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HIMSS 2015: Girish Navani

Apr 8, 2015• 1

By MICHELLE RONAN NOTEBOOM

Our intrepid tech columnist Michelle Noteboom caught up with eClinicalWorks CEO Girish Navani last week to talk with him about his company’s future, his patient engagement strategy and his plans for international expansion.

Michelle Noteboom: What’s the latest news from eClinicalWorks?

Girish Kumar: There’s a lot Michelle. I like to put it into some buckets so that I can define them. The core is our EHR and practice management space and the focus continues to be on usability and always making it’s more provider-friendly; the whole space around using touch and speech. We seem to be doing some innovative work in that arena to make EHR even more usable than just point and click. In that space we’re seeing continuous growth based on good customer satisfaction and retention.

That’s part one. Obviously the government mandates dictate a lot of other things. Meaningful Use 3 comes on the horizon. Interoperability is a big deal and I think we’ve done some good work with Epic and eCW integrations now for our mutual customers, which is making interoperability even better with faster deployment for our clients.

That’s the core. There are three other things. One is revenue cycle management, which averages 2.9%. We’ve gotten good momentum in that space, with both new customers and convergent customers.

Population health: we’re competing with stand-alone companies in that space reasonably well in both ACO product lines. We did well with other quality programs, so that’s an area that we’ll continue to invest.

SGR. RIP, Hopefully

Apr 8, 2015• 12

By STEVEN FINDLAY

The U.S. Senate has an opportunity next week to hammer the final nail in the coffin of the failed “sustainable growth rate” (SGR) formula for Medicare physician payment. At the same time, it can move the U.S. closer to a system that pays doctors for the quality of care they deliver, not the quantity.

Bear in mind that Medicare pays about a third of the tab each year for all physician services in the U.S.

For those who have not been following this issue (and I don’t blame you, it’s convoluted, even tortuous), here’s a quick recap:

The House in a rare bipartisan vote (392-37) voted on Thursday, March 26 to repeal the SGR formula, which has been in place since 1998. The formula, part of the Balanced Budget Act of 1997, was intended to constrain Medicare spending by pegging annual physician fee updates to a target based on the growth in overall physician spending and the gross domestic product.

The formula never worked. I’ll spare you the details on that. Suffice is to say that the disparities between the growth in physician costs and GDP over the period 2002-2013 were such that reducing physician fees each year by the amount the formula dictated were—well, let’s just say they were very politically distasteful. Continue reading…

The Digital Doctor – The Review

Apr 8, 2015• 20

By MATTHEW HOLT

Bob Wachter has been about as influential an academic doctor as there’s been in recent years. He more or less invented the concept of the hospitalist, he’s been a leader in patient safety, and even dressed up and sang as Elton John at the conference he runs! (He’s also pissed off lots of doctors by being a recent one year chair of the newly controversial and perhaps scandalous ABIM). But for the last 2 years he’s been touring the good and the great of health care and IT to try to figure out what the recent introduction of EMRs at scale has meant and will mean. The resulting book The Digital Doctor is one of this year’s “must reads” and yes we will have Bob as the keynote at this Fall’s Health 2.0 Conference.

The immersion research he conducted was fantastic. Bob interviewed just about anyone you’ve ever heard of and a few you wish you hadn’t (more on that later). And in fact he’s been running interviews on THCB and elsewhere sharing some of the stuff that didn’t get in the book. But I’m still wrestling a little with what I think about the book itself. And I think it’s because I largely agree with him and his angst.

There is lots of wonderful stuff in this book. The change in the role of radiology post PACS, how patients are using open notes, whether Vinod Khosla agrees with Vinod Khosla about algorithms replacing doctors–all this and much more are here. But the book is largely about the introduction of the current generation of EMRs into the everyday practice of ordinary clinicians. There are by and large three camps of opinions about what’s happened.

One is that the EMR is a pox visited on physicians that costs a fortune, has worsened quality, heightened medical errors, blown up successful processes, and ruined the lives of doctors–unless they were given scribes. The second is that because of the “rush to judgement” caused by the HITECH Act and Meaningful Use, we put in EMRs that were based on 1990s client-server technology but they were the only ones mature enough for the job. Most of this camp thinks that they were way better than paper, will slowly improve, and that doctors and patients will find that these technologies will soon integrate with easy to use iPhone-like apps as their APIs open up–and that if we hadn’t mandated EMRs when the great recession gave us the chance, nothing would have happened. The third camp agrees that EMRs are better than paper but felt that the way HITECH was rolled out kept a bunch of dinosaurs in business, and is preventing the health IT equivalent of Salesforce displacing Siebel (or Slack displacing email).Continue reading…

HIMSS 2015 THCB Sponsor Directory. Thank You Sponsors!

Apr 8, 2015

Booth: 2023 Map
Hall: South

athenahealth is a leading provider of cloud-based services for EHR, practice management and care coordination, named the Best in KLAS #1 Overall Software Vendor for 2013. With a cloud-based network of more than 50,000 providers, athenahealth helps caregivers thrive through change and stay focused on patient care.

Booth: 8115 Map
Hall: North

Corepoint Health solutions help hospitals and care providers create seamless health data interoperability in a scalable, cost-effective manner. The Corepoint Health team offers healthcare’s most flexible integration platform along with industry-leading customer support and services. Discover why Corepoint Integration Engine has been ranked number one for six consecutive years in the Best in KLAS® Awards: Sofware & Services report.

Booth: 3413 Map
Hall: South
Booth: 2084 Map
Show Floor Landmark: Interoperability Showcase

eClinicalWorks offers ambulatory clinical solutions consisting of EMR/PM software, patient portals and a community health records application. With more than 85,000 physicians and 545,000 users across all 50 states using its solutions, customers include physician practices, out-patient departments of hospitals, health centers, departments of health and convenient care clinics.

Livongo Health adds $20m, Tullman interview

Apr 7, 2015

By MATTHEW HOLT

Livongo Health is creating a tech-based service that aims to supersede the glucometer. Headed by former Allscripts CEO (and THCB interview regular) Glen Tullman, it raised another $20m from Kleiner Perkins, DFG & General Catalyst today. I grabbed 10 minutes to talk to Glen Tullman this morning. he had very interesting things to say not only about his business but Cerner, Epic & open systems too.
[youtube]https://youtu.be/4w-pHj91PKM[/youtube]

Epic Systems’ Open Platform Will Bring U.S. Health Care Delivery Into the 21st Century

Apr 7, 2015• 11

By STEPHEN M. KRUPA

Epic Systems, the market leader in electronic health record software (EHR), recently made a quiet but potentially transformative announcement that may finally shake the healthcare industry out of its technological doldrums.

Epic said it is prepared to support the creation of a more open interoperability platform for integration with other diversified healthcare applications. This will attract substantial investment to create software that operates, hopefully seamlessly, within the Epic EHR infrastructure. Expect Epic’s competitors to follow suit, eventually opening up the marketplace of installed EHRs to third-party software developers and the efficiencies of modern, post-EHR technology ecosystem.

Epic’s critics have often denounced the company for selling a mostly closed technology, dampening hopes for the creation of an ecosystem of best-of-breed applications that work together with the EHR to automate much of the care delivery infrastructure beyond patient intake and billing. The value of such an infrastructure is extremely compelling and so the company is under enormous pressure from its customers to become more open.

Training Day

Apr 6, 2015• 6

By ROSS KOPPEL and STEPHEN SOUMERAI

Dr. Samuels’ day-long training experience is unfortunate, but it’s only the opening chords of a much longer symphony of time commitments required by electronic medical records (EHRs). Many studies document the extra time that EHRs impose on doctors and patients. Research in U.S. hospitals and medical offices suggest that these systems can add a half-hour or much more time to a day. A study by McDonald et al (2013 JAMA Internal Medicine) found EHRs added 48 minutes/day to ambulatory physicians, and Hill et al found that in a large community hospital emergency room 43% of all physician time was spent entering data into the EHR. This almost doubled the time spent caring for patients, and tripled the time needed to interpret tests and records. (Annals of Emergency Medicine, 2014).

Some of that extra time is spent with clunky interfaces and hide-n-go seeking for information that should be immediately available, such as arbitrary or unexpected presentations of data, e.g., having to find a patient’s history by clicking on her current room number, or lab reports that may be arranged by chronology, by reverse chronology, by the lab company, by the organ system, by who ordered them, or by some informal heading, such as “blood work” or “tests” or “labs.” Then there’s the constant box clicking (or what clinicians call “clickarrhea”). EHRs also send thousands of usually irrelevant alerts that desensitize doctors to legitimate clinical recommendations.
Continue reading…

Health Care Ux Design: Crucial But Conflicted

Apr 6, 2015• 5

By ANDY ORAM

The focus on design for health IT at the HxRefactored conference on March 31 raised several tough questions about the hazard-strewn path app developers must travel in that field. My sampling of introductory workshops and afternoon sessions (I unfortunately had the chance to attend only the first day of the two-day conference) brought up many fine design principles, but most of the presenters were general-purpose designers having limited experience in health care. Still, some important distinctions to recognize when entering health IT came up.

One factor making design is so difficult in health care is the vast variety of tasks health care professionals perform. If you’re designing an app to reserve a restaurant table or buy a sweater, how many pathways can a user take? Probably at most a dozen or two. Now think of a hospital ward: one patient whose heart has to be monitored constantly, another who needs regular injections, and yet another whose medication has put her in a delirium that leads her to jump out of bed and wander. Truly, the pathways that a doctor or nurse can take through the health care application verges on the infinite.

Processed Food Wars: Why the Stuff You Buy at Whole Foods May Be Cheaper Than You Think

Apr 6, 2015• 11

By JONATHAN S. FEIT

April 5, 2015, is Easter Sunday, the third day of Passover, and the four month-and-three day mark to the scheduled birth of my first baby (!!!). My wife and I won’t be finding out what we’re having because there are so few natural surprises in this world — why not enjoy the few that we can?

But I’m head-steaming angry today, even amid such beauty and hope for the future of my family, because on a tour of my own mother’s cupboard I found sample after sample of the substance that will be, I predict, the bane of Western health…and beyond, as the worst influences of our processed-food culture spread like a virus around the world to countries that lack or ability to medically intervene into the cardiac diseases and high cholesterol — what the Mayo Clinic calls a “double whammy” — that can be wrought by fake-food.

Let’s not be subtle; let’s name names: the culprits were cake mixes, soup and dip mixes, and even a matzo ball mix (my heart broke that such an innocuous, nostalgic treat could be putrid) sold and/or distributed under the Manischewitz and Goodman’s brands.

How Meaningful Use Stage 3 Got Patient Engagement Wrong

Apr 5, 2015• 4

By JOSEPH KVEDAR, MD

Criteria for Stage 3 of meaningful use of EHRs were released recently and there is lots of controversy, as would have been predicted. One set of recommendations that is raising eyebrows is around patient engagement.

The recommendations include three measures of engagement, and providers would have to report on all three of them, but successfully meet thresholds on two.

Following on the Stage 2 measure of getting patients to view, download, and transmit their personal health data, the Office of the National Coordinator (ONC) has proposed an increase from five to 25 percent.

The second measure requires that more than 35 percent of all patients seen by the provider or discharged from the hospital receive a secure message using the electronic health record’s (EHR) electronic messaging function or in response to a secure message sent by the patient (or the patient’s authorized representative).

The third measure calls for more than 15 percent of patients to contribute patient-generated health data or data from a non-clinical setting, to the EHR.