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The Anti-ACO / Hospital Medical Practice Consolidation

Posted on February 11, 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.

A physician, Charles Beauchamp, recently left the following comment (shown below) on my ACO and Hospital Consolidation post on EMR and EHR. This might be another example of the EHR Physician Revolt. I wonder how many other doctors will go “against the grain” like Dr. Beauchamp.

As a physician who is going “against the grain” (ie “hospital owned” to private practice” rather than in the opposite direction) I have the following model of action to become part of a patient centered rather than exploitative ACO:

1) Establish my rural practice in my house at a very low cost, including asking some of my patients who volunteered to help with construction.

2) Employ myself, a front desk person and a Medical Assistant with backups

3) Establish Telemedicine links to needed specialties (rheumatology, pulmonary, cardiology) AND use physician social networks (eg, Sermo, MedLink Neurology Forum) for informal networking

4) Use LabCorp as a reference lab with negotiated discounts on high yield labs for one of the practice’s centerpieces: preventing stokes, heart attacks, renal insufficiency, onset of diabetes and diabetes complications. Likewise have a systematic literature scan process using EMBASE rather than PubMed for enhancing the testing and intervention effectiveness of the practice’s goals

5) Embed in the practice’s patient education, instruction and self-care facilitation expertise in efficiently discussing and following up on patient-centered discussions

6) Embed in the practice’s counseling activities the ability to counsel patients about which Part-D plan to choose and which health insurance plan to purchase (minus Medicare)

7) Use a general internist centric and concept driven EMR as the practice’s EMR and optimize its functionality for delivering efficacious brief interventions

8) Participate in community groups (eg, Rotarians) and recruit community leaders interested in enhancing the value of care that is being delivered to the community

9) Intersect with the state’s evolving HIE and structure information collection so that disease classification information can be transmitted to an HIE capable of accepting that information. Constantly improve the practice’s ability to collect disease classification information and include that information within the practice’s concept driven EMR.

10) Code reponsively with the help of a viable clinical concept parser, emphasize patient communication, use evidence and experience to follow-up on disease classification information by using efficacious brief interventions and systematically track outcomes while emphasizing 24 x 7 continuity of outpatient internal medicine care.

Quest EHR Lab Interfaces

Posted on March 7, 2012 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.

While at HIMSS I had the pleasure of spending some time talking with Rohit Nayak, VP of Physician Tech Solutions at Quest Diagnostics. Not only is Rohit a very nice gentleman, but he also provides a number of really interesting perspectives on the healthcare industry. Quest is obviously known in the lab world, but as I mentioned last year, Quest is shifting from being a lab company to a technology company. This is clearly seen by their Care360 EHR product.

At one point, Rohit and I started talking about Quest’s approach to interfacing with EHR software. When you consider that Quest has the lab results that many EHR companies want and now Quest is offering their own EHR it makes for an interesting situation. Rohit told me that Quest has 120 EHR interfaces. He told me Quest’s approach was to be open when it comes to sharing data.

Before I talk more about these interfaces, I think it’s worth commenting on the 120 EHR interface number. The number of EHR vendors is often debated and discussed. I personally like to use the 300 EHR companies number. I’ve seen some go as high as 600 EHR companies, but I think those people are counting any software regardless of if it offers a comprehensive EHR product. For example, they might include an ePrescribing app which is part of an EHR, but I wouldn’t count it in my number.

With that as background, I find the 120 EHR interfaces with Quest quite interesting. Outside of some very localized EHR companies, you’d think that most legitimate EHR companies would have been almost forced to build an interface with Quest. Although, someone did recently tell me that Quest and LabCorp only have 7% of the lab market so maybe I’m overstating EHR vendors need to interface with Quest. I’d be interested to hear from EHR vendors who don’t interface with Quest and why they haven’t yet done so.

Heading back to interfacing with Quest, I was interested in how Care360 EHR users that don’t use Quest for their labs would be handled. Say I was a doctor who used LabCorp for my labs, but wanted to use Quest’s Care360 EHR. Would Quest support a lab interface from Care360 to LabCorp? Rohit told me that Quest would have no problem integrating Care360 with Labcorp, but that LabCorp wouldn’t let them do it. Don’t you love competition?

Of course, I only had the chance to talk with Quest about this topic. I don’t remember ever even seeing LabCorp at HIMSS. Considering LabCorp hasn’t taken the EHR route directly that could be why. I’m not sure many LabCorp users would want to use the Care360 EHR, but it is interesting to consider.

Rohit and I also started an interesting discussion about how well EHR software is consuming the Lab data that’s being sent across these lab interfaces. I’ve asked him to do a guest post on the subject, so I hope to bring you that in the future. You can also check out this 5 EHR Questions with Rohit Nayak video I did while at HIMSS as well.