Readers Write 8/5/11

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Why IN-Eligible Professionals Should Still Buy and Implement Certified EHRs
By Mary Stroupe

If you don’t bill Medicare or Medicaid, you don’t qualify for federal Electronic Health Record (EHR) incentives. However, you should still implement a certified EHR if you want to keep patients and fellow physicians highly satisfied.

Our Movement Toward National Information Exchange and Interoperability

The US healthcare system is moving toward electronic health information exchange (HIE). Today, data is shared electronically among providers using Regional Health Information Organizations (RHIOs). Soon, a Nationwide Health Information Network (NHIN) will enable immediate, authorized access to patient data (similar to banking access provided by the ATM network). The goals of a NHIN are to reduce medical errors, duplicate tests and healthcare costs. Another goal is to provide patients with access to medical records, which are currently scattered across multiple medical entities.

How Interoperability Supports that Movement

The goals of the NHIN can only be realized by interoperability among EHRs: the ability to send and receive clinical data that means the same thing in whichever system it is viewed. The key to interoperability is standardized data. Just as data is standardized in other industries (like banking, to make ATMs work), medical data must be standardized so clinicians can properly interpret it.

How Certified EHRs Support that Movement

Certification is the single variable ensuring the EHR you purchase meets national interoperability standards. Two types of certification exist: ONC-ATCB (ARRA) certification and CCHIT Certification 2011. ARRA (or “Meaningful Use”) certification is what is minimally required for government reimbursement. CCHIT Certification 2011 provides an additional level of assurance that the product meets a more rigorous security inspection and complies with specific functionality, workflow, and usability criteria.

Why a Certified EHR? For Patient and Physician Satisfaction

With the steady growth of Personal Health Records (PHRs), patients will expect you to provide their health data electronically. Why? For eligible professionals to receive government reimbursement, they must be able to supply patient data electronically when it is requested of them. Once savvy patients realize they can get it, they will start asking for it – from all their providers, not just the ones who received incentive payments! Without an EHR and data that certifiably meets national standards, you will be unable to provide patients with data that can be shared with their PHR. If patient satisfaction matters, this matters.

As the wave of EHR adoption rolls across the US, physician offices will no longer staff to levels required to deal with paper (e.g., hard copy referral notes). Providers will exchange data electronically, using standardized data sets that make it possible. It is reasonable to expect, then, that referral providers may avoid colleagues who cannot provide data electronically. If physician satisfaction matters, this matters.

The Bottom Line

Providers who do not implement interoperable, certified EHRs risk becoming data islands to their patients and fellow providers (like a bank that cannot connect to the ATM network).

Mary Stroupe is President of Integritas, Inc. in Monterey, CA.

A Field Trip to athenahealth 8/5/11

My recent big adventures around the Boston area included a visit to athenahealth’s headquarters in Watertown. athenahealth’s offices are in a decommissioned World War II military arsenal near the Charles River. The main building is in a 111,000 square foot facility that has been transformed from its original cavernous shell to a more functional office building, but keeping its brick walls, warehouse atmosphere, and abundance of natural lighting.

John Hallock, athenahealth’s director of communications, met me at the company’s adjacent smaller building, which holds executive offices, the corporate cafeteria, and customer training rooms. It has conference rooms, and for less formal gatherings, tables and couches in open areas.

The company was in the midst of an off-site sales meeting, so a good number of employees were out the office, including CEO Jonathan Bush. However, I took at a peek at his office, which was  as eclectic and scattered as one might think if you have ever experienced the hyper Bush. It has no desk per se, just a conference table, since Bush apparently likes to work standing up.

The windows, couch, and walls were covered with giant Post-it notes, which Hallock joked could very well represent athenahealth’s five-year operating plan. In addition to lots of photos of Bush’s five kids, there are pictures of some of his more politically connected family members and his celebrity brother. I am not quite sure what the two-foot Batman figure was all about, but it seemed appropriate.

Hallock then took me over to the main building, which serves as home base for the rest of athenahealth’s 800 Watertown employees. I found the Network Operations Center (NOC) particularly impressive. The NOC is a single room with multiple monitors that display aggregated performance metrics for athenahealths’ hosted systems.

Employees monitor performance 24×7 (the third shift is covered by offshore workers) and can pinpoint performance issues down to the individual practice level. On that particular day, employees were tracking the system performance of a large practice that was going live.

The overall layout of the building was interesting. athenahealth handles payment posting and insurance follow-up for its clients, which means designated employees have access to vast amounts of personal health information. For that reason, corridor walls are curved to minimize unintentional viewing of data.

Departments are segmented into large work areas with high ceilings, huge windows, and low-profile cubicles. Modest-sized offices and conference rooms are sprinkled throughout. Employees can decorate their work spaces and the variety suggests an abundance of creativity. In both buildings, framed news articles featuring athenahealth and Bush adorn the walls.

The company scans literally every financial and clinical document that comes in the door using the most sophisticated scanners I’ve ever seen. In every work area and hallway, monitors display the status of incoming support calls and visually flag those that have been holding for too long.

Security cameras are everywhere and badges are required to open almost every door. The IT guys wouldn’t share the exact location of their offsite servers. Employees are required to follow strict protocols for how their badges are displayed.

athenahealth has preserved the best of the complex’s arsenal roots with the technology and infrastructure needed to support its creative employees.

E-mail Inga.

A Field Trip to eClinicalWorks 8/4/11

With the notable exceptions of HIMSS and MGMA, my HIStalk reporting rarely takes me away from my little laptop in my home office. Because a girl needs to get out now and then, I recently paid a visit to the brand new headquarters of eClinicalWorks in Westborough, MA. eCW moved to its new digs in May after spending over $18 million for the property and remodeling.

Sam Bhat, eCW’s VP of sales and one of the company’s five co-founders, was my host. About 600 employees work in the two-story facility, which includes customer training rooms, an employee cafeteria, lots of work surfaces (aka cubicles), and not too many offices.

CEO Girish Navani, who was traveling the day of my visit, has a 10×10 office. Outside, in open space adjoining several rows of cubicles, is a conference table where he and others conduct meetings. The design promotes transparency and collaboration and suggests the availability and willingness of execs to be in the trenches with their employees.

Though there are rows and rows of work spaces throughout the building, the walls of each cube are low. As a result, employees can sit at their desks and still see outside. The facility also has multiple break rooms with colorful walls and fun touches like the orange mobile-like structures hanging from the ceiling.

eCW also created multiple open areas that employees can use for meetings. Sam explained that the colors for these spaces are all slightly different (greens, oranges, blues) and suggest an East meets West theme. I don’t know about that, but I do know I liked the vibrant colors and the abundance of non-traditional work areas.

Because the facility is new, a few areas are still getting finishing touches. For example, an on-site gym for employees is opening soon. A few areas are also awaiting furniture or artwork, and I noticed several workmen doing their thing throughout my tour.

eCW has six customer training rooms as well as break areas specifically for clients. Customers enter the building through a separate entrance for security reasons. The office park has two hotels, which allows out-of-town customers (or employees) to literally walk across the street to attend classes or meetings.

eCW has several additional classrooms for internal employee training. On the day I was there, about 45 new hires were attending orientation and training. Sam told me most employees (at least in technical positions, implementation, and support) are recruited from graduate schools and typically have earned degrees in engineering or similar fields. The main hiring criterion is analytical ability.

I rounded out my visit with lunch at the employee cafeteria. The daily menu includes traditional American grub as well as an Indian entree. I went for the Indian, which was an excellent choice. OK, I must confess I really don’t know what I ate, although I know it was vegetarian and included rice and some sort of squash. It was delicious and a ton of food for an affordable $5.

The cafeteria has a huge screen and projector at either end. The space can be reconfigured as needed for large employee gatherings. In fact, Sam told me that a couple of weeks before move-in, a few dozen employees tried out the room and its AV setup to watch the world cricket finals at 5:30 a.m. on a Saturday.

eCW established the new headquarters to accommodate its rapid growth, but expects to outgrow the space in the next year or so, expecting to secure additional space in the same office park.

My conclusion is that the facility itself is lovely and functional, but not over the top. Its design reflects eCW’s culture, which strikes me as family-oriented and collaborative, with a heavy emphasis on transparency.

A big thank you to Sam and eCW for giving me a peek.

E-mail Inga.

News 8/2/11

Aprima Medical announces that its bookings for fiscal year 2012 increased 128%  compared to the previous year. Key wins include a the 15-provider Ankle & Foot Centers of Georgia and the six-physician Pensacola Lung Group.

Analysts suggest that Emdeon could go private if existing talks with private equity firm Blackstone Group fail to end in a sale. Since going public two years ago, the company’s earnings and stock price have lagged; going private would allow Emdeon to restructure its operations and add new products and services without the scrutiny of public investors.

MinuteClinic, the retail healthcare division of CVS Caremark, announces that over 10 million patients have visited its walk-in medical clinics since 2007. MinuteClinic’s strategy includes collaborative affiliations with regional healthcare delivery networks and EMR integration with partnering hospitals systems.

NextGen parent company Quality Systems, Inc. reports Q1 results: revenue up 21%, EPS $0.65 vs. $0.42, beating estimates on both. Shares will split two for one on October 27.

RCM provider Navicure says it is on track to increase its revenues by 30% during 2011, pushing the company’s run rate to over $40 million.

Sage announces Intergy v7, which includes user enhancements, certification of all 44 ONC-ATCB clinical quality measures, and 5010 support for the PM/EMR system.

The Healthcare Billing & Management Association (HBMA) announces details of its 2011 Fall Annual Conference September 14-16th in Las Vegas.

The AMA and other national and state medical societies ask CMS to consider exempting older physicians from the pending Medicare penalty for not e-prescribing. The organizations argue that physicians eligible for Social Security benefits by 2014 would find it economically burdensome to install and use e-prescribing and thus may choose retirement to avoid the penalty.

Radisphere names Alison Shurell chief marketing officer. Shurell was most recently the VP of product marketing for IntraLinks.

Physician practices are the fastest-growing segment of healthcare mergers and acquisitions. During the second quarter of 2011, Irving Levin Associates calculated 27 publically announced mergers and acquisitions  involving physician practices. That’s up 200% over the same period in 2010 and represents $416 million in transactions.

E-mail Inga.

DOCtalk by Dr. Gregg 7/30/11

Stage General

Knowing how much Mr. H enjoys his tunes, I found myself thinking of him and the whole HIStalk world last night when I was attending a benefit concert for our local Madison County Health Partners Free Clinic. (I know…sad, right? Thinking of HIT during some rare time out for a charity benefit … sigh.)

First off, the setting: the First Presbyterian Church here in little London, Ohio. Packed to the gills and then some. On stage: a homegrown, 18-year-old, multi-instrumental phenom named Chase Potter, along with a cornucopia of very talented musicians and singers from 18 to well past 18 who enter and leave through a nonstop revolving door process orchestrated seamlessly by Chase.

The music: another cornucopia, with lots of jazz, swing, gypsy swing, blues, gospel, big band, rock, French impressionist, and more, including some rather complex and moving original tunes penned by Chase himself.

To say that this guitar-bass-violin-alto sax-drum-playing young man is talented is sort of like saying Mr. H knows a thing or two about HIT. Truly, when I used “phenom” to describe him, I chose that word very specifically. As I mentioned, he had assembled a group of talent for this night which included some very fine artists: some younger and skilled, some quite well experienced with histories of playing on the world’s bigger musical stages.

All were very good. Chase, however, was the sun around which all these satellites revolved.

Now, from my past life as a rock-n-roll sound man, I know that almost everywhere you go, there are musical talents galore. Every city, town, village, and burg seems to have a group of amazing musicians that, but for fate or circumstance, could all be gracing the cover of Rolling Stone or kicking it at Carnegie Hall. But, some cream just seems to be destined to rise higher. This kid is that highest-rising of creams.

Technically, he’s good. But, he adds that Stevie Ray Vaughn quality when embracing an instrument; he sort of becomes a part of the instrument, melding himself into it so that the music which flows out is more of a collaboration than a performance. It makes the music more of an experience than a listen.

OK. He’s hugely talented, right? Sure, but, what captured the HIT side of my brain, though, was that this kid had this natural “stage general” capability that was flawless. With almost every song, he exchanged one set of musicians with another, rotating them in, out, and back in again with lighthearted verbal dexterity and an effortless, suave stage presence that most veteran performers would envy.

Bringing up singers, pickers, piano men, and this horn or that, he made the show flow seamlessly. Despite all of the ins and outs and “who’s on whats” that were constantly occurring, he was the consummate conductor and more. This stage general was directing the musician “troops,” staging the musical “attacks,” and commanding the attention of all.

Exactly what the world of HIT needs.

No, I’m not speaking of Mostashari and ONC. I’m speaking more in terms of medical IT tools that work in concert allowing a central conductor to orchestrate their harmonies. We need systems that don’t need to be the one-man band trying to do it all as much as we need good “stage generals” who know when to bring certain pieces into play, when to send others back to their seats, and what to say to the “audience” during the down time between “songs.”

Just as no one-man band can ever outdo a full orchestra, no single HIT performer is ever going to outshine the combined power of a coordinated set of “hot” players.

Perhaps this thought was also motivated by the recent Innovator Showcase on HIStalk. The product promo’ed there by Aventura certainly seems to be focused upon playing a specific role in the HIT ensemble, but also has some of the generalship which I saw in Chase. They aren’t the overall stage general, though they appear to have some conductor in them. They seem to understand that their role is to facilitate the bigger picture, to make the whole orchestra better.

Powerful, joltingly good HIT parts and pieces are out there, but they can’t get onto the same stage. Just like a mess of musicians milling about tuning up before the show, it’s an asynchronous cacophony. If they could be allowed to perform together, with a good stage general/conductor, what a symphony we might have.

I know it’s wish list stuff, but thinking of it in an HIT tangential, I hope we see more development of HIT stage generals who allow lots of other players on stage, bringing in their supporting talents, knowing when to bring ‘em up and sit ‘em down, and who can also, just like Chase, make me smile between songs …er, I mean patients.

From the trenches …

“The principal task of a conductor is not to put himself in evidence but to disappear behind his functions as much as possible.” – Franz Liszt

PS – In case you were wondering, Melissa Canney, the Free Clinic’s director and one of the best people walking the planet, told me this afternoon that Chase et al generated some $4,000 in donations. Quite a bit better than the standard bake sale!

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).