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Do Primary Care Physicians Have A Bigger Stake in EMR Adoption?

Posted on April 30, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Here’s a theory I’ve been working on — one which I’ve come to doubt — but I’ll put it out there anyway and see what readers think. As I’ve watched the slow, painful process of physician EMR adoption, I’ve had the sense that primary care physicians were under the most pressure to move ahead and were likely to lead the parade.

Sure, everyone has their eye on HITECH incentives, but primary care doctors have even more to worry about. For starters, they have a more challenging  population management task at hand.  Now, they’re under even more pressure, being expected to provide a “medical home” for patients, do more monitoring of their condition, coordinate specialist care and check up on patients’ compliance with preventive health measures.

In theory, PCPs can do such monitoring on paper, and some actually do.  But one can only assume that it’d be easier to manage these increasing levels of responsibility  — and to provide the extensive quality data health plans demand — if they get an EMR in place quickly.

Sure, I hear plenty about specialist EMR adoption, and technology for specific specialty niches, but my gut feeling has remained that primary care doctors have the most to lose if they don’t move quickly.

However, search though I might, I can’t find any anecdotal or statistical data to support my conclusion, so maybe I’m way off here.  Folks, what are you hearing?  Are primary care doctors adopting EMRs at a faster rate than their specialist colleagues, or are specialists picking up the ball at a similar pace?

Good Advice: Three Things Practices Should Do After Buying An EMR

Posted on April 29, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Here’s a handy little blog item from health IT consulting firm Entegration.  While many bloggers focus on big-picture issues, firm president Art Gross has offered three easy-to-understand, concrete suggestions on how medical practices should protect themselves when they’re first rolling out their EMR.

Gross suggests they consider the following steps:

*  HIPAA security:  Gross recommends hiring HIPAA security services to help train employees and implement protocols which will make sure protected patient information isn’t compromised.

* Off-site data backup:  Few medical practices do more than back up their existing files to tape, but as he notes, data gets corrupted, backups are sometimes overwritten by mistake and disasters (fire, floods and more) can destroy on-site archives.

* Disaster recovery:   To be prepared for all contingencies, practices must have more than one copy of current data available, methods for accessing that data and detailed procedures in place for accessing the duplicate data.

Sure, companies with big IT staffs would do these things as a matter of course, but many small physician practices don’t even have a single full-time IT employee, relying instead on consultants to do basic maintenance.  That drive-by consultant is unlikely to be evaluating the practice’s overall readiness to keep an EMR up and running securely.

Reminding doctors that they must be careful custodians of their new digital data is a good idea.  Let’s hope more consultants )and vendors) dealing with small practices are preaching this gospel.

Types of EMR Reporting

Posted on April 28, 2011 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Guest Post: Carl Bergman of SilverSoft, Inc. is a principal of EHRSelector.com.

My wife and I play a game called Write Only Files. The only rule is who’s first to notice that something’s been stored never to be retrieved. They come in all sorts of places. I once visited a nursing home that dutifully kept all the residents jewelry in a closet, but without any IDs. It didn’t matter; the owners never came back to claim them.

EMRs are not as dismal, but sometimes I think all we talk about is how to put data in an EMR without dealing with how to get it out. You’d think that the entire function of an EMR is to put in and retrieve single patient records.

Yet, a versatile, intuitive reporting system is absolutely necessary. Not only can it answer questions that paper systems cannot approach, but it also can produce insights into both medical and financial issues fundamental to a practice.

Stage 1 has changed some of this by requiring reporting on populations, not just retrieving single patient records. To deal with this, vendors have put on a full court press to modify their systems for Stage 1 reports. Their efforts, which often required new capacities, point out how neglected EMR report writers have been.

The need for more sophisticated and user oriented report writers is only going to increase. Stage 2, ACOs and other HIE initiatives will make even greater demands not to mention increased use of EMRs.

These external demands will be complimented by user demands for more information about the practice both medically and financially. Meeting these demands are a mixed bag of current systems. Some products will grow into these new roles while other vendors will need to rethink their approach or fail.

Current EMR report writers fall into three basic groups, of which only one can fulfill their role. These are:

•      Wired Reports. These EMRs don’t have a real report writer; instead, they have single purpose “push button” reports for specific purposes. Users have little or no control over what they find or present. A typical report might show no show patients for a day.

•      Parameter Reports. A step up from wired reports, these allow users a fair degree of control over what the report finds and some control over formatting. For example, the user may choose sorting order. These are often built in a tools such as Crystal Reports. Depending on the development effort, the result may be a robust tool. However, the use of third part tool can have major drawbacks. These include:

     o   Rigidity. Modifying a report may require an on site programmer or paying the vendor

     o   Cost. The user often has to pay for the tool, its annual license and maintenance. If there are problems, the user may be caught between the EMR vendor and the tool vendor.

     o   Conflicts. These tools are generalized applications designed to work on many different systems not just the particular EMR. Problems can range from not having the desired function to the tool ending support for the application type.

     o   Learning Curve. Users will have to master both the EMR and the tool’s way of doing things.

•      Built In Report Writers. These are designed as an integral portion of the system. These overcome the problems of the other two classes; assuming they are built to meet a variety of reporting tasks. Even if a report writer can carry find and sort the desired data, it must also meet other requirements. For example, if the FDA issued a bulletin requiring practices to notify all their patients who have Crohns disease and take acetaminophen. The report writer should be able to identify these patients, email or prepare letters to them.

Even if an EMR has a crackerjack system, its mission can still fail if it does not have access to all practice financial data. Systems with a single database can do this. Those that link or coordinate the EMR database and the practice management db have a harder, but possible task. Those systems that have separate, uncoordinated, datatbases are out of luck regardless of how good the individual report writers may be. If a report writer can’t cross the EMR and PM line, it is not taking full advantage of practice data. Each time it can’t produce the needed reports it’s creating write only files for my collection.

Is Hospital Consolidation Being Driven By HIT Issues?

Posted on April 27, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As just about any reader would know, Community Health Systems is engaged in a $3 billion hostile bid to take over Tenet Healthcare Corp.  As I noted on another blog, this may or may not be a good idea, but hospital consolidation is clearly in the air.

Just look at the past year. Not only has CHS attempted to take over Tenet, Tenet moved to gobble up Australian hospital chain Healthscope, private equity firms have been  sinking big bucks into regional systems and local chains are merging with big ones.

All told, according to Irving Levin Associates, 77 hospital-related M&A deals took place during 2010, the highest number since 2001. We’re talking a monumental $12.6 billion in deals, according to Irving Levin research.

The question is, why last year as opposed to any other?  Commonly-cited factors include:

*  Attempts to batten down the hatches to prepare for health reform

*  Opportunistic buying by chains and venture firms, as hospitals continue to struggle with the aftermath of the 2008 market crash

* Hospital willingness to close or merge in the face of rapidly-changing times

What you don’t see mentioned often — in the mainstream business press at least — is the staggering cost of upgrading health IT infrastructure to the levels needed for enterprise-grade performance.

During the process of implementing an EMR, IT costs can shoot up 80 percent, according to Accenture, driving up hospital costs 200 basis points or more.

And that’s just the beginning.  Health IT leaders must address database management, workflow integration, upgrades to communication infrastructure and much, much more.

The bottom line is that if all of these systems don’t work together smoothly, hospitals won’t be able to collect the quality data they must produce to survive in the new era.

Given these pressures, it’s hardly surprising that hospitals and systems hope to stare down their massive IT costs by throwing their lot in with bigger partners.  Hey,  it’s certainly worth a try.

ONC Healthcare IT Blog

Posted on April 26, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m extremely biased in this opinion, but I love that ONC has a healthcare IT blog. I’m sure it still has to go through the government filter, but I love that the members of ONC have a place where they can put out comments and thoughts and receive feedback from the greater community.

One thing that’s beautiful about a blog is that the community of readers often provide as much value in the comments as the writer provides in the commentary. I think that’s a hard shift for many journalists to make since they’ve been so well trained that they are suppose to provide the font of information, cover all angles, research out the facts, etc.

Since I’m not a journalist, this hasn’t been hard for me at all. In fact, one of the main reasons I started this blog was for me to share the information that I had learned and I learned very quickly that when I was wrong that the good people reading my site would be happy to correct me. I’m not sure I’d call all of those corrections a fun experience, but once I put my pride behind me I’m always grateful to be smarter after than I was before.

I imagine that ONC has seen the same thing. They’ve probably heard some comments that were hard for them to hear. However, once they get over those hard things, I’m sure they were grateful to have access to some candid feedback. Argue what you may about the value of meaningful use, certified EHR, and , all of the people from ONC that I’ve met have been very good people trying to do the best they can. I imagine the blog helps them do that even better.

Want People To Use PHRs? Try Making Them A Game

Posted on April 25, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I’m embarrassed to admit this, but over the last week I’ve become addicted to a hideously cute little iPhone app called Shopkick.  The app locates where you are geographically, spits out a list of retailers for you, and when you click on the retailer’s name, typically rewards you with “kickbucks.”

The more kickbucks you get, the higher “level” you’re at, whatever that means — and when you collect, say, thousands of points you can get a $25 gift card. (Yippee!)  In truth, the rewards Shopkick offers probably average out to about 3 cents an hour. Who cares?  I keep playing with the stupid app until I’m out of offers to click.

Now can anyone tell me why the same type of scheme wouldn’t motivate at least some consumers to add data to their PHR on a regular basis?  Small cash rewards are already proving effective at improving medication compliance, after all, and for most people, updating their PHR would be no harder than taking a pill.

In the past, I’ve scoffed mightily at online schemes which reward people for participating in communities, filling out forms or otherwise doing what they’re told.  After all, why should anyone care if a site names them an “explorer” or a “champion” or a “grand poobah”?  But there I am, getting psyched when Shopkick promotes me from level 3 to level 4.  Hey, I can’t help it — every time you level up you get such a cute little chime and a big green bubble to pop…  (Yes, I am otherwise a mature, responsible adult.)

But I’m being taught, by playing with this app, that rewarding people — even with very small incentives — can do an amazing job of getting them to repeat behavior.  Offer patients relevant reinforcement and patients are likely to take the PHR maintenance job more seriously.   What if, for example, a health plan teamed up with a pharmacy retailer to offer discounts on products if patients maintained their data? It could be huge.

But don’t make the rewards too exciting. Hey, you might have to keep releasing new, updated versions of your gaming system to satisfy fans.

Can Paraprofessionals Solve The Health IT Talent Shortage?

Posted on April 23, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As anyone reading this blog knows, there’s not enough HIT specialists available to  manage  the massive wave of EMR implementations under way.  In fact, many CIOs fear that they won’t be able to find enough EMR help to get stimulus funding, according to a CHIME survey from late last year.

More than 70 percent CIOs responding to the survey said that they might not be able to bring enough staff on board to get HITECH incentives, CHIME reports.  Many are turning to third-party consultants to get the job done, but as we all know, outsourcing the implementation of a mission-critical system like an EMR comes with problems of its own.

So, wouldn’t it be nice if there was a way to reduce the need for scarce health IT veterans and fob off at least some of the work on paraprofessionals?  It seems that at least one organization has exactly that in mind.

A group of impressive HIT experts, led by Steven Lazarus of the Boundary Information Group, have come together to offer a series of certification courses which train students to handle some EMR management functions.   The certifications include:

*  Certified Professional in Electronic Health Records (CPEHR)

*  Certified Professional in Health Information Technology (CPHIT)

Certified Professional in Health Information Exchange (CPHIE)

The organization, known simply as Health IT Certification, has already partnered with three Regional Extension Centers. It’s also working with several trade organizations, including the MGMA and WEDI.

The group frankly acknowledges that these certifications are no substitute for in-depth health IT expertise, but argues that people who meet its certification requirements can be a big help nonetheless.

My guess is that such paraprofessionals would be especially attractive to small medical practices, which seldom — if ever — have a traditional IT expert on staff and can ill-afford high-end EMR consulting.

However, I don’t know if they’d make a dent in a hospital or health system’s staffing problems, as I doubt that even the best-informed paraprofessional could handle the implementation of high-end enterprise EMR systems.

That being said, it’s hard to tell what will and won’t work as the EMR juggernaut descends upon the industry.  Maybe these certified folks — call them HIT extenders? — can make a real impact.  What do you think?

This Is Not An Ad For The Connected Health Conference, But Go Anyway, OK?

Posted on April 20, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In October of this year, the very smart people at the Center for Connected Health in Boston will again hold their annual symposium.  And unless I get hit by a bus, I intend to be there and learn everything I can.

While you’ve seen me get flip here from time to time, I’m not joking now.  I think that it’s an event that should be taken dead seriously by essentially anyone who cares about the future of health IT, disease management and e-medicine.  Their mission, which I regard as central to the future of healthcare generally, is as follows:

We are engaging patients, providers and the connected health community to deliver quality care outside of traditional medical settings. Telehealth, remote care and disease management initiatives reflect the opportunities for technology-enabled care programs.

By the way, in case you suspect the same, I’m not endorsing the conference because the center is backed by Partners HealthCare, an IDS backed by hoity-toity names like Mass General Hospital and Brigham and Women’s.   Their Harvard connection isn’t the point.

No, I’m ranting about the Connected Health Symposium because I think it’s exactly where HIT visionaries ought to be spending their time.  Their programs are demonstrating, today, how the living, breathing HIT structure can bring care to where it’s needed in addition to documenting what happens in traditional settings.

There’s too much going on at the Center for me to provide a wealth of detail, but here’s some examples of what it does (summaries borrowed from media announcements):

*  Last summer, the CCH announced the results of a medication adherence study, using a wireless electronic pill bottle to remind patients with high blood pressure to take their medication. The ongoing study measured a 27% higher rate of medication adherence in
patients using Internet connected medication packaging and feedback services compared to controls.

* Another study found that remote online visits with dermatologists, or e-visits, achieved equivalent clinical outcomes for acne patients. Data further revealed that this model of care delivery was popular with participating doctors and patients, ranking e-visits as convenient and time-saving.

* Data from a late 2009 pilot  conducted by the Center suggested that its online diabetes management program, Diabetes Connected Health, may lead to improved patient knowledge, engagement and accountability, as well as improved patient provider communication.

Don’t get me wrong, the industry can’t avoid wrestling with EMR implementation and management efforts even if providers spend a lot more on remote patient monitoring and telemedicine.  Any reasonable long-term vision of a fully-connected U.S. digital health network includes all of these technologies, plus mobile health innovations we probably haven’t even heard of yet.

But in the mean time, c-health is where the rubber meets the road. (If you want to know what c-health is, read the blog written by the Center’s Dr. Joe Kvedar.)

Hoping to meet y’all in October!

Succeed at EMR – A Vendor Perspective

Posted on April 19, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Rob Tholemeier from Crosstree Capital Partners had an interesting article a while back on the Health Data Management blogs about ways that EMR vendors succeed. He provides 5 approaches that these EMR companies take to the EMR and EHR market. Here’s the 5 methods he identifies with a few of my thoughts after each:
Leveraging Size – I call these the Jabba the Hutt EHR vendors. They’re really big and powerful and no doubt will continue to sell a bunch of software since they have “leading vendor” name recognition. Rob correctly notes that they’ll continue to grow through mergers and acquisitions.

Specialization – I find this segment of the market really interesting. I’ve been seeing more and more of these specialty specific EHR vendors carving out their niche in the market. I still think the best play for a “leading EHR vendor” is likely to acquire a number of specialty specific EHR.

Regional Focus – Many people to want to “buy local.” There’s something really powerful about knowing your EHR vendor’s office is down the street and you can go and wring their neck personally if something goes wrong. < sarcasm >Not that anything would ever go wrong with an EMR. < end sarcasm font>

Suite Selling – I found this one interesting. Although, I think that it’s more of a factor for hospital EMR selection. I guess you could make the case that practices purchasing their EHR based on the hospital system purchase might fall into this category as well. Basically, the practice adopts a certain EHR because their hospital is subsidizing it or has a nicely built connection to that specific EHR company.

Advanced Technology – I’ve seen a few companies that have made this pitch. I still find this a challenge for an EMR company to make this pitch and be heard above all the EMR noise. However, I think if anyone is going to do it, I think it will likely come in the user interface.

An interesting way to stratify the various EMR companies. Are there any other categories of approaches that he missed?

EMRs: The Question of the Lady or the Tiger

Posted on April 18, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Here’s a tale which, believe it or not, may be worth discussing on an EMR blog.

In a classic short story by Frank Stockton, published in 1882, readers are asked to make their guesses about human nature and the capacity for self-sabotage, jealousy and fear of the unknown.

As the story, “The Lady, Or The Tiger,” goes, a princess has taken a lover below her social class — and to punish her, the king submits both her and her lover to an ordeal. The lover must enter an arena and choose one of two doors, one with a woman behind it and another with a ferocious killer tiger poised inside to spring.  If he chooses the tiger, he’ll be killed; if he chooses the door where the woman waits, he must marry her.

The princess, as it happens, knows which door poses which threat. But she has a dilemma to face. She doesn’t want her lover dead, but she doesn’t like the idea of his marrying another woman, one whom she actually envies. The question Stockton poses, at the end of the story: “Will the tiger come out of that door, or the lady?”   Nobody knows, since Stockton doesn’t tell us, but it’s food for thought — as a parable for EMR adoption.

Am I crazy to draw such a comparison?  Actually, I don’t think so.

Right now, hospital and physician staff members essentially have their own choice to make — embrace EMRs or dig in their heels and make the transition last as long as possible and cost as much as possible.  Sure, individuals will have more nuanced reactions, but globally, I’d argue that an institution either embraces EMRs or fights them.

So, clinicians and support staffers basically have two doors to choose from, one which generates certain disruption, change and possibly the end of the jobs they know (the tiger). That’s embracing EMRs.  The other door (the lady) comes with requirements of its own but is arguably a much less painful choice.

Which door they choose, fortunately, isn’t completely up to chance.  If there’s a “princess” — OK, the analogy falls apart here, guys — to indicate which door works and give people the guts to open it, things will move more smoothly.  That “princess” leader (in reality, many leaders at many levels) will have to sell people on the value of disruption, change and ultimate benefit, rather than the “lady” door which seems so much less threatening.

But the story, which is more than a century old, reminds us that even the leaders may not be sure where they want to lead if both choices force them to change their lives.   Diminish anxiety, detooth the tiger, and your EMR install may move forward.  Allow people to get hung up on the illusion of having a choice, and you’re out of luck.