Intelligent Healthcare Information Integration 8/23/10

EHR Data Sharing – No Manhattan Transfer

A recent change in working arrangements led to the need to look into the exchange of a few hundred patients’ records, from one well-known EHR system to another very prominent company’s system. To say such an exchange is easy or, especially to say it is cheap, would be the understatement of the month.

Don’t get me wrong, it is possible — in some format or another. Demographics only via .CSV or full CCR/CCD transfer of medical data are possible. But for small practices who want to share large chunks of data from one well-built system to another, it is certainly cost-prohibitive and not a simple “have your peeps call my peeps and set it up” type of deal. You’d think that by this time we might have had enough such transfers that the cost would be decreasing and the intercourse would be, well, more satisfying.

You may not be a fan of vocal jazz as put forth by “The Manhattan Transfer,” but they have been putting out some pretty silky songs for some 40 years. Their sustainability is founded upon their ability to incorporate and appropriate from many diverse styles and formats. They bring in elements from many great musical genres and meld them into their own particular musical system.

EHRs must be able to share amongst the many, many digital “genres” now fairly entrenched throughout the country and do so in a way that isn’t another bloodletting point for small practices. If not, the whole NHIN (or whatever version or flavor or name du jour it is) concept might as well be called the Big Organization EHR Information Network. Add “Group” at the end and it’s BOEING. (Hmmmm… Big government contracts, mega-corporate mindset and attitude…there’s some association there.)

Us little guys don’t have the overhead room to afford playing in the big digital sandbox if simplicity and small guy costs aren’t a part of the plan. I know, I know — healthcare data is complicated and these multi-siloed, often incompatible systems and system architectures argue against simplicity and inexpensive costs. But, you know, we let it get built that way. There’s no rule that says we can’t reengineer.

I hope so. The more I use our EHR, the more value I see within it. It has its problems, sure, but they’re far more acceptable than the hassles associated with pen and paper. It just shouldn’t make such off-key squawks when all I want is syncopation.

From the trenches…

“Beauty of style and harmony and grace and good rhythm depend on simplicity.” – Plato

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

News 8/19/10

Steven Waldren, MD, the director of AAFP’s Center for Health IT, says the the final ruling on Meaningful Use includes some good changes. But, he cautions, meeting Meaningful Use objectives will still require significant effort. Specific concerns include a) the Medicare program places a heavier burden of Meaningful Use compliance in the first year compared to Medicaid’s;  b) the aggressive timeline for implementation; c) the absence of certified EHR technology in the market; and, d) the complexity of Meaningful Use rules. Waldren also notes that RECs and vendors lack adequate skilled personnel to meet the market’s implementation and support demands. [Update 8/23/10: A few readers asked for clarification about Waldren’s comment that Medicare places a heavier burden for MU compliance than Medicaid.  Thanks to Steven Waldren for the following:

The burden difference for the first year of participation between Medicare and Medicaid is that one does not have to report/achieve the measures of meaningful use under Medicaid to receive the incentive.

From the final rule:

“The HITECH Act allows Medicaid EPs and eligible hospitals to receive an incentive for the adoption, implementation, or upgrade of certified EHR technology in their first participation year. In subsequent years, these EPs and eligible hospitals must demonstrate that they are meaningful users. There are no parallel provisions under the Medicare EHR incentive program that would authorize us to make payments to Medicare EPs, eligible hospitals, and CAHs for the adoption, implementation or upgrade of certified EHR technology. Rather, in accordance with sections 1848(o)(2), 1886(n)(3)(A), and 1814(l)(3)(A) of the Act, Medicare incentive payments are only made to EPs, eligible hospitals, and CAHs for the demonstration of meaningful use of certified EHR technology.”]

In a profile of the 176-physician Baptist Memorial Medical Group (TN), the group’s CEO says the hospital takes care of all the business concerns for their physicians, including leasing space and hiring and training staff for the billing and EMR systems. MGMA weighs in, noting that the main reason doctors are becoming part of hospital groups is the money. In fact, MGMA says that in 2009, first-year primary care and specialist physicians in hospital owned groups averaged higher compensation than those in other type practices.

Speaking of MGMA, the organization reports that compensation for practice management professionals has remained static over the last year. Interestingly, MGMA members are earning more than their non-member counterparts: office managers average $13K more per year and finance directors earn almost $1,000 per year more. ACMPE members achieve an ever bigger delta, earning at least 21% more working in practices of seven or more physicians. And, ACMPE-affiliated CFOs average $59K more than their non-affiliated peers. Note that you can join both organizations for a mere $585 per year.

A big welcome and thank you to AdvancedMD, our newest HIStalk Practice Platinum sponsor (and sponsoring HIStalk at the Platinum level as well). A few weeks ago, I had a chance to chat with AdvancedMD’s CEO, Eric Morgan, who is quite upbeat about the recent successes and rapid growth of his 10-year-old company. AdvancedMD started out with a SaaS-delivered practice management solution and acquired EHR vendor PracticeOne late last year. The Draper, UT-based AdvancedMD has over 10,000 connected providers, plus over 300 billing service providers participating in their AdvancedBiller program. We are pleased to have AdvancedMD on board!

Patients are more concerned about ready access to their medical records than they are potential record inaccuracies, according to Practice Fusion-sponsored survey. Their other top concerns include the theft or loss of medical record data and inaccessible data when in an ER.

I noticed that e-MDs posted some Facebook pictures from its sold out User Conference & Symposium in Austin, TX last month. This happy bunch were either Casino Night winners or members of e-MDs Advisory Board.

The seven-provider Good Neighbor Community Health Center (NE) selects Sage Intergy CHC as its EHR system.

E-mail Inga.

News 8/17/10

Ingenix announces plans to acquire HIE vendor Axolotl. Ingenix offers a number of HIT products and services, including PM, RCM, and EHR solutions for physician practices. About 3 1/2 years ago, Ingenix introduced its own suite of HIE products, but Axolotl has been more successful in that market.

The 2,000-member Indianapolis  Medical Society announces discounted subscription pricing for iSALUS EMR and PM software.

Practice Fusion announces ChartShare, which enables physicians to electronically refer patients to other providers. The press release stresses that access to data within Practice Fusion is “controlled by well-defined provider roles and access levels, the enforcement of strong login passwords, stringent user authentication and user inactivity locks” and only NP- and MD-level users can access the referral system. However, a provider sharing patient information with the ChartShare module apparently uses a template to create the letter, which is then forwarded via fax. I suppose technically that is an “electronic” referral and I suppose faxes are “secure.”  Why nitpick about a free product?

Speaking of Practice Fusion, the Las Vegas-based Ecco Healthcare is named a Practice Fusion Premier Certified Consultant.

Medical Informatics Engineering (MIE) names Bruce Lisanti CEO and president. He takes over for founder Doug Horner, who will remain board chair and CTO. MIE, by the way, is the EHR company that Google selected for its onsite employee health clinics. Lisanti spent time at EDS and GE before working working with several high tech startups.

Culbert Healthcare Solutions appoints Brian McCartie regional VP of its Midwest division. He’s a former VP of business development for Cejka Solutions.

Now that the Allscripts and Eclipsys boards have approved their merger, Allscripts initiates a public offering of 25 million shares of common stock. The shares are actually being sold by Misys to reduce its equity stake in Allscripts, just the next step in a complicated transaction.

AHRQ talks to a small group of clinicians (27) and evaluates the use of technology to assess patient health within specific practices. Findings: (a) practices with EHRs perform more practice-based population heath (PBPH) functions, such as identifying patients for clinical trials or disease management programs; (b) even practices with EHRs don’t fully utilize the functionality they have; and (c) barriers to adopting PBPH include lack of technological innovation, practice workflow, and lack of usable data. Hey, those are some of the same reasons practices don’t embrace EHRs!

Whether or not to adopt EHR is an especially tough decision if you are a facing retirement. Healthcare consultant Joseph Mack discusses the pros and cons in amanews.com, but here’s the bottom line: a physician less than three years away from retirement may have a hard time justifying the expense. Those who are 8-10 years away should probably find a way to make the investment so they can avoid penalties and earn incentive pay.

I am rooting for this guy. Greg Waldstreicher is co-founded of DoseSpot, a 2009 e-prescribing start-up company mentioned on HIStalk early this month. I can’t say his company’s offering is better or worse than other e-prescribing companies, though the product is Surescripts certified. Waldstreicher, however, is just a senior in college (at the Maryland Technology Enterprise Institute) and one of five finalists for Entrepreneur magazine’s Entrepreneur of 2010 Awards in the college entrepreneur category. I am sure I have shoes older than him. Nonetheless, I’m all about helping our HIT brethren out, so feel free to give him a vote here. Voting ends September 10th.

I’m chatting with an accountable care organization (ACO) guru tomorrow, which is a great thing, since I don’t have a good grasp on the whole ACO concept. A couple of the biggest question marks in my mind is how payment works for individual providers and is there adequate funding to make provider participation worthwhile. MGMA offers some good background in one of their recent blog post, which is helpful for newbies like me, as well as anyone contemplating participation in an ACO.

E-mail Inga.

Intelligent Healthcare Information Integration 8/16/10

Help for an Amazing Pioneer

Like most of you, I try to accomplish a few things during my time here on this earthly coil. Every now and again, I start getting a little full of myself and start getting a Steve Martin The Jerk-esque “I’m somebody now” sort of feeling. You know, a “look at me, look at me” moment just like every little kid shouts to their mom or pop at some point to achieve a little validation of their worth.

Through some of what I do in the realm of HIT, and especially through some of my writing here on HIStalk Practice (thank you, again, Mr. H and Inga), I have made some pretty wonderful contacts and some even more wonderful friends. These folks come from across the gamut of healthcare, from all over the US and even from around the world. When I start thinking about how fortunate I am to have such a breadth of colleagues and acquaintances and start to consider how I’ve maybe been able to have some impact upon the growth of this fledgling industry, I can sometimes actually feel my cranium getting fuller as it begins to swell. Until…

Until I remember Sid.

Dr. Sidney Nesbitt, to be precise. Sid is a pediatrician in Nairobi, Kenya. He is one of the “blessings” I have been granted through my time in the HIT realm. He runs the Muthaiga Pediatrics Clinic located on the grounds of the Gertrude’s Children’s Hospital, a charitable trust founded over 70 years ago to help the children of East and Central Africa.

Sid’s working very hard to develop and employ advanced office design, practice management, and especially healthcare information technology techniques and tools at Muthaiga Pediatrics. His goal is to set a standard, an example that he can share with physicians all around East/Central Africa. He even engaged the interest of MIT Sloan’s Global Health Delivery “G-Lab” which worked with him for months helping him evaluate and deploy better business tools specific to the needs in Nairobi. I was lucky enough, along with the wonderful Drs. Dan Feiten of Denver and Larry Rosen of New Jersey (himself, an MIT alum) to consult with their project.

On top of this, he is the director of their pediatric endocrinology fellowship, sponsored by the World Diabetes Foundation, which brings volunteer visiting professors from Canada and the U.S. each month to help train African pediatricians. He is pioneering similar initiatives to establish fellowship programs in Africa in Infectious Diseases, Emergency Pediatrics, and Pediatric Cardiology, Gastroenterology, Neurology, and Pulmonology over the next five years.

There is more work with charitable and volunteer efforts to advance child health in Africa with which Sid is engaged than I could begin to cover here. He is planning on sharing some his amazing work this year at the American Academy of Pediatrics (AAP) National Conference and Exhibition (NCE) in October, specifically, at the “Pediatric Office of the Future” (POF) educational exhibit in a section called “Future Pediatrics International.” (I am the director of the POF, for full disclosure’s sake.)

He is truly an inspiration for me and, I’ll wager, for many, many more folks around his native Kenya. He’s a joy with whom to talk and constant source of “what others are striving to do with far less resources and far greater challenges.” He helps me remember what’s important.

But, Sid could use some help. He is springing to bring himself to America for this event, but as any pediatrician anywhere in the world will tell you, we’re not the rich boys of medicine. So, if any of you good folks out there would be able to help my friend by helping him cover just the costs of the exhibit expenses, I will do everything I can to help promote your sponsorship. Expenses cover his presentation, PC, exhibit accessories, large screen monitor rental, etc. – pricey exhibit hall fees – at the conference site, totaling around $3,000.

(FYI – The POF is doing well and getting so much love from the AAP, we’re just finishing our own web site within the NCE site – somewhat unique – which highlights, and links to, our generous sponsors. The site’s a work in progress, but you’ll see the foundation. Plus, the AAP blasts emails to some 60,000 pediatricians and has great onsite marketing providing great exposure.)

Besides the marketing potential you’ll receive, you’ll be helping one very good man. His vision and his tireless efforts to advance HIT as he seeks to help the children of Africa are those of a true pioneer.

If you can help my friend, please contact me as soon as possible here in the trenches…

“There has to be this pioneer, the individual who has the courage, the ambition to overcome the obstacles that always develop when one tries to do something worthwhile, especially when it is new and different.” – Alfred P. Sloan

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

Joel Diamond 8/13/10

Lies, Damned Lies, and Statistics

Would you be nervous if I told you that using a phone doubles your risk of contracting a particular illness? What if I told you that the chance of getting this condition is one in a gazillion? To most, it might seem absurd to give up your phone just to cut your risk to two in a gazillion, but certainly there are others who would call for a federal ban on phone usage.

Patient access to the Internet continues to confuse a well-intentioned but often unlearned public. One of the biggest misunderstandings results from ignorance of absolute versus relative risk. Patients frequently are fearful of a particular treatment, “if it increases my chance of developing some rare condition by 5%.” Reported side effects of medications greatly worry my patients, who unfortunately have little knowledge of comparative placebo-controlled trials.

In fact, daily activities that we hardly think of day to day confer much higher risk. Yet dramatically better odds, when referring to medical risks, have an amazingly different effect on decision making.

Let me give you an example. Did you know that statistically speaking, walking a mile is 19 times or 1,900 percent more dangerous than driving a mile in a recalled Toyota?

Now let me show how statistics, when expressed differently, can have a profound effect on perception of health and disease.

Several years ago, a 62-year-old male patient of mine came in with the chief complaint of “something personal.” Since we’re dealing with statistics today, 90% of the time this translates into, “I’m here to get a prescription for Viagra”. Sure enough, this gentleman was highly distressed that the frequency of sexual intercourse with his wife had declined “by 50%” in the past several months.

Seeking additional history, I asked him what this translated to in encounters per week. “Well you know how it is doc, like everyone, the Mrs. and I usually had sex every night before we went to sleep and of course again every morning when we got up”. Dejectedly he added, “Now we just do at each night”.

I’m not joking when I tell you that he actually waved his hand in front of my speechless and disbelieving stare. “Doc, doc… are you listening to me? Did you hear what I said?” Regaining my professionalism, I replied, “I’m sorry, for a minute there I thought you said that you’re sex life has gone from 14 times per week to seven.” “Exactly!” he replied.

I explained to him that half of men over age 60 reported having sex once per month (admittedly a statistic out of context). He boldly strode out of my exam room with a new sense of youth and virility.

I’ve taken the liberty to assemble some (not so) related statistics. I leave it to you to draw your own conclusions from the data.

• 1: 4 – incidence of orthopedic surgeons who will cut the wrong limb at some point in their career
• 1:1000 – incidence of general pediatricians who will operate on the wrong appendage
• 1:2 – ratio of average salary of pediatricians compared to orthopedic surgeons
• 278 – number of bacteria colonies that are exchanged during a kiss
• 45 – percentage of tongue piercings that show signs of infection
• 2 and 63 – percentage of staph infections resistant to methicillin (MRSA) reported in 1973 and 2004, respectively
• 8 – percent increase in average hospital cost for unhelmeted motorcyclists involved in crashes compared to helmeted riders
• 8 – average percent savings on six pack of Pabst Blue Ribbon during ‘Bike Week’ promotional event
• 100 – number of cases of diphalia (two penises) reported, ever
• 50,000 – number of women in the US with didelphic uterus (two uteri and often two vaginas)

The power of analytics that will result from increasing codifiable EMR data will no doubt markedly transform medicine. Physicians themselves will have increasing difficulty comprehending this information without new approaches to reporting and representation.

It is our patients, however, who will be poorly prepared for this new (tidal) wave of information. I shudder to think how Personal Health Records will compound the problem.

 

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.