Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
News 4/24/10
CCHIT extends 2011 Ambulatory EHR certification to a couple of new products, the first additions since January. CureMD EHR Version 10 is now fully certified. while NeoMed EHR 3.0 receives pre-market certification.
The Alaska EHR Alliance selects e-MDs and Greenway Medical as the “best choices” for the state’s healthcare providers. ACS Healthcare Solutions was the managing consultant for the selection process, which lasted eight months and started from a pool of over 250 EHR vendors.
Olympic Medical Center (WA) plans to take two clinics live on GE Centricity EMR this week.
Sevocity EHR says that none of the 200 providers who have implemented Sevocity over the last year have asked to take advantage of the company’s implementation guarantee program. The program allows providers to cancel their EHR contract within 60 days of implementation and receive 100% of their money back. Wisely, Sevocity requires providers to document at least 100 patient visits during those 60 days before requesting a cancellation. If a physician documents that many visits, he/she is likely to have gotten over the initial frustrations common with any new EHR.
MGMA adds Navicure to its AdminiServe Partner Network. As a network partner, Navicure will extend MGMA members special terms and discounts for its clearinghouse solution.
National Billing will serve as a certified consultant for practices transitioning to Practice Fusion’s EHR program.
The American College of Physicians speaks out in favor of EHRs, saying they are critical for effective reporting on quality measurements.
athenahealth signs a business process services agreement with IBM to provide voice, data, and administrative support for athenahealth’s RCM services.
An Indianapolis geriatric clinic cuts its “missed specialist referral” rate 20% after implementing a system that generates automated reminders to primary-care physicians if specialist scheduling doesn’t occur in a timely manner. Researchers estimate that 50% of patients fail to receive the specialist treatment recommended by their primary care providers.
Coastal Orthpaedic Associates (SC) selects SRS EMR for its 14 providers.
A group of Massachusetts General Hospital dermatologists determines that online visits are as effective as in-office visits for acne patients. Patients participating in the online study sent their providers digital photos of their skin and answered online questions on their condition. Physicians spent about the same time per patient evaluating online patients as they did in-office patients. Patients, however, spent much less time using online alternative.
Salesforce.com will provide an EMR for this week’s free healthcare clinic at the Los Angeles Sports Arena. Volunteers will enter patient records into 35 laptops and e-mail them to healthcare providers for follow-up care. Over 6,300 people received care at last year’s event.
The Raleigh, NC paper says Allscripts plans to hire about 500 people in the coming year, including about 250 in Raleigh.
The American Academy of Pediatrics names Christoph Lehmann, MD director of of its new Child Health Informatics Center. He is tasked with the development and implementation of medical informatics programs to help pediatricians and pediatric hospitals adopt EMRs and other healthcare technology.
The AMA launches an online resource to help physicians recoup money from UnitedHealth Group following the insurance carrier’s legal settlement for price-fixing allegations. AMA’s online program will help physicians determine eligibility for reimbursement and will facilitate claims filing. The settlement made more than $350 million available to compensate physicians and patients.
A pediatrician blogger offers seven reasons why medical practices have yet to adopt EMRs. The noted items include a couple we have heard many times before: price and usability. However, he also points out that the lack of dominant players and too many product choices makes the selection process confusing. Doctors also realize that because of the size of the investment, they are locked in with their choice for a while once they settle on a solution. Finally, interoperability is mentioned as a concern. I’d also throw in the reason (excuse?) that many physicians are hoping that someone else will step forward with a checkbook to pay for the project (the hospital, perhaps). Any others?
>>> Any others?
Hi Inga! There are many…
I use a really great non-“meaningful use” capable hybrid EMR that I programmed myself using MS Office. It handles my billing and chemotherapy too. Why would I want to give this great program up which makes me so efficient and lets me enjoy my practice so much more? What, exchange this for a GE, NextGen, Greenway, or Allscripts albatross? NO WAY!!!
The way I look at ePrescribing is that I send my prescriptions to the printer. Period. I see eRx as only being an ill-conceived political Obama/Democratic kickback program to Glen Tullman, CEO of Allscripts, who is one of the largest lobbyists on this planet. I don’t want to play because I feel that eRx and HITECH are wrong, disingenuous, and should be illegal. They are not about HIT but about “spreading the wealth,” this time being physician wealth.
The fact that HITECH and “meaningful use” still seem to be a poorly funded and increasingly complicated process in evolution has made physicians prefer to wait in the sidelines to see how things pan out. The cost of complying is multiple factors more than the lousy $44000.00 grant.
HITECH also is a rebate-style payment scheme which most likely will result in about 60-80% of those attempting to comply ending up empty handed. This number is the average seen in your local computer store rebate programs as well as in the prior 2 P4P Medicare programs.
Many physicians aren’t really sure if they’ll stay in Medicare at all. I for one will be going “nonpar” meaning that I’ll only be partially participating. Patients will need to pay me up front and I can charge about 10% more for each CPT code billed. Of course, “nonpar” docs can’t participate with HITECH, so why bother with a complicated, expensive EHR and with the bothersome, intrusive “meaningful use” BS then?
I’d rather see the less sick, easier to see, better reimbursed privately insured patient than the sick, multiple-problem-list-hit-ground Medicare patient in which now we have to report on their “meaningful use” encounters. I can see 2-3 of the former for every Medicare patient that walks through my office… without even using an EMR.
Lastly, Medicare will be going bankrupt by 2017, so why try to comply when we’ll get stuck standing on a sinking ship while having to pay for the ongoing costs of a “meaningful use” EHR? That’s nuts!
As you can see, these are very important reasons to not buy a “meaningful use” EHR.
Al
Al’s third to last paragraph tells us all we need to know.
Is something seriously “off” with MDs? Mass hysteria? It’s an unrelentingly boo hoo about EHRs- too many choices, too hard, too expensive, too slow…yet even if hand picked, easy, fast and we pay them, “we don’t wanna”… don’t care about writing complete legible orders (CDS) others can read, don’t want to document information someone else might need and use! Don’t want to treat old people either if we can’t get rich off of them, don’t want to care for the uninsured but don’t want anyone else to take care of them either, that’s “socialized medicine”.
Let’s put 500K Luddite MDs in a giant jumbo jet on a stormy cross ocean flight with a pilot who refuses to use computers so they get a sense of how it feels to be treated by an MD flying blind without an EMR.
You’re fighting a mid-20th century battle – after 40 years EMRs not going away -and most of the rest of use are happy about that. We work in a highly complex, multidisciplinary, data intensive, risky industry and…hold your breath Al…MDs are not the center of our universe! The patient is. No, seriously.
And Al, we confess. HITECH is a giant conspiracy hatched to torture those doctors who for years failed to self-police, engage seriously with us in the quality of care fight (or EHR implementations) and acknowledge you’re part of a care team not the slave master of the plantation health care. The non-stop whining about your incomes and physician wealth (looked up lately?) is beyond tedious – certainly not moving us forward.
Yes, lock your doors and windows docs, those big bad computers, President Obama and Glenn Tullman are all coming after you. BOO!
Welcome to the 21st century.
>>> Let’s put 500K Luddite MDs in a giant jumbo jet on a stormy cross ocean flight with a pilot who refuses to use computers so they get a sense of how it feels to be treated by an MD flying blind without an EMR.
Different scenario- the pilot is not forced to actually have to BUY an EMR, and his cockpit interface actually makes sense. He doesn’t have to worry about a 50% crash rate. Thus the analogy sucks- flying an airplane is NOT like practicing medicine where seeing patients is more of an art, rather than the practice of accumulating data. We do have technologies in our offices, Peppermint Patty, it’s just not EHR. According to the CDC only 6% of office based physicians and only 2% of hospitals are ready for HITECH, and only a portion of those will be “meaningful use” ready, so your “mid-20th century battle” reference is misplaced. The fact is that 21st century medicine doesn’t need/want Obama’s (and his lobbyists) EMR ideas.
This is a political battle on where we want medicine to go- 1) into an expensive, poorly funded mandate, poorly studied technologic territory dominated by vendors hell-bent on extracting physician incomes for their own benefits with little proof that the patient will benefit, or 2) continue with a less expensive, less bureaucratic healthcare system that has the best chance of benefiting all. The former will eventually be paid for by the taxpayers either through increased healthcare-related taxes or through increased healthcare costs.
>>> Don’t want to treat old people either if we can’t get rich off of them… etc etc etc
You do make a lot of senseless rants. Were you able to get your HIT frustrations out? Feel better? ;^) It’s not going to make EHR more palatable, that’s for sure…
Al
The airplane analogy didn’t resonate because you still believe medicine is mostly art. Like flying there is clearly a critical component that IS art, but also of science that in our case takes decades to become part of medical practice.
Surely of 250 EMRs you can find one that you find usable. I am equally critical of vendors poor investment in UI and applaud all efforts to get more accountability in this area.
There is ample evidence that EHRs can improve patient safety if well designed and implemented – can you seriously argue that the most data intensive industry should remain on paper? There is a ten year period where the industry will struggle with acceptance of IT – largely by older clinicians not raised or schooled on it. The MDs of all ages I work can’t imagine working without an EMR for guidance, but you sound like a pilot who would fly blind which is why you missed the point of the analogy. It’s not the UI or who pays, it’s having people in life critical roles who refuse to accept that they don’t have all the answers.
The comment on getting rich off poor people was meant as a jab – surely you haven’t missed the MD now obsessive focus on their income and lack of “team spirit”. Need I offer proof?
Regarding the senseless rants – LOL and “physician heal yourself”. You are the most prodigious and notorious “ranter” in the blog sphere. I know it’s shocking to you but some of us actually find the EMR not only palatable, but valuable. They say converts are the most powerful promoters, so I hope you’ll see the light and jump on board one day.
Hi Patty:
>>> Surely of 250 EMRs you can find one that you find usable.
Actually, I have… MINE!!! I built it from the ground up using Visual Basic on the MS Office platform. It’s massive, functional, and very helpful, making me more productive. At my website, http://www.msofficeemrproject.com, I have an on-line tutorial to help other docs consider doing the same, so I am much of an EMR promoter. My site nowadays gets about 2500 visits a month and continues to grow… I didn’t know that there were that many nerds in the HIT/healthcare!
Most of these “meaningful use” Obama-friendly EHRs are usable alright, but not in a real “meaningful” sense. I consider HITECH another “cash for clunkers” legislation that is trying to postpone the eventual demise of the expensive “enterprise” EHR systems which will eventually be overtaken by cheap, basic EMR systems in the future.
Most physicians only need just a sooped up MS Word for dictations and other note taking and a simple MS Access-like database solution as a rolodex to find patient charts and to enter in vital patient information.
Physicians don’t need a “meaningful use” HER which are now estimated to have a median up-front cost of $33000 with a median $1800 per month ongoing costs, and other costs s.a. training, expensive servers and the like. Physicians don’t need to go through P4P schemes where they have to waste their time reporting patient information using their EHRs… which is a very bizarre situation in that we’re supposed to buy the HIT that then turns around and screws us in our pocketbook by forcing us into reporting, CPOE, and other complexities that make our lives hell.
>>> There is ample evidence that EHRs can improve patient safety if well designed and implemented – can you seriously argue that the most data intensive industry should remain on paper?
Yes. Show me one study that has actually been performed prospectively and randomly, using the same parameters in both the EHR and in the basic EMR/ paper arms showing that the EHR has performed in a superior manner. Actually show me 3 studies to verify outcomes and to confirm the results in different institutional settings and I’ll become a convert- promise. In the meantime, there are numerous other articles showing how the EHR can increase costs, increase errors, and decrease quality- just go to my website at http://msofficeemrproject.com/Page7.htm .
The only situations that I’ve seen where the EHR has helped somewhat are:
1) The VAMC, where veterans can go to any VA hospital and have their charts available. Morbidity and mortality studies still haven’t been done compared to paper/basic EMR, but it has made the system more efficient, and patients generally like the new HIT changes.
2) Kaiser- at Kaiser their $4 billion dollar “Epic” system has increased some efficiencies, but many doctors there admit that entering the information into the EHR is cumbersome and doctor-patient time has suffered, which could theoretically bring about increased morbidity and mortality. Patients generally hate Kaiser because although Kaiser has spent a lot on their EMR and on their pretty buildings, the way they handle patients and serious disease states remains weak. Denials and the use of physician extenders prevail.
In Massachusetts, HIT has now become universal, but again, doctors tend to dislike HIT even with its efficiencies. Healthcare under the MA HIT umbrella has proven to be 15% more costly than the rest of the USA because of numerous reasons including socialized healthcare as per this recent article (http://www.mass.gov/?pageID=eohhs2terminal&L=6&L0=Home&L1=Researcher&L2=Physical+Health+and+Treatment&L3=Health+Care+Delivery+System&L4=Health+Care+Cost+Trends&L5=Health+Care+Cost+Trends+Preliminary++Reports&sid=Eeohhs2&b=terminalcontent&f=dhcfp_researcher_cost_trends_cost_trends_01&csid=Eeohhs2 ) but they failed to add in the cost of HIT which I am absolutely sure is part of the problem. HIT-happy Partners Healthcare in particular has run into a 25% shortfall putting it in the red (see http://ducknetweb.blogspot.com/2010/05/partners-healthcare-report-substantial.html ).
In Arizona, providers adopted EHR technology in large numbers largely thanks to a 2005 executive order by then-Gov. Janet Napolitano requiring all healthcare providers to install EMRs by 2010. Now, many are deinstalling these systems in large numbers. Read more: http://www.fiercehealthcare.com/story/trend-arizona-providers-de-installing-electronic-medical-records/2009-06-25#ixzz0okxfT28T
Just a few days ago this article ran in JAMA about HIT increasing costs in hospitals: http://www.e-healthcaresolutions.com/AMA/aciphex-amednews-0310-inter.php?url=http://www.ama-assn.org/amednews/2010/05/17/bisf0521.htm
>>> You are the most prodigious and notorious “ranter” in the blog sphere.
Aw shucks, I thought that I have gone unnoticed! I have jumped on board a long time ago, offering I hope the “other side” of the forced HIT movement which is starting to resonate with people (see http://blogs.wsj.com/health/2010/05/18/too-much-too-soon-electronic-medical-record-effort-gets-pushback/ ).
Al
Almost 10 months have passed by and Peppermint Patty remains speachless. Maybe it might be because a lot has happened since then-
1) CDC has reported that 2 years after Obama signed off on this HITECH monster, less than 10% of physicians are actually meaningful use (MU) ready.
2) Another article stated that of these, only 10% will actually see MU money.
3) Republicans are getting ready to cut HITECH (think “MU”) pork together with other Obama stimulus funds not yet spent/wasted.
4) It will be interesting to see what happens to the concept of MU this year when the Supreme Court eventually rules that Congress cannot penalize anyone for not buying healthcare insurance. If that happens, the same thing can be said about HITECH’s provision that after 2015 physicians are to be penalized for not buying and MU an EHR- the Commerce Clause cannot Constitutionally force anyone into doing commerce with a private company (the EHR vendor) through the process of penalties.
Why some folks hate physicians enough to try to penalize them into poverty is beyond me. Fortunately, events in 2011 may end HITECH/MU once and for all. That’s a good thing for healthcare. If big government finally leaves HIT alone, it might be good for vendors too- freeing them up from the bureaucratic regulations that are costing them so much of their profits. Who knows- maybe we’ll see better interfaces, lower prices, and maybe even intracommunication between systems. Leaving private enterprise alone would be a good thing.
Al