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The CommonWell Health Alliance: Can The Private Sector Push Interoperability Over the Finish Line?

CommonWell Health Alliance

The HIMSS13 Conference in New Orleans, one of the biggest gatherings of Health Information Technology professionals of the year, was host to speakers, panel discussions, and one pretty large announcement from some of the big names in the electronic health record industry.

Allscripts, AthenaHealth, Cerner, Greenway, and McKesson have announced the founding of the CommonWell Health Alliance, a non-profit trade group designed to implement standards around some of the most difficult problems with interoperability between systems. CommonWell will focus on working to standardize three areas: patient matching, patient access consent, and record location. Once standards are set for these areas, they can be made public and licensed at a “reasonable cost”. The Alliance’s formation was inspired in part by a Bipartisan Coalition meeting, and especially a comment from National Coordinator for HIT Farzad Mostashari. The conversation was recalled by David McCallie, vice president of informatics at Cerner, in an interview with HealthcareITNews:

“…everyone was sort of complaining to Farzad: “You’ve got to go solve this identifier problem, it’s killing us.” And Farzad said, “Look, it’s against the law! I can’t do it. You guys have to solve it.” I came back and literally quoted that – “you guys have to solve it” – I sent an email to Arien and he said, “We think the same thing. Let’s talk about it.” And within a week, we knew this was what to do.”

Interoperability is the principle that patient information that is shared between two different software packages should work seamlessly. Think about the interoperability of the Internet. A web page can be read on any brand of computer, any browser, and with any internet service provider. It just works. Interoperability between EHR software would look very similar. Anywhere a patient needs care, their records could be transferred and read electronically, without having to worry about the different software formats. It’s important to distinguish between interoperability, which allows different software packages to understand each other, and Health Information Exchange, which is simply a means of communication between locations and providers. To extend the analogy, a telephone can connect two people, but if they speak two different languages, you will need a translator between them.

The founders of the CHA have extended an open invitation for other vendors to join the alliance, but one big name was conspicuously absent from the list of participants: Madison, Wisconsin’s Epic Systems, who serves almost half of the US market. Epic founder and CEO Judith Faulkner was dismissive of the announcement:

“We did not know about it. We were not invited,” Faulkner said. “It appears on the surface to be used as a competitive weapon and that’s just wrong. It’s wrong for the country.”

Epic COO Carl Dvorak was even more to the point, calling CommonWell a “marketing opportunity.” Epic System made a collaborative announcement of their own during HIMSS, introducing the DRIVE program to test Epic software in virtualized environments with the help of Dell, Red Hat, Intel and VMWare. The program would be especially useful to facilities looking to bridge older, closed software installations, with more modern and open systems.

Whether or not CommonWell will be a net win for patients or just an opportunity for vendors to make up ground with Epic remains to be seen. Proponents argue that CHA is a step in the right direction for the industry to achieve real interoperability, even if the gains are only modest. The skeptical take, articulated very well by Adrian Grooper, MD at TheHealthcareBlog says there is no real difference between giants like Epic and coalitions like CommonWell.

“The shame is that another program with opaque governance by the largest incumbents in health IT is being passed off as progress. The missed opportunity is to answer the call for patient engagement and the frustrations of physicians with EHRs and reverse the institutional control over the physician-patient relationship. Physicians take an oath to put their patient’s interest above all others while in reality we are manipulated to participate in massive amounts of unwarranted care.”

So what do you think? Is CommonWell a good step for interoperability, or just another excuse for big software players to control the marketplace? Let us know in the comments!




ePrescribing Survivial Guide: Getting Your Ten Electronic Prescriptions Done in the Next 30 Days

Medicine drugs

Image via Wikipedia

 

 

This is a busy time for most practices. Managers are preparing for the annual juggling act of getting staff and physicians coordinated for summer vacations. Practices are ramping up for new doctors joining their practice at the traditional end of residency programs in the summer. Many practices are in the midst of shopping for, negotiating for or implementing EMRs. And most everyone without an existing EMR is struggling with the e-prescribing deadline looming in 30 days. Read my first post on this topic here.

As a reminder:

  • Eligible professionals who are not successful e-prescribers, based on claims submitted between January 1, 2011 and June 30, 2011, may be subject to a “payment adjustment” (read payment cut) in their Medicare Part B Physician Fee Schedule (PFS) for covered professional services in 2012.
  • Those that do not e-prescribe as a part of 10 Medicare patient encounters by June 30, 2011 will only receive 99% of their Medicare payment for all encounters in 2012.
  • Those that do not e-prescribe as a part of 25 encounters by December 31, 2011, will only receive 98.5% of their Medicare payments for all encounters in 2013 and only 98% of their Medicare payments for encounters during 2014 and going forward.

Here are the problems practices have encountered trying to get their ten:

  • Physicians seeing patients in facilities and using the codes that are eligible for eRx, but not having the ability to e-prescribe during the visit
  • Physicians in specialties not prescribing many medications
  • Physicians in specialties prescribing predominantly controlled drugs, which are not currently eligible for electronic prescribing

Today, the AMA released this announcement

May 31, 2011

On May 26 the Center for Medicare and Medicaid Services (CMS) responded to AMA concerns about the e-prescribing penalty program and issued a proposed rule that makes significant changes to it by adding more exemption categories. These changes will assure that physicians are not unfairly penalized for failing to meet the requirements under the 2012 e-prescribing penalty program.

Physicians are still required to e-prescribe using a qualifying e-prescribing system and report the G8553 code on at least 10 Medicare Part B claims from Jan. 1, 2011, through June 30, 2011, to avoid the 2012 e-prescribing penalty.

However, to avoid the 2012 e-prescribing penalty, physicians now will have an opportunity to attest through an on-line web portal that they are eligible for one of the following penalty exemptions:

  • Physician’s practice is located in a rural area without high speed internet access
  • Physician’s practice is located in an area without sufficient available pharmacies for electronic prescribing
  • Physician is registered to participate in the Medicare or Medicaid EHR Incentive Program and has adopted certified EHR technology (New)
  • Physician is unable to electronically prescribe due to local, State, or Federal law or Regulation (e.g., prescribes controlled substances) (New)
  • Physician infrequently prescribes (e.g., prescribe fewer than 10 prescriptions between January 1, 2011 –June 30, 2011) (New)
  • There are insufficient opportunities to report the e-prescribing measure due to program limitations (e.g., surgeons) (New)

Physicians will have to apply for an exemption from the 2012 e-prescribing penalty via the web-portal tool by Oct. 1.

What if you don’t fall into one of these new categories?

It’s time to tap into one of the free electronic prescribing packages available. Here are two choices:

  1. The National ePrescribing Patient Safety Initiative (NEPSI) – Free, Allscripts Software
  2. Practice Fusion – Free, probably will have advertising and your data will be mined (all 10 prescriptions!) but you may be able to get it up and running very quickly

 

Some other thoughts on getting your ten done

  1. Prescribe over-the-counter drugs including stool softeners and anti-emetics.
  2. Prescribe Tylenol3 or another non-controlled pain reliever – patients do not need to pick these prescriptions up or pay for them.
  3. Ask your Medicare patients if they have any prescriptions they would like you to refill while they are in the office. Over-the-phone refills do not count as there is no associated face-to-face service.
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The First 2011/2012 Certified EHR List: Is Your EHR on the List?

holding my breath until I turn invisible

Image by qwrrty via Flickr

Everybody has been holding their breath to see which EHR software will pass the ONC-ATCB (Office of the National Coordinator for Healthcare IT – Authorized Testing & Certification Body) 2011/2012 certification.  Some will buy a system based on this information, and others will continue on with their system feeling a great sense of relief that the system they’ve already paid for is now certified.  Still others will wonder if their system of choice has applied and failed, or not applied yet.  All this and more information is available on the websites of the three companies that have been approved via the Temporary Certification Program for Health Information Technology.
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The companies are:
  1. CCHIT (Ed. Note, CCHIT has ceased operations)
  2. Drummond
  3. InfoGard
CCHIT and Drummond announced their first group of certified systems October 1, 2010 and InfoGard has yet to make an announcement.
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EHR software companies “…are required to provide complete information on the details of their ONC-ATCB 2011/2012 certification, including company and product name and version, date certified, unique product identification number, the criteria for which they are certified, and the clinical quality measures for which they were tested, and any additional software a complete EHR or EHR module relied upon to demonstrate its compliance with a certification criteria,” states the CCHIT website.  This information should be available on the product websites, the certifying body website and the ONCHIT website.
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As you are reviewing the bolded product names below, notice that the information is split into separate categories for providers and hospitals, is divided based on the company that certified the EHR and is also broken into complete EHRs software versus software modules.

ELIGIBLE PROVIDERS

Complete EHRs for Eligible Providers (CCHIT)

  1. ABEL Medical Software, Inc. for ABELMed EHR – EMR/PM, version 11
  2. Allscripts, Allscripts Professional EHR, version 9.2
  3. Aprima Medical Software, Inc. for Aprima, version 2011
  4. athenahealth, Inc. for athenaclinicals, version 10.10
  5. CureMD Corporation for CureMD EHR, version 10
  6. The DocPatientNetwork.com for Doctations, version 2.0
  7. Epic Systems Corporation for EpicCare Ambulatory – Core EMR, version Spring 2008
  8. GE Healthcare for Centricity Advance, version 10.1
  9. gloStream, Inc. for gloEMR, version 6.0
  10. Intuitive Medical Software for UroChartEHR, version 4.0
  11. MCS – Medical Communication Systems, Inc. for iPatientCare, version 4.0
  12. Medical Informatics Engineering for WebChart EHR, version 5.1
  13. meditab Software, Inc. for IMS, version 14.0
  14. NeoDeck Software for NeoMed EHR, version 3.0
  15. NextGen Healthcare for NextGen Ambulatory EHR, version 5.6
  16. Nortec Software Inc for Nortec Ambulatory EHR, version 7.0
  17. Pulse Systems for 2011 Pulse Complete EHR, version 2011
  18. SuccessEHS for SuccessEHS, version 6.0

EHR Modules for Eligible Providers (CCHIT)

  1. Allscripts for Allscripts Peak Practice, version 5.5
  2. eClinicalWorks LLC for eClinicalWorks, version 8.0.48
  3. NexTech Systems, Inc. for NexTech Practice 2011, version 9.7
  4. nextEMR, LLC for nextEMR, LLC, version 1.5.0.0
  5. Sammy Systems for SammyEHR, version 1.1.248
  6. Universal EMR Solutions for Physician’s Solution, version 5.0
  7. Vision Infonet Inc., for MDCare EMR, version 4.2
  8. WellCentive for WellCentive Registry, version 2.0

Complete EHRs for Eligible Providers (Drummond)

  1. ChartLogic, Inc for ChartLogic EMR 7, version not noted

EHR Modules for Eligible Providers (Drummond)

  1. ifa united i-tech Inc. for ifa EMR, modules 170.302.A-J, 170.302.M, 170.302.O-V (specialized to ophthalmology)
  2. QRS INC. for PARADIGM, version 8.3, modules 170.302.A-W, 170.304.A,  170.304.C-J

HOSPITALS

Complete EHRs for Hospitals (CCHIT)

  1. Epic Systems Corporation for EpicCare Inpatient – Core EMR, version Spring 2008

EHR Modules for Hospitals (CCHIT)

  1. Allscripts for Allscripts ED, version 6.3
  2. Health Care Systems, Inc. for HCS eMR, version 4.0
  3. PeriGen for PeriBirth, version 4.3.50
  4. Prognosis Health Information Systems for ChartAccess, version 4
  5. T-System Technologies for T-SystemEV, version 2.7
  6. Wellsoft Corporation for WellsoftEDS, version 11



Allscripts and Eclipsys to Merge Creating Customer Base of 180,000 Physicians

See story here.




Talking With Steve Malik of Medfusion: What Has Your Website Done For You Lately?

I recently had the pleasure of speaking with Steve Malik, the CEO and Founder of Medfusion.  Medfusion offers an array of products to the healthcare industry including physician websites and patient/provider portals.  With a background in healthcare billing and eligibility, Steve has been in a unique position to guide his company to solutions that make good sense financially and efficiency-wise for physician practices.  Steve predicts that Medfusion will be serving more than 40,000 physicians by the end of 2009 and says that “patients are used to the world of self-service, and physician offices want to offer that option.”  He sees practices ultimately offering completely automated check-in (including collecting payments) prior to the office visit similar to airline kiosks.

Based in Cary, North Carolina, Medfusion enjoys the distinction of being named the leader in patient portals by KLAS, a company which independently monitors and ranks healthcare technology vendor performance.  The HIPAA-compliant patient portal developed by Medfusion allows patients and providers to communicate and share protected health information and private identifiers such as social security and credit card numbers via a secure portal.  Medfusion’s secure portal empowers patients and practices in a number of ways including:

  • Secure online bill pay.
  • Appointment reminders and lab results messages.
  • Patient registration, demographic and health history completion online.
  • Completion of a history of present illness prior to the visit.
  • eVisits or Virtual Office Visits for established patients. Patients may pay out-of-pocket for the visit or pay a co-pay and the practice can file for the balance of the reimbursement (note: payers, most notably BC/BS, are starting to pay for virtual visits.)
  • Shared patient communication between practices.  Practices that refer patients to a specialty practice can make that referral electronically and can follow-up on the patient’s progress via the portal.
  • “Chat with a Biller” function.
  • Appointment requests and requests for prescription refills.
  • Credit card payments without the use of a credit card machine; online payment plans that automatically drafts the patient’s credit or debit card monthly.
  • Patient refunds via the web portal.

Medfusion has strategic relationships with the American Academy of Family Physicians (AAFP) and the Medical Group Management Association (MGMA) to provide website services to their member practices.  Steve is an active speaker and presenter on technology in healthcare , and is widely quoted in industry publications. The company also has a relationship with Allscripts and Origin Healthcare Solutions and provides connectivity to those products to import information from the patient portal into the practice management system.

Recently Medfusion enhanced its existing Symptom Assessment and Virtual Office Visit solutions to include H1N1 Influenza (Swine Flu) screening.  Medfusion’s press release from May 2009 states:

Without having to come into the office, the patient can log into the practice’s secure HIPAA-compliant patient portal, select either Symptom Assessment or Virtual Office Visit, and type in Swine flu when they are prompted for a condition. The patient then responds to a series of interactive clinical questions relative to their symptoms so that the doctor can provide a secure online consultation, prescribe the appropriate anti-viral drug, if necessary, or determine if the patient needs an in-office visit.

Additionally, physician practices have been able to use Medfusion’s Secure Patient Messaging solution to mass broadcast the availability of H1N1 influenza online screening and to keep patients informed about the latest news regarding this outbreak or any other dire health issues. ‘We immediately launched Webinar training session’s specific to Swine flu patient messaging and Virtual Office Visits, and the response from the practices was overwhelming,’ said Crystal Upson, Vice President of Client Services. Medfusion continues to hold these training sessions regularly. Also, physician practices that have a website powered by Medfusion have complete control over their content management, which means they are able to post and change messaging at any given time about their services and the latest health issue developments.

After all the excitement of the products described above, it seems a little anti-climatic to discuss Medfusion’s website design and hosting offerings, but it is well-worth mentioning as the products above can be integrated into a custom-designed website by Medfusion, or an existing website.  Medfusion will take the look and feel of a practice’s current website and replicate it so the patient always feels that they are “inside” the practice’s site.

What doesn’t Medfusion do?  I recently saw the Medfusion product line again and was a tad disappointed that the referral portal does not have the ability to use custom forms.  It would be ideal to refer a patient to another practice or a test facility and be able to complete the order electronically including an electronic signature.  Referrals are one of the most time-consuming functions of a physician’s practice (primary care practices particularly) and can significantly impact patient care and reimbursement when done incorrectly.

What’s in Medfusion’s future? It was recently announced that Medfusion purchased Medem and their iHealth personal electronic record.  As personal health record capability  is included in definitions of “meaningful use” of an electronic health record eligible for the ARRA stimulus money, it looks like Medfusion will be well-positioned to help its strategic partners meet that definition.

By the way, I have used Medfusion at three different practices in the past and am evaluating it again for my current employer.  I’ve not received any consideration for this article.




Nuance (Dragon) Comments on Blocking the Consumer Edition from EMR Integration

©Lidian Neeleman/Dreamstime.com

©Lidian Neeleman/Dreamstime.com

My August 20th post (read it here) noted that Dragon voice recognition software has been quietly gaining acceptance as a mainstream solution to hefty transcription costs and EMR integration. 10% of the healthcare providers in the United States are currently using Dragon Medical.

Yesterday, HISTalk noted that:

At least one doc is unhappy that Nuance has blocked the use of Dragon Naturally Speaking with EMRs in Version 10. Nuance states “…we found that some large hospitals were using the consumer editions of Dragon and not getting the accuracy, quality and manageability that would be achieved when using Dragon Medical.”

Nuance responded on HISTalk via comment, saying in part:

“Nuance has made a significant investment in building, tuning and distributing Dragon Medical for exclusive use by the health care industry. The integration and engineering required to deliver the ease-of-use of Dragon Medical with all major EMR vendors, including Allscripts„¢, Epic, Misys®, GE® Healthcare, NextGen®, Siemens, eClinicalWorks, Meditech, McKesson®, Cerner and Eclipsys®, requires a Herculean effort, comprising thousands of man hours in developing and testing. As one would expect, there is a premium associated with the delivery of this capability and the resources devoted to further hone and evolve the product to meet the specific needs of the medical end user.”

Nuance also points to the Microsoft model of charging differently for enterprise/professional software and consumer software offerings.

I don’t dispute a vendor’s right to charge accordingly for a product that has taken a lot of R & D to bring to the market, but like everything else that has a place in the medical world, it will cost much more based on the healthcare application. A set of plastic drawers for home costs $9.99 at your local store and lists for $99.99 in a medical catalog.