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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 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Rural vs. City Medical Record Perspective

Posted on April 20, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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 the ACP conference in San Diego (yes, it’s fun for a tech person to attend a medical conference), I had a really interesting conversation with a medical records lady from Cardone EHR Solutions. In our discussion she highlighted an interesting difference between the rural and city perspectives on a medical record.

In essence…

Rural clinics want to keep the medical record forever. City clinics want to get rid of as soon as possible.

When she said this idea, it really rang true to me. Of course, the real issue has to do with liability. The real issue is how litigious our society has become and I think it’s fair to say that those in the urban environment are more litigious than those in the rural setting. That’s why clinics in a city generally want to dispose of the record as soon as is legally possible. They don’t want to be held liable for a record that’s 20 years old. However, the rural community would be aghast at the idea that a clinic wouldn’t keep their clinical record forever. Of course, it’s quite likely that many of those in the rural community will be going to that doctor or hospital for their entire life.

I’ll admit that I’m far from an expert on the differences in these environments, but I found this perspective quite interesting. Has some interesting impacts as clinics and EHR vendors start to discuss the idea of records retention in a digital world.

Another side benefit to talking with Cardone EHR Solutions at ACP was that I got a chance to meet Dr. J. I guess it’s fitting to have Dr. J at a conference for doctors.