Practice Fusion Blog

Red Herring

I am excited to announce that today Red Herring selected Practice Fusion as one of the finalists for the 'Red Herring 100'.  I feel this is a direct testament to the Practice Fusion team's hard work, and our continued growth and innovation in the HealthcareIT space.  To read more click here.

About the 'Red Herring 100':
For more than ten years, Red Herring has been the known leader in finding and advocating the most promising tech startups. Red Herring North America continues this tradition by once again recognizing the top 100 privately held companies in North America. Formerly named Red Herring Spring, this is where we will reveal the Red Herring 100 North America Award winners. At the conference visionaries, corporate leaders, and investors will converge for two days of interaction that will shape the future of the tech industry.

Google Health Comments

One of our advisory board members, Graham Walker, made some interesting comments on Eric Schmidt' s recent speech at HIMMS that I wanted to share - the original post can be found here.

Several comments and critiques as I watched Eric Schmidt, Google’s CEO, talk about Google Health:

• Please stop calling patients consumers. Patients are people with illnesses or injuries who need medical care; consumers are people who purchase goods or services and are informed about what they’re purchasing. (Most patients are not actively dictating what health care resources they’re consuming.) Note: there are certainly consumers of health information, but a person who comes to me seeking medical attention is not a consumer. He or she is a patient.
• The medical record is not the patient’s property. I believe the model we need to use for the medical record is “shared control,” that is, the patient controls who sees the information in their medical record, but the patient’s physician controls the actual information. A patient with HIV or a history of anaphylactic shock to penicillin should not be able to delete this from their medical record.
• Wow, it would be amazingly cool to have all XRays and CT scans from everyone in the country online. I would love that.
• Dr. Schmidt talks about young people, and how we already see the future of what will happen with society, what changes will occur and how quickly and says that the older people like him need to be ready to change and adapt. But I’d guess no one on their Health Advisory Board, with the exception of Matthew Zachary, is under 40 or 50; few if any likely have a Youtube account or Facebook profile. If young people are so in the know, get our opinions!

-Ryan Howard, CEO Practice Fusion

Advisory Board

I would like to take this opportunity to annouce Practice Fusion's Advisory Board.  Over the last year, these industry leaders have each played a key role in assisting us in establishing our business model and bringing Practice Fusion to market:

Cora Tellez
CEO, Sterling HSA; Ex President/CEO Healthnet, Blue Shield CA, Prudential Healthcare
Marty Diamond
Founder, Diamond Group; President & CAO, John Muir Medical Center; Director, UCSF/ Mount Zion Hospital
James Hickman
VP Comm, Institute for OneWorld Health; Ex CEO, St. Luke’s Hospital Foundation
Jonathan Gerber
CEO and Founder, Physician Services, Inc.
Stan Stead, M.D.
President, The Stead Group; Ex Sr. Associate Director at UC Davis Health System
Flash Gordon, M.D.
President/CEO, Ross Valley Medical Corp; Former Director, Haight Ashbusy Free Clinic
Manly Hyde, M.D.
Cardiac Surgeon, Kaiser Permanente; Founder, Click411.com
Alan Rosenstein
Vice President & Medical Director, VHA West Coast
Gwen Watanabe
Vice President of Business Development, Nelix; General Partner, Saratoga Ventures
Scott Munro
Managing Director, PageMill Partners, Ex President/CEO Savior Technology Group

-Ryan Howard, CEO, Practice Fusion

Who pays for the Benefit?

Sometimes the world of the blog gets wrapped up in itself.  We all know how it goes.  A quick sanity check usually comes in the form of an article in a national newspaper.  We had such a sanity check last week.

After weeks of one-off articles on healthcare and its problems, on June 11, the New York Times devoted an entire section, The Business of Health, to our small corner of the blogsphere.  Its lead article "Who Pays for Efficiency?" chronicled several doctor’s journeys in streamlining and automating their office workflows.

Not only did it validate our assumptions in the challenges these doctors face, but it brought to light the inequity in the cost-benefit ratio.  One would think that if the doctors, spending tens of thousands of dollars of their practices’ earnings, install the technology, they would realize the lion’s share of the benefits. But they don’t.  One guess in who does .. tick tock, tick tock … the public and private insurers.

If the gains are not aligned with the spend, the old software license model has to change. 

-Gail Romano

VP Marketing, Practice Fusion

Hill medical group invests in IT, hurting net income

The San Francisco Business Times is running a great article about how Hill Physicians Medical Group's NextGen implementation is impacting the organization's revenues.  Here's the entire story:

Hill Physicians Medical Group, one of the few medical groups or IPAs to publicly divulge its financial results, generated $428 million in revenue and $5.3 million in net income last year, according to preliminary figures from the San Ramon-based group. Its formal annual report is expected by early June.

Dan Robinson, vice president of corporate services for 2,600-doctor Hill and its PriMed Management Consulting Services management group, said 2006 revenue increased 3.4 percent over the prior year. Net income fell 31 percent, from $7.7 million in 2005, due to a steep increase in funds invested in implementing its electronic medical record system and increased performance-based pay for its doctors.
Hill spent $5.89 million on its EMR implementation last year, 78 percent more than 2005's $3.3 million, Robinson said; meanwhile, performance-based pay jumped 23 percent, from $26 million two years ago to $32 million in 2006.

PriMed's administrative costs remained low, he said, at 10.8 percent, "whereas other similar groups generally run in the 13 percent to 14 percent range."

Hill, run by longtime CEO Steve McDermott, is considered one of the best-run IPAs in California, if not the nation, and is one of the very few to provide any public accounting of its financial results. "Bottom line, financial performance remained strong again," Robinson said of the preliminary results. "We're continuing to invest aggressively but judiciously in clinical and technical support services that support our physicians' practices."

-Ryan Howard
CEO, Practice Fusion

Thinking Like A Doctor

Doctors, for the most part, aren't software engineers.

And software engineers, for the most part, aren't doctors.

This would be just one of many reasons electronic medical record
(EMR) software has been incredibly slow to be adopted by the medical field. Medicine is a highly complicated field--add the complexity of the human body to the complexity of all the human bodies in the health care field and you're bound to struggle to keep things simple. 
No  matter *what* type of system you try to use to keep track of patients and their health.

And because of this, you end up with incredibly complex computer software. This database has to talk to that one, this system has to integrate with that one, Network A has to merge with Network B. This is not the work for a doctor--it's the work for a software engineer.

The problem, I often find, is that so much work is necessarily spent on the "backend" -- that is, making the software work and record and recall information accurately and securely without crashing -- that very little time seems to be spent on the "frontend" -- what the user of the system actually sees. Since doctors are usually the ones that have to take the data from a patient (his or her symptoms, physical findings, lab values, and past medical history) and turn it into a diagnosis, shouldn't these systems be setup to think like a doctor would?

(The answer is yes.)

Unfortunately this is often not the case. Information is put into categories and presented in ways that may make sense, or be easiest to program, for a software engineer, but when it comes time to turn the software over to the doctor, it seems downright clunky, inefficient, and frustrating to use.

We need systems that take physicians' thought processes and workflows into consideration. Systems that understand how a doctor makes it through the day in a clinic, and helps facilitate that process, not hinder it.

The Practice Fusion goal is to create a software package that provides physicians with such a system. *And* something that doesn't require an entire IT department to support. Software that helps physicians to be more efficient--and therefore have more face time with patients. Software that has thought through how doctors work and process information, and software smart enough to show doctors pertinent information right in front of them. Software that also provides an extra layer of safety, without mind-numbing clicking of errors and alerts that end up getting ignored anyway.

Graham Walker
Medical Student, Stanford University School of Medicine
Practice Fusion Advisory Board Member

Doctor Accused of Unethical Chart Access

With the adoption of electronic of medical records, one concern that many stakeholders have is security of the records, particularly, who is accessing the records (auditing and logging).  I speak often to how electronic medical are more secure than a traditional paper record and this story is of particular interest for the reason that if Berkshire Medical Center was still using paper, no one would have discovered that the records were accessed.

"An employee of a Pittsfield, Mass.-based hospital is suing a physician there, claiming that the doctor accessed her medical chart because he was interested in her romantically. The employee, Ashley Keyes, is suing pulmonary and critical-care specialist Dr. Boris Alberto Murillo, as well as his employer, Berkshire Medical Center parent company Berkshire Health Systems.

The dispute arose from Keyes' discovery, in January 2006, that Murillo had been reviewing her electronic medical records for years. Murillo had allegedly been making sexual advances to Keyes during the same period. The suit accuses Berkshire Health Systems of failing to protect Keyes' HIPAA rights and failing to train Murillo properly in these rights. Keyes is requesting $250,000 in damages."

To read the complete story, click here.

Ryan Howard, CEO, Practice Fusion

EMR Usabity

Dr Gordon is a practicing physician, the CEO of Ross Valley Medical and an advisory board member with Practice Fusion. I consider him very technically savvy physician, as he is one of the few private practice doctors I know of that has an EMR implemented.  In a recent discussion about the usability of our system versus currently systems, Dr. Gordon volunteered to share his candid experiences:

"I'm sure AllScripts was a great idea when it first started. Unfortunately, having spent the last couple of years struggling with it, I think it's just a bloated, user-hostile, counterintuitive, unresponsive, and unproductive way to waste time.

Our billing service provides AllScripts to my practice. I guess they saw which way the winds were blowing in medicine, and realized that with a good EHR, practices could do their own billing effectively and not need a billing company. Being reluctant to join other buggy whip manufacturing companies, they decided to jump on the bandwagon and pre-emptivey offer us it at bargain prices to lock us in to their services.

It is convenient being able to see the notes from other practices that the billing company serves right after they're entered, but the extra time it takes to do things The AllScripts Way might not be worth it. For example, if I get an MRI result, I can just click on [VERIFY] which tells the system I've seen it, and removes it from my virtual Inbox (my TASKS list).

However, if there's a stress echocardiogram result from the cardiologists, it can't be VERIFIED – it has to be SIGNED. And because of a glitch that's been in the system for more than a year, in order to SIGN a document in my TASKS list, I have to choose that patient's chart, go to the chart, select the document, select SIGN, enter my PASSWORD, scroll down from AUTHOR to ACKNOWLEDGMENT, select ACKNOWLEDGMENT, click OK, and go back to my TASKS list.

It's not uncommon to have ten or fifteen documents from cardiology – multiply the above procedure that many times and you have an idea of the potential time sink.

Filling prescriptions is another royal pain. If the name on the incoming prescription from the pharmacy is in any way not exactly identical to the name in the record, even if the address and date of birth matches, it has to be manually verified. So, if my patient Gretchen Pfefferkuchen gets an incoming prescription in the name G Pfefferkuchen, there's another runaround.

Rather than present a list of possible patients, I have to hit a button to go to the NAME SEARCH screen. Once there, I have to manually select the SEARCH button (c'mon, couldn't that be the default?) and find the name. I then go back to the prescription screen, and then have to go through several more screens (“Please verify patient's address”) until I can click OK.

Having AllScripts not follow Windows conventions is annoying. In real Windows programs, there's an ALT menu: i.e., hitting ALT-F usually brings up the FILE menu; ALT-V brings up VIEW, and so on. In AllScripts, some commands have a letter underlined, leading me to believe they'll work with the ALT button – but they don't. This is also very annoying.

The problem with AllScripts is that it's like dealing with General Motors. You can't just call them or email them with complaints or suggestions: they much all go through the local “dealer” - in this case, the local billing company.

I like the idea of dealing with a company that actually listens to what its customers says, like Practice Fusion. Not only can we customize the EHR right out of the box, but we can provide direct feedback, helping develop a product that works like it's supposed to."

-Dr Flash Gordon, MD

-Ryan Howard, CEO, Practice Fusion

Intel/Cisco Dossia Initiative

I recently wrote a commentary that was featured in today's Modern Healthcare about Intel's and Cisco's Dossia initiative, which can be read here.

Another item to note is that Cisco, Adobe, Cadence, NEC and Oracle worked with RelayHealth on a similar project in 2001 to enable their employees to message their physicians. While this is not an exact apples to apples comparison, the resulting low adoption reflects the trends of physicians and patients today.

Even when these products are subsidized by a third party (ex. Blue Cross), physicians and patients are not using them. Again, the problem is that these solutions are not integrated into the typical physician's practice management and EMR systems, thus not part of the physician's current business process flow within their practice. Thus, when patients login to these systems, there is no medical record, billing, or prescription information. 

Another issue with these solutions is that since all of this patient information (appointments, billing, prescription and possibly chart data) is residing in the practice management/emr solution, users within in the office (including nurses, office administrators and practice managers) must attempt to work between multiple solutions to utilize these applications, making their data entry workload significantly higher.

-Ryan Howard, CEO, Practice Fusion

 

The Cost of a Data Breach

Fierce Healthcare and PGP have made available an excellent study named 'The Cost of a Data Breach' here. The study quantifies actual data breach costs - often into eight figures - incurred by 31 organizations that lost confidential information and had a regulatory requirement to publicly notify affected individuals. Includes key findings, cost breakdowns, and insight into the high cost of lax data security.

 

This is a great read, particularly if you are considering hosting data in-house in your practice, or having your physicians host their own data.

 

-Ryan Howard, CEO, Practice Fusion