News 1/28/16

Top News

The CDC publishes data from its 2014 National Electronic Health Records Survey, finding that 74 percent of office-based physicians are now using certified EHRs, while 32 percent are sharing patient health information with external providers. Physicians with a certified EHR were also more likely than non-certified users to share patient data electronically with behavioral health, long-term care, and home health providers. 

Webinars

None scheduled in the next few weeks. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Announcements and Implementations

DrFirst releases a new version of its e-medication management platform, adding predictive analytics and a mobile app.

Florida Orthopaedic Institute selects a predictive rules engine platform from RCxRules to enhance its RCM processes.

People

Massachusetts General Hospital President Peter Slavin joins American Well’s Board of Directors.

Drew Hamilton (TeleTrac) joins Kareo as chief sales officer.

Telemedicine

Golub Corp. partners with Doctor on Demand to pilot telemedicine services at five Price Chopper locations in New York and Vermont, part of the company’s broader effort to build a successful chain of walk-in clinics at its affiliated Market 32 grocery stores. In the wake of HealthSpot’s bankruptcy filing, I found it interesting that Golub VP Kathy Bryant says the telemedicine push ties in nicely with the chain’s Computerized Screening health stations that can gather biometric information like temperature, weight, and blood oxygen levels.

The Garage – a curiously named health IT company based in Orlando, FL -  signs multiple contracts with providers for its Ignite telemedicine platform, which includes audio, video, and text.

Government and Politics

The Office of Information and Regulatory Affairs reviews a proposed ONC rule that seeks to develop enhanced oversight and accountability for its health IT certification program. No leaks yet on what the proposed rule portends for the program, which was set up last fall. I’m willing to bet (literally, since a good chunk of the industry will be in Las Vegas next month) that ONC drops the details during HIMSS.

CMS issues a final rule that requires physicians to document face-to-face encounters with Medicaid patients before ordering home health services or medical equipment. The healthcare IT connection involves the rule’s clarification that such encounters can include telemedicine for homebound patients in need of timely services. Updated Medicaid telemedicine rules are in the works.

Other

Ascension Ventures, Athenahealth, and Cambia Health Solutions will host Invest for Health on March 14 as part of the SXSW Interactive Festival in Austin, Texas. Organizers hope to attract entrepreneurs, heathcare executives, and venture capitalists to the inaugural event. Given that the first session is entitled “Where it Hurts: What’s Wrong with Healthcare in America?” (the almost exact title of Athenahealth CEO Jonathan Bush’s 2014 book) it’s probably safe to assume that executives from the three companies above will headline.

Contacts

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

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News 1/27/16

Top News

SnapMD closes a $5.3 million Series A funding round led by Shea Ventures, TYLT Labs, and Whittier Ventures. The company will use the fresh funds to expand its direct sales capabilities and product development of its private-label telemedicine platform.

HIStalk Practice Announcements, Requests, and Musings

I’m a bit of a journalism junkie, given that I got my start in trade magazines and am now covering the always exciting world of healthcare technology. I fondly remember hand-pasting in advertisements during my first internship at the Flagpole, a weekly similar in tone to Creative Loafing, but with its own unique Athens, GA flavor. (Where else could you keep up to date with the latest Michael Stipe sightings?) Imagine my excitement when the 50th anniversary issue of Southern Living hit my doorstep yesterday – chock full of editorial tales of mistakes, successes, and just plain bad headlines. The healthcare IT connection was almost made when I came across the tale of a disgruntled former employee who held ad copy hostage, hoping for a $10,000 payment, before that month’s issue was put to bed. It’s not quite the stuff of EHR and ransomware legend, but it helped me connect the dots to my paper-based publishing past and digital present.

Webinars

None scheduled in the next few weeks. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Riverside Medical Group announces plans to go to an “always-open” model later this month at one of its six locations. The family-owned practice seems to have a history of attempting to keep up with new practice business models, offering same-day appointments, easy specialist access, and later hours before many of its competitors. It is also exploring telemedicine through partnerships with MedX and Pingmd.  “It’s about convenient care,” says RMG Principal Zeyad Baker, MD. “Most doctors are stuck and saying, ‘Well I’m the doctor, this is my schedule and you have to fit into it. Well, sorry, that’s gone. Patients are demanding and they want more, and it’s not unreasonable.”

SCIO Health Analytics acquires Clear Vision Information Systems for an undisclosed sum. SCIO will combine Clear Vision’s risk adjustment and quality metric analytics, and outreach services with its services focused on reimbursement and care optimization. SCIO CEO Siva Namasivayam, who founded the company in 2007, has done stints with Perot Systems, Gartner, and Intel.

Announcements and Implementations

Wolters Kluwer’s Health Division partners with Anthem subsidiary HealthCore to develop data normalization services for the statewide Cal Index HIE. Anthem Blue Cross and Blue Shield of California contributed $80 million in seed funding to launch the HIE in August 2014. It came under fire last February for its shaky privacy policies.

Telemedicine

The Missouri Farm Bureau includes telemedicine in its list of 2016 legislative priorities, along with increased access to rural broadband. The state received mixed marks for its telemedicine-friendliness in ATA’s May 2015 gaps analysis report, getting an A for private insurance and state health plans, and a C for Medicaid reimbursement.

The National Coalition on Health Care expresses to lawmakers its support to for allowing Medicare Advantage plans to include telemedicine in their annual bid amounts. Citing the success of Medicare’s Health Buddies remote-monitoring and telemedicine program, NCHC President and CEO John Rother notes that, “Telehealth should not be considered just another supplemental benefit; it ought to be considered a means of delivering a broad range of Medicare benefits.”

Government and Politics

The American College of Physicians responds to the Senate Finance Committee’s Bipartisan Chronic Care Working Group Policy Options document, released last December. The 27-page document emphasizes healthcare IT in several ways, recommending the creation of codes to provide reimbursement for e-consults, providing ACOs the ability to expand the use of telemedicine, expanding access to digital coaching, and providing reimbursement for e-consults both between hospitalists and primary care physicians and specialists and primary care physicians. 

Research and Innovation

Physician social network Doximity takes a look at physician compensation trends based on the data of 35,000 members. Highest-paying states for PCPs include Arkansas, South Dakota, and Iowa, with salaries ranging between $330,000 and $305,000. PCPs in Delaware, West Virginia, and Washington, DC only see salaries of between $218,000 and $192,000. Academic physicians make 13 percent less than their non-academic peers, and male physicians tend to make 21 percent more than their female counterparts.

Other

Last night’s AMA Town Hall with the Washington State Medical Association wasn’t all EHR-bashing, as WSMA Executive Director Jennifer Hanscom’s tweet above reflects. The Seattle event, held at Swedish Medical Center, seemed to generate far fewer tweets than similar events held on the East Coast last year. Perhaps the physician furor has died down somewhat thanks to Andy Slavitt’s recent remarks.

Fitbit plans to update its security measures after a spate of hackers break into Fitbit user accounts and gather warranty information that they then sell on the black market. The hackers also had access to personal health data such as weight, GPS data, running routes, and sleeping patterns. Reports have circulated that Fitbit user account logins and passwords have been traded on the black online market for as little as 50 cents.

Sponsor Updates

• EClinicalWorks is recognized as having the highest market share among cloud-based EHR vendors
• Versus creates a dedicated clinical solutions department of RNs.

Blog Posts

• Reflections on 2015: Paving the Way to Value-Based Care (Medicity)
• Take Full Advantage of EPCS (AdvancedMD)
• 7 HIT Trends to Watch in 2016 (Culbert Healthcare Solutions)
• Using a Care Team Model to Drive Patient Engagement (Healthwise)

Contacts

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

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News 1/26/16

Top News

AMA takes its Break the Red Tape campaign to Seattle tonight, where it will co-host a town hall with the Washington State Medical Association. AMA President Steven Stack will be on hand to encourage physicians to share their EHR war stories and their concerns around Stage 3 of Meaningful Use. Similar events were held last year in Atlanta and Boston. The free live stream kicks off at 7 pm PT.

HIStalk Practice Announcements and Requests

Remember when computer games were simple? I remember being mesmerized by the soft glow of solitaire after my parents purchased our family’s first desktop computer. My how times have changed. Donald Rumsfeld, of all people, also shares my love for the game – so much so that he has created an app of a version once played by Winston Churchill. The former US defense secretary learned the game – “an incredibly devilish version of solitaire” – in 1973 from a Belgian diplomat who learned it from Churchill himself.

Webinars

None scheduled in the next few weeks. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Announcements and Implementations

EHR vendor Prime Clinical Systems partners with Sphinx Medical Technologies to develop an answering service app that integrates with Prime Clinical’s Patient Chart Manager EHR and OnStaff PM system.

CareSync joins Athenahealth’s More Disruption Please program, offering AthenaClinicals users access to its chronic-care management platform.

EHNAC and the National Health Information Sharing and Analysis Center collaborate on the adoption of secure, identity-validated health information exchange via Direct, and development of additional uses of Direct for secure and encrypted health data exchange. Deliverables will include educational materials and presentations, incident response, and impact analysis.

People

Family Care Partners names Thomas Watson (Aetna) CEO, Paul Miller (Cornerstone Healthcare) CFO, and Clay Lowder, MD (Colonial Family Practice) CMO.

Telemedicine

Minneapolis-based startup RetraceHealth raises $500,000 from a group of investors that includes Blue Cross and Blue Shield of Minnesota, HealthEast Care System (MN), and McKesson Ventures. This latest round wraps up its $1 million fundraising round that started last summer. The company offers virtual visits, house calls, and lab services. I love founder Thompson Aderinkomi’s professional headline on LinkedIn: “The problem with healthcare is the price.”

Other

Proving once again that employees are a company’s greatest security threat, St. Louis-based payer Centene discloses that six hard drives containing the PHI of 950,000 members are unaccounted for among its “inventory of IT assets.” The drives were part of a data project using laboratory results to improve the health outcomes of its members. A search for the missing drives is ongoing.

Contacts

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

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Readers Write: The Future of EHRs – Less Meaningful Use and More Physician Satisfaction

The Future of EHRs: Less Meaningful Use and More Physician Satisfaction
By John Squire

Healthcare providers have been turning against the Meaningful Use program in growing numbers since the switch to MU Stage 2. The original concept of MU was supported by well-meaning public health advocates, but the ultimate manifestation of the program had the unintended consequence of intruding on the physician’s time with patients, and breeding more costly and difficult to use software.

Is MU Already Over?
For years, critics have knocked MU for focusing too much on providers checking off boxes rather than actually improving care. It makes physicians less efficient in the exam room and forces them to spend more time typing and clicking than healing. MU2 added new metrics over which physicians have little or no control, such as getting patients to sign up for a practice portal, or reporting immunizations to non-operational state registries.

Recently, CMS finally acknowledged that the program was not benefitting physicians or patients. Acting CMS Administrator Andy Slavitt said publicly that the agency "has the opportunity" to sunset MU in 2016 and that "the Meaningful Use program as it has existed, will now be effectively over and replaced with something better.”

The Blueprint for Future EHRS 
That still leaves EHR systems bloated with MU Core and Menu measures embedded in all workflows, and many physicians no longer want them. Providers want to strip away all the check-boxes, reports, and other clutter. They want clean, streamlined screens that look the way they did before the mandates, and they want to complete routine tasks with minimal clicks. Let’s explore what the EHR of the future might look like.

The Reality of Cognitive Overload in the Exam Room
One criticism of MU is that it interferes with how providers think about patient problems in the exam room. By removing MU, we have an opportunity to make EHRs “think” more like a provider – or at least support the logical thought process of a provider, rather than hinder or intrude upon it.

Providers think in problems, yet nearly all EHR systems organize data by source. A patient’s lab results, for example, are presented as a single list, regardless of the problems for which the labs were ordered. The same source-based organizing principle is used for exam notes, medications, orders, referrals, etc. As a result of this mismatch, providers feel as if they are drowning in an ocean of disorganized data and the addition of MU measures only exacerbates the issue. The capacity of providers to multitask effectively is often stretched beyond its limits, leading to cognitive overload, which impairs the medical decision-making process and can lead to errors such as misdiagnosis and other potentially life-threatening mistakes.

Use a Problem-Oriented Medical Record
The future EHR system will be a problem-oriented medical record (POMR). In this approach, all notes, medications, labs, orders, referrals, etc. are associated with specific patient problems. A problem list not only delivers a “table of contents” to clinically relevant issues, but also gives a provider a longitudinal view of a patient’s healthcare over time. Another benefit of this approach is it allows user interface designers to make screens look cleaner and less cluttered.

This more intuitive, problem-based method of organizing information makes it easier for both provider and patient to set the agenda at the start of the exam. Once the exam is underway, the POMR accommodates the nonlinear nature of an encounter. The provider can easily shift from problem to problem, or document new problems, as they interact with the patient, allowing for more eye contact and less clicking and typing.

Support Sound Medical Decisions
In medical school, providers are trained to “think” in patient problems. Because the POMR organizes and presents patient health information the same way, it is naturally more intuitive to use. An EHR with the patient problem list as its organizing principle can even help reduce cognitive overload in the exam room. Providers can now see “bits” of datum – like lab results – associated with a specific problem, thus easing the number of mental connections required to make a sound, well-informed medical decisions.

Learn How a Provider Practices
The future EHR system will learn a provider’s behavior as they practice to minimize typing and time spent looking at the screen, which has always been one of the biggest complaints about MU. For example, the EHR system can learn which medication a provider typically orders for a particular problem, including details such as dosage and formulary, and then suggest the same medication whenever the problem is diagnosed again. In theory, a medicine could be ordered in as few as three mouse-clicks. The same principle is applied to labs, orders, referrals, etc. These efficiencies will return time for face-to-face interactions with patients.

Allow for Quality Reporting and Data Exchange
The early signs are that the CMS program will shift to emphasize quality of care and outcomes, allowing physicians to focus on patients and care. It will encourage quality tracking and reporting, but limit intrusions into the physician’s workflow. CMS will also continue to promote the idea of standard interfaces between disparate EHR systems to enable information exchange among physicians, hospitals, health information exchanges (HIEs), and other elements of the broader healthcare ecosystem.

As these changes occur, the EHR of the future should be able to manage them in the background, in a way that maximizes productivity and does not interfere with patient visits. It should support the ability of providers to operate independently, but still interact with their ecosystem.

The Future is Bright for Providers
As we gaze into our crystal ball at the future of the EHR, the picture is clear. Providers will flock to a full-featured EHR system that combines the efficiency of pre-MU software with a POMR. This new approach to the EHR system promises to deliver both increased professional satisfaction for providers, as well as improved health outcomes for patients.

John Squire is president and COO of Amazing Charts in North Kingstown, RI.

Contacts

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

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News 1/25/16

Top News

CMS releases the application for hardship exemptions from Meaningful Use penalties in 2015. Physicians have the ability to request an exemption based on an “extreme and uncontrollable circumstance in the form of EHR certification/vendor issues.” This is one box-checking opportunity I’m sure many physicians won’t mind taking advantage of. Penalties will occur in 2017, totaling 3 percent of Medicare payments for physicians who don’t attest or qualify for the exemption. EP exemption applications are due March 15.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Specialty-focused healthcare IT vendor Nextech Systems acquires SupraMed, a developer of EHR and PM systems for plastic surgeons, for an undisclosed sum. SupraMed founder Robert Pollack, MD will step into an advisory role for the newly combined organization.

Telemedicine

The state of Mississippi’s insurance department selects telemedicine services from Teladoc as part of its new virtual care plan for volunteer firefighters and their dependents.

The Federation of State Medical Boards announces that Alaska, Arizona, Colorado, Kansas, New Hampshire, and Washington have introduced Interstate Medical Licensure Compact legislation in 2016. Twelve states have already enacted the compact, which when fully developed will offer streamlined licensing process for physicians interested in practicing medicine in multiple states. The Interstate Medical Licensure Compact Commission, which is working to put the compact into practice, will meet again on March 16.

Emerge Urgent Care opens today in Buda, TX. The four exam room facility bills itself as the first telemedicine-based urgent care center in the US.

Research and Innovation

University College London researchers develop the Dementia Risk Score, an algorithm that can estimate a patient’s chance of developing dementia within the next five years. The algorithm, which has demonstrated an accuracy of up to 85 percent in patients between 60 and 79, uses health data collected from 377 practices in the UK. The researchers feel the score has potential as an addition to clinical software systems, though they stress additional pilots should be done with more populations.

Other

Cerner CEO Neal Patterson reveals he is suffering from soft tissue cancer and will plan to undergo treatment immediately. His physician has assured him that this type of cancer is treatable and curable. “I plan to stay involved in the business, but with less travel and fewer meetings,” Patterson said in a company statement. “In reality it will not be a big change compared to how we run Cerner day-to-day already. It’s not often I’m forced to slow down, but the silver lining will be having some extra ‘think’ time to reflect on all the extraordinary opportunities we have in health IT. After years of studying healthcare systems around the world, this unique opportunity already has my gears turning.” Patterson’s ability to find the silver lining is admirable, and one he has likely honed during his wife’s years-long battle with breast cancer – a diagnosis that he has cited as an impetus for CommonWell’s interoperability efforts.

Alaska Orthopedic Specialists, which closed in March 2015, notifies patients that a former employee sent copies of patient information to the employee’s personal email account without permission. AOS is taking steps to secure the return of all information. No foul play seems to have occurred.

Contacts

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

More news: HIStalk, HIStalk Connect.

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