MD is an internist and chief medical information officer at Crystal Run Healthcare in Wallkill, NY.

Describe your practice and what changes, good and bad, that your EMR brought about since it was installed several years ago. 

When our group was founded 13 years ago, we were a single-site medical practice with nine providers and 35 employees. We have grown 20-fold since then and are currently are a 170+ provider multi-specialty group with nearly 1,000 employees and 11 sites. We are opening an ASC this summer. Our growth was mostly from hiring individual physicians and not from mergers of existing groups.

We bought NextGen in 1999. The changes  in the EMR since that time have been massive and positive. Initially, the NextGen product was more of a tool kit to help you develop your own EMR. Now there is an extensive template set that comes off the shelf with the product.

The company has grown almost as quickly as we have. They had a rough patch a few years ago where their sales staff outpaced their support functions. They have improved and are doing much better in that regard. NextGen’s product also had issues with speed and scalability in the past, but this too seems overall better.

Practices that don’t have EMRs worry about the physician time they require and the perceived value they provide in return. What is your experience?   

EMRs require a lot of time and money to set up and maintain. Once you are facile, EMRs are a lot more efficient than handwriting, but not so much for those who dictate everything. 

The value EMR that can return is real, but is largely untapped by most users. Using as many bells and whistles that the product has is more important than you think. Population management is just starting to be done, as an example.

The predominant value EMR returns is most not monetary. You could probably save money by throwing a bunch of low-level file clerks and transcriptionists at an office. You cannot do certain things without EMR, no matter how much money and people you throw at it.

Beyond your EMR and practice management systems, does your practice use other practice applications or connections to outside data sources or information exchanges?

Yes, lots of them. We have a home-grown patient portal for patients to request appointments, meds, etc. We use Televox to confirm over 1,000 of our patient visits a day. We extensively use MS Exchange and Outlook with BlackBerries for remote clinical communication. 

We have Orchard for our laboratory information system and are in the process of implementing Carestream as a RIS/PACS  We use Citrix both within the office as well as for remote access via its web VPN. We have our own data warehouse that we use for business intelligence as well as clinical purposes.

What do new doctors coming into the practice think when they see the technology?  

We have hired 27 doctors in the last six months and will hire another 20 more by the summer. New hires uniformly consider the EMR a positive and often is a deciding factor in selecting our practice. We have merged with a few other groups. Established physicians definitely have a harder time with the EMR. 

Have patient outcomes or patient satisfaction been affected by using an EMR?  

Yes. We have demonstrated improved rates of mammogram, PSA, and other clinical parameters with a care manager program that uses the EMR. We track patient satisfaction, but have no "before/after" data for comparison.