Physician Practice Management

EHR Benefits: A Macro and a Micro View

The New York Times ran a short piece by Steve Lohr yesterday that highlighted a new study led by two doctors from Massachusetts General Hospital.

The study compared 3,000 hospitals at various stages of implementing and using electronic health records (EHRs).  For those who see EHRs as a panacea for the healthcare system, the initial findings are disappointing.  To quote from Lohr’s story: “In the heart failure category, for example, the hospitals with advanced electronic records met best-practice standards 87.8 percent of the time; those with basic computer records, 86.7 percent; and those without, 85.9 percent. The differences in other categories were similarly slender.

“Reducing the length of hospital stays, according to many experts, should be a big money-saving payoff from electronic health records — as better care aided by technology translates into less time spent in hospitals. For hospitals with full-featured digital records, the average length of stay was 5.5 days; for those with basic computer records, 5.7 days; and those without, 5.7 days. The differences, Dr. Jha said, were ‘really, really marginal.’”

So, at least by these two measures the return on the use of EHRs so far is pretty meager. But, as the study authors point out, the evidence for gains from EHRs so far has come from an “elite” group of high-performing providers that have spent years adapting to the technology. No surprise, with just 20 percent of U.S. physicians now using computerized health records (and less than 5 percent in very small practice groups) there’s a long way to go to meet the federal EHR usage goals, despite the financial incentives in the HITECH portion of the 2009 ARRA stimulus package.

That’s a macro view. But if you take a micro view, there are some stunning successes in the use of EHRs to improve physicians’ practice operations and patient care.  Twice this year I’ve had the pleasure of seeing a presentation by Dr. Jim Morrow, formerly of the North Fulton Family Medicine Center. Dr. Morrow presented at HIMSS 2009 in Chicago, and a few weeks ago he presented at the HIMSS and Massachusetts Health Data Consortium Healthmart 09 conference in Worcester. Massachusetts.  Morrow is a compelling presenter and he tells a detailed story about his small medical practice group implementing and using EHR technology, going back almost 10 years.  Here are his slides.

To summarize some of the ROI from his four-physician practice:
 

• Transcription costs dropped from $110,000/year to zero
• Chart handling dropped from $30,000/year to zero
• Chart searches dropped from $16,000/year to zero
• Dictation dropped from $32,000/year to zero
• Reduced cost per patient visit from $112 to $79
• Full time employees per provider dropped from 4.7 to 2.8

Morrow estimates that EHR technology saved the practice 11,440 billable staff hours per year, which could go into serving more patients. His presentation has some compelling images of unreadable handwritten prescriptions next to clear, legible e-prescriptions – a key part of reducing medical errors.

Now, none of this is new. EHR vendors, HHS officials, Dr. David Blumenthal and many others have been pushing for widespread EHR adoption for years. And it’s not that surprising that a study would find that so far the measureable benefits are not compelling across the entire U.S. hospital system. But EHRs will help transform healthcare and it’s only a matter of time.

This study is like taking a snapshot of internet-enabled e-commerce in 1996. What looked like hype back then is now a critical underpinning of our economy. Many people have invoked the so-called Metcalfe’s Law (ie.: the value of the network is proportional to the square of the number of users) first postulated about communications networks, as something that will come into play as EHR usage reaches critical mass. Let’s hope that’s the case, and the findings of this new Mass General study are simply a realistic progress check.

Posted by Dave Close on November 17, 2009 at 11:54 AM
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Docs Rate Plans

The AMA recently issued its first health insurance report card grading how quickly and accurately doctors get paid. Docs hope the report card will reduce the cost of claims processing and help in contract negotiations with the health plans. 

According to the AMA, the report card compares Medicare and seven national commercial health insurers on the timeliness and accuracy of claims processing. UnitedHealthcare had the lowest rate  – only 62 percent of medical services billed were paid by them at the agreed rate. Aetna came in higher at 71 percent, and the Medicare at an impressive 98 percent.

What you can do:  If you are a healthcare IT physician practice management or EMR vendor who facilitates electronic coding and billing, use the AMA report to highlight how you can improve payment rates for you customers.  It's likely your solution improves reimbursement rates and speed, translating into a more efficient and profitable practice. 

Posted by Shawn Whalen on September 30, 2008 at 2:15 PM
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The Cost of National EHR

Government Health IT reported that full implementation of networked e-health records in U.S. doctors’ offices and hospitals could cost around $150 billion over eight years.

According to Robert Miller, a professor of health economics at the University of California, San Francisco, this $150 billion estimate is actually “manageable” because it amounts to less than a 1 percent increase per year in the nation’s total health care spending.

Miller said hospitals are further along the path toward implementing clinical information systems, partly because they get some boosts in revenues when they install EHRs. With hospital profit margins around 5 percent, most hospitals can afford it.

Miller’s projections call for hospitals to spend $35 billion to acquire and expand EHR systems and $55 billion in new operating costs over eight years. Financial incentives and reporting requirements are going to be key to getting useful data from EHR users, Miller said.

The Rand Corp. reported in 2005 that the total cost over 15 years would be $114 billion, an amount Rand said would be completely offset by cost efficiencies and other financial benefits of EHR use.

What you can do: HCIT PR practitioners may want to consider highlighting the ROI of their EHR solutions in contrast to all this talk about costs. For those vendors with low cost hosted solutions, take full advantage of this feature in comparison to the bigger and more expensive licensed solution vendors.

Posted by Shawn Whalen on August 15, 2008 at 12:30 PM
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Putting Money Where Their Mouth Is

I don’t write too much about government bills and initiatives for healthcare IT, because it’s just so much hot air until a bill passes or money is ponied up. However it is worth mentioning that Health & Human Services’ Secretary Mike Leavitt announced 12 communities that will participate in a national Medicare demonstration project that provides incentive payments to physicians for using CCHIT-certified electronic EHRs to improve the quality of patient care. The five-year project is expected to improve the quality of care provided to an estimated 3.6 million people.

Chosen among a field of more than 30 applicants, the communities selected include Alabama, Delaware, Jacksonville, Fla., Georgia, Maine, Louisiana, Maryland/Washington, DC, Oklahoma, Pittsburgh, Pa., South Dakota, Virginia and Madison, Wis.

Financial incentives will be provided to as many as 1,200 primary care physician practices in the selected communities that use certified EHRs to improve quality as measured by their performance on specific clinical quality measures. Total payments under the demonstration for all five years may be up to $58,000 per physician, or $290,000 per practice.

If you are a PR practitioner for one of the EHR vendors who have participating doctors in these communities, it’s a good opportunity to leverage the project. Promote to the media how your EHR solution is helping move the country toward the National Health Information Infrastructure. Demonstrate the ROI and payment incentives your software is delivering to your customers in the form of a case study pitched to the healthcare IT trades and local media. Encourage trend stories on the project which could include your customer reference. For more ideas, feel free to contact me.

 

Posted by Shawn Whalen on July 22, 2008 at 11:13 AM
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Med Students Speak

The results of the third annual Future Physicians of America survey were released today, capturing the opinions of more than 900 medical students. Following are some of the key survey findings according to the press release:

Technology adoption grows — Year over year, medical students overwhelmingly agree technology improves patient safety and care. Today, more than one in three medical students use software solutions on their mobile devices, often at the encouragement of their medical school. The majority of respondents also report experience with electronic medical record (EMR) systems during rotations, yet less than 20 percent see wide-spread adoption in the U.S. within the next five years.

Preparing for practice — Nearly 70 percent of medical students do not feel adequately prepared for managing or owning a practice in the future. However, they give schools' clinical training programs top marks, showing improvements since 2006. Likely a result of early exposure in training, the availability of an EMR system will be a significant deciding factor in where 60 percent of students choose to practice (nearly a 20 percent increase over the previous year).

Assessing the healthcare system — Forty percent of survey respondents, increasing from 29 percent in 2006, give the U.S. healthcare system an unsatisfactory grade (D or F). Students cited insurance coverage issues as the system's main challenge in 2007. Approximately 35 percent of this year's respondents predict healthcare system reform within the next five years.
 
Students get personal — Students go online for more than clinical answers, with 75 percent spending time on popular networking sites - primarily Facebook – for a reprieve and social interaction. While most spend less than five hours a week, six percent of medical students spend between 24 - 40 hours a month on Facebook.

The Future Physicians of America survey is conducted on an annual basis. Survey participants are opted-in to participate in market research surveys through the Epocrates Honors Panel.

Posted by Shawn Whalen on June 25, 2008 at 10:01 AM
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CBO: What Savings?

A recent report from the Congressional Budget Office joins several other reports in asserting that the health IT won’t deliver significant cost savings. The report specifically attacked the often-cited RAND report number of $77 billion in annual cost savings.

According to the report, health IT will only yield cost savings if implemented with broader healthcare reform measures. Also, government-mandated technologies such as e-presecribing could generate savings.

Coming from the Congressional Budget Office, many pundits have said that the report could effect prospects for legislation to boost the use of health IT. I don’t think so, given the number of reports that claim otherwise and the growing political importance of healthcare to the new administration soon to be in power.

Posted by Shawn Whalen on June 16, 2008 at 7:16 AM
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CEOs Support Wired for Health Care Act

Today brings a guest column on healthcare quality and technology by Maria Ghazal, director of public policy with the Business Roundtable, an association of CEOs of leading U.S. companies with $4.5 trillion in annual revenues and more than 10 million employees.

Health IT Will Save Lives and Money - First We Need Policymakers to Wire Us for Health Care Quality

Imagine if every few days a passenger plane crashed while travelling across America. There would be a massive outcry over safety standards and America would want answers…the airline industry would be investigated, held accountable and would make the necessary changes to ensure air travel is as safe as possible. Shockingly, the equivalent is happening in the healthcare space and no one seems to notice. Every year as many as 98,000 people die due to preventable medical errors, the equivalent of a 747 crashing every two or three days, and yet there is no public outcry, no call for reform and no alteration to our current health care system.

This must change. I work for the Business Roundtable – an association of CEOs of leading U.S. companies such as Verizon, Aetna and General Motors – who are pushing Congress to recognize that the cost we currently pay for our outdated system, in both human lives and dollars, is unacceptable. Based on both their business experience and their insights from insuring more than 35 million Americans, Business Roundtable CEOs believe that utilizing health information technology, more commonly known as health IT, will provide better quality of care while saving money and ensuring the security of private medical information.

 

Continue reading "CEOs Support Wired for Health Care Act" »

Posted by Shawn Whalen on May 19, 2008 at 1:46 PM
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NY Loves RHIO

In a vote of confidence in regional healthcare information organizations (RHIOs), the state of New York gave out  $105 million in grants recently. Among the 19 grants, Brooklyn’s Health Information Exchange snagged the largest grant of $12.7 million.

The Empire state's HCIT goals include supporting Medicaid providers, streamlining public health reporting and monitoring, increasing patients’ involvement in their care, and improving the quality of care.

In a press conference, New York pointed out how they are giving more money out than the Federal government office headed by Kolodner. This financial support by New York is an example of how state governments can help increase adoption of technology.

From the healthcare IT marketers perspective, any vendors with New York customers part of these grants should consider ways of promoting their involvement, from a simple congratulations letter to a press release. Others ideas include pitching such customers to the media as case studies, as part of RHIO trend stories, for joint bylines with your executives or as speaking engagement case study submissions.

Posted by Shawn Whalen on April 7, 2008 at 2:54 PM
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A European Perspective

Research and consulting firm Health Industry Insights (HII) released its 2008 Western European Top 10 Predictions. According to HII analysts Jan Duffy and Silvia Piai, European healthcare providers are facing an "inconvenient truth": the traditional healthcare service delivery model — based on big box hospitals set up to deal with acute episodes, doctors as the only owners of clinical information, and little attention dedicated to wellness and prevention — is no longer sustainable. New patterns of demand, resource constraints, and glitches in the quality of service have brought this model to the point of no return. Health Industry Insights foresees common patterns of transformation of both the service delivery model and information technology modernization in Western Europe.

For their predictions for 10 key changes taking place in 2008, please click the "Continue Reading" link.

Continue reading "A European Perspective" »

Posted by Shawn Whalen on March 18, 2008 at 9:05 AM
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EMR Blues

I thought it progressive of Blue Cross Blue Shield of Massachusetts to give out $50 million in grants a few years ago to medical practices to adopt EMRs. So it was interesting to see BCBSMA suggest that the financial ROI wasn’t worth the cost to doctors in medical practices.

Citing studies including an AMA report saying docs get only 11 cents of every dollar saved through the use of an EMR, BCBSMA decided not to require physicians to install an EMR to participate in its bonus program. They still however offer financial incentives to medical groups to adopt EMRs.

BCBSMA’s own cost-benefit analysis showed that CPOE made financial sense in the hospital setting. So they will require health systems to install CPOE by 2012 to participate in the bonus program.

The BCBSMA news came after a local study by the New England Healthcare Institute. It found that that CPOEs could help prevent 55,000 medication errors in MA and provide an annual cost savings of $170 million, or $2.7 million per hospital.  No surprise there, given medication errors are one of the more easily addressed problems with IT.

BCBSMA estimates it would take five to six years for an EMR to recoup its cost in an office-based practice. AMA policy supports EMRs but does not support requiring physicians to purchase them.

While I think the financial ROI aspect of EMRs is important, especially if you’re the doc paying for the system, there are other quality, safety and pay-for-performance benefits that should be considered. Understandably however, the small and medium sized medical practice has a tough time swallowing the cost of the typical EMR.

Industry is responding with cheaper, simpler, hosted solutions. Insurers continue to support and provide financial assistance.  Changes in the Stark Law are allowing hospitals to provide free or discounted systems to their network practices. And perhaps government will start providing tax incentives.

Massachusetts may pass legislation that would provide $175 million in grants to physicians to adopt EMRs.  This may change MA insurers perspective on EMRs and bonuses.

Posted by Shawn Whalen on March 10, 2008 at 10:17 AM
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Report from HIMSS

Another year, another HIMSS.  Florida was a nice break from the cold of Massachusetts. We had about 10 clients at the show, fielding a combined 100 media interviews.  Plenty of others whose job it is to analyze have covered the show, such as Healthcare IT News.  So I’ll just share some photos.
 

Sniffing out prospects. Attendance seemed lighter than last year, though HIMSS claims otherwise.
 

Klaatu barada nikto. The aliens have landed, and they come bearing interoperability.
 

This doc looks smart enough to buy an EMR.
 

Hyland not only had the most popular booth - a sports pub serving beer - but also a novel marketing idea using baseball cards.
 

Vroom, vroom. Driver decision support and PHR come standard.
 

The GE Kingdom. Will they follow Cerner and not return next year?
 

These sleek filing cabinets hold up to 200 patient records per drawer ;)
 

Organic, green, enviro-styling booth, though I can’t recall what they do.
 

R2-D2-EMR. Good for carting around rebel IT secret plans.
 

The wheeling and dealing home base.

Posted by Shawn Whalen on February 27, 2008 at 3:15 PM
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Mo' Money Mo' Money

Picking up from the Jan. 3 post about the 2008 budget for the Federal Office of the National Coordinator for Health IT, the 2009 budget proposal came in at $66 million. A whopping $4.7 million more than 2008’s $61.3 million.

On the positive side, beyond the Office budget are several other budget proposals including $45 million for the Agency for Healthcare Research and Quality to advance health IT to boost patient safety; $26 million to continue trial implementations of the Nationwide Health Information Network; $3.8 million for CMS to fund the second year of a EHR demonstration project; and $3 million for the Office of the Assistant Secretary for Planning and Evaluation to conduct independent evaluations of EHR adoption
 
The complete Health & Human Services 2009 budget proposal is here.

To echo past advice, these budget discussions give healthcare IT vendors a PR opportunity to highlight how they are making the government’s vision a reality. Consider thought leadership PR for your executives to comment on the government fiscal short-comings, and how private sector companies such as yourselves are solving healthcare's problems today.

Posted by Shawn Whalen on February 12, 2008 at 10:36 AM
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2008 Trends to Watch

Industry analyst firm Health Industry Insights released their 2008 healthcare IT predictions. Business intelligence tops the list.  Their announcement discusses how data integration and interoperability will continue to drive major shifts in IT spending. These initiatives will be sharpened by an industry focus on cost containment, process improvements, and improved patient outcomes. Listed below are key highlights from their provider and payer top ten trends.

U.S. Provider 2008 Top 10 Predictions identifies major trends that will impact the provider IT landscape in 2008. The industry is approaching a critical turning point whereby delivery models and applications are increasingly accessible and easier to use providing much needed data exchange and interoperability. Providers need to examine opportunities to expand EMR investments as this is becoming a key requirement in the inpatient and ambulatory care setting. Health Industry Insights also predicts that providers should keep an eye on Health 2.0 as it is changing the way consumers interact with healthcare information.

U.S. Payer 2008 Top 10 Predictions reflect a volatile and changing business and technology environment, with investment planned in multiple traditional areas and new initiatives, rather than the more single-themed focus of some previous years (e.g., HIPAA, consumerism, the collaborative business model). Business intelligence, prioritized investment on consumer information management and transaction tools, as well as "extra-enterprise" technology investment emerge as overarching themes and areas of the greatest investment in the next 12-18 months. Fragmentation and high technology costs will continue as the U.S. healthcare payer market technology investment encompasses over 50% of the total worldwide healthcare payer IT spend.

Health Industry Insights’ Top 10 predictions across the industry sectors include:

- Business intelligence and related information management are leading categories of technology spending increases in 2008 across all segments
- Outsourcing seen as instrumental as the focus on cost reduction continues to increase
- Drug safety will remain front and center as a primary concern in 2008
- SaaS (software as a service) will spur adoption of EMR's for small providers
- Healthcare/financial services interface and competition will heat up in 2008 as healthcare payers shift costs and payment responsibilities to consumers
- "Extra-enterprise" investments become mainstream as over 40% of healthcare payers report technology investments for use by consumers and providers
- Retail clinics and their technology will proliferate, increasingly disrupting healthcare delivery

"We predict there will be accelerated investment in 2008 in the Business Intelligence segment with spending growing more than 13% over the next 12-18 months," said Scott Lundstrom, vice president of Research, Health Industry Insights. "In addition, the healthcare industry should anticipate more innovative use of Web 2.0 technologies in healthcare by mainstream technology vendors and niche companies over the next 12-24 months."

Posted by Shawn Whalen on January 14, 2008 at 10:32 AM
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Tax Cut an Answer

There are almost 20 different proposed government bills for healthcare IT. I personally think the most sensible solution is the one endorsed by the American Medical Association. It's a full, refundable federal tax credit for the cost of purchasing and implementing clinical IT, including EMRs.

Small and medium sized medical practices can't afford this technology, so a tax break makes sense. About 12% of office-based physicians used a comprehensive EMR system in 2006, according to an October Centers for Disease Control and Prevention report. That figure fell to 7% and 9% for solo and two-physician practices, respectively.

For EMR and PPM vendors, this situation lends itself to PR that highlights the plight of small physician groups. These make up a majority of the care continuum in the U.S., yet are the least able to afford the technology. Trade reporters may respond to trend stories or case studies on low cost solutions that demonstrate ROI. The software-as-a-service model is gaining steam. Illustrate your customer's story in a problem-solution-benefit format to gain the attention of healthcare media.

Posted by Shawn Whalen on January 10, 2008 at 12:02 PM
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Putting Money Where Your Mouth Is

All the Presidential hopefuls are singing from the same hymnal that EMR is part of the solution to improve healthcare quality and cut costs. I wonder if the next President will put his money where his mouth is and better fund the Office of the National Coordinator for Health IT.  The current administration set the '08 budget at $61.3 million, the same as last year, which was down from $125 million the previous year. 

This anemic amount will further slow efforts such as the National Health Information Network (NHIN), pilot programs and an architecture standard for personal health records (PHR).  Obviously government won't make reality Bush's EHR-for-every-citizen-by-2014 pipedream.

This gives healthcare IT vendors a PR opportunity to highlight how they are making this vision a reality. Consider thought leadership PR for your executives to comment on the government fiscal short-comings, and how the private sector led by companies such as yourselves are solving healthcare's problems.

Posted by Shawn Whalen on January 3, 2008 at 5:04 PM
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KLAS Acts

 2007 Best in KLAS Awards

General Market Software

Some new names in some top spots. eClinicalWorks and athena are dislodged from some of their previously held top spots.

Acute Care CDR, Orders and Charting (Large, 200+ Beds) - Epic

Acute Care Reg., Sched., PA (Large, 200+ Beds) - Epic Hospital

Cardiology PACS (Acute Care) - Emageon

Decision Support - Business - EPSi

Document Management and Imaging (Acute Care) - Perceptive Software

Emergency Department Systems - Wellsoft

Enterprise Scheduling - USA RMS

Financial/ERP (GL,AP,MM,Payroll,HR) - McKesson

Financial/Materials Management/Laboratory (Larbe, 200+ beds) -  Sunquest Lab

PACS (Large, 200+ Beds) - DR Systems

Pharmacy (Large, 200+ Beds) - Epic EpicRx

Radiology (Large, 200+ Beds) - GE Centricity RIS-IC

Surgery Management - USA ORMS

Transcription and Back-End Speech Rec.- eScription EditScript

Community Hospital Software

Community HIS - Overall McKesson Paragon Community HIS (Small - 200 or Less Beds)

Community Clinical Ancillary Software - Overall DR Systems Unity (Small - 1-200 Beds)

Physician Practice Software

Ambulatory Billing and Sched. (Over 100 Physicians)- Epic

Ambulatory Billing and Sched. (26-100) - athenahealth

Ambulatory Billing and Sched. (6-25) - AdvancedMD

Ambulatory Billing and Sched. (1-5)- DoctorsPartner

Ambulatory EMR (Over 100)- Epic EpicCare Ambulatory

Ambulatory EMR (26-100) - Allscripts 

Ambulatory EMR (6-25) - Greenway Medical 

Ambulatory EMR (1-5) - MedcomSoft

Professional Services

Clinical Implementation Principal- IBM Healthlink

Clinical Implementation Supportive - Coastal Healthcare Consulting

Financial Implementation Principal- ACS

ITOutsourcing (Extensive)- Eclipsys IT Outsourcing

Outsourced Transcription - Encompass Outsourced Transcription

Planning and Assessment - Hayes Management

Revenue Cycle Consulting-Transformation - Stockamp & Associates

Technical Consulting - Hayes Management

Medical Equipment

Computed Radiography (CR) - Konica Xpress CR Dual Bay

Computed Tomography (CT) - Toshiba Aquilion 64-slice CT

Hand-Carried Ultrasound - ZONARE z.one

Magnetic Resonance (MR) - Toshiba Vantage 1.5T MR

Smart Pumps - B. Braun Outlook

Ultrasound - Toshiba Xario

Other Software

Home Care - McKesson Horizon Homecare (Home Health)

Posted by Shawn Whalen on December 28, 2007 at 10:05 AM
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Whew!!, Honey I Can Get that 750i This Year

Despite the recommendations of Health and Human Services' Mike Leavitt and the hopes of EHR industry vendors, Congress approved Medicare legislation that does not include the adoption of healthcare IT as a means for doctors to increase their Medicare reimbursements.

With all the bad publicity around cutting doctors Medicare reimbursement by 10% and the impact on seniors who would get turned away from doctors (hey, Bimmer prices aren't going down), it was inevitable that Congress would do away with the cut and add a .5% increase. Bad boy Bush will sign.

But there are enough proposed bills out there for HCIT to stuff the big mouths of all the candidates. Among these bills, Sen. John Kerry has one to require docs to do e-prescribing or face financial penalties. Esteemed imbiber Sen. Edward Kennedy has the Wired for Healthcare Quality Act.  I suspect none of these will get through. HHS will continue to blow the HCIT horn. EMR PR folks can continue the dance.

Posted by Shawn Whalen on December 27, 2007 at 3:05 PM
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The RHIO Reality?

According to a study by Harvard researchers published this month in Health Affairs, achieving electronic clinical data exchange across the United States is still a distant reality. From the abstract: In early 2007 we surveyed 145 RHIOs. Nearly one in four was likely defunct. Only 20 efforts were of at least modest size and exchanging clinical data. Most early successes involved the exchange of test results. To support themselves, 13 RHIOs received regular fees from
participating organizations, and eight were heavily dependent on grants. Our findings raise concerns about the ability of the current approach to achieve widespread electronic clinical data exchange. [Health Affairs 27, no. 1 (2008): w60-w69 (published online 11 December 2007; 10.1377/hlthaff.27.1.w60)]

Posted by Shawn Whalen on December 12, 2007 at 4:41 PM
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Presidential Candidates on HCIT

The EMR Medical Software Information and Resources blog has a useful summary of the Presidential candidates position on healthcare IT. For the convenience of the healthcare IT marketers and PR folks that read this blog, I'll include it here.
 
Election day is more than twelve months away, but the contest for president of the United States is already shaping up to be a fierce one. Many presidential candidates have either released or announced their intention to release a comprehensive plan for health care reform. Following is an attempt to summarize each candidate's position on health care information technology such as e-prescribing and electronic medical records. You are encouraged to visit each candidate's Web site on your own, as their positions may change in the future. Please hit "Continue Reading" for the details...

Continue reading "Presidential Candidates on HCIT" »

Posted by Shawn Whalen on October 19, 2007 at 2:52 PM
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Hospital IT Spend Trends

We represent here Leerick Swann & Company, a boutique healthcare equity research company. From time to time I'll share research of interest to healthcare IT marketers.

Healthcare IT - Hospitals Remain Committed to IT Spend Through 2008

·  HCIT Investment Remains a Top Priority at Hospitals - A recent MEDACorp survey indicates that 24% of surveyed hospitals maintained that healthcare IT and related spending will be their top capital expenditure priority in 2008. The survey of 61 hospitals asked the hospitals to rank-order their priority for capitals expenditures in 2008 -- 24% ranked IT and technology-related spending as their No. 1 priority, 23% of hospitals ranked IT at No. 2, and 21% of hospitals ranked IT at No. 3. On average, hospital IT budgets are expected to increase 6% in 2008, compared with 12%E in 2007.

•  Where We Believe the Money Will Go - We believe that hospitals will continue to spend significant portions of their budget on information technology. Beginning in 2008, we believe investors could begin to see a shift in dollars spent by hospitals on inpatient systems to outpatient systems as a result of the relaxation of the Stark law. We believe that some of this spending has already begun to occur and that the mix shift should accelerate through 2008.

·  We Expect Increasing Levels for Inpatient IT - We believe that we are coming to the end of a major hospital IT cycle, as most hospitals throughout the country have invested heavily over the last 5-6 years in clinical technology systems. However, we believe that inpatient spending on IT should continue to be robust as hospitals that have previously invested in IT raise their ongoing operating expense level dedicated to IT. We recently observed this trend at Cerner's leadership forum and expect this effect to impact other incumbent vendors as well. 

·  Maintain Ratings & Estimates - We maintain our ratings and estimates on the inpatient IT systems vendors. We maintain our Outperform rating on CERN, which we view as one of the best-in-class healthcare IT vendors. We maintain our Market Perform ratings on CPSI, ECLP (Eclipse) and MCK (McKesson) shares. We continue to fear that larger vendors will move down-market, negatively impacting CPSI's competitive position. We believe the recent run in ECLP shares already reflects the improved operations of the business. And we believe that the value of MCK's IT business will be difficult for investors to fully realize while the company's valuation is largely tied to the drug distribution segment.

Posted by Shawn Whalen on October 15, 2007 at 5:29 PM
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Dead Canaries & RHIO Tech Survey

RHIOs has been a topic of interest on this blog, with a dozen or so posts. The research firm Healthcare Industry Insights released a survey on RHIO technology solutions. Results highlighted in a press release:

From an extensive survey of 20 software products that service regional health information organizations (RHIOs) and health information exchanges (HIEs), including assessments of their features and capabilities, indicate no "one size fits all" solution yet exists for this rapidly evolving market. Key findings from the Health Industry Insights survey include the following:

• RHIOs vary widely in their business models and technical architectures; vendor products have been built around re-usable frameworks that can serve as the foundation for multiple, custom deployments.

• Vendors with products that were originally introduced to support Enterprise Master Patient Index (EMPI), clinical messaging, HL7 messaging, and clinical portal functions had more experience connecting to external clinical applications.

• Although HL7 standards have been in place for many years, direct vendor experience with the specific external source clinical applications is an important consideration when selecting a vendor's HIE solution.

• Most vendors are betting that surviving RHIOs will migrate to more robust architectures and will have the financial resources to do so.

To read more on the survey and HII's opinions on RHIOS, hit the "Continue Reading" link.

Continue reading "Dead Canaries & RHIO Tech Survey" »

Posted by Shawn Whalen on October 1, 2007 at 11:21 AM
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Healthcare IT Timeout?

There is much sound and fury over healthcare IT adoption, but in the end is it signifying nothing? Some would say yes, including the president of the National Alliance for Health IT. This past summer Scott Wallace told his membership at their annual meeting that health IT advocates should focus their efforts on just a few areas in which policy and true operational changes can make an impact. "We are at a point where we have run out of adrenaline," said Wallace.

Wallace said the fact that the few models of successful health IT systems are big academic medical centers can be limiting to the overall effort. I agree, considering most healthcare is delivered by small and medium sized medical groups.

On the positive side, continued efforts at standards and interoperability are helping open up health IT to more doctors. If the various proposed government health IT bills actually get passed in '08 or '09, that could help move EMR adoption from hype to reality.

From the PR perspective, health IT and particular areas like EMR are going through the natural hype curve. Time and again, for topics in all industries, there is this slow build before the damn breaks and the firehouse of media coverage floods everyone. Then they get tired of being wet and it collapses to a small but steady stream, quenching the thirst of only the truly interested. For you healthcare IT marketers and PR folks, take full advantage of the current media thirst. But be prepared with powerful ROI case studies showing the value and affordability of your solutions for medical practices and small hospitals, not just the "wealthy" academic or large network hospitals.

I think that the new President, whoever he is, will bring focus and more funding to the issue, just in time to coincide with new levels of standards and ROI shown by small and medium sized practices. The hype will have moved to more thoughtful consideration.

Posted by Shawn Whalen on September 24, 2007 at 12:30 PM
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'07 CCHIT Class

The Certification Commission for Healthcare Information Technology has announced the first CCHIT Certified Ambulatory electronic health records certified under the 2007 criteria. The six ambulatory EHR certified products are:

.    Community Computer Service (MEDENT 17) 

.    e-MDs, Inc. (e-MDs Solution Series 6.1.2) 

.    Greenway Medical Technologies (PrimeSuite 2007 R2)

.    McKesson Provider Technologies (Practice Partner 9.2.1)

.    NextGen Healthcare Information Systems, Inc. (NextGen EMR 5.4.29)

.    Purkinje (CareSeries EHR 2.0)

Posted by Shawn Whalen on August 2, 2007 at 3:04 PM
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Too Little Too Late?

A Commonwealth Fund report says that congressional proposals to boost health information technology do not go far enough to make appreciable difference in American health care. The proposals in question include those that died last year as well as the upcoming Wired for Health Care Quality Act of 2007.

The report says none of the health IT bills "would commit the funds and central leadership required to realize the potential benefits of a health information system."  The solution, says the Commonwealth Fund, is more funding that is in line with the country's $3 trillion spend on healthcare.

Posted by Shawn Whalen on July 30, 2007 at 2:01 PM
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Do You Pass the Test?

The Feds launched a web site for vendors to test their products for standards compliance for participation in the National Health Information Network (NHIN).

The site provides information about the NHIN initiatives, CCHIT, HITSP, interoperability specifications, the standards referenced by the specifications, and the available test resources.

Let your voice be heard:  HITSP is encouraging feedback on the web site at http://hit-tst-team@nist.gov.  In addition, HITSP will hold a public comment period from July 23 to August 17 on several documents, including privacy and security proposed standards, and emergency responder EHR model, and two new use cases.

Posted by Shawn Whalen on July 16, 2007 at 11:42 AM
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I Love You, I Hate You

Showing some fancy footwork in the political dance, Secretary of Health and Human Services Michael Leavitt praises and warns Senator Edward Kennedy about his pending health IT legislation in a long five page letter on June 26.   It captures in fascinatingly boring detail the bureaucratic challenges facing health IT adoption.  The full repartee can be read here.

Posted by Shawn Whalen on July 6, 2007 at 10:56 AM
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Show Some KLAS

KLAS's mid-year rankings came out. Not too many surprises.  Category leaders are listed below, and other general market leaders, community hospital software and physician practice management leaders are listed in the Extended Field below.

2007 MID-YEAR CATEGORY LEADERS

Acute Care CDR, Orders and Charting
Epic EpicCare Inpatient

Financial/ERP
McKesson PW Financial/Materials Mgmt.

Acute Care Registration/Scheduling/Patient Accounting
QuadraMed Affinity

Laboratory
McKesson Horizon Lab

Cardiology PACS
ProSolv Cardiovascular (Fuji)

PACS
DR Systems Dominator

Decision Support - Business
EPSi Decision Support

Pharmacy
GE Centricity Pharmacy

Document Management and Imaging
MedPlus ChartMaxx

Radiology
GE Centricity RIS-IC

Emergency Department Systems
Wellsoft EDIS

Surgery Management
USA ORMS

Enterprise Scheduling
USA RMS

Transcription and Back-End Speech Recognition
eScription EditScript

Continue reading "Show Some KLAS" »

Posted by Shawn Whalen on July 2, 2007 at 4:22 PM
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Brailer Goes VC

Ex-Government healthcare IT czar Dr. David Brailer will be chairman of the new Health Evolution Partners, a private equity fund that will invest up to $700 million in "solutions that advance the quality, efficiency and consumer orientation of health care."

The press release goes on to say that Health Evolution will support promising health care ventures that challenge traditional models of delivering clinical services, including the way they are organized, financed and oriented toward patients. Among its targets will be companies working in disease management, chronic care improvement and pharmaceutical management, as well as telemedicine, remote and in-home patient monitoring and predictive genomics.

Venture capitalists haven't had the soaring success in healthcare IT that they've had in other technology sectors, but that may change given all the national attention on improving healthcare quality by technology.  VC rock star John Doerr of Kleiner Perkins has put some big investments into Purkinje, a HCIT vendor.  Merger and acquisition activity has been the exit for VCs the last several years. Recent IPOs have been lukewarm.

Posted by Shawn Whalen on June 8, 2007 at 10:51 AM
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CCHIT Happens

For those healthcare IT vendors burning to speak out on this sometimes controversial topic, a final comment period on the Certification Commission for Healthcare Information Technology's (CCHIT) proposed certification criteria and test scripts for inpatient electronic health records (EHRs) runs through June 19. Comments will only be accepted on changes made to a previous version of the criteria.  

The commission's board will approve final documents at a June 25 meeting, and then CCHIT will start accepting applications for certification under the new criteria Aug. 1. Earlier this month CCHIT announced that it had certified 30 additional electronic health record systems for ambulatory care under the 2006 criteria. CCHIT now has certified a total of 81 ambulatory EHR products.

Posted by Shawn Whalen on June 3, 2007 at 2:23 PM
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Salt and TEPR

The 2007 TEPR (Towards and Electronic Patient Record) awards were announced last week.
  
Mobile Applications for Healthcare

First-PatientKeeper
Second-Medical Communication Systems
Third-e-MDs

Stand-alone e-Prescribing Systems

First-Purkinje
Second-Misys Healthcare Systems
Third-Allscripts

Personal Health Records

First-CapMed
Second-Waiting Room Solutions
Third-Medical Communication Systems

Document Imaging in Healthcare

First-Medical Communication Systems
Second-BlueWare
Third-e-MedRec by Holt Systems

Hot Products in HIT

First-Phytel
Second-Sage Software

Continuity of Care Awards for Vendors

First-e-MDs and Medical Communication Systems (tie)
Second-Solventus
Third-Allscripts

Continuity of Care Awards for Implementers

First-New Orleans Health Department
Second-Pediatric Health Care at Newton-Wellesley, Newton, Mass.
Third-Northern Illinois Physicians for Connectivity, Glen Elyn, Ill. and Yuil Medical Center, Lawrence, Mass. (tie)

For a show that is all about EMRs, it was odd to see them discontinue the EMR category award. I guess they bowed to vendor pressure, not wanting to offend the hands that feed them. The award was replaced with an EMR usability demonstration at the show.  Hospitals and doctors wanting third-party opinion on the best EMR systems can check KLAS, AC Group EHR Report, the annual EHR systems review conducted by Andrew & Associates, and the leadership quadrant of Gartner.

Posted by Shawn Whalen on May 29, 2007 at 11:06 AM
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CHIMING In On Stark Law

Continuing this week the Stark Law reform topic, the College of Healthcare Information Management Executives (CHIME) recent survey showed that most hospital execs won't be taking advantage of the change that allows donation of EMRs to private physicians.

The survey found that 62% of respondents do not plan to take advantage of the new Stark exception and anti-kickback safe harbor laws. CIOs (read lawyers) are apparently concerned that the reform could be overturned and that exact interpretation of the law is not black-and-white. CHIME said that the 38% who do plan to take advantage of the reformed laws are planning on donating software, implementation support, training and help-desk support.

Posted by Shawn Whalen on May 15, 2007 at 4:20 PM
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Stark Implications

This week brings a guest blog post from Joel Andersen, VP at client Purkinje, on the dark side of Stark law reform. The piece originally appeared in Advance magazine.

The Stark Truth

While the Stark Law reforms have been hailed as a positive development for health care, a closer look at who is singing its praises may show an ulterior motive. Small and medium sized physician practices, which deliver 70 percent of the health care in America, could be force-fit with software from large acute care software vendors, many of which are ill-equipped to understand and service the needs of today's busy medical practices.

Ambulatory care is a very different world than acute care. In Stark law "reform," EMRs could likely become a loss leader for acute care technology vendors and hospitals. Many acute care vendors will practically give away their ambulatory solutions in order to secure millions of dollars in acute care software business from hospitals. As often discussed in the media and rankings from industry research groups, their ambulatory-specific technology is often dated, cumbersome to implement and use, difficult (or impossible) to integrate, and serviced by vendors who "just don't get it." 

Hospitals are often complicit in their own way. Hospitals, like any business, are looking for ways to grow business and want to drive admissions and use of ancillary services. The potential lure of free or low-cost EMRs that are integrated with hospital systems and data generated within their facility such as transcription, lab, radiology, and ADT may do just that. However, EMRs in this arrangement will likely become glorified order-and-result systems tied directly to the hospital.

Continue reading "Stark Implications" »

Posted by Shawn Whalen on May 8, 2007 at 12:51 PM
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Actions Speak Louder Than Words

Surprise surprise, Congress will have too many other time and money demands to pass comprehensive healthcare IT legislation, according to Modern Healthcare. The magazine reports that Medicare and children's health insurance are weightier priorities. HIMSS' lobbying arm must not be a strong as the pharmas.

In a similar effective act, former President Clinton at a trade show in Florida described his support for electronic health records, calling them "the number-one thing that can be done right now to make the American health-care system more efficient and cut costs."

Posted by Shawn Whalen on April 16, 2007 at 5:24 PM
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Hospitals and EHR

According to a Fall 2006 survey by the American Hospital Association (AHA), reported in HMT eNews March 21, 68 percent of U.S. hospitals use EHRs, with 11 percent of that number reporting full implementation. Computerized alerts that prevent negative drug interaction were used by 51 percent of hospitals, up from 23 percent in 2005. Nearly half that number reported sharing electronic patient data with laboratories, payers, other hospitals and private practice physician offices. The AHA data revealed that it is still predominantly larger urban hospitals with greater financial resources adopting EHRs rather than smaller, rural hospitals.

Posted by Shawn Whalen on April 9, 2007 at 2:29 PM
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EMR Grumbles

I heard some interesting grumbles at HIMSS from doctors about the evolving pressures of EMR adoption. Acute care vendors see small medical group practices as a major market opportunity. Spurred on by Stark law reform, the vendor big boys are forcing acute care systems onto small practices. They are tapping their hospital CIOs to distribute their EMR solutions to the associated medical practices. Docs often have to choose to adopt hospital-recommended systems or deploy and pay more for their own. If they go with the hospital choice, their data may be owned or co-opted by hospital.

Some docs feel their EMR choices are being narrowed by third parties, be they payors, RHIOs, CCHIT or hospitals each of whom have their own preferences. Certain states are funding initiatives to deploy EMRs to small practices, using a self selected list tied to CCHITT. All these pressures and continued market consolidation may put the more economic or specialty EMR developers out of business.  Then again, new services like the free Google EMR and V.A.'s Vista will continue to make the EMR market interesting to watch.

Posted by Shawn Whalen on March 19, 2007 at 2:58 PM
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Open Sesame

It was only a matter of time before open source and healthcare IT came together. The VA's OpenVista system was released as open source code last week.

Vendors are following suit. McKesson and Red Hat announced an end-to-end open source healthcare solution. Philips Medical Systems is using CollabNet for its new collaborative software development infrastructure. Palm is using Tolven's open source EHR records on their Treos smartphone.  Medicity launched an open source healthcare portal. The U.S. is following in the footsteps of other countries in this regard; Brazil's whole healthcare system is built on open-source technologies.

One hurdle to these open source efforts will gaining CCHIT approval where applicable, compatiability with RHIOs and payor systems, and countering proprietary software vendors' claims that open source is unreliable.  We see how effective that was for Microsoft ;)

These bleeding edge examples are largely symbolic in the big picture today, but like open source in the enterprise in another ten years it will be a different story.

Posted by Shawn Whalen on March 12, 2007 at 10:12 AM
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Live From HIMSS!

One of a Kind: Forget the dozen+ clients we had exhibiting ;)  Here’s a HIMSS first, a healthcare PR agency taking space.

I Want My GWN-TV:  One of the more interesting technologies was from GetWellNetwork, an interactive patient care solution putting education and entertainment resources at the patient bedside.

FierceParty:  One of the many parties was healthcare e-zine FierceHealthcareIT’s party at Utopia on Bourbon Street.

Mr. Roboto:  Yours truly with a cousin of Robbie, visiting from the future. It says in 2099 EMR adoption is 40%. See, we will make progress! 

Posted by on March 1, 2007 at 1:51 PM
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EMRs Caught CCHITing

In another flavor of standards, 18 more EMR vendors coughed up $20,000+ (and complied with some criteria ;) to be certified by CCHIT, Certification Commission for Healthcare Information Technology. This totals 55 EMRs so far, which CHEAT says is 25% of the market. Are there really 220 EMR vendors out there?   The new 18 certified EMRs:

· Advanced Data Systems Corp. (MedicsDocAssistant 3.0)

· Catalis (Accelerator Graphical Health Record 4.111)

· Encite (TouchChart 3.3)

· Henry Schein Medical Systems (MicroMD EMR 4.5)

· InteGreat Concepts, Inc. (IC-Chart Release 6.0)

· LSS Data Systems (MPM Suite MAGIC  Version 5.5) 

· LifeWatch (TIME 7.100) 

· Marshfield Clinic (CattailsMD Version 5) 

· MedAZ.net (MEDAZ 60720.001)

· Medicat (Medicat 8.8)

· MedicWare (MedicWare EMR 7)

· MedInformatix (MedInformatix V 6.0)

· Meditab Software (Intelligent Medical Software 2007)

· Pulse Systems (Patient Relationship Management 3.1.1)

· Spring Medical Systems (SpringCharts EHR 9.0)

· SSIMED (Emrge 6.0 Release 1.0)

· Universal Software Solutions (VersaSuite 7.5)

Posted by Shawn Whalen on February 15, 2007 at 5:21 PM
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Have You No Standards?

Health and Human Services Secretary Michael Leavitt has accepted 30 consensus standards to support an interoperable national health information network.

President Bush signed an executive order last year requiring federal agencies to use available interoperability standards when implementing or upgrading health information technology systems.

Among the standards:

- The Electronic Health Record Interoperability Specification, that supports interoperability between EMRs and lab systems.

- The Consumer Empowerment Interoperability Specification, for patients to exchange data with providers.

- The Biosurveillance Interoperability Specification, for the exchange of biosurveillance data among providers and public health agencies.

Posted by Shawn Whalen on February 2, 2007 at 3:05 PM
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Lies, Damned Lies, and Statistics

Though Twain had his doubts, marketers love statistics. So to help out healthcare IT marketers here are some stats from the Census Bureau, CMS and analysts.

The U.S. spent $2 trillion on healthcare, or $6,697 a person, in 2005.

Healthcare costs account for one-sixth of the economy, compared with one-tenth in the early 1980s.

In 2006, 61% of businesses offered health benefits to at least some employees, down from 69% in 2000.

Young adults are the most likely to be uninsured. Those between the ages of 18 and 34 account for 25% of the population, but 41% of those without insurance. Texas has the largest percentage of uninsured citizens (24.6%), followed by New Mexico and Florida. Can you say que?

According to Forrester Research, CDH enrollment will reach 12 million, or seven percent of the commercially insured market, in 2007.

Up to 98,000 Americans die each year from preventable medical mistakes they experience during hospitalization, according to the Institute of Medicine.                                                                          

Mistakes in healthcare are costly.  A wound infection costs $21,000 on average. A post-operative infection costs more than $25,000 and re-opening a surgical site will cost more than $36,000.  The Juran Institute and Midwest Business Group recently quantified the direct costs of health benefits for poor-quality care over $1,300 per employee per year with indirect costs of lost productivity from poor care at another $500 per employee per year. 

Posted by Shawn Whalen on January 12, 2007 at 5:39 PM
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Crystal Ball

Analyst firm Health Industry Insights/IDC is holding its "Top Ten Predictions for the Health Industry in 2007"  Webinar on January 10, 2007, 12:00-1:00 pm EST. Here is the link to register:

http://www.idc.com/getdoc.jsp?containerId=IDC_P14515

Posted by Shawn Whalen on January 4, 2007 at 2:58 PM
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Politics as Usual

When the new Democratic Congress opens session, healthcare IT legislation will be a major priority, according to AIS Health.com.  Citing a Government Health IT article, although HIT legislation is high on the list of priorities, rapid action on health IT legislation is unlikely because new hearings will be necessary. Health IT bills failed to pass in 2006 when the House and Senate could not agree on a compromise version of legislation passed by both houses. Democrats' concerns over patient privacy and interoperability standards and the Republicans' desire to create a loophole in the Stark and anti-kickback rules are among the issues that have the two parties at odds.

Posted by Shawn Whalen on December 19, 2006 at 4:17 PM
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2007 Healthcare Predictions

It's the time of year when consultants and industry analysts make their 2007 predictions on healthcare.

PricewaterhouseCoopers releases their own, calling 2007 a watershed for the health industries as health savings accounts reach a tipping point, states act where the federal government hasn't and pressure on pricing amid demand for transparency forces pharmaceutical companies, hospitals and health plans to rethink their strategies.

PricewaterhouseCoopers' top seven trends:

1. States Take the Initiative:  In the presence of federal gridlock, states are taking the lead on divisive issues such as stem cell research, health insurance coverage for the uninsured and oversight of advertising and promotion by pharmaceutical companies.  Responding to local social and fiscal concerns, states are developing innovative insurance programs, forming public-private partnerships to spur innovation and passing legislation to drive greater accountability and transparency from hospitals, physicians and pharmaceutical manufacturers.  According to PwC, such state-led initiatives will likely expand in 2007, but the risk is a patchwork quilt of local programs and regulations.

2. Transparency Could be Revealing:   The demand for transparency around pricing, quality measures, safety standards and community benefit is being driven by and is supportive of consumer-directed healthcare and pay-for-performance.  In 2007, the health industries will focus on becoming more transparent, but government, insurers and employers need to educate consumers about the availability and use of such information.  Providers will need to dedicate more resources to reporting, a strategic issue that can no longer be delegated down in the organization.

For the other five predictions follow the link...

Continue reading "2007 Healthcare Predictions" »

Posted by Shawn Whalen on November 30, 2006 at 5:34 PM
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Oh You Mean That Interoperability

For all the hoopla electronic health record system certification via CCHIT (Certification Commission for Healthcare IT) received, it was surprising to hear Health and Human Services (HHS) head and CCHIT Chair Mark Leavitt describe the interoperability criteria as weak. Apparently the only 2006 interoperability requirement necessary is the ability to electronically receive laboratory test results.

That makes one wonder how poor the grades of the 17 vendors who flunked the recent round of tests were.  CCHIT withheld those names (to protect the innocence of their customers?)

In 2007, the requirement will expand to electronic prescription transmission. Eventually CCHIT will move vendors up to a more comprehensive interoperability requirement.

For a list of the latest 11 vendors to pass CCHIT, read it here:

Continue reading "Oh You Mean That Interoperability" »

Posted by Shawn Whalen on November 8, 2006 at 2:01 PM
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Tech Alone Does Not a RHIO Make

The challenge of creating regional health information exchanges goes well beyond the bits and bytes of making a network run, according to the Oct. 31 AIS Today in E-Health Business. AIS reports this latest finding from a First Consulting Group, which examined the top 10 non-technical challenges of regional health information organizations (RHIOs.)  RHIOs are seen as a building block for exchanging patient records electronically. The report found that successful RHIOs:

1. Have a common vision so that all involved understand the value of such a network;
2. Have an experienced leader who is organized, passionate and trustworthy;
3. Have governance that is consistent with the organization's mission;
4. Have a variety of stakeholders participating in the process;
5. Help organizations that may be direct competitors come to agreement on how to deliver common services that protect all participants;
6. Do not stretch resources too far by attempting to tackle too many initiatives;
7. Be clear that participants will get varying returns on their investment;
8. Collect fees that reflect the value that each participant will receive from the RHIO;
9. Have formal agreements on how to share data; and
10. Have privacy standards and procedures in place for system security.

The paper is available for download at http://www.fcg.com/.

Posted by Shawn Whalen on November 1, 2006 at 11:43 AM
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Doctor, Doctor Give Me Some News

VHA’s Dr. Robert Kolodner, developer of the VA’s EMR system, has been tapped to replace Dr. David Brailer to head the Office of the National Coordinator for Health IT (ONCHIT).  Brailer resigned in April. Kolodner will likely last through the change in Presidential administration. 

Kolodner brings considerable healthcare IT experience to the post given his role in developing the VA’s Decentralized Hospital Computer Program, which preceded the EMR system which is technically the nation’s largest integrated health system (though many EMR vendors call it antiquated at this point.)

Said Health and Human Services Secretary Mike Leavitt in  statement: ““Kolodner joins us at a time when we are making steady progress in advancing the president’s health IT initiative, and his experience in patient care, health IT, and government will be invaluable to those efforts.”

I think it’s about time a replacement was found for Brailer, even if “interim” (technically Kolodner is on loan from the VA).  It shouldn’t be too surprising though, given the position has been one of big hat, no cattle since Bush’s paltry funding of the office. Perhaps the new administration will bolster the priority in ‘08, but likely not. The private sector will continue to inch along in the various RHIO experiments and eventually form an NHIN, but I think it will be a decade past Bush’s desired date.

For Dr. Kolodner’s full bio, follow the link.

Continue reading "Doctor, Doctor Give Me Some News" »

Posted by Shawn Whalen on September 21, 2006 at 8:00 AM
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Connecting Communities

Though surveys sponsored by IT vendors are sometimes suspect in the media’s eyes, a McKesson-sponsored Harris Interactive poll made an interesting point in hospitals being a driver of EMR adoption among medical practices.  In a survey of primary care physicians and specialists, more than seven in 10 respondents who plan to implement EHRs said they would be receptive to working with a local hospital to leverage its IT infrastructure and buying power. Given hospitals have been investing more and longer in technology, local physicians in medical groups would take advantage of such resources for connections among providers, insurers and patients.

The survey showed that three-quarters of the nation's physicians plan to adopt EHRs for their practices, with 91% planning to do so within three years. Eighty percent of respondents ranked "coordination of care across care settings" as the No. 1 benefit of an EHR, while 52% indicated that the system will save their practice money in the long run.

According to McKesson, the EHR survey was conducted in June, 2006. The goal was to explore physician attitudes toward working with local hospitals to deploy EHRs in support of a goal set by President Bush for the majority of Americans to have EHRs by 2014. The findings in the survey coincide with ongoing efforts to convert the nation's paper health records into digital format as a way to improve patient safety and curb skyrocketing healthcare costs.

The government recently took two major steps to accelerate EHR adoption. First, the Certification Commission for Healthcare Information Technology (CCHIT) established an industry-wide benchmark for EHR-certified products. Second, final regulations issued last month by the Department of Health and Human Services for e-prescribing and EHRs set the stage for greater collaboration between hospitals and physicians by allowing for the donation of e-prescribing and EHR technology.

Posted by Shawn Whalen on September 19, 2006 at 10:22 AM
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Why EHR? Survey Answers.

According to the Medical Records Institute and Health Data Management there are positive trends in the future for EHR adoption.  In a study recently released by the two organizations, the top reasons cited for adopting EHRs include:

• Efficiency and convenience (82%)

• Increased revenue/lower costs (60%)

• Patient/physician satisfaction (52.6%)

• Half of all physicians are currently, or plan to within a year, allow remote access to the EHR

• About a third have drug reference guides and clinical guides in their EHR

• Less than 20% plan to integrate RFID technology into their EHR

• Less than 10% provide the EHR generated progress note to their patients

Posted by Shawn Whalen on September 12, 2006 at 4:06 PM
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Docs Like Bush

As reported in AISHealth.com, Aug. 24, continuing his support for the adoption of nationwide health IT, President Bush on Aug. 22 signed an executive order requiring federal agencies that administer or sponsor health programs to adopt and use interoperable health IT standards and quality-improvement measures.

The order states, "As each agency implements, acquires, or upgrades health information technology [HIT] systems used for the direct exchange of health information between agencies and with non-federal entities, it shall utilize, where available, [HIT] systems and products that meet recognized interoperability standards."

According to the order, which becomes effective next Jan. 1, HHS, the Department of Defense, the Department of Veterans Affairs and the Office of Personnel Management, which oversees the Federal Employees Health Benefits Program all must comply with the order. In a conference call Aug. 22 with health care industry executives, HHS Sec. Mike Leavitt said organizations that contract with those federal agencies — such as private health plans that participate in Medicare — would also be required to adopt the same standards outlined in the order.

In response to Bush's executive order, e-Health Initiative CEO Janet Marchibroda said, "The ongoing support and keen insight demonstrated by President Bush...on the issues at the intersection of health care quality and information technology are critical to move forward and to make both better patient care and interoperability a reality."  

"These orders won't have much effect at all," Stephen Davidson, professor of health care management and management policy at Boston University's School of Management, told Information Week. According to the magazine, Davidson said, "The missing link is that not many doctors have systems that talk to each other....and even if the software works in the way it's supposed to work, the benefits of those systems go to the payers and the patients."

Posted by Shawn Whalen on August 26, 2006 at 1:31 PM
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Executive Order Up

Healthcare IT vendors should be aware of a President Bush executive order on healthcare IT. It presents media possibilities for comment. On August 22, 2006, President Bush signed an executive order that requires the Department of Health & Human Services (HHS), the Department of Defense, the Department of Veterans Affairs and the Office of Personnel Management to collect more information about the quality and cost of healthcare they provide and share that data with each other and with beneficiaries.

The order directs the agencies to work with the private sector and other government agencies to develop and enact programs to measure quality of care. The agencies would also work to identify practices that promote high-quality care. The information will enable consumers to make informed choices among doctors and hospitals, and it will help support doctors and hospitals in their efforts to improve care and lower its costs.

The order also calls for the agencies to use interoperable electronic health records “where available,” and requires the agencies to compile information on the prices they pay for common services available to their members. Agencies must have the new programs in operation by January 1, 2007.

The President said he hopes the Federal action will be followed by similar commitments in the private sector, and in the state and local government. The U.S. House of Representatives also recently passed a measure (HR 4157 “The Health IT Promotion Act of 2006”) that serves to remove legal barriers to the provision of IT technology to physician.

Posted by Shawn Whalen on August 22, 2006 at 4:39 PM
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Lunch and Learn

Support your local healthcare IT events:

Sponsor: Mass Technology Leadership Council
Event Title: Healthcare IT Lunch & Learn with Health Industry Insights
Date/Time: Friday, Sept. 8, 12:00 pm
Location: BlueCross BlueShield of Massachusetts, Landmark Ctr., 401 Park Dr., Boston
Registration is required, contact me via Comment to this blog post

Event Details: The Mass Technology Leadership Council presents an executive Lunch & Learn with Health Industry Insights Vice President Scott Lundstrom. Lundstrom will explore the latest trends in healthcare IT adoption, providing insightful market data, research highlights, success stories and actionable analysis. As public and private sectors move the healthcare industry toward wide-spread IT adoption, both providers and payers are improving not only quality of care but also their bottom line. Data mining, integration and evidence-based medicine are driving personalized care management, pay-for-performance and healthcare transparency. Join us for this executive briefing 'Lunch and Learn' session.

Posted by Shawn Whalen on August 17, 2006 at 1:21 PM
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P4P MD

Here in Massachusetts, Blue Cross Blue Shield of Massachusetts continues its progressive stance on healthcare with new pay-for-performance (P4P) incentives. This comes not long after its $50 million technology grant for small practices to adopt EMRs (see my April 25 post, "The Wal-Mart of EMR.")

BCBSMA is spending $189 million on performance incentives this year. Though controversial and disliked by many doctors, pay-for-performance is gaining national traction. The long standard automatic payment to doctors for care is being shifted to a portion of payment contingent on quality, in the belief that it will make healthcare more cost effective. Premiums have been rising in double digits this decade.

In P4P, health insurers grade doctors and give bonuses on factors such as the number of patients who receive cholesterol testing, regular pap smears and mammograms, etc. About 13 percent of BCBSMA payments to primary-care doctors will be incentives, about $10,000 per doctor, up three percent from 2005.

In critiquing P4P, doctors frequently complain about having sicker patients or dispute third party standards. Often
doctors will boost their business volume to raise income to offset potential incentive hits. I wonder if increasing the number of patients lessens their individual time and overall care quality?

Another wrinkle: Data amassed and crunched by IT systems runs most P4P analysis. While large hospitals have IT systems with more comprehensive data, a majority of care is delivered by small and medium sized practices who lack such IT. In their case, BCBSMA uses billing data which many in the industry say lacks the necessary detail. And this may be simplistic, but if doctors get stiffed because a patient's health doesn't improve, will they start rejecting chronically ill patients?

Payors are certainly aware of these issues and are slowly working out the wrinkles. As a business practice, P4P is putting capitalist pressure on a bloated system to bring to bear quality and cost improvements, which I think is a good thing.

Posted by Shawn Whalen on July 19, 2006 at 1:31 PM
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Goosing EMRs, and Can 700,000 Doctors Be Wrong?

Recently retired national healthcare IT coordinator Dr. David Brailer once called himself the lead goose guiding the flock in healthcare IT. Leavitt of HHS seems in no rush to replace him, though Brailer's office did get an '06 budget increase to $125 million. If one finds a quarter on the ground, that will count as much toward your retirement fund as Brailer's budget does to national IT adoption.

While a voluntary approach to EMR adoption is preferred, Dr. Brailer's inferences at HIMSS and in other speeches about a possible national sponsored healthcare system (and corresponding EMR - the antique Vista EMR used by the VA system) is unlikely under President Bush. That would also kill the EMR market of the big vendors, all of whom support HIMSS' EHR Vendor Consortium.

The political, consumer and technological heat will put doctors who don't adopt EMR out of business by 2015. Small doc practices who've had legitimate price complaints against adoption have increasingly cheap options from small vendors like NextGen and eMDs. Even the large vendors like Cerner are eyeing the small doc group market.

In the payor world, UnitedHealth scored a legal victory when a Federal judge dismissed the class-action suit against it from the 700,000 doctors who claimed the insurer unfairly cut their reimbursements. The country's largest managed care company held out for seven years for their victory, while peers Aetna, Cigna and Wellpoint settled for many millions.

Robert Seligson, president of the North Carolina Medical Society who participated in the law suit, was cited in my May 16 post, "United We Stand, Together We Fall," about UnitedHealth's allegedly abusive reimbursement practices. UnitedHealth's legal victory comes at a time when the SEC is looking into the stock option timing of CEO Dr. William McGuire.

While the judge liked what UnitedHealth had to say, Wall Street hasn't: The stock is down over 25 percent this year due to the stock timing scandal.

Posted by Shawn Whalen on June 29, 2006 at 4:52 PM
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Head of the KLAS

KLAS released its mid-year customer satisfaction report card on healthcare IT vendors. The research firm surveys thousands of providers; rankings are watched closely by industry. Follow the extended field for the first place vendors in each category:

Continue reading "Head of the KLAS" »

Posted by Shawn Whalen on June 27, 2006 at 11:46 AM
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A Penny for Your Health?

As we celebrate National Health IT Week this week it's interesting to put the United States healthcare IT consumption into a global perspective. As reported in AISHealth.com, the May/June issue of Health Affairs states that U.S. government is spending just a few cents on the dollar on healthcare IT when compared with other industrialized nations. America is about a dozen years behind most other industrialized nations in healthcare IT adoption. Citing a lack of studies that prove a correlation between cost reduction and HIT adoption, the study points out that simply because the U.S. trails in HIT spending, one can't conclude there is a direct relationship between its relative performance and its spending on care. Congress authorized $125 million for fiscal 2006 and $155 million for fiscal 2007 for healthcare IT. A RAND study puts the amount at $156 billion over a five-year period.

Posted by Shawn Whalen on June 5, 2006 at 2:50 PM
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Miss EMR

Every year is the year of the EMR at TEPR. Congrats to the winners of this year's beauty contest:

EMR Systems for Small Practices (1 - 5 Physicians)
First Honors: Practice Partner - Patient Records
Second Honors: eClinicalWorks - eClinicalWorks
Third Honors: Medical Communication Systems - mMD.Net EMR

EMR Systems for Medium and Large Practices
First Honors: eClinicalWorks - eClinicalWorks
Second Honors: Allscripts - Touchworks EHR
Third Honors: Practice Partner - Patient Records

Personal Health Record Systems
First Honors: CapMed - Personal Health Key
Second Honors: Medical Communications Systems - mMD.Net PHR
Third Honors: Cerner - IQ Health

Medical Transcription Businesses
First Honors (tie): MedQuist - DoQment Enterprise Platform
First Honors (tie): Spheris

Document Imaging
First Honors: SRS Software - Freedom Chart Manager
Second Honors (tie): e-MDs - Doc Man
Second Honors (tie): Medical Communication Systems mMD.Net DIM

Standalone e-Prescribing Systems
First Honors: Allscripts - Touch Script eRx
Second Honors: Purkinje - ePrescribe
Third Honors: Dr. First - R copia

Hot Products
First Honors: Misys - Homecare PDA Solution
Second Honors: Synamed

Posted by Shawn Whalen on May 25, 2006 at 4:01 PM
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Support Your Local HCIT Events

A quick plug for the Massachusetts Technology Leadership Council's Healthcare IT Program. This group brings together local HCIT end users, vendors, thought leaders and interested parties to discuss important issues. The next event, open to the public, is Wednesday, May 17, 7:30am-12:30, at Sun Micro Systems in Burlington, on healthcare technology and robotics. Panelists include executives from Harvard Pilgrim, Boston's Children Hospital, Sun, CIMIT, Foley Hoag and Benemax. Register here.

Posted by Shawn Whalen on May 8, 2006 at 4:04 PM
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Blame It On RHIO

Interesting RHIO survey from HIMSS, from AISHealth.com's Today in E-Health Business a few weeks ago:

In light of the recognition that regional health information organizations (RHIOs) have great potential for improving the quality of care of patients, why are more not being developed? The Healthcare Information and Management Systems Society (HIMSS) says it knows the answer. According to the April 2006 HIMSS Vantage Point, 46% of 243 health care IT respondents identify the cost of developing RHIOs as the biggest barrier to implementation. HIMSS adds that the second most frequently cited hurdle -- with 25% of respondents -- was the lack of organizational leadership. Respondents also pointed to the lack of clinical nomenclature and concerns about data security as two other barriers to RHIO implementation, according to HIMSS. But one thing is for sure: Most respondents agree on potential RHIO benefits. An overwhelming 86% report that the biggest potential benefit RHIOs afford is improved quality of care through better access to medical information. At a distant second with 7% was the reduction of health care costs.

Posted by Shawn Whalen on May 5, 2006 at 5:15 PM
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Windows Open; Brailer Exits; A Stark Reality

The company everyone loves to hate announced its panacea for the managed care industry. Microsoft unveiled it's Knowledge Driven Health Plans at the recent World Health Congress. The solution set, usually customized for managed care via partners, is comprised of the .NET framework, BizTalk Server, Windows Servers and Communications, SQL Server and of course MS Office.

Scuttlebutt among the cynical at the conference was that Microsoft was following its usual strategy of setting forth a borrowed vision, solution set, partner list and demonstration of momentum that makes its "leadership" position only natural. This is news to the payor IT leaders who own the market -- Amisys Synertech, EDS, DST Health, Perot Systems and TriZetto Group -- none of whom appeared in Microsoft's partnership press release.

But you can't argue with success, and no one has been more successful in technology than Microsoft. Their formal entry into the managed care market comes as Federal healthcare IT czar Dr. David Brailer resigns. Microsoft will help bring further attention and technology to help connect islands of information in healthcare. This is one of Brailer's chief concerns in his resignation speech, as reported in eWeek.

"Everybody's connected but nobody is sharing," says Brailer. "That's the natural consequence without federal intervention." Brailer's other big worry: Smaller healthcare providers will be left behind (see my Plight of the Small Doc post).

Those worries aside, Microsoft, other vendors and hospitals are still wondering about the Stark and anti-kickback legislation that has hindered health IT adoption. These laws prevent hospitals and vendors from donating technology or services to doctors. Congress proposed some exceptions, but the issue remains. Time will tell if Brailer's replacement has the cure.

Posted by Shawn Whalen on May 1, 2006 at 1:00 PM
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The Wal-Mart of EMR

Recently the Massachusetts eHealth Collaborative announced the winners of a $50 million EMR pilot funded by the Blue Cross Blue Shield of Massachusetts Foundation. Among the EMR vendors in the bake-off for the 180 medical group practice contracts: GE Healthcare, NextGen, Allscripts, eClinicalWorks. eClinicalWorks roasted the competition, garnering 170 of the 180 practices.

eHealth Collaborative chief Micky Tripathi says "that was somewhat unexpected" to the Boston Globe. But to those who follow the EMR market, it shouldn't be that surprising. eClinicalWorks beat out a host of larger EMR players. Why? I've heard competitors refer to eClinicalWorks as "the Wal-Mart of EMRs." This is a compliment, given the company's success in the small and medium practice group market. A regular Best in KLAS favorite, eClinicalWorks is cheap, easy to use, built natively on the Web, and strong on functionality without laboring under lots of bells and whistles. "Value," as Wal-Mart shoppers would say. And eClinicalWorks' independent customer Web site keeps the company honest and listening to their customers.

Do the EMR big boys have such responsiveness? Obviously those Massachusetts doctors didn't think so. These practices are for the most part small medical groups, who tend to follow each other like a herd and seek inexpensive, simple technology. Money wasn't an issue in this case, as BCBSMA financed the IT purchase. This make eClinicalWorks' victory all the more telling about its technology.

Sure, the contract value for eClinicalWorks' customers is much smaller than the Cerners and GEs of the world. The big dollars are still at the high end with hospitals (until, or if, Uncle Sam ramps up grants or tax breaks - see "Plight of the Small Doc" post), where the eClinicalWorks of the world rarely qualify. Nonetheless, the EMR vendor big boys should take heed of the lesson of Massachusetts.

Posted by Shawn Whalen on April 25, 2006 at 11:00 AM
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The Plight of the Small Doc

I recently called my doctor to schedule a check-up and learned he had dropped my insurer. Said payor shall remain nameless, but my small group practice doctor had had enough battling to get paid in a timely fashion. When the job of getting paid is tougher than the practice of providing care, you know something is broken in the business of healthcare.

While the WebMDs, Cerners and Intels of the world are grabbing headlines and joining hands in a healthcare interoperability kumbayah, the majority of doctors in the United States are being left out in the cold. These are the doctors of small and medium-sized practices that comprise 70% of healthcare delivery and who most need technology. Ironically they are also the group least able to afford EMR or PPM technology.

My doctor had a rudimentary EMR that didn't address the reimbursement cycle management that is the financial lifeblood of any practice. This is the boat the majority of small and medium sized practices are in. Hundreds of payors offer thousands of benefit packages, each a little different from the other. Medical practices can't keep pace. The result: claims denied or delayed up to 70-90 days, a payment cycle that would put most companies out of business.

Sure EMR increases doctor efficiency and streamlines workflow, but a truly useful EMR solution gets docs out of the reimbursement management morass with automated coding and payor interaction.

We've all heard solutions to tackle this problem. I agree with what my now-former doctor said: neither the vendors nor government alone can fix healthcare, it will take combined public and private efforts. A few weeks ago at HIMSS, Rep. Phil Gingrey, M.D., (R-GA) recommended tax incentives to encourage EMR adoption. His proposal calls for increased deductions for healthcare organizations that purchase IT. Financial incentives must be in place to motivate the purchase, then the technology must truly yield ROI to maintain its use.

Posted by Shawn Whalen on April 3, 2006 at 9:21 PM
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