Monday Morning Update 1/5/09

NYC offers $60 million in subsidies for eClinicalworks EMR, with doctors in the poorest neighborhoods receiving the most assistance. One doctor notes how their program may vary from other initiatives around the country: “We know that at these fancy schmancy systems, they can do these things, but here in New York, we’re trying to do this for the storefront in Harlem.”

In another not so “fancy schmancy” part of the world, the Maine Health Access Foundation announces new low-interest loans to promote EMR adoption in primary care medical practices.

"Free EMR" vendor PracticeFusion has always been questionable to us because their announcements seem to invite more "confusion" than "fusion" (i.e. misleading claims of a Google partnership, announcements of rapid growth that didn’t seem all that rapid, the company’s business model of selling de-identified patient data and pushing ads, how to get the records back out if the honeymoon sours) but the company seems to be playing seriously, bringing on management talent and releasing a good-looking 2.0 product (click above to enlarge). I’m starting to feel more convinced, although it’s hard to know how deeply doctors are actually "using" the product instead of just signing up for it because it’s free. That’s true of all vendors, though — the real question is what functions are being used, by whom, and with what result? We’ve yet to run across a real, live PracticeFusion user, so if you know one, let us know. Surely if it’s anything but terrible someone must be using it — it’s free and online.

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The New York Times overviews the Marshfield Clinic’s (WI) use of technology and an EMR. The article discusses the potential EMRs have for improving healthcare, especially as patient data is mined to find patterns (e.g. outcomes) to manage chronic diseases. Marshfield leaders emphasize that measurable ROI is not the key to assessing the EMR’s success. I wonder if the Harlem and Mainer docs agree.

Outgoing HHS Secretary Mike Leavitt’s editorial in the Washington Post that we mentioned last week urges that any government "investments" in healthcare IT be limited to systems that are CCHIT-certified as interoperable. One might argue that the government should not be intervening in the EMR market by trying to pressure vendors to make them interoperable (a theoretical capability) than to pressure providers to actually share information in whatever way the government has in mind and then let them pressure vendors themselves. Just because you own an "interoperable" EMR doesn’t mean that you’ll ever actually exchange data, either because you as a practitioner don’t want to or because there’s no organization technically prepared to accept your information in the first place.

The local paper highlights Tucson physicians who are moving to EMRs. A former EMR resister believes the transition is “hands-down better for the patent because there are much fewer things you miss." He also notes that his productivity dropped from 25 to 10 patients a day during the changeover to NextGen, but has presumably improved since. The administrator admits the ROI is not immediate, though there is immediate improvement in patient quality care.

Forbes quotes a Congressional Budget Office study that says EMRs will save $7 billion over five years. So given the thousands of EMR-using practices out there, doesn’t that constitute a pilot study group that should already be saving those dollars? The problem, of course, is that it isn’t the practices that are saving the money, most likely, so poring over their books would probably show nothing but additional EMR expense since the savings accrue to insurance companies, patients, and employers. The article cites several self-proclaimed experts, none of whom appear to actually practice medicine and, in fact, all of whom make money selling EMRs and related services. The reporters who write these articles always seem to marginalize the concerns and observations of real, practicing doctors, writing them off as irrelevant Luddites when there are fast-talking sales types available who, not surprisingly, sing the praises of whatever they’re selling at the moment.

GE Healthcare releases Centricity Business 4.3. I assume Centricity “Business” is the old IDX software since it is geared to academic medical centers and large practices.

Sermo introduces a new infectious disease monitoring tool called Sermo FluMonitor that allows physicians to report geographically based clinical observations in real time. I’d love to see how the reliability compares to Google’s flu trend tool.

A new report notes the shift from a provider-owned medical record to a record shared and controlled by both the provider and patient. It predicts the EMR market will grow by 14.1% annually through 2012. Of course I remember the days when everyone predicted 30% per year growth, a rate the market never quite achieved.

A UMass study says that medication errors occur in 7% of adult chemotherapy visits and 19% of those of children. The biggest question that lay people and even clinicians often forget to ask is whether the "errors" actually had the potential to cause patient harm without being caught down the line. The authors of this study did ask and found that about half had that potential, with most of them involving failed reconciliation between initial chemo orders and those adjusted for a specific visit. Many of the errors were cause by people in the home preparing and giving doses, not medical professionals. The clinic with the lowest rate of errors, one per 500 visits, used an EMR system with physician order entry.

Financial conditions are hitting physicians: more of them want hospitals to pay them for on-call cover or to hire them outright and fewer of them will attend conferences that involve overnight travel in 2009. Another example: a practice management company for plastic surgeons is laying employees off this week, which might logically be interpreted as meaning that fewer people are willing or able to shell out for cosmetic surgery.

Here’s a significant but tiny news item that the usual healthcare media will probably miss (unless they read it here, of course). A primary care office in Maryland cancels its plan to move to a boutique practice model when the Maryland Insurance Administration, worried about losing more primary care doctors, held hearings to decide whether retainer-based medicine is a form of health insurance that requires additional state regulation. Is it insurance to charge patients a flat yearly fee rather than fee-for-service? My first reaction was an emphatic no, but I can see how there is some gray area that would need to be carefully spelled out in whatever agreement the patient and practice sign. Other than that, it’s still an emphatic no in my book, but I’m not a state insurance bureaucrat. My suspicion is that the state wouldn’t have cared if it was a small group doing it.

Medical bills that have been turned over to a collection agency are keeping many people from qualifying for a mortgage, a mortgage company says, calling it a "huge injustice" that credit scores are hurt even when the debt is fully paid. I’ll go out on a limb to speculate that those mortgage companies who can’t get the money owned to them without turning it over to a collection agency (or who even experience only ‘slow pay’ from debtors) feel it’s entirely right and good that their deadbeats take a credit score hit.

I’ve always found the Zagat restaurant surveys to be pretty reliable. As Zagat expands into healthcare, we’ll see if the results will be as solid. The new Zagat Health Survey tool, offered in partnership with BCBS North Carolina, allows patients to evaluate their physicians on a set of distinct criteria. I wonder if consumers are as willing to rate their doctors as they are a good meal.

This is Inga’s kind of doctor. An Irvine plastic surgeon sets his Botox rates based on the rise and fall of the Dow Jones industrial average ($1/Botox unit for every 1,000 points on the Dow.) On those days his patients open their 401K statements and become depressed by all those losses, they can now find consolation from a little cosmetic refresh.

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News 12/23/08

A Tennessee physician receives disciplinary action for allowing staff to examine patients without supervision while he spent a month in the hospital. Unlicensed staff continued to provide care for 115 patients and also billed for nurse visits despite having no nurses on staff.

East Tennessee Medical Group receives the 2008 TECHMED Award for its outstanding use of patient care technology and its innovative use of electronic medical records (EMR) in its practice. The multi-specialty clinic includes over 50 physicians.

If you are looking to implement electronic lab results, Physicians Practice offers some tips for integrating the functionality into your existing EMR.

Put your e-mail address in the "Get Instant Updates" box to your upper right and you’ll get an e-mail blast notification every time we write something new here.

Despite being preoccupied with other matters, Illinois governor Rod Blagojevich signs a law that extends the Medical Practice Act until 2010. The bill continues the regulation of physicians and ensures that no licenses for practice doctors expire at the end of the year.

I’d love to know what, if any, practice management system this cardiologist has in place. A Kansas office manager pleads guilty to embezzling over $300,000 from the physician who employed her for 12 years. Frances E. Holt’s duties included keeping payroll records, entering patient charges, creating financial reports, and printing checks and paying bills for her physicians. At some point, Holt obtained a credit card in his name, used it herself, and had the doctor pay for it.

We made some minor adjustments to the format of HIStalkPractice to provide a visual cue that you’re here instead of HIStalk (since we also hope you’re reading both sites).

What do you think is the primary barrier for small practices looking to adopt EHR systems?

Cost

76.92%

Implementation

15.38%

Participant buy-in

5.77%

A recent eHealth Smartbrief survey concludes the primary barrier for small practices looking to adopt EHR is cost, according to 77% of respondents. Fifteen percent claim implementation is the main issue.

Holland Hospital (MI) forms a physician clinic subsidiary, claiming doctors want a new model that allows them to practice medicine without worrying about administrative issues. The hospital CEO says that one of the heaviest financial burdens for physicians is the high cost of IT for an EMR deployment.

The Minnesota Department of Health issues a 13-page complaint against the Mayo Clinic, charging that the practice failed to obtain federally mandated written permission from patients undergoing major surgical procedures, including organ transplants. Mayo physicians instead obtained oral consent and noted it in the patient record.

A researcher at Worcester Polytechnic Institute (MA) is awarded a $750K National Science Foundation grant for a three-year study on whether a "single best way" exists for implementing and using electronic medical records.

Outgoing HHS Secretary Mike Leavitt writes an op-ed piece for The Washington Post, insisting that any federal stimulus money earmarked for healthcare IT should be used only for CCHIT-certified, interoperable systems. "If stimulus money supports a proliferation of systems that can’t exchange information, we will only be replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful."

An Archives of Internal Medicine article suggests that physicians using EMRs are less likely to have paid malpractice claims (10.8% of paper-based physicians vs. 6.1% of those using electronic records). The authors hope that similar studies will encourage insurance companies to lower malpractice rates for EMR-using doctors.

A Congressional Budget Office review of the Obama administration’s healthcare proposals finds that most of them would be expensive and wouldn’t save much money, but the biggest potential winner is the requirement for doctors and hospitals to use electronic systems. CBO estimates savings of $34 billion over 10 years in addition to lower malpractice insurance. Another financial winner is allowing generic equivalents of biotechnology drugs, estimated to save $12 billion over 10 years beyond the individual savings for consumers and employers.

HHS affirms the right of health care providers to refuse to participate in services to which they object, such as abortion.

CCHIT says it will use the recently released HHS privacy framework into its certification for personal health records when that program starts in 2009. It includes a draft policy notice for PHRs that lets consumers compare the privacy practices of PHR vendors.

UC Physicians (OH) combines 16 practices into one company in an attempt to save more than $1 million next year. Leaders expect that more negotiating power with insurers and consolidated back-office departments could lead help the group to double annual revenue of $180 million within five years. The group includes 649 doctors and 2,200 employees.

Good news for all good girls and boys, big and small. Baylor University Medical Center clears Santa for takeoff after physical exam. Mr. Claus was warned to lay off the milk and cookies, however. (is telling you that a HIPAA violation?)

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News 12/18/08

From Ad Guy: “Re: PracticeFusion. The way they are able to offer the software for free is that it is run through an ASP and is supported by ‘discreet’ advertising. A hundred bucks a month gets you an ad-free version.” Something about their press releases announcing a single new user here and there makes me suspect it’s been a struggle for them, free or not. And, they were a bit shifty about throwing Google’s name all over their early announcements when it turned out the only Google connection was that they planned to use AdSense ads like any other Web site can do. I would be interested in seeing a review of the software, not just its price, from a real user.

From Bubble Burster: “Re: new site. I am struggling with its intent compared to the original HIStalk. Who is the target audience? You might want to make it look a little different with a font change or something." Thanks to everyone who has already provided us feedback on our new venture (even though we’ve done it in stealth mode with no announcements). Most of it was very encouraging. HIStalkPractice is definitely a work in progress and reader input will help us fine tune things. So, to back up a bit, our annual HIStalk reader surveys indicate that the majority of our visitors come from the hospital side of healthcare. Our goal with HIStalkPractice is to offer information and commentary of particular benefit to physicians and their office staff, some of it from experts who can inform and educate folks in that ambulatory setting. We absolutely intend to include vendor news. And of course we love rumors. We recognize there is overlap between the hospital and physician world, so you might occasionally see an item mentioned more than once if you read both sites (and we certainly don’t recommend that you stop reading HIStalk since it won’t all be duped here). We’re also tweaking things a bit so the site looks more unique. Stay tuned and keep providing your feedback.

Community Care Physicians selects Allscripts’ Practice Management for its 190+ provider group. The practice already uses Allscripts’ Enterprise EHR.

Pediatrix Medical Group acquires Florida Perinatal Associates. Pediatrix paid cash for the seven-doctor group. I see that Pediatrix now employs over 1,200 physician specialists and 400 nurse practitioners in 32 states.

AdvancedMD names Christopher J. Bijou executive VP of sales. He had similar roles with UCN and Oracle before that.

Good news for medical billers: demand for medical billing experts remains steady.

AAFP Board Chair Jim King, MD tells the CMS to fix PQRI or doctors may not want to participate. The biggest complaint stems around the fact that thousands of physicians participating in the PQRI did not receive promised Medicare bonuses. CMS had coding problems and other technical issues, so less than half of the participating physicians received their 1.5% Medicare bonus.

Eclipsys wins a Frost & Sullivan award for Healthcare Innovation in the North American Clinical IS market. The honored product is the former MediNotes physician practice solution. Nothing against Eclipsys or its products, but I’ve never quite understood why a company would go to the time and expense to “win” one of these awards. I could be wrong, but my impression of how easy it is to win an F&S award is on par with the soccer trophies handed out to every player in the league (at least if soccer players paid big bucks just to take the field).

The North Carolina Medical Society endorses Web portal software developer Medfusion (also of North Carolina). Medical society members will be eligible for discounts on Medfusion’s patient portal products.

Sevocity launches a new secure web portal that facilitates communication between Sevocity EHR users and their patients. It’s free to customers in the latest software release.

Physicians in 15 states and DC can now manage their Medicare enrollment online. The new service is named Provider Enrollment, Chain, and Ownership System or (PECOS) and will be rolled out to all states over the next couple of months. I’m surprised that CMS is just automating this function.

If you are an iPhone/iTouch user who’d like to maximize its use, check out this posting from a Tulane medical student. He names the top 10 medical resources available, including Eponyms, Mediquations, and Epocrates RX.

HIMSS issues its "recommendations" for the Obama administration, wrapped around a suggested healthcare IT industry donation of $25 billion (does every handout-seeking industry always ask for $25 billion?) to encourage adoption of electronic medical records. HIMSS wants higher government visibility of healthcare IT and insists that no government money be paid out to encourage use of any software that is not certified by CCHIT. Also interesting (and out of left field, but a good idea) is to bar payments to providers by check – the funds would have to be electronically transferred. It should be noted, however, that HIMSS has had marked lack of success in pushing any of its special interest recommendation, so there’s no guarantee that anything in the laundry list will be approved.

Some Best in KLAS winners in the ambulatory market: Epic, Allscripts, and Greenway (EMRs); Epic, athenahealth, and Greenway (practice management).

Highmark Blue Cross Blue Shield (PA) opens up its database of physician quality measures to members. Ratings are based on preventive screenings, office visits, and recommended tests and procedures for diabetes, pediatrics, and women’s health. Only PCPs are scored, getting one, two, or three stars based on how often they provide services to Highmark’s members compared to the average (how well Highmark pays them to do so is another story).

A new survey finds that about 40% of doctors use electronic medical records, but many of them say their systems aren’t very good. Only 4% said their systems do the job to their satisfaction. While the results aren’t encouraging that vendors are selling the products that doctors need, the survey did ask the right questions — not just whether the physicians had access to ‘electronic medical records,’ but exactly what functions they are using them for, which is really the important fact. It would be highly interesting to see those stats broken out by system vendors, of course, but that’s another survey (say, since vendors would never sponsor something like that for fear of bad results, maybe we should run one).

And speaking of EMRs, it would be interesting to find out what customer relationship management capabilities are built in. Can you enter a few notes to help you chat personably with the patient next time, like that they were headed off to Greece for the summer or changing jobs? Some of the early systems focused on that, helping doctors and office staff build relationships with customers, but you don’t hear too much about it these days.

Something too few people worry about: that little footnote in the medical insurance documents that says everybody gets a lifetime dollar cap, and then they’re on their own. This patient is an example: a surprise attack of AML led to a 48-day hospital say, followed by chemo, BMT, and another five months as an inpatient. Because of high costs, she hit her $2 million lifetime cap and her insurance had run out. Employers are accepting all kinds of compromises (high deductibles, high copays, etc.) to keep offering at least some kind of insurance to employees. The article says lifetime caps have dropped to as low as $250K in some cases, which coupled with high copays could leave patients with help only for the middle ground.

Odd lawsuit: a physician complaining of throat problems is told he’s OK in a 1999 hospital exam, but dies in 2007 of esophageal cancer missed by the pathologist in the original exam and not discovered until 2005. His widow is suing the hospital, but the statute of limitations has run out since the clock starts ticking when the alleged malpractice occurs. She wants the law changed so her lawsuit can go on.

A Michigan doctor has all his medical evidence and expert testimony thrown out by a judge when it’s found that he was paid $500 per exam by personal injury lawyers for claiming 7,323 patients had radiologic and respiratory evidence of the asbestos complications the lawyers were suing over. He netted a cool $3.6 million despite having minimal qualifications to interpret films. A previous example from West Virginia is cited where a radiologist made $10 million from a "lawsuit mill," claiming he examined 515 patients in a single day, all of whom had something litigable, no doubt.

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Monday Morning Update 12/15/08

At least 1,200 California physicians have been waiting since June to be paid for Medicare claims. The problems stem from a switch to a new Medicare claims contractor on top of new ID requirements. Physicians report being owed hundreds of thousands of dollars, forcing many to work without a paycheck and take out loans and second mortgages on their homes. A Oakland dermatology practice is owed $450,000. “You’re witnessing a slow death here, except the death is no longer slow.”

FQHC RiverStone Health (Montana) is going live on eClinicalWorks EMR/PM solution. RiverStone will also providing hosting for three other Montana FQHCs.

The WSJ blog interviews a relatively calm Jonathan Bush of athenahealth (check out the video of the actual interview). Bush comments on Obama’s plans to digitize healthcare. Oh, and manages to get a plug in for athenahealth’s (and others) hosted system model, claiming it’s superior to the “broken” approach of developing/selling traditional software to run healthcare.

Dayton, OH is already feeling the pressure of too few primary care physicians, with experts estimating another 200 more providers are needed to meet current demand. A physician with Premier Health Partners is promoting the idea of developing a medical home project to provide some relief. To develop the model would require up to $20 million in capital and a shift in the way primary care is funded, since additional monthly premiums would be needed to supplement traditional reimbursement.

A survey by the National Center for Health Statistics finds that only 38% of physicians are using full or partial EMR systems. Only 4% of the 2,000 physician respondents report that their EMRs are fully functioning. Compare that to a Commonwealth Fund study this summer that found 98% of doctors in the Netherlands and 89% in the UK physicians use EMRs.

The Obama economic stimulus package seems likely to include some electronic medical records line item, but does that really help stimulate the economy? A university professor says EMRs are a good idea, but of no macroeconomic benefit.

The Detroit Institute for Children signs a five-year renewal agreement with CareTech Solutions to provide outsourcing services. CareTech has been providing it with full IT services for the last three years.

Practice Fusion signs up a couple of new clients in Chicago and Seattle. The company’s product is called Free Electronic Medical Records and they claim it can be deployed in “days or less with no cost.” What’s the catch, right?

Physician Pauline Chen’s New York Times editorial bemoans the declining number of primary care doctors just as Obama’s health plan will probably prescribe better access. “Mr. Obama and his team may find ways to give more Americans access to the waiting room, but what if there’s no doctor on the other side of the door? The crisis in primary care must be addressed before any real change can occur; otherwise, the flood of new patients may instead turn out to be a final strike for our ailing health care system.”

A massage parlor operating in a medical office building and offering to accept workers compensation insurance is raided in Lake City,WA, following a police crackdown on Craigslist advertisers.

I suppose it is fitting that I came across this post just as we begin our launch of HIStalkPractice. Who knew that Dr. Lawrence L. Weed is credited with being the brainchild behind the first computerized electronic medical records? In the 1960s, Weed’s initial concept formed the basis for the PROMIS project at the University of Vermont, and in 1970 the Medical Center Hospital of Vermont used the system for the first time. Around the same time, The Mayo Clinic began working on its own version.

Stevens Hospital (WA) is taking advantage of relaxed Stark law provisions and subsidizing the purchase of GE Healthcare’s Centricity EMR for four Seattle-area physician practices.

A Houston physician launches the second boutique medical practice in Sugar Land, TX.

Newseek covers online second opinions, concluding that it’s a small but growing trend, the logistics are cumbersome for patients, and they nearly always must pay the full cost out of pocket.

If you are a physician and iPhone user, check out pMDsoft’s new charge capture software that allows providers to track patients, write sign-off notes while rounding, and enter billing information. It’s available on the iPhone App Store.

Medical Present Value signs up six new physician groups and will be helping them to better monitor payor compliance and verify reimbursement at the line item level.

During my days working in the vendor world, this is the kind of stuff we hated messing with. Consulting firm EHR Group is offering a free document called “7 Costly Mistakes Made When Purchasing Electronic Medical Records and Health IT – And How to Avoid Them.” I’m sure the report includes some great tips on how to select the right EMR, get the right price, and negotiate a favorable contract. Just the kind of stuff vendors hate messing with. Not because they are trying to take advantage of you, but because every time a prospect asks to make a change to the standard deal, paperwork has to be re-done and terms have to be approved (and, of course those sales types just want to close the deal and never have to talk to you again, right?) Anyway, if you are shopping for health IT goodies, I’m guessing this white paper may be worth a read.

Here’s some proof that while many things change in healthcare, some things seem to stay the same. A local Utah paper highlights the career of Dr. Norman Fawson, a physician who recently retired after 40 years of practice. He claims that when he started, a visit cost $3 – or perhaps a few eggs or a chicken if the patient didn’t have cash. He also states that the two things he didn’t like about being a physician were “the computer and government intrusion into health care.”

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