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Clinicians File Class Action Suit Against eClinicalWorks

Posted on January 9, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

EMR provider eClinicalWorks has been hit by another class action lawsuit, this time a suit led by clinicians, raising questions as to how much legal trouble the vendor can survive.

The new suit is the latest of a series of dominos falling on eCW. Its legal problems began in May of last year, when it was forced to settle a suit filed by the U.S. Department of Justice for $155 million. The suit contended that eCW got its Meaningful Use certification by misrepresenting its capabilities.

Then, in November of last year, eCW was slammed with a class action lawsuit, this one demanding $1 billion. The suit alleged that by lying about the capabilities of its software, eCW “failed millions of patients by failing to maintain the integrity of patient records.”

Now, eCW faces another class action suit, this time led by primary care doctors. The suit alleges that because eCW’s software didn’t meet MU standards as promised, they lost government reimbursement. The suit asserts the eCW gave the PCPs “no reason to suspect that [it] had made false statements to obtain its certification.”

All of this is interesting in and of itself, but it doesn’t address the bigger question: Can eCW survive the legal firestorm that has engulfed the company?

eClinicalWorks is a private company, so I can’t offer detailed information on its finances, but it reported revenue of $130 million for the third quarter of 2017. If that’s a representative number, the company generates roughly half a billion dollars a year.

That’s a lot of money, but it’s not an infinite supply. The $155 million settlement has to have hurt (though I suppose it might have been covered in part or entirely by business liability insurance).

The other two lawsuits could prove more deadly. While it’s hard to predict whether a suit will go anywhere, there’s at least some chance that eCW will face a $1 billion judgment. Of course, even if it does lose the case, it will take effect only after several years of legal wrangling. Nonetheless, it seems likely that such a conclusion could bankrupt the company.

The other key question is whether eCW can hold onto its customers as lawsuit after lawsuit is filed. It might seem to some that eCW has been punished enough for its indiscretions, and that the additional lawsuits are largely part of a feeding frenzy. On the other hand, one might suggest that if eCW lied to all of its customers, it deserves to be forced out of business. It’s a flip of the coin at  this point.

Regardless, the suits do suggest that EMR vendors had better keep their noses clean. If they try to fool customers – or the feds – the results could be catastrophic.

Google, Stanford Pilot “Digital Scribe” As Human Alternative

Posted on November 29, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Without a doubt, doctors benefit from the face-to-face contact with patients restored to them by scribe use; also, patients seem to like that they can talk freely without waiting for doctors to catch up with their typing. Unfortunately, though, putting scribes in place to gather EMR information can be pricey.

But what if human scribes could be replaced by digital versions, ones which interpreted the content of office visits using speech recognition and machine learning tools which automatically entered that data into an EHR system? Could this be done effectively, safely and affordably? (Side Note: John proposed something similar happening with what he called the Video EHR back in 2006.)

We don’t know the answer yet, but we may find out soon. Working with Google, a Stanford University doctor is piloting the use of digital scribes at the family medicine clinic where he works. Dr. Steven Lin is conducting a 9-month long study of the concept at the clinic, which will include all nine doctors currently working there.

Patients can choose whether to participate or not. If they do opt in, researchers plan to protect their privacy by removing their protected health information from any data used in the study.

To capture the visit information, doctors will wear a microphone and record the session. Once the session is recorded, team members plan to use machine learning algorithms to detect patterns in the recordings that can be used to complete progress notes automatically.

As one might imagine, the purpose of the pilot is to see what challenges doctors face in using digital scribes. Not surprisingly, Dr. Lin (and doubtless, Google as well), hope to develop a digital scribe tool that can be used widely if the test goes well.

While the information Stanford is sharing on the pilot is intriguing in and of itself, there are a few questions I’d hope to see project leaders answer in the future:

  • Will the use of digital scribes save money over the cost of human scribes? How much?
  • How much human technical involvement will be necessary to make this work? If the answer is “a lot” can this approach scale up to widespread use?
  • How will providers do quality control? After all, even the best voice recognition software isn’t perfect. Unless there’s some form of human content oversight, mis-translated words could end up in patient records indefinitely – and that could lead to major problems.

Don’t get me wrong: I think this is a super idea, and if this approach works it could conceivably change EHR information gathering for the better. I just think it’s important that we consider some of the tradeoffs that we’ll inevitably face if it takes off after the pilot has come and gone.

E-Patient Update: A Missed Opportunity For Primary Care Collaboration

Posted on March 3, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Tell me if you’ve run into the following.

You call your primary care doctor to set an appointment, wading through the inevitable voice-response prompts and choosing the right number to reach a clerk. You wait on hold for a while – perhaps a LONG while – and finally get a clerk.

The clerk asks why you’re booking an appointment, and you name a problem. The clerk says she needs to consult a nurse about the problem before she books you, so you wait on hold while she calls the nurse. Of course, the nurse is too busy to answer her phone, so you leave her a voicemail message.

The next day she finally calls back and tells you a standard appointment will be fine. Yay.

This might sound like an incredibly twisty process, but this is exactly how it works at my PCP office. And the truth is that I’ve been run through a similar mill before by other primary care practices of this size.

In theory, many of these problems would go away if my PCP office simply took advantage of the scheduling tools its portal already offers. But for some reason its leaders don’t seem to value that function much; in fact, when it went offline for a while the practice didn’t seem to know.

But there are alternatives to this crazy workflow pattern that don’t require the re-invention of the lightbulb. In fact, all it would take is adding a few functions to the portal to make progress.

Gathering the threads

From what I can see, the key to streamlining this type of process is to gather these threads together. And it doesn’t take much imagination to picture how that would work.

What if my initial contact with the practice wasn’t via phone, but via more sophisticated interface than a calendaring app? This interface should ask patients what prompts their requested visit, and offer a pulldown menu providing a list of standard situations and conditions.

If a patient chooses a condition that might be hazardous, the system would automatically kick the request to a nurse, who can email or call the patient directly, possibly avoiding hit-or-miss phone tag. Or the practice could provide the nurse with a secure messaging client to use in connecting with clients on the go.  Using such an app, the nurse could even conference in the doctor as needed.

Meanwhile, if a patient wants to get a provider’s opinion on their condition – whether they should wait and see what happens, go to urgent care, make an appointment or hit the ED – the same interface could route the request to the provider on call. If the patient can be treated effectively with a basic appointment, the clinician routes the request to the front desk, with a request that the clerk schedule an appointment. The clerk reaches out to the patient, which means the patient (me!) doesn’t have to call in and wait for an age while the clerk handles other issues.

The same process would also work well for medication refill and referral requests, which my practice now handles in the same cumbersome, time-wasting manner. Not only that, automating such requests would leave an audit trail, which doesn’t exist at present.

Pursuing the obvious

What bugs me about all of this is that if I can imagine this, anyone in healthcare could — it’s a massive case of pursuing the obvious. Though I’m an HIT fan, and I follow the industry closely, I’m no programmer or engineer. I’m just somebody who wants to do my business effectively. Surely my PCP does too?

Of course, I know that just because an approach is possible, it doesn’t mean that it will be easy to implement. Not only that, only the largest and most prosperous practices have enough clout to demand that vendors develop such features. So it may not be as easy as it should be to put them in place.

Still, I see a crying need here, or perhaps one might call it an opportunity.  If we arm primary care doctors – who will play a steadily-growing role in next-gen systems – with better workflow options, every part of the system will benefit.