There’s been a lot of talk lately about the perils of cloned documentation. I had several readers forward me the recent notification from Medicare administrative contractor National Government Services that states that it will deny payments for encounters whose documentation appears cloned.

Let’s face it. Many of us have been creating what could be construed as cloned documentation since our residency days. Back when the average length of stay was a little longer (especially on a teaching service), we were encouraged to completely recap the contents of the previous day’s note, which often led to copying.

With 15 or 20 patients on our rosters, it was often impossible to remember subtleties about each patient, so you just copied what you had from the previous day, updated the lab values, any new complaints, etc. It was a lot like using copy forward / update technology in EHRs today, except a pen with a drug company logo and some truly horrific penmanship was involved.

When dictating discharge summaries, the vast majority of patients had strikingly similar exams since patients had to have largely normalized to go home: Heart regular rate and rhythm; no murmurs, rubs or gallops; lungs clear to auscultation bilaterally; and so on. When confronted with a stack of discharge summaries to dictate (which lazy attending physicians had kindly “flipped” our way) on patients we had maybe seen once, they all started to sound remarkably alike in other ways as well.

I remember being on service at a pediatric hospital, where in a single call night I personally admitted 17 patients for asthma exacerbation. The other interns on the team had at least five or 10 asthma patients each as well. Since there were three interns on a team, the senior resident was covering nearly 50 patients – and more than 30 of them had similar chief complaints and presentations. We had strict criteria for who was admitted (thanks to evidence-based medicine), so their presentations were actually very similar, and all had failed identical interventions in the emergency department before admission. You can bet those senior resident notes didn’t have any new or different information than what was presented in ours.

Ditto on Labor and Delivery during residency, where I trained at one of the highest volume birthing hospitals in the region. Since a normal uncomplicated childbirth really isn’t an illness, the documentation was routine and nearly identical. It would have been difficult to find truly unique information to write about some of the patients. I supposed we could have put in frivolous information like, “This blonde Caucasian mother of the adorable blue-eyed infant has no complaints,” but we were tasked with rounding, not writing beautiful, flowing prose.

My problem with the entire issue of cloned notes is that no one really has defined what they consider cloned, making this just another arbitrary way for payers to deny reimbursement. One contractor defines it as, “Documentation that repeats language from previous entries on that patient or from other patients with similar conditions.” I dare anyone to find a note written in the last two decades that doesn’t repeat language in some way, shape, or form.

Prior to EHR, I used a homegrown paper template documentation system that created remarkably uniform notes. On the positive side, it also created remarkably high-quality visits. Clinical decision support was baked into the documentation forms for various chief complaints. We often took materials provided by various professional organizations (AAFP, AAP, ACOG, CDC, etc.) and customized it to meet local and payer guidelines. For uncomplicated illness (strep throat, sinusitis, urinary tract infection, etc.) the notes would be strikingly similar from patient to patient.

Why is it bad thing for the physician to document exactly the appropriate information to substantiate level of care and quality? Should extraneous information be required for payment so that the note appears individualized just for the sake of being individualized?

I can easily avoid the appearance of cloned documentation across patients by including nuance information in the history of present illness. I have no problems doing so if it is relevant to the patient’s story and his or her care.

Another issue entirely is that of cloned documentation within a single patient chart. Regulators and anti-EHR voices are after those of us who like to “drag and drop” previous visits into today’s note, then update it. Note that I said “update.” I didn’t say drag, drop, and depart. Who among us who actually cares for patients does not have at least a few dozen “Groundhog Day” patients, those where every single visit is the same? I’m talking about patients like the noncompliant hypertensive diabetic who refuses to follow the instructions from the previous visit. Every single assessment and plan looks something like this:

1) Diabetes: Reviewed blood sugar log. Counseled patient to take medications as directed and continue 1,800-calorie ADA diet. Patient to exercise 30 minutes daily and check blood sugars daily, bringing meter to next visit for download.

2) Hypertension: Counseled again regarding sodium intake and packaged foods. Exercise as above, continue medications.

3) Obesity: Discussed diet and exercise as above. Refer to nutritionist. Discussed consequences of continued noncompliance including worsening of chronic health conditions, heart disease, and potentially premature death.

Really, what else do I need to say here? Maybe I should start adding incremental data like, “Counseled patient for the 15th time” to make it more individualized. Or I could document specific details of the data in the blood sugar log, but that would be redundant and also introduce a potential source of error as I manually key numbers into my note.

The bottom line is this. Why should I not be able to pull this data forward, then update or add to it? It’s clear, it’s complete, and it accurately documents what I stated in the visit. I shouldn’t have to add extraneous information just to satisfy an auditor.

A friend of mine has a collection of hilarious patient visit notes (of course, with any patient identifiers carefully redacted with a broad-tip Sharpie) from both the paper and EHR realms. One of my favorite pages in his scrapbook is the ultimate healthcare haiku, written before the days of E&M Coding:

Boil-Lanced.

And that, dear readers, is a thing of beauty.

Have a great example of patient documentation to share? E-mail me.

E-mail Dr. Jayne.

A Single-Screen EHR Design for the Patient Encounter

The benchmark . . . for all navigation techniques should be the saccadic [rapid] eye movement. This allows us to acquire a new set of informative visual objects in 100-200 [milliseconds]. Moreover, information acquired in this way will be integrated readily with other information that we have recently acquired from the same space. Thus, the ideal visualization is one in which all the information for visualization is available on a single high-resolution screen. – Colin Ware, Information Visualization: Perception for Design

I would like to bring together some of the user interface designs we have been considering and propose for discussion a single-screen EHR design for a patient encounter. Before presenting the design itself, it is useful to recall the design concepts covered in previous posts:

• The human visual system is very good at organizing data spatially (Why T-Sheets Work; Pane Management – Part 2).
• We excel at grasping patterns and seeing relationships among data elements when they are presented in a single view, but have limited capacity to remember these elements when they are distributed across multiple screens (Humans Have Limited Working Memory).
• The most efficient way to navigate visual space is by using rapid (saccadic) eye movements (Fitts’ Law).
• Using a large, high-resolution screen supports navigation by saccadic eye movement (Pane Management – Part 1).
• When we do need to navigate using a mouse or other input device, we can reduce the cognitive costs by making the targets large and reasonably close (Fitts’ Law).
• It is often easier to grasp patterns visually than mathematically or verbally (Computer-Centered versus User-Centered Design).
• It’s easier to find patterns and solve problems with data presented compactly and grouped visually – using columns, rows, and formatting – than with data presented as free text (Pane Management – Part 1).
• Using vertical and horizontal scrollbars to navigate small panes requires cognitive effort and doesn’t solve the working memory problem (The Problem with Scrolling). It is preferable to display an overview of the data and use mouse hovers or clicks to display details as needed (Overview with Details on Demand).

The Design

A large single screen with high resolution, for instance 1920 x 1080 pixels (full HD), is used to display all the categories of data for a patient encounter on a particular date. Each category of data is assigned to a pane of fixed size and location on the screen:

Because humans are able retain about nine spatial locations in visual working memory (although we can only remember simple visual objects or patterns contained in about three to five of them), a set of nine panes arranged in a 3×3 grid was chosen for the high-level design.

The figure below shows this same screen design populated with data from a patient encounter:

Click on the thumbnail below to see the design at higher (but not full) resolution:

The figure below shows the Problem List pane:

A marker (for instance, an asterisk) indicates that more detail is available for a data field. Detail can be displayed by hovering or clicking, as shown below for Diabetes Mellitus:

and for transient ischemic attack (TIA):

The same high-level design is used for all panes, as in the Exam pane below (size slightly reduced):

Again, hovering over or clicking on a line with an asterisk brings up more detail for that data field:

The design allows default or normal findings to be summarized:

while still making the full default text available on demand:

Expanded Panes:

As an alternative to expanding individual data fields, all the data fields within a pane can be simultaneously expanded by hovering or clicking on the pane’s title bar, as shown below for the Problem List:

An expanded pane will necessarily obscure adjacent panes, as below:

Even in this case, context is at least partially preserved because of the large high-resolution screen.

Design Considerations

Expanded data fields:

• In order to maintain as much context as possible, data fields within an individual pane expand only to the minimum size required.
• More than one data field within a pane can be expanded at the same time, provided that the expanded fields don’t overlap.

Expanded panes:

• In order to maintain as much context as possible, panes expand only to the minimum size required.
• More than one pane can be expanded at the same time, provided that the expanded panes don’t overlap.
• The same single-screen design is used both for data entry and subsequent data review. Any pane can expand for data entry and then contract to its original size.

I would propose that this kind of single-screen design for a patient encounter, with all its interactive capability both within panes and among panes, should be thought of as the chart note. In this design, there is no separate text-based or PDF "completed note," except as needed for use outside the EHR.

The design above is a sketch – a design being considered, reformulated, and reworked. I tried to design it based on an understanding of how the human brain best takes in, processes, and organizes information. Its purpose is to generate discussion and debate. I look forward to your comments and suggestions.

Finally, there is a major caveat that comes along with the single-screen design presented here. A patient’s electronic health record is a longitudinal record, while the design above represents a snapshot in time. More on this in coming posts.

Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

I think this has been in the works and development for a while as back in the 2009 the company announced peer to peer sharing where providers could share records and I am guessing this was in the prior client/server version and of course since that time eClinicalWorks has their web based program so it makes sense to expand sharing even further.

eClinicalWorks Announces Peer to Peer Sharing Availability 4th Quarter

You can see from the image that there are over 10k physicians currently connected and as I understand here the new network will even enable doctors who are not user of the eClinicalWorks software also connect.  The network uses an open architecture built from the Direct or NHIN network.  That was one of the smartest standards  and sharing capabilities that has come along in a while.  You do not need the CONNECT protocol to connect to the NHIN and many have developed their own interfaces such as this one.  When you stop and think about it, what do we do today, email and the NHIN network with an interface handles it nicely.  Again the beauty of this is that any doctor can connect, regardless of whether they use eClinical or another medical records system.  BD

Hospitals and Providers Using NHIN (Nationwide Health Information Network) To Connect and Share Medical Records With the VA and DOD And Even With Each Other

Here’s a video that explains a little bit more on how it works. 

Even HealthVault set up for the Direct project back in February of 2009 and again there are many more that wrote their interface to the Direct program.  BD

HealthVault-Setting Up Consumer Email Address For Secure Messages Using Government Direct Project

This peer-to-peer network will support national standards or networks and will be Nationwide Health Information Network (NHIN) Direct compatible, making interoperability affordable. Members that Join The Network are able to:

• Easily find and connect with providers;
• Send electronic referrals to other providers along with demographic and insurance information, saving time and reducing errors;
• Transmit patient record with attachments, including progress notes, lab results, medical summary and patient scanned documents;
• Automatically receive recommended providers within a 10 mile radius;
• Find providers using a member-specified radius and specialty; and
• Build personal address book.

This open network can be accessed via www.jointhenetwork.com or www.p2popen.co

http://www.heraldonline.com/2012/09/17/4267839/eclinicalworks-launches-join-the.html

Smartphones may have dominated the news this week, but Fitbit, creators of the Fitbit Ultra smart fitness tracker and the Fitbit Aria smart wireless scale, today unveiled two new fitness trackers (which will both sync to said smartphones, by the way).

First up is the Fitbit Zip. It’s a petite tracker (about the size of a quarter coin) that comes in five fun colors and measures your everyday activity stats in real time, including steps taken, distance traveled and calories burned. It has a unique tap interface to switch between different stats and is “oops-proof”, meaning it’ll survive a stroll through the rain or a good sweat.

Read More

Spinal USA (Pearl, MS) has announced that its Slimplicity Solo anterior cervical plate system has been cleared via FDA’s 510(k) pathway, making it the third product that the company has introduced in the last two years. In 2011, the company debuted the Vault ALIF System and the Sure Lok Mini Posterior Cervical/Upper Thoracic System.

The Simplicity Solo device was designed for fixation of the C2–C7 vertebrae to manage trauma, degenerative disc disease, deformity, pseudarthrosis, failed previous fusion, spondylolisthesis, and spinal stenosis.

Read More

Good news for Chrome users who love medical animations. Blausen Medical Communications has just released a beta version of its free Chrome browser extension (available here) that automatically scans text on a website and links it to its library of animations. So, for example, if you search for “prostate cancer,” an icon appears next to the resulting text that, when clicked, displays an animation explaining the condition. According to Blausen’s press release:

The app searches among 2,000 keywords related to over 450 medical topics. After the word is highlighted, a user can select one of four presentation modes: 3D animations with or without narration, 3D derived illustrations or 3D models. In some cases there are multiple content topic options, as well definition and feedback features.

Read More

You do have to say one thing about Nuance, they seem to almost own the world of speech recognition as I seem to remember posting several articles when they purchase another company. The phonetag solution I

would guess is one of the features with mobile phones would be a hot ticket. Voice to text is huge now. I have it on my Windows phone and it seem everyone is working on accuracy and it will get there as Ditech also has Voice Quality Assurance with their designed algorithms . Recently Nuance also launched their competitor for Siri as well so I am guessing these two technologies might be working together? 

Siri Has Competition Nina From Nuance And Ready to Give the Virtual Personal Assistant Business A Run for the Money

One NASDAQ-listed firm buying another as voice and language

solutions provider Nuance this morning announced that it has agreed to acquire San Jose, California-based Ditech Networks (Ditech) for $1.45 per share in cash, representing a total value of approximately $22.5 million. 

That purchase price is net of Ditech’s cash as of the signing date, and is almost exactly the company’s market capitalization at the last market close.

The transaction is expected to close late in 2012.

Nuance says it was particularly interested in getting its hands on Ditech’s Voice Quality Assurance (VQA) technology and PhoneTag voicemail-to-text services, which it will use to enhance its own portfolio of mobile and enterprise voice offerings.

More specifically, Ditech’s PhoneTag service will boost Nuance’s Dragon Voice to Text Services business by adding customers and ‘complementary technologies’.

http://thenextweb.com/insider/2012/09/18/nuance-buys-nasdaq-listed-voice-technology-firm-ditech-1-45-per-share-22-5m/

One thing I love about Twitter is the on the ground insight you can get into healthcare. Here’s a tweet example of this:

RT @erictopol: On attending rounds today, when med stu or residents don’t know answer they Google it rather than using @epocrates, @medscape

— WendySueSwanson MD (@SeattleMamaDoc) September 17, 2012

When I read the tweet, I was fascinated by the shift that Eric Topol observed by his residents. I’m sure many doctors out there are cringing at the idea that Google instead of some “trusted” source of information is where new doctors are turning for health information.

I think this view is a little short sighted and ignores the sophisticated ways that people are using Google. I find myself doing this more and more as well as I search out information on the internet. When I’m searching, I don’t always select the top Google result. Instead, I regularly find myself checking the website for that result to see if that website is what I would consider a trusted source. I’m sure that many residents do the same thing as well.

Certainly this shift is not without its pitfalls. Some likely don’t look to see if the Google result is a trusted source. Even what may look like a trusted source might not be trusted. However, I believe this is the minority of people searching (in particular residents).

One other change that’s happening is that many people are triangulating the results from their search. Instead of blindly looking at a result from Google, when you’re making a decision like a doctor is making you’ll often take a look at multiple sources and compare how the results and information compares. Instead of treating Epocrates like the Bible, they’re looking at Epocrates and Medscape and Google and triangulating all that information into what is the best course of action or the best information. This is a very good shift and many in the latest generation just do this naturally.

Since this is largely an EHR site, it makes me wonder if more EHR vendors should be integrating Google searches into their EHR. It wouldn’t have to be blatantly Google. I think the web browser is likely the right implementation to consider. If you highlight a word in the Google Chrome web browser and then right click, it will do a Google search on the highlighted word. Seems like it wouldn’t be too hard to do the same within an EHR.

While the tweet might indicate that companies like Epocrates and Medscape our in trouble (see my post about Taking Down the Epocrates Monopoly), there’s no reason that these health information companies can’t capitalize on Google search results as well. They’ll just have to learn how to get their information listed in Google as opposed to stuck in an app.

Related posts:

1. Health Search Engine – Competition with Google Health?
2. Google Health Co-op (Making Google Health Portal Possible)
3. Google Wave and PHR

Medtronic has announced the upcoming launch of its silicone Ascenda Catheter for use with the company’s SynchroMed II programmable baclofen injection pump.  Baclofen injection (Lioresal Intrathecal) is an option over oral administration of the drug for patients with severe spasticity.

The SynchroMed II pump is implanted below the skin and the Ascenda Catheter snakes from the device to the intrathecal space that surrounds the spinal cord.  By directly delivering the medication to the spinal cord, side effects from the baclofen can be substantially reduced.

Read More

Targeted drug delivery by ferrying nanoparticles is a major field of research, promising highly effective therapies for all kinds of diseases while limiting side effects. The brain has been particularly interesting for this research, as it’s an organ that’s evolved all kinds of defense strategies – from the scalp to the blood brain barrier – making it difficult to work on, directly.

The brain’s extracellular space (ECS) is a network of channels that form between cells within which an ionic fluid transports nutrients, signaling molecules, and other chemicals throughout the brain. The narrow channels of the ECS limit the size of the particles that can move through, a problem that has put serious brakes on the use of nano-therapies in the brain.

Read More

I was happy to be invited to participate in the HIMSS #NHITWeek e-Book. They just recently posted the HIMSS ProBook (PDF) which includes mine and 17 other health IT experts responses. It’s nice to see my name alongside wonderful health IT pros like Regina Holliday, John Moore, and Eric J. Topol (to name a few). You can find my responses on page 26-27 in the e-book or I’ve posted my responses below.  I kind of got this last minute, so my responses are a bit off the cuff.  I’d love to hear your thoughts or your responses to these questions.

1. How has the conversation about health IT evolved and / or progressed since last year’s National Health IT Week?

With the announcement of meaningful use stage 2, we’re starting to see a real dividing line between those healthcare organizations that plan to show meaningful use of a certified EHR and those organizations that plan to stay far away from it. All but a few smaller hospitals are getting on board with EHR because the EHR incentive money is so large. In smaller practices, many are still afraid that EHR will slow them down, decrease their productivity, and cause them more headache than the value it will provide.

With EHR incentive money dominating the EHR discussions, ACOs are also drawing a lot of attention and discussion in the world of health IT. Everyone seems to realize that if we’re going to make ACOs a reality, then it’s going to take a heavy dose of well implemented health IT. The increase in discussion happening around health data warehouses has really increased and more and more health organizations are trying to find was to pull value out of all the data that’s now being stored in their health IT systems.

Mobile Health is still the wild wild west. Mobile health apps are popping up in every corner of the mobile world. However, we still don’t have any breakout mobile health app superstars which have captivated the imagination of the world. Considering the number of apps, one of them is bound to reach that point soon.

2. What are the major challenges to hospitals and healthcare providers as we move toward a new century of health technology?

I’ve often said that health IT is the great magnifier. Health IT will take the good and make it better, but it will also point out the bad just as easily. What I think the implementation of health IT has done is caused many healthcare organizations wake up to some of the problems they never realized they had. Overcoming much of the built in healthcare problems is going to be the biggest challenge to the implementation of health technology.

Along similar lines, the biggest built in problem in healthcare IT is the walled gardens which create incredibly difficult to access data silos. Much like a President once famously said, “Healthcare, take down your walls.” Unfortunately, there doesn’t seem to be any authority that can make such a strong statement. Breaking down the walls surrounding healthcare data is going to be an almost insurmountable challenge.

One other major challenge we’ll see and we’re starting to see already is how to handle the literal flood of healthcare data. Floods of data will be pointed at health care providers from HIEs, PHR’s, medical devices, genomics, etc. Creating IT systems which process all the data into a digestible format will be key to the future of healthcare.

3. How can we increase adoption and meaningful use of health IT in hospitals and health systems across the U.S.?

I think we need a fundamental change in how we define meaningful use. The current definition of meaningful use might provide benefits to healthcare in general, but I know very few hospitals and health systems that see value in what HITECH has defined as meaningful use.

The hospitals and health systems I talk to see meaningful use of an EHR as improved patient care, improved revenue integrity, and streamlined processes. This is a much different definition of “meaningful” use of EHR. Once EHR vendors achieve this type of meaningful, healthcare won’t know how to live without it.

4. What advice would you give to the next generation of health IT leaders and their role in improving our healthcare system through advancement of IT?

My advice is that “when you’re a hammer, everything looks like a nail.” To make the comparison, just because you’re an IT leader doesn’t mean that IT is always the solution. Sometimes the solution is to fix the process first. Applying IT to bad processes just makes things worse. Be thoughtful in when and where you implement health IT. IT has tremendous potential, but only when applied the right way to the right problems.

5. What’s one thing the general public should know about health IT that they do not already, and what’s an easy way for them to get involved?

I believe the general public doesn’t realize the power they yield. Patient demand is likely the most powerful force in healthcare. If enough patients requested online patient scheduling, we’d see more doctors providing online patient scheduling. If more patients demanded e-visits, we’d see more e-visits. Patients need to stop accepting the current method of care delivery and start caring more about the healthcare services they receive.

6. What’s one health technology you are most excited about?

I’m absolutely fascinated with non-obtrusive health monitoring devices. It’s amazing how much health data can be collected with a simple cell phone camera. Everything from pulse, blood pressure, and cholesterol can potentially be monitored with a digital camera. Plus, we’re just at the beginning of the health monitoring that will occur using a person’s cell phone.

7. Fill in the blank. Health IT is _________________
Health IT is integral to the future of healthcare.

Those were my responses. You can find the other 17 responses to these questions in the HIMSS ProBook (PDF).

Related posts:

1. Giveaways Added to New Media Meetup at HIMSS 2012 Thanks to Ozmosis – Social Media Genius Bar at HIMSS
2. HIMSS Twitter List and New Media Meetups at HIMSS
3. Heard in the HIMSS Hallway – Accessing Epic Data

Don't forget to participate in a webinar tomorrow entitled Technical Barriers to the Adoption of Digital Pathology. The time will be 11:00 AM - 12:00 PM EST. This event is the second in the Digital Pathology Association (DPA), Association of Pathology Informatics (API), and CAP Today's series of one-hour presentations focusing on the barriers to the adoption of digital pathology. The lectures tomorrow will feature Sean Costello, Head of Product Management, Digital Pathology, Leica Microsystems, and Kim Dickinson, MD, President-Elect of the DPA. It will be moderated by Robert McGonnagle, publisher of CAP Today. Registration for the event is required; non-DPA members can create a profile at the DPA web site.

Over the last few weeks a number of clients and readers have asked a similar question:

I’ve been approached by company X to partner with us. Do you know them and what do you think we should do?

Since many startups, especially technology firms, partner for the wrong reasons and end up having failed or suboptimal relationships I thought I’d give as simple an answer as possible for partnering.

There are of course a number of reasons you’d want to partner with someone but if you’re focused on sales and marketing (revenue generation) then you should consider the following questions.

Will working with the partner:

1. Generate or accelerate the generation of new sales leads? How many?
2. Help close existing deals faster? How many?
3. Close any new deals simply because you’re working with them? How many?
4. Accelerate revenue recognition? By how many days?
5. Reduce sales costs? By a significant amount? How much?
6. Reduce implementation timeline? How much?
7. Reduce implementation costs? How much?
8. Reduce support calls / cost? By how much?

If there’s not a solid “yes” for some, many, or all of the questions above (followed by appropriate metrics), don’t spend the time considering the partnership.

• ICD-10
• Meaningful Use Stage 2
• Mobile & mHealth
• Interoperability & health information exchange
• Innovation in & Future of Healthcare
• Meaningful Use
• RFID/RTLS
• Patient-Centered Care & ACOs
• & more!

Top News

Massachusetts Eye and Ear Infirmary and its physician group will pay HHS $1.5 million to settle potential HIPAA violations following the theft of an unencrypted laptop containing electronic PHI of patients and research subjects.

Reader Comments

From Honky Cat: “Re: Waiting in line at Apple. Don’t wait in line for your iPhone upgrade. Go to this link and pre-order your phone. They will ship it to you in two to three weeks. Surely you can wait that long for it.” I considered setting my alarm to be one of the first people to go online last Friday and place an order. Instead, I slept in and waited until 6:00 am to get online. By that time Apple had stopped taking orders to reserve the iPhone 5s for pick up at the local Apple store, so I’ll wait for mine to be delivered in a couple of weeks. Apple, by the way, sold two million iPhone 5s in the first 24 hours of pre-orders, more than double the previous record set in 2011.

From The PACS Designer: “Re: mobile image viewing. TPD congratulates Aycan Medical Systems for being one of the first to gain FDA approval for its Aycan Mobile for the iPad. Now that the FDA is involved with mobile solutions, we’ll see more teleradiology mobile solution approvals for other vendors.“

From Steve: “Re: QuadraMed. To be sold in the next 7-10 days.” Unverified.

From Pointer: “Re: EHRs. A vendor-agnostic viewpoint on how they don’t change the cost curve.” It may be vendor-agnostic, but this particular article is a clearly labeled opinion piece written by authors who have been historically negative toward EMRs, EMR vendors, and government. They are entitled to their opinions, but recognize them as such despite the bait-and-switch newspaper headline trumpeting “A Major Glitch.” Their editorial conclusion is accurate, though – most studies have failed to prove that EMRs save money (I haven’t seen any studies that convinced me that paper records save money or improve outcomes either, of course.) That’s not to say they don’t, only that it’s tough to prove since nothing in healthcare stays unchanged long enough to get a baseline. It’s also true that expecting technology alone to create savings with changed incentives is unreasonable. I agree with the authors that blowing taxpayer billions to get providers to buy software they weren’t willing to spend their own money on was illogical, but no amount of Monday morning quarterbacking will bring that cash back or cause providers to toss their EMRs out the nearest window. It’s time to move on, realize that healthcare IT is here to stay, and constructively make it better instead of hand-wringing. Like everything else, the industry has 10% cheerleaders, 10% naysayers, and 80% rational people who don’t need the self-proclaimed experts on either end of the spectrum to tell them what to think or do. If you’re a provider, choose EMR or paper as you desire, do something innovative with it that improves outcomes and reduces costs, and then write your own article. That’s the one I’d rather read.

From Looking Deeper: “Re: patient portals and self-scheduling. I install patient portals for a living, including scheduling. There really aren’t technical challenges any more. Providing convenient, immediate online scheduling is a solved problem even in healthcare, especially in primary care. The problem is in people’s heads. Whenever online scheduling comes up, physicians and clinic staff will tell you that their patients can’t possibly handle it – they’ll schedule the wrong kind of visit (office visit vs. physical) or create some other vague problem. I dutifully inform them that online scheduling is working fine in clinics and practices across the nation. ‘Other clinics find that their patients can handle this,’ I always say. They usually say, ‘Not our patients.’ Interestingly, clinics serving less-affluent areas and the indigent tend to be more in favor of such patient-centric services. ‘Our patients are an especially incompetent group’ is a pretty negative view to hold of the people you’re trying to care for. If we could just get past this attitude, pretty much all primary care visits could be scheduled online. In the rare case where something needs to change, the clinic can call or e-mail the patient and reschedule, but that’s less than 5 percent of appointments scheduled online. Specialty and procedure visits are a different beast and need some careful analysis before they are opened up to online scheduling, but online scheduling for primary care is a solved problem.”

HIStalk Announcements and Requests

I have newfound respect for anyone working with insurance companies to secure payments. I had mentioned a few months ago that I had a minor medical procedure that resulted in some complications, lots of doctor office visits, and about 20 different medical claims. I was lucky enough to have both primary and secondary coverage in place since the claims were in the thousands. I also thought I was lucky because both policies were from the same very big insurance company. Unfortunately, the insurance company has spent the last four months trying to decide internally which policy should be primary, and so far no claims coordination has occurred. After several weeks of hour-long phone calls, yesterday I finally turned “not nice” and demanded to speak to a supervisor. I explained that I didn’t give a (expletive) which policy was primary or secondary, it was all one insurance company, and the (expletive) claims needed to be paid. I actually believe the claims will finally be processed correctly. The moral of this story is that if you work in a hospital or practice, take a moment to say thanks to your billing and collection staff. And bring them chocolate on a regular basis.

I don’t know about you, but I’ve been busy turning off all my Facebook and Twitter connections to folks who keep preaching politics. Has anybody ever convinced someone to change their political beliefs by proudly posting a Facebook link to the latest nut-job partisan article? Actually, they sometimes almost convince me to vote the other way out of annoyance.

Thanks to Healthcare Quality Catalyst supporting HIStalk as a Platinum Sponsor. The Salt Lake City company offers a practical clinical data warehouse solution that combine technology and clinical improvement methodologies to improve care. The information needed to answer a clinical improvement question is scattered in most hospitals (satisfaction surveys, Epic Clarity transactions, and lab and prescription information, for example) and HQC puts it together in its Adaptive Data Warehouse and subject-specific data marts (such as women and newborns) to support continuous, evidence-based care improvements. HQC offers more than just the tools, supplying clinical improvement methodologies such as role definitions and process templates to create effective improvement teams. If you’ve been around the industry for some time, you surely know some of their folks: Todd Cozzens, Larry Grandia, Dale Sanders, Bruce Turkstra, and David Burton, MD were some of those I immediately recognized. I interviewed co-founder and CIO Steve Barlow a year ago and got a good background on the company. Thanks to Healthcare Quality Catalyst for supporting HIStalk.

I naturally cruised over to YouTube and found this video that introduces Healthcare Quality Catalyst better than I did.

Acquisitions, Funding, Business, and Stock

PE firm ABRY Partners makes a “significant” investment in SourceMedical Solutions, a provider of software and services for ASCs and rehab centers.

In England, a company that commercializes university research invests in an Oxford spinoff whose software that can monitor pulse, respiration, and oxygen saturation using only a webcam.

Also in England, eHealth Insider reports that CSC will stop selling iSoft GP systems to NHS markets, in which it has 582 practice customers. CSC denies the report.

Vipaar, which sells surgery proctoring software based on technology developed at the University of Alabama at Birmingham medical school, raises half of its $1.2 million funding goal.

Sales

Community Medical Center (NE) selects BridgeHead Software’s Healthcare Data Management Solution for backup and archiving.

CommUnity Care (TX) will deploy NextGen RCM Services throughout its 22 clinics.

Pemiscot Memorial Health Systems will expand its deployment of Prognosis Health Information System by implementing its financial system and its laboratory information system powered by Orchard.

Community Hospital Grand Junction (CO) chooses the perioperative system of Surgical Information Systems.

People

Zotec Partners hires Kristy Floyd (American Society of Anesthesiologists) as director of anesthesia business development.

The Medical College of Wisconsin appoints David C. Hotchkiss (University of Texas Health Science Center) VP/CIO.

Healthland names Patrick Spangler (Epocrates) CFO.

Douglas Billian, founder of Billian Publishing, died September 15 at 84.

Announcements and Implementations

HIMSS Analytics recognizes Fort HealthCare (WI) with its Stage 7 Award for EMR adoption.

Providence Medford Medical Center and Asante Rogue Regional Medical Center (OR) will complete their hospital and clinic implementations of Epic in April.

Nuance will purchase Ditech Networks, a provider of voice technologies and voice-to-text services, for $22.5 million.

AMA releases the 2013 CPT code set, which goes into effect for claims filed as of January 1, 2013.

Certify Data Systems announces the general availability of its HealthLogix HIE platform, which it says is the first to deliver an aggregated patient view from all community health encounters regardless of EHR.

Cincinnati Children’s Hospital Medical Center (OH) implements Passport Health’s PatientSimple and Smart Statement online billing solutions.

eClinicalWorks launches its $10 million open, secure collaboration platform that works with any EHR or even paper-based practices. The NHIN Direct-compatible network allows members to transmit electronic referrals and patient records with attachments.

Government and Politics

ONC posts the second wave of draft test procedures for the 2014 Edition EHR certification criteria.

I don’t think Farzad ever followed through on his promise to name the EMR vendors who took his #VDTnow pledge to allow patients to view, download, and transmit their medical information. Claudia Williams of ONC tweeted her list, which I assume is complete: Allscripts, NextGen, AlereWellogic, Intellicure, eClinicalWorks, Greenway, SOAPware, athenahealth, Azzly, and Cerner. Conspicuously but not surprisingly missing is Epic, which doesn’t even have a Twitter account as far as I know. Maybe they already offer the capability as some have suggested, but if so, all they had to do was tweet out their already-met pledge. Judy’s on ONC’s Health IT Policy Committee, after all.

Innovation and Research

The National Library of Medicine awards The Ohio State University College of Medicine’s Department of Biomedical Informatics $1.3 million to develop a system that uses EHRs to identify potential patients for clinical trials.

Other

Wider use of EHRs over the last decade may be contributing to a growing up-coding trend that has added $11 billion to healthcare costs. Physicians argue the higher codes are justified because care of seniors has become more complex and technology allows them to code more accurately. Critics say the findings suggest billing abuse and fraud. I I were still selling EMRs, I’d be handing this study to doctors and touting it as proof that technology is helping physicians bill and be paid for the actual care provided. Meanwhile, naysayers like Mr. H will probably dig deeper and suggest objections to such hasty conclusions.

Hell hath no fury: a Washington dermatologist wins a $600,000 settlement and a rare apology from state health officials who had investigated him for drug abuse and medical fraud. An anonymous tipster had reported that the doctor was falsifying drug records, using cocaine, and running in-office orgies among his staff, patients, and prostitutes. In a separate lawsuit, the doctor was award more than $100,000 from his former wife, who turned out to be the anonymous tipster who had filed the complaint late in the couple’s bitter divorce proceedings.

The folks from Arizona Associated Surgeons sent over their video for the Western Users Group meeting at ACE (the Allscripts user meeting) last month.

Want to rub elbows with sexy celebrities on your hospital employer’s dime? CHIME’s Fall CIO Forum will feature Olympic beach volleyball gold medalists Misty May-Treanor and Kerri Walsh Jennings, mostly known for leaping around nearly naked in prime time reminiscent of the much-beloved “Girls on Trampolines” segment of The Man Show except with smaller bikinis. Misty and Kerri (or was that Misti and Kerry?) will discuss Meaningful Use Stage 2 and … no, wait, they’ll pose with star-struck CIOs, sign autographs, and collect a big non-amateur payday courtesy of patients who pay $5 for an aspirin.

A group of 30+ physicians labeling themselves as “Doccupy” complain to Contra Costa, CA county supervisors about the $45 million implementation of Epic at its hospitals. They said 10 percent of ED patients are leaving without seeing a doctor, a number that increased after the hospital’s July 1 go-live as the average time in the ED increased from three hours to four. Patient loads were cut in half to prepare for the implementation, but the doctors claim that several of their peers still quit because of stress, saying, “We were not ready for Epic and Epic was not ready for us.” An ED physician going off shift said she still had documentation to complete for 16 patients, adding, “It’s going to implode.” Some doctors spoke up about the advantages of Epic, and all agreed that it’s important to have an integrated electronic record. Detention facility nurses had complained about Epic to the supervisors last month.

The Cure JM Foundation (juvenile myositis) is in the running for a $250K research grant that will go to the charity with the highest number of Facebook votes. Information and voting links are here. Several HIT folks I’ve heard from have children with JM and I’m sure they would appreciate your vote.

Patients storm Charlton Memorial Hospital (GA) after a contracted collection company incorrectly manipulates the hospital-provided data file, sending patients collection notices for bills they don’t owe.

Of the seven highest-earning non-profit CEOs in the country, four run hospitals, according to the Chronicle of Philanthropy. I think they’ve missed a few since I’ve seen several hospital tax forms with CEO salaries above these figures.

Bloomberg Businessweek profiles Terry Ragon, founder of the Boston-based InterSystems, which sells the Cache’ database that runs Epic, Meditech, and quite a few other MUMPS-based healthcare systems. The article calls Ragon a “Hidden Software Billionaire,” estimating the value of the company he directly owns at $2 billion.

Here’s a fun coincidence. Dave Miller, vice chancellor and CIO of the University of Arkansas for Medical Sciences, sent over the above video of him doing a nice cover of “Mustang Sally” at Epic’s UGM (his wife had the camera 90 degrees off kilter for a few seconds, but his singing was fine). The day they got back home, he impulsively bought some raffle tickets from a charity fundraiser. He won the prize, which was made in 1967, the same year Wilson Pickett released “Mustang Sally” on an album – a classic Ford Mustang.

Sponsor Updates

• SuccessEHR grows its RCM services business 92 percent over the last year.
• First Databank hosts its 2012 FDB Customer Seminar this week in San Diego.
• T-System offers Webinars this week on  improving ED throughput.
• Melanie Pita JD, EVP of product management at Prognosis Health Information Systems, presented a session on EHRs and Meaningful Use at the Georgia Rural Health Association conference this week at Callaway Gardens.
• TeraRecon is exhibiting its advanced visualization solutions for medical imaging this week at CIRSE 2012 in Lisbon, Portugal.
• Michigan Health Connect HIE and Greenway Medical will provide data exchange between Greenway’s PrimeSUITE customers and hospitals on the Michigan Health Connect platform.   
• MedPlus offers a three-part Webinar series hosted by Steven Waldren, MD, director of the AAFP’s Center for Health IT.
• White Plume releases a white paper discussing practical considerations to minimize losses while migrating to ICD-10.
• ChartWise Medical Systems unveils its ChartWise:CDI software at this month’s AHIMA convention in Chicago.
• Orion Health opens an office in Singapore for development and technical support employees.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Mobile.