Thursday, October 04, 2012

Why the next wave of health IT innovation will build on EMRs, cater to “physician happiness”

I am always impressed when a reporter can ask a few questions, listen to me talk for 30 minutes, and then assemble it into a great article which really explains my thoughts well... and I am even more amazed when they can do it in 24 hours!  Thanks to reporter Deanna Pogorelc from MedCityNews for doing such a great job - and I love the title too: Why the next wave of health IT innovation will build on EMRs, cater to “physician happiness”... Here it is (with a few bolds and comments in brackets from me):

There’s no shortage of primary physicians, but rather a shortage of primary physicians who are able to use their time efficiently in today’s healthcare environment.  That’s why the industry is moving away from the first version of the EMR, according to Dr. Lyle Berkowitz, the associate chief medical officer of innovation at Northwestern Memorial Hospital and Medical Director of IT & Innovation at for Northwest Memorial Physicians Group in Chicago

The inaugural EMRs are basically computerized versions of paper records that weren't necessarily designed with usability in mind, he noted. So rather than saving time and making administrative processes easier, they’re in some cases adding to doctors’ workloads.
[Or as many say - they focused on just documentation and billing, not clinical workflow] 

Enter the next wave of health IT innovators, who are taking EMR data and using it elsewhere to improve workflow. “(EMR vendors) are kind of stuck to Meaningful Use and creating a standardized format to make sure everybody is at the first-base level,” Berkowitz said. “That’s a good start, but we have to start building tools that can fit on top of these. A whole ecosystem is going to build up on top of EMR systems to make them easier and faster to use.”
[Check out the ONC Standards Hub to see how Meaningful Use Part 2 will require all EMR vendors to adhere to certain standards which will make it even easier for 3rd party vendors to work with them]

And, it seems that EMR companies are getting on board with that as well. “They buy into this idea that innovation comes from the outside by saying, we’re going to open up our system and let others build on it,” he said. “AllScripts I think is leadingthe charge. Athenahealth is moving that way, and some others. EMR vendors are going to be end up being able to provide more and more solutions to their users this way.”

EMR extender companies have been around for a while; business intelligence and data analytics are well-established industries. But we’re seeing the dawn of a new category of innovation focused on workflow tools to make doctors more productive and efficient – what Berkowitz calls “physician happiness.”

There’s evidence of that, in the form of companies like Modernizing Medicine, which makes a touch-based “electronicmedical assistant” for specialists, and SchedFull, which is working on a way to help physiciansfill canceled appointments that it hopes to integrate with web-based EMRs.

There’s also healthfinch, the company Berkowitz co-founded with designer Jonathan Baran and programmer Ash Gupta in 2010. It’s focused on making the practice of medicine more enjoyable for physicians by letting them focus on the higher-order thinking they’re good at, rather than spending their time on paperwork. (He compared this to the process of making a new car, and the absurdity of the idea that the people who design technology for the cars would spend part of their time working on the assembly line.)
[What I was trying to say is that a car company knows that their smart car engineers should spend time on solving problems and designing cars, not on screwing in car seats… let them focus on the higher order stuff, and delegate the assembly line work to the people on the floor… another analogy would be that you don't walk into a bank and ask the VP to withdraw $200 - you go to the teller, or the ATM!]

The place where doctors can best apply their skills is the 10 to 20 percent of very sick, complex patients they see, Berkowitz said. That’s precisely why healthfinch focuses on the other 80 percent of patients who might be fairly stable. By creating protocols and automated processes for meeting the needs of these stable patients, other staff members can work together to take care of them, and the doctor has more time to spend with sicker patients.

Its first product focuses on using data to design a protocol for handling medication refills. Doctors receive many refill requests every day, many of which require them to review charts to ensure patients have completed follow-ups or lab tests. Some of this work could be delegated to the nursing staff or medical assistants. To make that happen, RefillWizard leverages EMRs to help practices manage prescriptions more efficiently.
[By using their rules based workflow software to allow for safe and easy delegation of tasks away from docs and towards their team]

Healthfinch plans on using the same technology and philosophy to continue developing products that will save doctors more time by using every person on the staff to the highest level of his or her licensure.  “I’m always on the lookout for things I do repetitively, to see if they can be automated,”Berkowitz added, in illustrating what inspires his innovation. “I’m always trying to figure out how to take something I do in 20 steps and cut it down to five steps or, even better, zero steps.”  [That's one of our new slogans - "The Power of Zero"!]

Wednesday, October 03, 2012

Abuse of EMRs? Really - Let's Take a Closer Look!

The New York Times recently published an article called "Abuse of Electronic Medical Records", in which they started off by saying "The Obama administration has issued a strong and much-needed warning to hospitals and doctors about the fraudulent use of electronic medical records to illegally inflate their billings to Medicare."

REALLY?!?!   Let's take a closer look:  First, the evidence is that billings and coding has gone up over the past 5 - 10 years, and EMR vendors tout better billing as one of their benefits.   Hmmm... that's not exactly a smoking gun.

But fair enough, so let's review why we might get increasing billings and coding:

1. The EMR makes it easier to code appropriately.  I hate when they say "upcode", which implies fraud.  Rather, I think that many doctors (especially primary care and other non-proceduralists) have undercoded for years... and the EMR actually allows them to document all the "thought work" they have been doing for a long time.  The E/M system was designed to help value "thinking doctors" - and it's starting to work!  Let's applaud that, not try and make it sound like fraud.

2. The EMR allows docs to do more at a single visit.  I think this is an often overlooked reason to explain what has happened.  I know in my practice that having an EMR allows me to get to more things in a single visit than in a paper-based system.  So without an EMR, if a patient came in for a sprained ankle - I might just take care of that and told them to come back for their other issues.  With an EMR, it makes it easier to see everything at once and manage multiple issues.  This is an incredibly GOOD thing for the patient, and for the system - since one "bigger visit" (e.g. "Level 4") is cheaper and more efficient than two "smaller visits" (e.g. Level 3).   So maybe the government should not just look at billings, but also at the total number of visits a patient had - and see if that decreased over the past 5 - 10 years... maybe because docs were doing more work in less visits!

Oh wait, they did do this!?  One of my favorite blogs (HISTalk) actually ran this snippet of info today: The Census Bureau says adults under age 65 made an average of 3.9 visits to physicians in 2010, down from 4.8 visits in 2001. Possible explanations: more uninsured, fewer physicians, higher patient costs, innovation that allows providers to accomplish more in a single visit, and more meds available without a prescription.  So maybe the attorney general and HHS could talk to their own colleagues a bit more before throwing around accusations slandering docs who use EMRs?

3. Docs are using EMRs to defraud the government.  Obviously, there will always be some small amount of doctors who commit fraud - whether that is on paper or EMRs... but I certainly don't think that using an EMR all of a sudden makes doctors more fraudulent.  And by the way, since this fraud is happening in both paper and IT systems... I'd appreciate if our government didn't just pick on EMRs, and said something like this instead:   "We know most doctors are outstanding citizens who give of their time to help others, but there are a few who commit fraud... and whether they do so on paper or EMRs - we will find them and prosecute them!  And while healthcare IT may make it easier for some to perform some fraud, it also makes it easier for us to catch them - so watch out bad guys!" 


  • Coding: Up, Down or Around? I'm quoted in this HDM article - basically saying EMRs make us more efficient docs and better coders (in contrast to the HHS report trying to make EMRs sound like fraud machines)!