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Do You Need An EMR To Make ACOs Work?

Posted on February 28, 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.

Right now, as things stand, only a small percentage of medical practices have fully implemented EMRs (about 15 percent), research suggests.  But the trend toward integrating physicians in Accountable Care Organizations is moving much faster.

I don’t have stats to hand, but everything I’ve read and heard suggests that the provider community is a lot more comfortable with the ACO concept than EMR adoption.

The thing is, can ACOs advance without higher EMR adoption rates?  I don’t think so.  To my mind, if you want to integrate medical practices and hospitals — with the goal of managing quality jointly — a shared EMR seems virtually indispensable.

During the first wave of ACO adoption, we’re seeing tie-ups between mid-sized to large practices and large health systems.  Those large practices are reasonably likely to have EMR systems in place, and just as importantly, an IT department to support them.

But if ACOs models are to work, they’ll eventually have to embrace smaller practices, which make up the vast majority of U.S. medical groups overall. And if those groups are either EMR-less or just getting started, it’s going to be pretty tough to share value-based payments, coordinate across episodes of care and track quality jointly.

Yes, hospitals can give doctors access to their own, industrial-grade EMRs — and some do — but ultimately, EMR use will have to be part of the smaller practices’ culture for ACOs to work.

And while medical practices will understand ACOs, particularly if they’ve been through lots of fashionable hospital-practice partnership models, EMRs will still be tough to swallow.

So, ACO backers, do you think you can move ahead if your physician partners aren’t EMR-connected and savvy?  Or are we looking at a big problem here?

Investing in EMR Companies

Posted on 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 was asked a really interesting question recently:
“If you could invest in an EMR company, which EMR company would you choose to invest in?”

I find this question really interesting, because I’ve seen the detailed financials of an EMR vendor before. The business model of an EMR company is very clear and proven in many other industries.

Yet, the question about which EMR companies you’d invest in is a very different question. Certainly, there are a lot of variables when investing, but I’d love to hear other people’s thoughts about this question. Feel free to leave it in the comments or if you prefer to do it in private you can submit it on the EMR and EHR contact us page.

Physician Adoption of EMRs Growing, But Don’t Expect A Landslide

Posted on February 26, 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.

About 30 years ago, when cable television hit its stride,  pundits watching the industry assumed that home adoption would quickly climb to near 100 percent. Instead, for a variety of reasons, consumer adoption more or less froze at the 50 percent mark for many years.

Maybe the industry didn’t their pricing strategy right; maybe consumers were perfectly happy with broadcast television; or  maybe the existing broadcast networks greased a few palms and helped regulators slow down its growth in subtle ways.

In any event, the cable industry has improved its performance enormously; in fact, it hit 70% in the late 90s, though that number has fallen significantly as satellite providers have horned in.

So, why bring up cable TV in a forum aimed at dissecting the EMR business?  Because I think the cable industry’s experience is instructive in how we think about EMR adoption.

First, some data points.  According to study released in January by the CDC’s National Center for Health Statistics, 50.7 percent of physicians were using EMRs in their offices in 2010.  That’s a dramatic upswing from previous years, the agency noted.

Of course, practices are eager to collect Meaningful Use incentives if they can.  Also, as older physicians retire, younger, more-wired MDs are taking up the EMR banner. (In fact, CDC data concludes that the younger a physician is, the more likely they were to adopt EMR technology.)

Not only that, hospitals are helping to grease the skids, with one-third offering to subsidize EMR buys and 60 percent offering doctors access to the facility’s EMR, the CDC found.

All of that sounds great, particularly if you’re an EMR vendor.  But I think it’s a bit early, as it was for cable pundits, to predict that EMR adoption is at some kind of tipping point.  Whiz-bang technology always looks great from the peanut gallery — especially to analysts and editors — but it often looks different on the ground.

Not only do I think exponential growth is unlikely, I’d argue that adoption by physicians will be painfully slow for at least a few years more, gaining say, 5 to 7 percentage points a year at best.

Why do I feel that way?  Here’s a few reasons:

*  Few (if any) vendors can honestly say that introducing their product won’t bog down a practice and trash its productivity for months at least.  Doctors know this.

*  Smaller practices don’t, and aren’t likely to, have full-time IT staffers.  Even practices that want to adopt don’t have the reassurance of a dedicated IT brain that knows their needs. Under these circumstances, buying an EMR is a scary investment.

* Other trends that might spark EMR adoption — such as the emergence of RHIOs/HIEs — are moving at a snail’s pace.  If a doctor doesn’t have the added incentive of sharing patient data to spark adoption, that’s one more reason to delay.

Look, maybe I’m being pessimistic, or short-sighted. But I simply don’t think the EMR vendor market nor the physician buyer side have gelled enough to spark a revolution. I guess we’ll just have to wait and see.

Will EMR Vendors Cut Through The Noise This Year?

Posted on February 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.

Folks,  as an editor covering this industry I’ve read more EMR vendor news, pored over more of their press releases and taken in more their advertising pitches than most.   Despite that, I’ve seldom walked away with a clear sense of why that vendor was truly special.

While that’s never a good thing for any vendor, it’s a particularly bad problem in 2011, which, I predict, will make or break many smaller EMR developers.  If it was hard to get buyers’ attention over the last two years — especially that of fearful physicians — it’s going to be a Herculean challenge this year.  The noise level is higher than a pack of screaming fans at a Metallica concert.

I’m not suggesting that EMRs have become a commodity like John suggested was a possibility (the real problem is how diverse they are, in fact!) but I am saying that many are still doing a terrible job of setting themselves apart.  Too much of the content churned out by EMR vendors makes appallingly broad generalizations or strings together a list of “me-too” features.

I do sympathize, tremendously, with the struggle health IT marketers go through in trying to sell such a complex product in a way which clearly communicates:

*  Affordability
*  Easy maintenance
*  Easy-to-establish productivity
*  Reliability

and in the case of selling to larger entities like hospitals:

*  Interoperability
*  Data integrity
*  Intelligently designed infrastructure
*  Scalability
*  And much, much more!

Still, there’s no getting around the fact that they’ve got to get the job done.  This year, if an EMR vendor seems like a me-too, they’ll be history in 18 months, tops.   Like it or not, the time has come to put up (a clear message) or shut up.

Ways to save money in a modern electronic medical practice part 3. Smartphone dictation.

Posted on February 24, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

The free Dragon Dictation app from Nuance software is probably one of the most useful apps I’ve ever met. It allows me to eliminate all transcription costs and finish my notes, for the most part, by the end of the day.  Last Friday, I saw 20 patients (mostly followups) and had no homework for the weekend (although I was humping it all day long, believe you me!).  I type in most of the more mundane information during initial office visits with patients, such as the past medical, family and social histories, the allergy and medication lists, physical exam template and  management plan.

Thus, 90% of the note is done when I walk out of the room.  The dictation I perform is for the history of present illness (HPI), i.e. the patient’s story, and this takes me about two minutes to dictate per patient.  Dragon Dictation automates the typing for me and I send the draft to an anonymous email account that I can then immediately use for editing, followed by cutting and pasting into the EHR note.   Editing these notes takes about two minutes each since about 90% of the spelling is already correct using this great app.

Recently, I was interviewed for Diabetes Practice Options, and the topic of e-dictation and security came up.  Our discussion included how to protect patient anonymity in this process while still gaining the efficiency.  One thing a provider can do is use only a single initial from the patient’s name to mark each dictation. Because there are no other pieces of personal information such as dates of birth or social security numbers, anonymity is fairly preserved.  Other options include using a number instead of an initial or eliminating this step altogether since it’s usually superfluous for most providers.  After all, it’s hard to forget which story goes with which patient if you do your job well and take the time necessary to get to know your patients.

EMR Parody Reveals Backers, Makes Serious Points

Posted on February 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.

For those who haven’t been following the story of Extormity, a fictional EMR parodying the sprawling, difficult-to-integrate EMRs used by large enterprises, you’ve missed a treat.

Extormity, whose tagline is “Expensive, Exasperating, Exhausting,” proudly boasts that it was accredited by standards body SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHRs.  The company, they’ll have you know, chose its name because its products are at “the confluence of extortion and conformity.”

For quite a long time — as I recall, at least two years — the people behind this sophisticated mockery of big, pompous EMR players have written reams of extremely funny, but telling, material worth of The Onion or The Daily Show for their Web site.

They also churned out a laugh-out-loud series of fake press releases which helped to build their loyal following. (I think my favorites were “Posting as Guam, Extormity Snags ARRA HIE Grant,” and “SEEDIE Announces ARRA Acronym Certification Program.”)

Though the parody got quite a lot of attention, the companies behind it refused to reveal their identities throughout the entire charade.

Now, in a release premiered at HIMSS (of course), the anonymous players have identified themselves (Check out how EMR and HIPAA broke the Extormity news before the press conference):  they’re NoMoreClipboard.com and MIE- Medical Informatics Engineering.

Of course, when the two companies issued a real press release unveiling their true identities, they did some selling, making comparisons between the ponderous Extormity and their real, lightweight, Web-based product. But hey, after years of entertainment, I was very ready to listen.

I take my hat off to the creative, hugely funny people behind Extormity and SEEDIE, and encourage them to continue with their barbed critique of clumsy EHRs.  Hopefully, encouraged by their advice, no one will have to call their new “EHR Depression Hotline.” But you never know…

Heard in the HIMSS Hallway – Government Wants All EHR Software Easily Certified and Doctors Showing Meaningful Use

Posted on February 22, 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.

Today, the most interesting thing I heard in the hallway of HIMSS was about ONC and the government’s perspective on the current EHR certification and meaningful use stage 1.

Someone I spoke told me that ONC is vry focused on getting all EHR software certified. It won’t quite be a basic rubber stamp, but ONC-ATCB’s are to work with the EHR vendors to help as many EHR vendors be certified as possible.

Similar to that, ONC wants doctors to easily be able to show meaningful use stage 1. Then, they’ll tighten down on future stages.

On face, this might not seem like a big deal. No doubt, ONC wants as many certified EHR vendors and doctors that are meaningful users as possible.

However, I find it interesting to think that they’re deliberately trying to get as many people as possible meaningfully using a certified EHR even if those users and EHR vendors aren’t likely to be able to comply with future more stringent requirements.

Will this mean we’ll have a whole wave of EHR users having to switch EHR software once the more stringent standards are implemented? Or will doctors just take the meaningful use stage 1 EHR incentive money and then not worry about the rest of the government handout?

I’m not sure the outcome, but it’s definitely something worth thinking about.

GE Promotes EMR Through Patient Safety Organization

Posted on February 21, 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.

So, here’s a vendor move which I’m surprised others haven’t made yet (at least to my knowledge).

GE Healthcare has formed an official Patient Safety Organization, one blessed by HHS and AHRQ, a step which puts its EMR in the hospital buyer’s face without its having to constantly pitch.

As I see it, this is a clever move which not only helps GE gather data useful in refining Centricity, but also helps make sure people don’t think of safety problems when they think EMR.

The PSO works as follows.  GE has brought together sixteen hospitals, most in Rhode Island, to share data on medical errors.  The data will be captured through MERS, a Web-based event reporting system which all participants will use.   To handle heavy-duty data crunching, GE’s PSO is working with SAS, whose job it will be to integrate and analyze root causes that  contribute to risk.

Not only does this promote GE Healthcare’s brand, it also tightens the bond between itself and the hospitals, which may become reliant on the integration and data management capabilities vendor like SAS can supply.  (Somehow, I doubt your average community hospital has SAS  on board;  its products are just too costly.)

All told, a very interesting development.

Heard in the HIMSS Hallway – Accessing Epic Data

Posted on February 20, 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.

In case you’re not following my HIMSS coverage, go over to EMR and HIPAA and check out my HIMSS day 1 coverage.

Although, I heard an amazing thing in the proverbial “hallyway” of HIMSS. As most people know, one of the biggest arguments against Epic was/is that it’s a pain to get the data out of it. I remember hearing someone say (maybe Glen Tullman from Allscripts) that the only EMR vendor not participating in EMR interoperability was Epic.

Yet, I heard someone say today at HIMSS that Epic has 750 people working on interoperability now. My mouth dropped at that number. They hadn’t heard it from Epic, so maybe it’s not the right number. However, the idea that Epic’s putting significant resources into freeing the data in their systems is a great thing. I hope it turns out to be true.

Our Disaster Recovery “Fire Drill”

Posted on I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Last Friday our practice had an opportunity to practice our disaster recovery protocol.  This was actually good news; we are replacing our 6 year old servers with virtual servers and a storage area network (SAN).  The implementation plan required more down time than a weekend would provide so we added a Friday to it.

Unlike a real disaster we had the opportunity to prepare immediately before, knowing exactly when the system was going down.  We printed our clinic schedules and printed the clinic note from the last visit for patients who had appointments.  We did not cancel appointments or reduce the number of patients seen.  For appointments requiring other documentation (i.e., pathology reports for post-surgery visits) we printed those.  We also printed a generous number of our most common handouts and got our paper prescription pads ready.

The day was free of major problems and the staff performed very well.  The experience was very interesting:

  1. My description above is a little too rosy.  We ended up searching for some documents at the last minute.  We ran behind schedule and there was a mild degree of disorganization throughout the day.
  2. Patients were very understanding about the delay and about our EMR being down.  Everyone understands that computers go down and I was thankful to see that our patients remembered that.  In some cases I had to ask patients to refresh my memory regarding prior visits since I didn’t have the entire chart available.  No one seemed to mind.
  3. I was still able to use my PC and Dragon Speech. Dragon runs locally on my desktop.  I dictated notes in Notepad and saved a separate note for each patient.  On Monday, my assistant will create Friday’s chart notes in the EMR, enter their data (vital signs etc.) and route the notes to my desktop.  Then I will copy / paste my notes into the EMR chart.
  4. Dictating unstructured chart notes into my PC was refreshing.  It was also an impressive reminder of how much garbage CPT forces us to add to our notes.  Even for complicated, new patients I was able to record everything relevant in less than two-thirds of a page.  Adding the CPT-required material almost doubles the size of the note without adding any relevant, useful data.
  5. With the system down the front office could focus on patient service without having to obsess over data entry.
  6. With all the extra paper floating around the back office was a mess.  I can’t imagine going back to paper charts.
  7. We were still compromised operationally when we had a patient who needed to schedule surgery.  Without the EMR workflow engine we could not print customized surgical packets.  Handwriting surgical consents is not acceptable.  We will have to catch up on this workflow next week.

Take home lessons:

We need to improve our disaster readiness, but at the moment our readiness is not too bad.  Our new SAN is configured to perform incremental backups every night and full backups every weekend.  The virtual servers and SAN will allow us to redirect workload in the event of a server or hard drive failure.  For a network failure we can follow the protocol we just rehearsed, but we should take the time to update our hard copies of handouts and surgical consents.  This is interesting because on more than one occasion we have had IT vendors try to push their way in to our practice using our presumed lack of disaster readiness as their excuse.

Once our new servers and SAN are settled in I may look into an automated method of copying appointment schedules and recent chart notes for patients with appointments to a local PC in each office rather than wasting all that time and paper every day.

I understand that all that front office data entry is a necessary evil.  But I never realized how much it distracts the front office from tending to patients.  I am going to double my efforts to make it attractive for patients to enter their own data online in advance of the visit – or at least have them use the patient portal to enter their own data in the waiting room.  As much as we have tried so far, our patient portal still has not caught on with our patients in the waiting room, and there has been only moderate use from home.  I don’t think our web portal is good enough yet.