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For Health IT Opportunities, Look to the Chaos

Posted on October 9, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Sunnie Southern, founder and CEO of Viable Synergy, spends her days pushing for health IT innovation. Her firm provides products and consulting services for commercialization and community engagement. One of its best-known projects is Innov8 for Health, a Cincinnati-based tech accelerator. Southern, a registered dietitian who started her firm in 2010, talked about her work and about EMRs — as they are and as they could be.

Sunnie Southern

What does Viable Synergy do?

Viable Synergy specializes in commercializing assets that transform health. It offers consulting services and proprietary products that support the development and deployment of innovative health solutions from concept to customer. This year and next, Viable Synergy is focused on the institutional market by helping hospitals and provider organizations to generate new (non-clinical) revenue from currently available assets.

You are part of the Health Data Consortium. What is that?

The Health Data Consortium is a collaboration among government, non-profit and private sector organizations working to foster the availability and innovative use of data to improve health and health care.

Viable Synergy leads the Ohio Affiliate of the Health Data Consortium through our Innov8 for Health program. HDC Affiliates host events and build local networks of groups including startups, entrepreneurs, health companies, universities, government agencies and other innovators to create an ecosystem around using open data to improve health outcomes for individuals and communities.

Do you think EMRs are reaching their potential in improving health?

We are at the very beginning of a new era of leveraging technology to improve health and care and reduce costs. EHRs are an essential component of gaining access to health data to make better decisions.

What is missing from the equation?

Time. We need time to bring the plans to fruition to increase engagement and activation.

The essential elements are in place:

  • Standards that provide direction on necessary features and now interoperability/accessibility (MU2)
  • Incentives to increase purchase, implementation and meaningful use
  • Awareness within the health care community and beyond about the importance of ensuring that providers and patients have access to the critical information they need to make informed decisions

What goals do you think we should be prioritizing in health IT right now?

Interoperability, integration and convergence. There are so many places that providers and patients must go to access critical information that it is difficult to get a complete picture of a patient’s history or a physician’s patient population. I hope that we will begin to see tools that allow for data to be aggregated from multiple sources and provided in an easily consumable fashion. We’ll also need the appropriate regulations to secure and support the aggregation.

What’s the most exciting thing you see happening in health IT at the moment?

The whole system is being turned inside out and upside down. Everyone across the health care continuum is focusing on how to perform their role better. Innovative solutions are popping up everywhere. The chaos is creating massive opportunities. We really have a chance to make a difference. I believe it is the best time ever to be an entrepreneur in health care. So glad to be a part of it!

Doctor Explains Why He’s Avoiding EMR

Posted on October 3, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Dr. Peter Kambelos likes being in solo practice because he can make all the decisions.

And for now, the internist has decided to keep using paper records.

Kambelos

It’s partially an economic decision. He doesn’t feel he can afford the switch to an EMR.

Politics might play a bit of a role, too. Kambelos, who is president-elect of the Academy of Medicine of Cincinnati, likes to keep the government out of his exam room.

Still, he doesn’t rule out going electronic in the not-too-distant future. After all, he’s a mid-career physician, and it would be absurd to think of sticking with analog charts forever.

Late adopters like Kambelos represent an opportunity for health IT vendors, but one that will be challenging to capitalize on. As I wrote previously, future EMR-industry growth will require more resources and creativity to achieve.

More than 50 percent of physician offices have adopted an electronic records system, according to the U.S. Department of Health and Human Services. Among family physicians, one group of researchers found, the number is likely to exceed 80 percent this year.

In an interview, Kambelos explained why he practices — and thinks — the way he does.

Tell me about your practice.

It’s a large internal medicine practice with many elderly patients. I take care of generations of people, grandparents to grandkids. We know our patients and their families, and they know us. This has been, and remains, our patients’ “medical home.” I have two employees and they work hard.

What is record-keeping like in your practice?

I’ve practiced with paper charts for 17 years and they work fine for me. Many are very thick and chock-full of years of valuable and pertinent data. But I have my patients’ histories in my head and don’t need to be chained to a paper chart or an EMR to provide them with outstanding medical care and supervision. Most doctors who really know their patients can say the same.

Have you seriously considered moving to an EMR, and why?

Yes, for the supposed improved efficiency once fully implemented.

Are the Meaningful Use incentives much of a motivator?

Zero. The government is the biggest obstacle to health care delivery in this country.

Do vendors often reach out to you?

Periodically, we receive in-person and virtual solicitations. It happens a couple of times a month, perhaps.

Why haven’t you made the shift?

One reason and one reason only: the cost of making the transition, both in terms of my limited productivity during such a transition and the inherent labor costs in so doing.

In your view, what is the primary shortcoming of the systems out there?

Lack of interoperability. As I understand it, most EHRs don’t interface such that data across hospital systems is readily available to any given user.

What should EMR companies know about doctors like you?

We don’t fear, but rather embrace, new technology. But we work on tight budgets and cannot absorb the costs associated with transitions like this. Federal grants come nowhere near covering these costs and come with too many strings attached.

Things Your EMR Will Never Do

Posted on August 15, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

EMRs can be powerful tools for building practice efficiency.

But they can’t do it all.

Ruth Sara Hart-Schneider, sales and marketing director for Cincinnati-based Salix, says health care providers are still paying too many people to move too much paper. Her firm helps them to fill the gaps left after even the most successful EMR implementation.
Ruth Sara Hart-Schneider is sales and marketing director for Salix
Salix specializes in workflow automation, business process outsourcing and litigation support. Health care makes up about 30 percent of its workload.

Hart-Schneider works with physician practices, hospitals and a variety of other health care clients, such as durable medical equipment firms and clinical research organizations. She deals with 26 EMR systems.

Note: If you catch her hanging out by your fax machine, don’t be alarmed. It’s part of her job.

Here’s what Hart-Schneider had to say:

Can you explain more about what your company does in health care IT?

We support health care companies in leveraging the electronic data they already have. We help them to avoid having redundant systems or people hand-filling forms or electronic systems generating paper systems. We work around the electronic systems in an office, like EMRs and practice management systems. Usually an office will have both, but there are all these other functions that have been left on the table.

What are some examples?

Most EMRs we deal with are not set up for prior authorization requests. And every state has its own forms for different programs — Medicaid HMOs, workers’ compensation. Particularly for practices dealing across state lines, it becomes cumbersome for the staff. EMR companies don’t want to program all these forms for all the states, and they change constantly anyway. That’s a sweet spot for us. Prescription monitoring is another one if the practice is giving many narcotics. Also, EMRs don’t interface with many of the tools the carriers have out there for eligibility, benefits and claims status. Some other areas are disability, return-to-work forms, immunization logs for pediatrics and certificates of medical necessity for things like wheelchairs and oxygen.

When practices invest in EMRs, do they realize how much they’ll still need to do on paper?

They’re trying to meet meaningful use. When they choose a system, they know what it will do. It’s not a tool to manage your office. Still, people get frustrated with how many repetitive tasks their employees have to do even after all this money has been spent. For example, a group had a pulmonary function testing machine that wouldn’t talk to the EMR. They would print the report and then walk over and scan it into the EMR. A lot of equipment is like that.

How do you identify the inefficiencies in a practice?

If you stand by the fax for 10 minutes and watch what comes through, you’ll have a pretty good idea. You can also look around at the stacks of paper. You can ask people what they’re behind on.

How do you help?

Salix will work with an organization to help them identify their biggest pain points and then customize a solution that will free up staff time and save them money. We look for the best tools for each application. We like FileBound, which has an ASP model product that meets all the HIPAA security requirements, has a very reasonable price point and allows unlimited users without user fees.

Among our services: We can help with the auto-population of forms, we can provide data-entry services for labs and test results that are faxed in and we can help provide interface solutions for equipment that’s not hooked to the EMR. For a surgery practice, as one example, we can help design and implement systems so that the manager can look at tomorrow’s schedule and ensure that all pre-certs have been completed.

How important is it to address these areas?

Most often, there are higher-level tasks that aren’t getting done because staff is bogged down in some very menial, basic and repetitive tasks. You don’t need your nurse spending time on data entry or filling out school forms.

Is it realistic for a practice to go completely paperless?

Yes, but not in the near future. You couldn’t do it yourself. Vendors and everyone else that you deal with would have to be paperless, too, and that’s not happening. Many of the nursing home and hospice operators I talk to say they’re not going electronic because they don’t have the money. I think some things will always come in on paper.

Develop Your Own EMR – Crazy, But This Guy Did It Anyway

Posted on July 30, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

When I read John Lynn’s post “Develop Your Own EMR – You’re Still Crazy!” the other day, I thought of Dr. Terry Ellis. I talked to him in 2005 when I worked for the daily Leaf-Chronicle in Tennessee. He had developed his own EMR, and I wrote about it.

Dr. Ellis operates Ellis Oral & Maxillofacial Surgery and Implants in Clarksville. Another surgeon, Dr. Ted McCurdy, practices with him. He wrote his EMR after teaching himself Visual Basic 6.0. I thought that was cool. His only other programming experience had been a one-semester college course in 1977. Dr. Ellis started using the software in his own office in 2002. He started a firm called DescriptMed and began licensing the product, The Chart, to other practices.

Dr. Terry Ellis, an oral surgeon in Tennessee, developed his own EMR called The Chart.

Dr. Terry Ellis, an oral surgeon in Tennessee, developed his own EMR called The Chart.

I wondered where Dr. Ellis’ EMR journey had taken him since we last talked, so I got in touch. The story had an interesting turn. Dr. Ellis still uses a descendant of his EMR every day, but it’s from a different company, and it has a new name. Here’s what he had to say.

How did you develop your EMR?

I spent many hours from 2002 to 2007 improving this EMR. Many nights, weekends and nearly all of my spare time was spent either programming in VB6 and SQL or thinking of coding problems that would come about from a “fresh idea.”

Why didn’t you go with an established vendor?

Primarily the EMRs that were available were obviously written by non-practitioners and did not enable me to effectively use the product in my practice. Most of the products were rigidly programmed or “hard coded.” Most had limited flexibility and really didn’t offer bang for the buck. I only looked at a few, and the closest that ever made it was Amazing Charts, but it still was not what I needed.

Did you have any software development experience?

No. I had taken Fortran IV in college at Murray State University in 1977. I had to learn VB6, VB.Net & C# as well as SQL with database programming on my own. I bought several good books and did a lot of searching online.

How well has it worked for your practice?

It has been the best thing I have done for record keeping. We would never go back to paper.

You eventually expanded it beyond your own practice. How successful has that effort been; how many practices are using it now?

I had users from New York to Georgia, Oklahoma, California and Washington. A cardiologist in Pomona, Calif., still uses it. He even flew me out there to help him get started. My longest user is an internist in San Jose, Calif.

What’s different about your EMR compared with others on the market?

The biggest thing was the flexibility that users had. They could put almost anything they wanted in their own words into the H&P elements. Thus things like complex counseling or treatment statements/paragraphs could be entered in one or two clicks. Other products did not offer this approach. By the way, I hold a copyright on my product.

How has it changed over time?

I moved it from Access database to MySQL and MS SQL. It has numerous features that can support multiple specialties

How has it fared in Meaningful Use?

Not well. I haven’t tried to keep up with that rat race.

How do you keep it updated?

Currently my EMR is embedded in a product out of Washington state. We work together to produce a full-featured PM/EMR for oral and maxillofacial surgeons. I don’t know how many are using it, but I believe there are several hundred oral and maxillofacial surgeons using the EMR under the Oral Surgery-Exec name. This is being marketed by DSN Software in Centralia, Wash. They have a strong following.

CPOE and MU with Marc Probst and M*Modal

Posted on June 26, 2013 I Written By

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

As part of my ongoing series of EHR videos, I had the chance to sit down with Marc Probst, CIO of Intermountain and a member of a number of important healthcare IT committees, Mike Raymer, Senior Vice President of Solutions Management at M*Modal and Dr. Jonathan Handler, CMIO of M*Modal to talk about CPOE and Meaningful Use. It’s another great addition to the Healthcare Scene YouTube channel.

In the interview we have a chance to talk about Intermountain’s move from zero CPOE to mobile, voice recognized CPOE. We talk about the future possibilities of voice in healthcare. I also ask Marc Probst about his views on EHR certification, meaningful use, and CommonWell.


*Note: Marc Probst’s sound was less than ideal. Next time we’ll be sure he has a better microphone.

Dr. Lynn Ho Interview – Micropractice Working Towards Meaningful Use

Posted on August 10, 2011 I Written By

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

This is the next in a series of EMR and EHR interviews that will be done on EMR and HIPAA and EMR and EHR. The full EMR interview with Dr. Ho can be found on the new EHR and EMR interviews website. The following is a summary of that interview written by Kathy Bongiovi.

After completing a family practice residency at the University of Rochester in 1989, Dr. Ho worked in a variety of settings before making her decision to open her no-staff “micropractice” in 2004. Ho defines micropractice as being “a small, low overhead, no staff, hightech-high touch practice.” Because Ho believes the current financing model of delivering primary care by cranking up the volume of visits in order to meet overhead and salary is broken she wanted to move to a model that would be better for patients and give her more professional satisfaction.

Ho realized that one of the keys to running a successful micropractice is maintaining a low overhead. Her overhead is 25-30% of gross collections instead of the typical 60% that arises from paying staff salaries and for multiple work stations.

Amazing Charts was her choice of EHR and she has found the company very responsive to user requests. All of the software pieces needed to integrate well with her EMR, both via formal interfaces and in her informal workflow.

Ho has been able to make her office completely “paperless.” She accomplished this by having all patients send her their clinical histories using Instant Medical History from her website. She also has all new patients sign a laminated “HIPAA consent, for both billing and emailing, with one signature. Then she scans the page along with a copy of their insurance card to a file. She erases the patient’s information from the laminated sheet and reuses it for the next patient. She uses EDI interfaces for most labs and some x-rays and consults. Most consultants fax her their information electronically.

Dr. Ho had no formal training in using a computer and, in fact, had only used a Mac for accessing her email prior to opening her practice in 2004. She felt that with a laptop, an all-in-one, an internet connection and an EHR as the centerpiece of her technology stable, she was set for life. She was unaware of what her technology configuration would evolve into and she became mindful of just how many of her devices would have to successfully interact to properly implement the EHR system. As of the writing of this article she was in the process of attesting for Meaningful Use and was on course to achieving MU within three months of starting the process.

She updated her EHR to the latest version (Amazing Charts version 6) in order to use the “wizards” that would count the necessary data. Ho commented that it was taking only 2-5 minutes more, per encounter, to include the required documentation. Although she would prefer not to have to spend the extra time filling in the boxes, Ho did admit the MU wizard in her EMR makes it rather simple and not too painful to collect the necessary data.

She had the following thoughts on whether MU certification is proper for any given practice. “If you are already leveraging your EMR to help you in your practice in a meaningful way, then depending on your Medicare/Medicaid revenues/patient mix, it may be worth it to apply”. She felt the questions to be asked “are the monies received – or the penalty that you would incur, worth the time it will take you to: 1)learn about the MU program, 2) learn how to use the MU features of the EMR, and 3) actually do the documentation?” She also feels that a provider needs to consider his or her payor mix and practice volume. However, if a provider doesn’t use the EMR to collect demographic data or to E-prescribe, there will be additional work to adopt these processes into one’s workflow.

Dr. Ho feels that attestation is not proper for everyone. Smaller practices with very tight profit margins which lack breathing room may not be able to succeed because the benefits of certification may be outweighed by the efforts necessary to becoming schooled in MU deployment.

Read the full transcript of Dr. Ho’s EMR and Meaningful Use interview.

Family Practice Clinic Demonstrates Meaningful Use and Receives Maximum Medicare Incentive – EMR and EHR Interview

Posted on June 17, 2011 I Written By

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

This is the second in a series of EMR and EHR interviews that will be done on EMR and HIPAA and EMR and EHR. The full EMR interview with Dr. Muir can be found on the new EHR and EMR interviews website. The following is a summary of that interview written by Kathy Bongiovi.

If you’re a doctor, nurse, practice manager, EHR consultant, CEO or executive of an EHR vendor, etc with EMR experience that’s interested in being interviewed, let us know on our http://www.emrandehr.com/contact-us/“>Contact Us page.

Dr. Peter Muir of Springfield Center for Family Medicine was interviewed recently concerning his acquisition of the maximum Medicare Incentive for showing Meaningful Use of a Certified EHR. The Ohio based primary care practice has been using NextGen Ambulatory since 2003 and NextGen Management since 2006.

Dr. Muir stated that their practice chose NextGen EHR because the company focused on clinical offices. Dr. Muir and NextGen EHR share the philosophy of always searching for ways to improve the product. Dr. Muir not only believes in this philosophy but also attended a development think tank along these lines at NextGen’s headquarters. He was also drawn to NextGen because he wanted the capability of customizing his templates.

Having demographics, scheduling, clinical and billing information all on one database has had a huge impact on Muir’s practice. He feels that having a centralized database “makes reporting much easier and more comprehensive than those EHRs with separate databases or separate vendors”. The doctor admitted the conversion from paper charts to EHR was stressful for the first year but well worth it in the long run.

Since Muir’s office has been using EHRs (since 2003), there have been relatively few changes needed for Meaningful Use and any required upgrades to the system came as part of the standard NextGen maintenance fees. There was data that had to be added which was not normally collected by his practice as it had little relevance to his patients but from the patients’ perspective, there was no change in the attention patients received from Springfield Center.

The family practitioner Muir credits the CMS web site and NextGen Healthcare for not only the upgrades to their EHR software but also for their pathway documents and webinars which helped them show meaningful use. He also credits GBS of Youngstown, Ohio (his NextGen vendor for hardware, software) who also helped them implement security upgrades in 2010 in anticipation of the process.

Additionally, being a part of the ONC Meaningful Use Vanguard Program was a benefit to Dr. Muir because “it provides recognition which may allow a greater input in system design and operation.” Muir is concerned, though, that the Program’s flow of information may be difficult if multiple database silos remain in service and a lack of standardization isn’t addressed.

Especially with respect to Meaningful Use Stages 2 and 3, the doctor believes it is critical to have professional health providers utilizing some form of regional system – versus individual systems – in order to have a seamless flow of information. Muir has begun such a system within his own state of Ohio.

The doctor was intricately involved in starting CCHIE (Collaborating Communities Health Information Exchange) in Springfield, Ohio. CCHIE chose HealthBridge as their data engine and together they have partnered with other healthcare providers to provide electronic access to patients’ lab and radiology results as well as to admissions, discharges and transfer information. They have added regions in Southern Indiana and two regions in Northern Kentucky.

Dr. Muir’s advice to fellow doctors is that unless they are planning to retire within the next couple of years they should not delay in the implementation of an EHR. The longer they wait, the more difficult and time consuming the transition will be because, with time, the activities of daily practice will be much broader and more demanding. Additionally, he suggests providers select a system that does not just meet Meaningful Use requirements. His advice is to “select a system that assists you in providing better medical care”.

Read the full transcript of Dr. Muir’s interview.