Recent Articles:

Pretzel Logic 8/20/14

August 20, 2014 News No Comments

EHR Musical Chairs

As EHR use grows across the market, we see the replacement market starting to grow, too. Depending on whom you believe, the EHR replacement market could range from 40 to 80-plus percent of existing users. (The latter seems like a stretch, but to paraphrase John Maynard Keynes, in the long run we’re all dead, which I suppose applies to EHRs as well as people.) There is obviously a large and looming replacement market in front of us, and one characteristic that separates replacement customers from first-time buyers is that they are more seasoned (embittered?) and are usually adamant about not repeating the youthful indiscretions of their past.

Until recently, it’s been hard to find hard industry data on trends like EHR replacement. There are plenty of places to go for advice on how to manage EHR replacements, but the pickings are pretty sparse (OK, barren) when it comes to real data on the buying behavior of seasoned EHR users. It’s worth noting that the one thing the Meaningful Use program has given us is better industry data than we’ve ever had before. Jamie Stockton’s excellent analyst reports for Wells Fargo Securities offer some really fresh insights on industry dynamics using CMS data (a testament to the benefits of opendata.gov and crowd-sourcing). A professor of mine used to say that there is no Geneva Convention for data, and it’s fair to say that Jamie and his colleagues have sadistically extracted a lot of confessions from the CMS Public Use Files on MU attestation.

The Wells Fargo EHR replacement report (referenced in HIStalk) looks at the results of 6,000 physicians using over 500 EHR systems who attested to MU in 2011 or 2012 and then switched to a different vendor in 2013. These 6,000 physicians represent about 4 percent of the total physicians who attested during that time period and represent an early view of the choices being made in replacing one EHR with another.

One of the most interesting pieces of information in the report is head-to-head analyses between different EHR vendors – which systems are people running from and which systems are they running to? The data is in the report, but it takes a little work to calculate, and I’m guessing that few people have the time to drill into the data to this level. Luckily, I’ve done the work for you, and here are my conclusions:

There is growing consolidation in a smaller set of vendors.

  • Physicians used over 500 vendors for MU in 2011/2012. Yet, relatively few of these vendors had net gains among physicians switching vendors, with the biggest gainers being Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
  • Over 50 percent of all physicians who changed vendors switched to these five vendors.
  • The number of certified EHR systems has dropped almost 60 percent from MU Stage 1 (about 3,800) to MU Stage 2 (about 1,600). (I got this from the ONC CHPL site, not from the Wells Fargo report.)

Physicians fled from small vendors.

  • Over 2,000 of the physicians who switched EHRs went from a small vendor to a larger, established vendor

Everyone except Cerner lost customers to Epic.

  • Cerner was the only vendor to have a net gain against Epic.
  • The biggest losers to Epic were NextGen, GE, and Allscripts.

Athenahealth and eCW both lost to Epic. They fought each other to a draw, and both made significant gains against smaller vendors.

  • Athenahealth and eCW each lost two physicians for every one they gained from Epic.
  • Athenahealth and eCW lost as many as they gained against each other.
  • Athenahealth and eCW took more customers from small vendors than any other vendors, even Epic.

Physicians left Allscripts more than any other vendor.

  • Allscripts had the biggest net loss of physicians among all 500+ EHR vendors.
  • Allscripts lost head-to-head against every major vendor except McKesson.

I should note that there are limitations to this data. It covers only physicians participating in Meaningful Use, and it addresses only the market for replacement EHRs, not the entire market. And, while 6,000 physicians sounds like a big number, once you slice and dice the data down to the EHR-vs-EHR level, the numbers can get pretty small and thus less statistically reliable. I don’t want to make too much of this data, but to ignore it would be to make too little of it.

Is this data consistent with broader trends we’re seeing in the market? Darned if I know, but I’ll give it a shot.

1. The industry is slowly starting to consolidate on a smaller number of vendors. The financial injection of Meaningful Use Stage 1 put the market on steroids for a while, with lots of new EHR companies forming overnight to meet surging demand, but the inevitable industry shakeout now seems well underway. It’s unclear whether this is mostly a supply-side phenomenon (i.e., failures of startup vendors whose flaws were masked by MU dollars) or a demand-side phenomenon (i.e., physicians choosing to move to a smaller set of vendors, or hospital consolidation driving physicians to their enterprise vendor). Regardless, technology life cycles in every industry follow similar patterns. There is lots of product innovation at the outset, but the market eventually settles on a smaller set of dominant models that narrows market choices but enables more industry standardization. Process innovation starts to dominate over product innovation as users feel confident about investing in new organization processes that embed these new technologies. Which brings me to point #2.

2. There is growing separation between the enterprise EHR segment and the retail, small-practice EHR segment. With growing consolidation in ambulatory healthcare delivery from hospital acquisition of physician practices, as well as ACO formation, EHRs are increasingly being run by hospitals and ACO-like organizations who are trying to engineer fundamental process innovation for accountable care and patient-centric care. Are these still mostly just buzzwords? Yes, definitely. But an EHR vendor who doesn’t have management, products, and services to meet the needs of a complex array of enterprise users – such as IT, care and quality management, revenue cycle, security and compliance, and C-suite – doesn’t stand a chance in the enterprise space and may as well just focus on the market for small, independent physician practices. I got to peek over someone’s shoulder at a recent KLAS report on EHRs in the large practice space (11-75 physicians) that rated products not only according to what clinicians think, but also according to what IT and C-suite personnel think. More often than not, vendors that did well with clinical users did not do so well with IT and C-suite personnel, and vice versa. Athenahealth, Epic, and Greenway stood out as the only vendors who scored solid cross-enterprise ratings. Increasingly, EHR purchasers are in enterprises, and they value staff maturity and accountability, project management, product stability, and user support at least as much as nice user interfaces. In addition, clinicians within these enterprises seem to be gaining more respect for their IT and administrative counterparts as they become aware that those nice user interfaces are really ugly when they’re slow or unreliable.

3. Epic and Cerner seem to be moving ahead of the pack in reaching down into the enterprise ambulatory segment, while athenahealth and eCW seem to be battling it out in reaching up into the enterprise ambulatory segment. It’s unclear whether it’s better to start with a hospital product and step it down into the large ambulatory space, or start with a small office product and scale it up into the large ambulatory space. Deeper integration with hospitals than just lab results delivery is a fundamental requirement in this space, so the larger hospital vendors have a leg up there, as well as in their experience working with professional IT and administrative staff. The ambulatory vendors have the hearts of many clinicians though, which is important, but as noted above, will only go so far if they can’t scale their management and technology to work in higher-level settings.

4. If you’re an enterprise purchaser, your choices are mostly limited to a relatively small set of mature vendors. There are hundreds of EHR systems out there, but how many of them are backed by mature and robust implementation processes, deep technical bench-strength, strong support teams, and administrative features to centrally manage multiple practice EHRs? That takes more than a few Ruby programmers and a year’s supply of Mountain Dew. In looking to buy or replace an EHR, put a lot of emphasis on testing the vendor staff’s depth, experience, maturity, and professionalism. They will support you in the face of the unexpected, which in healthcare these days is just around the next bend.

5. If you’re a small-practice purchaser, you have more choices, but buyer beware. The small practice space is where a lot of product innovation will still take place for some time to come, but that comes at a price – lots of small vendors who are incredibly creative on the technology side don’t have the scale or backing to provide a lot of development and user support. That may be fine, because as a small practice your needs are easier to support because you don’t need complex interoperability, or population health, or IT administrative control, or high-powered analytics. You still want a vendor who will come running when you’re down and who will be around in the years to come, so don’t get too dazzled by shiny screens with no real people behind them.

It’s amazing what conclusions one can draw from a little data and a lot of artistic license! As more data is released by CMS, I’ll be sure to steal more insights from Wells Fargo Securities’ data analyses and share them with all of you.

image

Micky Tripathi is president and CEO of the Massachusetts eHealth Collaborative. The views expressed are his own.


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

JennHIStalk

News 8/19/15

August 19, 2014 News No Comments

Top News

image

Federal finger-pointing continues as recovered correspondence from CMS Administrator Marilyn Tavenner shows she asked a staffer to delete email related to the troubled launch of Healthcare.gov. “Time and again, the self-proclaimed ‘most transparent administration’ has been anything but,” House Energy and Commerce Committee Chairman Fred Upton, R-Mich., said in a statement. “And now we know that when HealthCare.gov was crashing, those in charge were hitting the delete button behind the scenes.” Adding to the drama is CMS’ refusal to hand over requested documents to the Associated Press about the kinds of security software and computer systems behind the federally funded website. CMS has told the AP that disclosing them could violate health-privacy laws because it might give hackers enough information to break into the service.


HIStalk Practice Announcements and Requests

Thanks to all of the readers who filled out the annual reader survey. I’ll have an overview of the results, plus a gift card winner, in my next post later this week.

If enterprise data is your thing, then be sure to register for the next HIStalk webinar – Enterprise Data – Tapping Your Most Critical Asset for Survival, presented by Encore, a Quintiles Company, happening on August 27 at 1 pm ET. This first in a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies. Presenters include Jonathan Velez, MD, FACEP, CMIO at Hartford Healthcare; and Randy Thomas, Associate Partner at Encore, A Quintiles Company.

If business intelligence is your thing, don’t miss “For Small Practices, the Time is Right for Business Intelligence.” Matt Barron of ADP AdvancedMD was kind enough to share his take on the topic in a recent HIStalk Readers Write piece.

Speaking of reader contributions, I am looking for guest authors who work in the world of physician practices to regularly write about their experiences with HIT. Do you work at a practice that has seen the writing on the wall and dropped out of Meaningful Use? Are you an Epic ambulatory user with a story to tell? Email me with your ideas for one-time or regular contributions.


Acquisitions, Funding, Business, and Stocks

image

Walmart trims its earnings forecast due to rising medical costs and increased spending on healthcare for its employees. The news comes just as the company begins to roll out 12 primary Care Clinics across the U.S. I wonder how Walmart will control its own clinic costs and service pricing, not to mention how likely its employees – many of them newly insured – will be to use them. I have little doubt the $4 employee rate for office visits will entice many. Perhaps it will take notice of what Cerner is doing to attract staffers to its on-site clinics and pharmacies, such as using push notifications to alert employees to “ways to save” and highly targeted educational messages and reminders that support specific health and wellness initiatives. No mention has been made yet as to whether the big-box retailer will follow in the Epic EHR footsteps of CVS MinuteClinics.

image

Speaking of Walmart, I had the opportunity to hear the opinions of several industry representatives on its entry into primary care at the recent Health Care Summit. Two panelists were painfully hesitant in providing their less-than-enthusiastic opinions of the impact retail clinics will have on the ambulatory space. Matt Portch, team leader of Commercial Effectiveness at Pfizer, said, “I’d hate to see an OR in the back of a Walmart,” adding that he’s concerned about retail businesses pushing the limits of healthcare business models. Laura Beaty, MD of concierge medical practice PartnerMD (GA), provided the best sound bite of the event when she said, “If we equate cheap with excellence, it doesn’t work. Value is a different story.” Walmart might have some work to do convincing its new peer group of the value of its services. Cost-conscious Walmart shoppers probably won’t need as much.

Private equity firm GTCR will invest up to $200 million in Cedar Gate Technologies, which it will form with former Medco CEO David Snow, who will add $20 million of his own money and serve as CEO. The company plans to “build a transformative company in the healthcare information technology industry by acquiring outstanding healthcare data and analytics businesses and accelerating their growth.”

image

InnovaHealth Innovations opens up shop in Portland to help physician practices comply with ACA regulations via audit and compliance reviews. The consulting firm will also offer performance improvement analyses and educational seminars on implementing innovative practice strategies. Roberta Kaplan (Oregon Health Authority) will lead the new company.

National medical group Mednax agrees to acquire medical practice revenue cycle management company MedData for an undisclosed sum. The acquisition will help Mednax expand its relationships with hospitals where its physicians work and build new relationships with MedData’s client base of 3,000 physicians in 43 states.


Announcements and Implementations

image

Origin Healthcare Solutions and MDS Medical partner to offer mdsAnalytics – a customized version of Origin Analytics – to users of Greenway Health’s PrimeSUITE EHR. The companies report the partnership will enable even the smallest of practices to take advantage of sophisticated reporting, dashboard, and visualization tools.

image

Navicure launches the Navicure Payments software platform to help providers collect co-pays or balances due before service, estimate patient financial responsibility and secure commitment to pay at the time of service, and collect balances after insurance adjudication.

Azalea Health signs up the physician groups of Georgia-based Dorminy Medical Center and Irwin County Hospital for its EHR and RCM systems.

image

AMD Global Telemedicine integrates video conferencing software from Vidyo into its Agnes Interactive software to simplify Web-based telemedicine workflow.

National physician specialty services company Sheridan Healthcare chooses VitalWare’s iDocuMint ICD-10 code assignment and bill preparation tool for its 2,800 providers.

image

Urology Centers of Alabama adds Greenway’s PrimeRCM revenue cycle solution, joining its PrimeSUITE EHR/PM system.

image

Co-creators of a new behavior health screening kiosk – the first to be installed in a retail clinic in the U.S. – tell me they are developing privacy modifications to the kiosk for future iterations.  These will likely include a curtain (like a voting booth), “blinders” built up around the sides of the device, or use of a flat-screen monitor. As I mentioned when I first wrote about the kiosk, privacy and mental health should go hand in hand when it comes to screening tools in retail spaces, so it’s nice to see the developers take that into consideration. While I agree with the need to more openly discuss mental health issues, I’m not so sure the average patient that suffers from one is ready to shout about it from the rooftops (or from the floor of their local retail clinic).


People

image

MModal announces that CEO Duncan James will resign from the company, which recently exited Chapter 11. MModal has also brought in a new board.

image

Family physician Jack Pinney, MD (MidMichigan Health Medical Center) joins the Optimizerx Board of Directors.

image

Divya Nag, founder of StartX Med, an accelerator to commercialize Stanford research, joins Apple to lead its healthcare initiatives.

People Magazine profiles the family of MedAptus employee Jennifer Crowley, whose six-year-old son Padraig has been diagnosed with stage 4 neuroblastoma, the same rare childhood cancer that killed her infant son in 2006. Friends have started a fundraising page to help cover the family’s medical bills. Padraig was started immediately on chemotherapy and will have a long stay at Memorial Sloan Kettering. 


Government and Politics

image

Newly released 2013 data from CMS show that 96 percent of federally funded health centers have implemented an EHR, and nearly 85 percent of their providers are receiving Meaningful Use payments. Over 54 percent of the centers have achieved recognition as Patient Centered Medical Homes.

image

Former House Speaker Newt Gingrich makes the case for smartphones and veterans healthcare at a recent American Enterprise Institute event. He cited applications from ZocDoc and Wello as innovations that will help deliver high-quality, accessible healthcare to veterans. “We have the opportunity to create a 21st century veterans service system empowering veterans to use their smartphones to re-center services on their lives at their convenience,” Gingrich added.

image

The Texas Health and Human Services Commission awards network security and fraud detection company 21 CT a $19.8 million contract to develop software that is already helping the state detect Medicaid fraud. The new Torch technology pulls data in from the state’s healthcare system, as well as federal data, physician data, business records, background checks, and Google maps. It then links it together and displays it in an easy to understand format, allowing investigators to spot trends in Medicaid reimbursement.


Research and Innovation

image

Harvard’s Forum on Healthcare Innovation launches the Healthcare Acceleration Challenge, a competition that aims to identify and promote proven innovations that if widely disseminated could lower the cost and increase the quality and access of healthcare delivery in the U.S. Finalists will share $150,000 and the opportunity to present their ideas at the Forum’s invitation-only conference in April 2015. The winner will be awarded an additional $50,000. Applications are being accepted through September 29.


Other

image

The Major William Adams Veterans TeleHealth Clinic (CO) receives the Caregivers of the Year award from the Colorado American Legion. Formed in 2007, the clinic was one of the first in the nation to utilize video conferencing equipment to connect veterans in rural and remote areas to doctors.

image

Urgent care and emergency medicine practice Legacy ER (TX) makes the Web pages of Architectural Digest as part of the magazine’s coverage of the American Institute of Architects’ National Healthcare Design Awards. 5G Studio Collaborative has won numerous awards for its design.

In Canada, B.C. Emergency Health Services drops its $2.8 million ambulance electronic patient care record a year after it was supposed to go live, saying that, ”the vendor was unable to meet our business requirements.” The vendor was Interdev Technology.

image

Local news correspondent Bruce Hensel, MD profiles the use of 3-D printing to create plastic models of bones to practice on before surgery. The report notes that 3-D printing technology is now fast enough and cheap enough for individual doctors to afford, and that some insurance companies are considering covering the cost of making the plastic models.

image

The local paper profiles nonprofit Community Health IT Inc., which is leading a project aimed at helping small practices connect to the Florida HIE via its MyHealthStory record-sharing service. The service, powered by Relay Health and free to patients, is intended to give clinics and medical offices, especially those in rural areas, a lower-cost alternative for sharing patient information.


Sponsor Updates

  • NextGen describes the three tiers of the Patient Centered Medical Home.
  • Kareo CMIO Tom Giannulli will present a session on “The Essential Role for Technology in Improving Patient Care” at UBM Medica’s Practice Rx Conference in Philadelphia, September 18-19.

News 8/14/14

August 14, 2014 News 1 Comment

Top News

image

The Healthcare Administrative Technology Association opens for business in California this week to serve as a forum for those in practice management software development. Membership is open to providers, vendors, payers, trade associations, and government entities. Membership fees, ranging from none to $10,000, seem to be based on a sliding scale reflective of annual revenue. HATA will act as a representative voice to advocate and influence key stakeholders and government representatives on healthcare administrative technology issues. Several founding organizations have been reported, including NextGen, ADP AdvancedMD, and eMDs. “ADP AdvancedMD is thrilled to be a founding member and part of the Steering Committee for the Healthcare Administrative Technology Association,” says Jill Finn, director of the company’s Business Solutions Center of Excellence. “This is an incredible opportunity for practice management vendors to collaborate on best practices, to influence regulation, and to be a voice for our customers.  As PM vendors, our central goal should be to ensure the success of our customers and HATA serves as a champion to encourage this unified vision.”

image

Cerner jumps to the top spot of the Kansas City Business Journal‘s Top Private-Sector Employers List due in large part to the addition of 1,550 local employees in the past year. That’s not counting the 16,000 it will need to hire to fill its recently approved $4.5 billion Three Trails Campus, which the company expects to be completed by 2017.


Acquisitions, Funding, Business, and Stock

image

GE Healthcare announces it will relocate the headquarters of its life sciences division from Piscataway, N.J., to a yet-to-be-determined city in Massachusetts. Company spokesman Benjamin Fox notes that, “More specific details will be available once they are finalized. Once completed, the new U.S. life sciences headquarters will create a significant number of new jobs and economic activity in Massachusetts.”

image

Healthcare performance improvement company MedAssets signs a definitive agreement to acquire healthcare market analysis and forecasting services firm Sg2 LLC for $142 million. The agreement brings with it a number of benefits, including improved channel access for Sg2 services, broader data utilization across the two companies, and complementary business intelligence and consulting businesses.

image

The local paper highlights the appeal of the healthcare scene in Nashville, TN, to outside investors, citing such companies as Unity Physician Partners and Aspire Health. Investors from Sandbox Industries and EDG Partners noted the city’s non-stop innovation and mentorship opportunities as two reasons why they chose to fund Nashville ventures.

image

Walgreens follows in the footsteps of CVS and Walmart with continued expansion of its retail healthcare clinics. The company will open 13 Healthcare Clinics in the Dallas-Forth Worth area of Texas by the end of this year. The news marks the company’s first foray into the DFW market.


People

image

Miles S. Snowden, MD (Optum) joins TeamHealth Holdings Inc. as chief medical officer. 


Announcements and Implementations

Allscripts expands its use of Clinical Architecture’s Symedical terminology management system by integrating it with the Allscripts dbMotion HIE platform. The expanded use will leverage Symedical’s interoperability features for code-set mapping, which includes sophisticated matching algorithms, optimized workflow, and the ability to use prior mapping selections to inform current decision processes.

image

The Willis-Knighton Physician Network (LA) selects InteliChart’s Enterprise Patient Portal to serve as a single portal solution for its system of network clinics. Physician Network Administrator Greg Gavin noted that “[a] vendor-neutral patient portal that provides a single source solution for our patients as well as a consistent brand across the entire Willis-Knighton System were top priorities in selecting a solution” to improve communication, coordinate care, and facilitate patient healthcare goals.

image

Phreesia becomes the first certified partner to support integrations with Allscripts EHR and Allscripts PM products as part of the Allscripts Developer Program. The integrated systems will offer practices a unified platform from which they can streamline patient check-in and payment processing.

Clinical Support Services Inc. enters into an agreement with Rite Aid through which CSS will provide MTMPath medication management software to pharmacies piloting the pharmacy’s new Health Alliance program. The program, introduced earlier this year, offers coordinated care and support to patients with chronic and poly-chronic conditions like congestive heart failure, diabetes, COPD, hypertension, and high cholesterol. Rite Aid pharmacists will use the MTMPath software to document medication reviews, enabling information to be collected in a standardized way and stored in an easy-to-access database for all members of the patient’s care team.


Government and Politics

image

HHS Secretary Sylvia Burwell appoints former Citigroup executive Kevin Thurm as senior counselor. Thurm, a former Rhodes Scholar, served as HHS deputy secretary before joining the finance firm in 2001.

image

The VA expands its Patient Centered Community Care contract with managed care organization Health Net Federal Services to include primary care services for veterans who are unable to obtain primary care at a VA medical center in the three PC3 regions in which Health Net operates. The PC3 program provides eligible veterans with timely access to care through a network of non-VA providers who meet VA quality standards when a local VA medical center cannot readily provide care.


Research and Innovation

image

A new report finds that using a touchscreen EHR to support and monitor a national antiretroviral therapy program in Malawi faced challenges similar to that of EHR adoption in the U.S.:

  • Implementing a point-of-care EHR has been more challenging than initially anticipated.
  • The success of a POC system ultimately depends as much on a commitment from system users as on the technologies employed.
  • Poor adherence to system use will result in incomplete data.
  • Health workers will not adopt a system if they do not find sufficient value in it. Consequently, the primary challenge is to identify and address the value proposition for the user. This is an iterative process that requires a commitment to regular and ongoing dialog with the users if this paradigm shift to POC system use is to be sustainable.

Other

image

Orthopaedic Specialty Institute Medical Group (CA) reports the theft of 742 boxes of patient X-rays by two employees at an Iron Mountain Record Management storage facility, who then melted down the X-rays to collect the silver. The X-rays were 10 to 15 years old and may have contained patient names, birth dates, and medical record numbers. They did not contain any financial information. Perhaps the thieves took their loot to a company like XpresShred, which offers what I’m sure are competitive rates for X-ray silver recycling.

image

Square adds online appointment booking to its list of services, which may throw a wrench in the works of physician practices already worried about HIPAA compliance. Square Appointments will link customer booking and staff scheduling tools to its Square Register payment processing app, which does not have to adhere to HIPAA rules because it doesn’t store medical information. I’m willing to bet appointment-related information will throw up many red flags for practices thinking of using the new feature.


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

JennHIStalk

News 8/12/14

August 12, 2014 News No Comments

Top News

image

HHS works to reconstruct CMS Administrator Marilyn Tavenner’s email inbox in response to requests for missing emails sought by congressional investigators relating to the flawed rollout of Healthcare.gov. The recordkeeping problem was discovered as HHS officials collected documents in response to subpoenas from Republican Rep. Darrell Issa of California, who chairs the House Oversight Committee. HHS expects to recover “most but not all” of the 10,000-12,000 emails Tavenner receives each month. The department has expended over 23,000 staff hours and turned over 135,000 pages of documents in response to the subpoenas. It does my pocketbook good to know my tax dollars are being put to such thorough use.


Acquisitions, Funding, Business, and Stock

image

United Food and Commercial Workers, Local 293 and meat company JBS USA announce plans to open an off-site medical practice run by an outside contractor for 5,000 employees and family members covered by the self-insured company’s health policy. The company is now evaluating candidates, hospital networks, and boutique clinic providers to operate the Nebraska practice, which will be run as a patient-centered medical home.

image

CVS Caremark Corp. opens its first walk-in MinuteClinics at select CVS stores across the states of Nebraska and Washington. The company now has clinics in 30 states and Washington, D.C., making it the largest and fastest expanding provider of such retail clinics in the U.S.

image

This blog highlights the growing threat of patent trolls, particularly to those companies working in EHR software development. “It’s a rapidly growing segment of the healthcare industry that is almost entirely software-based,” notes lawyer Leland Schultz, “and the leading companies don’t appear to be paying sufficient attention to patents, either as a valuable business asset or as a threat to their business.”

image

DrFirst secures $10 million in debt financing, which it will use to expand its development resources and prepare for international expansion.

Medicity and athenahealth will improve interoperability between their systems.


Announcements and Implementations

image

Infinity Primary Care (MI) selects population health management and analytics solutions from i2i Systems to help it easily produce reports associated with its quality measures and Meaningful Use participation. The majority of its 12 physician practices serving West Detroit are recognized as patient-centered medical homes.

image

The California Public Employees Retirement System (CalPERS) launches an online healthcare comparison tool for public-sector workers insured by Anthem Blue Cross. Developed by Castlight Health, the tool enables plan members to compare physicians, hospitals, medical tests, and procedures on a variety of factors including cost, quality, patient satisfaction, and convenience. Users can also track expenses.


Government and Politics

image

The White House creates the US Digital Service, a new program that will recruit the “country’s brightest digital talent” to provide strategic guidance on major IT projects like Healthcare.gov and iEHR. Mikey Dickerson, the engineer credited with saving Healthcare.gov, has been tapped to run the service. If his LinkedIn profile is any indication (No Fancy Title, Thanks), he’s likely to keep a low profile while getting the job(s) done.

image

The state of California’s Department of Health and Human Services launches a health portal to display high-value data sets to residents and developers. Initial data sets include popular birth names, birth profiles, poverty rates, locations of vendors that accept vouchers from government assistance programs, a mapped timeline of West Nile virus incidents, asthma statistics, and healthcare facilities data. Future data sets are likely to include healthcare construction and financing, workforce, and data comparing healthcare costs with quality of care.

image

ONC launches a website designed to collect feedback on its proposed interoperability roadmap. Stakeholders have until September 12 to provide their thoughts and comments, after which ONC will present aggregated feedback to the Federal Advisory Committee for its input and recommendations. An updated version of the roadmap will be posted for public comment early next year.


Research and Innovation

A survey finds that telemedicine could potentially deliver over $6 billion a year in healthcare savings to companies in the U.S. thanks to an expected 68-percent increase in the use of telemedicine services by employers. According to survey findings, 37 percent of employers expect by 2015 to offer employees telemedicine consultations as low-cost alternatives to ER or physician office visits for non-emergency health issues. Another 34 percent are considering offering telemedicine services in 2016 or 2017.

image

This blog highlights the growing interest in personal health data research and the challenges that set it apart from traditional health research, which is typically controlled, specific, and very focused. Personal health data research involves real-time data that is highly variable and without experimental controls or organized sampling. It is also prone to self-selection thanks to the rise in consumer use of smart phones and wearables. “Analyzing this type of ‘big data’ will require new statistical approaches, drawing from the fields of computer science, atmospheric science, and engineering,” explains Kevin Patrick, principal investigator for the Health Data Exploration project.


People

image

Shelly Russell is promoted to CEO of Mitchell County Regional Health Center (IA).

image

Harrison Fox (Continuum Care Improvement Through Information New York) joins the Lantana Consulting Group as product manager/project manager.


Other

image

IBM, Cornell Tech, and iniLabs continue to make progress on the SyNAPSE chip (Systems of Neuromorphic Adaptive Plastic Scalable Electronics), which emulates the human brain by processing extreme amounts of sensory information with very little power. After two years in development, the chip is now capable of 1 million programmable neurons, 256 million programmable synapses, and 46 billion synaptic operations per second, per watt. Potential applications include assistive glasses that could guide a visually impaired wearer without need of a Wi-Fi connection, and solar-powered, leaf-shaped sensor modules that could send out environmental and forest fire alerts.

image

St. Lawrence Medical Practice (U.K.) attempts to ban patients from posting negative comments about the practice on social media. The request was made after staff allegedly saw bad language used to describe the surgery’s standard of care on Facebook. Foul language aside, telling patients they’re not allowed to post negative comments on the social network of their choosing will ultimately backfire. Case in point: the New York hotel that attempted to “fine” brides $500 for every negative review left by their guests on any social network. The result: a slew of one-star reviews and comments on the hotel’s “terrible service” and use of intimidation.

image

HIPAA worries are causing obstetricians to remove “baby boards” that feature photos of babies they’ve delivered from their office walls. An OCR representative confirms that the practice is illegal even if the family sends the picture for that purpose since “implied consent” doesn’t count.

A new regulation in India requires doctors to write prescriptions in all capital letters to avoid sloppy cursive handwriting that was causing medication errors.


Sponsor Updates

  • PerfectServe posts an article titled “The Changing Role of the Physician.”
  • Allscripts is named among the best EHR vendors according to Black Book rankings data.
  • ADP AdvancedMD spotlights three smaller private practices using its cloud solution to stay clinically and fiscally efficient.
  • Kareo suggests six steps to take in hiring the right staff for a medical practice.
  • NextGen Healthcare announces a new name for its November user group meeting, NextGen One.
  • SRSsoft will participate in the American Society for Surgery of the Hand conference September 18-20 in Boston.
  • Allscripts shares what “Open” means for healthcare and why it’s so important.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

JennHIStalk

DOCtalk with Dr. Gregg 8/11/14

August 11, 2014 News No Comments

HIT Leads to HID

What’s that you say? What’s HID? Oh, sorry. That’s a new acronym going around related to the semi-rapidly-changing world of HIT.

HID stands for Health Information Disappointment.

image

If you’re anything like me, that definition rings both a cord of immediate understanding as well as a bell of bittersweet irony. If you’re a user of HIT to document, derive, or disperse health information, it is almost a guarantee that you intimately know the aches, pains, and disappointment involved.

Despite any (all?) HIT vendor’s best promise to the contrary, documenting digitally can be exasperating. The difficulty of completing virtually any digital documentation of a healthcare task is often harder than performing the task itself. (OK, so maybe certain procedures like quadruple coronary bypasses or triple organ transplants are harder than the documentation thereof, but the comment stands for many of medicine’s more commonplace care tasks.) Some systems do the documentation dance with more fluidity than others, to be sure. However, for many (most?) providers out there, recording their necessary daily data to adequately comply with all requirements – be they reimbursement or incentive – has become decidedly dreary, dull, and a drain upon their day.

(While writing this piece, Dr. Andy Spooner posted a very insightful “rant” entitled Scout’s Honor that highlights one very significant facet of this documentation dilemma. A good read.)

As disappointing as the recording of computerized health information can be, it isn’t nearly as disheartening as trying to derive information from another’s digital documentation – especially if it comes from a system outside your own, and even more so if it’s a printout version thereof. (So few systems actually share digitized data into reciprocally relevant information buckets that the conversation at this point is pretty much limited to printout information sharing, be it faxed or snail mailed.)

Digitized data entry has certainly eliminated the human eye-brain handwriting recognition and interpretation problem from the mix. However, it seems to have replaced that form of crypticism with one that, while legible, is often barely readable. Too long. Too short. Too poorly designed from a readability perspective. Too filled with reimbursement- or incentive-related gibberish that adds nothing of any identifiable value to the clinical narrative. If you’re a provider, you’ve seen each of these and you know how difficult it can be to divine the necessary clinical pearls of relevance from the splattershot of documentation detritus.

As to the distribution of healthcare information, well, that’s pretty much the reason fax machines are still being manufactured. We haven’t made too many advances for health data dispersal since the first commercialized version of the fax machine hit the markets in the mid-60s. (Sort of sad, when you think about it.) Sure, we’re starting to build connectivity and signs of sharing are certainly sprouting up here and there. Yet, the reality for most of us, most of the time, is that we’re still quite some distance from a system that shares data more effectively than our faithful old fax machines.

With healthcare’s current state of digitized over- or under-documentation, with medical storytelling that while legible is still cryptic, and with the ongoing limitations of health information sharing, is it any wonder that we have Health Information Disappointment?

From the trenches…

“I’m disappointed, but I’m not going to run around like Dennis Rodman and head-butt somebody.” – Greg Norman

(“Well … not yet.” – Dr. Gregg)

image

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

JennHIStalk

Founding Sponsors


  

Search All HIStalk Sites


Loading


Tweets

Platinum Sponsors


  

  

  

  

  

  

  

  

  

  

  

  

  

  

Gold Sponsors


  

Subscribe to Updates




Follow

Reader Comments

  • Anon: Square doesn't have to store medical information in order to bump into HIPAA. They are notoriously deliberately ignoran...
  • Steven Davidson: Yes, Andy, it's what the auditors want if they're going to approve paying the physician. It has nothing to do with the p...
  • Mildly Cynical: On one hand, I sincerely congratulate and encourage Dr. Gettleman's effort. Direct primary care makes so much sense and...
  • Kmhmd: Right on but not far enough in your assertions. The argument can be made that--and I suspect supported if someone wante...
  • The Alchemist: Dead on Andy! There is nothing more encouraging than the pathophysiologic implications in medicine. And just to help t...