San Francisco Medical Society Blog

Physician, Tweet Thyself

Mon, 20 May 2013 15:25:05 GMT

By Kim Newell, MD

Our patients are getting overloaded with health information from more and more sources, and yet they often don’t get to the right answer. Recent studies have shown that more than 98% of the online health-related discussions take place without the input of a health care professional.

How do we make sure that we remain an integral part of our patient’s health care conversations? As a pediatrician in an increasingly complex health care delivery system, in which I must provide more care with higher levels of service to increasingly savvy patients in less time, I have begun to turn to technology, the Internet, and especially social media to help me do my job better.

There are many compelling reasons that I am active in social media.

Social media makes me more efficient: I save time (and my voice) by sending my patients to my website to learn about why their child has green poop or how to tame their diaper rash.
Social media strengthens my connection with my patients: As I write about my joys and foibles in parenting, I become more human, which actually increases my authority with patients.

Social media keeps me up to date: Twitter is now my primary source for news about pediatrics, parenting, and health care policy. Twitter is an information accelerator, and there I get health news hot off the press. It has become the most efficient way for me to keep up both with scientific literature and with the popular media's take on health news (which my patients are reading).

Social media helps me network: Twitter has allowed me to interact with peers and colleagues in ways not previously possible. Just today I conversed with new contacts in three different states about an infant’s undiagnosed GI issue, and then watched a fascinating webcast about social media and health care put on by my own organization that I learned about on Twitter. Through Twitter I have also been asked to write a forward to a parenting book and advise a start-up company on a new mobile health product.
Social media gives me a voice in the sea of health information: Through my blog and Twitter I give scientific, evidence-based, timely and practical guidance on child health and parenting. Without physicians involved, this discussion can be unbalanced. When Jenny McCarthy claims that vaccines are unhealthy for our children on the Oprah Winfrey show and Donald Trump chimes in to agree, we have to get involved in the conversation—otherwise, the conversation is dominated by tweets like this on about the “dangers” of vaccines.

There was a time when we physicians didn’t have to compete for our patients’ attention—we were the one voice in the room. I believe that the core of our healing still happens one on one, with patients in our examining rooms. However, we must also begin to meet our patients where they are: on their smartphones and tablets and computers, doing research and engaging in discussions on Twitter and Facebook and in the blogosphere.

There’s a conversation going on. About health.

If you’re not active in social media, your voice as a physician, a scientist, a healer, and an advocate is likely to be drowned out.

In the end, the key is not in the technology or the tweets: It is in the trust that we build with patients. We, as a medical community, must figure out how to be not only a part of the health-related conversations happening in social media but also to lead those discussions. We can and must use these channels to combat misinformation, promote health, and engage the trust of our patients.

This article originally appeared in the May 2013 issue of San Francisco Medicine.

Dr. Kim Newell is a general pediatrician at Kaiser Permanente and a member of the SFMS board. She began to learn about technology and medicine upon moving to San Francisco for residency at UCSF and is now a technology lead at Kaiser, where she also teaches a class about vaccine safety for parents and helps lead an innovative obesity management program. She tweets at @drkimmd and sometimes blogs at drkimmd.com.

Outdated Communication Technologies Cost U.S. Hospitals More than $8.3 Billion Annually

Thu, 09 May 2013 13:44:41 GMT

U.S. hospitals lose a total of $8.3 billion annually due to inefficient communications technology, according to a new report from the Ponemon Institute the Wall Street Journal's "CIO Journal" reports.

The report was sponsored by Imprivata, a provider of health care security software and services.

For the report, Ponemon surveyed 577 health care and health IT professionals at medical facilities that ranged in size from having fewer than 100 beds to having more than 500 beds.

Findings on Communications Tools

The survey asked participants about the challenges they encounter in using communications tools, finding that:

52% of respondents said that pagers are inefficient
39% said that Wi-Fi is not available
38% said that their email system is inefficient
36% said that text messaging is not allowed
28% said that personal mobile devices are not allowed

Findings on HIPAA's Effects

The survey also asked participants about the effects of complying with HIPAA, finding that:

85% of respondents said that HIPAA reduces the amount of time available for delivering care
79% said that HIPAA makes accessing electronic patient data difficult
59% said that the complexity of HIPAA requirements were a major barrier to modernizing the health care system
56% said that HIPAA restricts the use of electronic communications

Findings on Time Spent Communicating

Survey participants also answered questions related to time spent communicating. The survey found that:

Clinicians said they waste an average of 46 minutes daily as a result of using outdated communications technology
Clinicians estimated that only 45% of each workday is spent with patients, with the remaining 55% being spent communicating and collaborating with other clinicians, as well as using electronic health record systems and other IT tools
65% of respondents said that they believe that secure text messaging could cut patients' discharge time by 50 minutes

Findings on Costs

The report estimated that inefficient communications technology causes the U.S. hospital industry to lose:

More than $5.1 billion annually as a result of decreased physician productivity and the decreased time that physicians have available to spend with patients
About $3.2 billion annually as a result of lengthy patient discharge times

Source: California Healthline, May 9, 2013.

“Pause Before Posting”: New Ethical Guidelines for Physicians and Social Media Usage

Fri, 12 Apr 2013 14:52:04 GMT

Physicians should exercise caution—and “pause before posting”—when interacting in online settings in order to preserve professionalism and maintain appropriate patient-physician relationships, according to a policy paper released today by the American College of Physicians and the Federation of State Medical Boards.

“Online Medical Professionalism: Patient and Public Relationships” addresses the use of online and social media and electronic communication between physicians and patients. The two organizations looked at opportunities and challenges created by new technologies and online forums, and provided recommendations and strategies for physician behavior in these areas.

Digital communications and social media use continue to increase in popularity among the public and medical profession. The ACP policy paper discusses best practices to inform standards for the professional conduct of physicians online and includes a chart of online activities, potential benefits and dangers, and recommended safeguards for physician behavior.

Notable recommendations from ACP and FSMB include:

Physicians should keep their professional and personal personas separate. Physicians should not “friend” or contact patients through personal social media.
Physicians should not use text messaging for medical interactions even with an established patient except with extreme caution and consent by the patient.
E-mail or other electronic communications should only be used by physicians within an established patient-physician relationship and with patient consent.
Establishing a professional profile so that it “appears” first during a search, instead of a physician ranking site, can provide some measure of control that the information read by patients prior to the initial encounter or thereafter is accurate.

The paper will be published in the April 16 issue of Annals of Internal Medicine, and is authored by ACP’s Ethics, Professionalism and Human Rights Committee; ACP’s Council of Associates; and FSMB’s Committee on Ethics and Professionalism.

Click here to view the complete policy paper.

Click here for the ACP press release.

When Email Is Part of the Doctor's Treatment

Wed, 27 Mar 2013 14:34:12 GMT

Patients love it. Physicians find it often saves them time and money. So why aren't more doctors burning up the email lines with their patients?

As the rest of the world has raced ahead with instant communication, medicine still lags far behind. Just under one-third of doctors reported emailing with patients in 2012, up from 27% five years earlier, according to annual studies of more than 3,000 doctors conducted by Manhattan Research, a health-care market-research firm. Those texting rose from 12% in 2010 to 18% in 2012.

Doctors who shun email cite concerns ranging from privacy and security issues to liability, inconvenience and the risk of miscommunication of important medical information. Some also say the time spent emailing with patients is time unpaid. Few doctors charge for the service.

Groups like the American Academy of Pediatrics' Section on Telehealth Care are working on developing initial guidelines on how to deal with electronic communication. Guidelines will address issues such as patient privacy and medical safety.

Those who do email say it is a convenient way to communicate with patients without the hassle of playing phone tag, and that it can keep patients from relying on Google searches that can sometimes lead to inaccurate information.

Jocelyn Bonneau of Manhattan generally asks her doctors up front if they give out an email address. The barriers to actually speaking with a doctor "can be frustrating," said the 28-year-old financial analyst, who said she sometimes will "just give up and Google [my symptom] or just say, 'I'll get better,' and that's probably not the best way." Being able to email with a doctor, like her endocrinologist Andrew Martorella, makes a world of difference, she said.

Dr. Martorella said his patients email him to get blood-test results, refill prescriptions or to say they're running late. He estimates he gets up to 40 or 50 a day, which can take a few hours to respond to. Without email, he said he would probably need at least one extra person on staff to field patient phone calls: "I think it is definitely made a big change in terms of reducing costs, especially for solo practitioners."

Dr. Martorella ends new-patient visits by asking if they'd like to communicate via email. If so, he asks them to sign a form agreeing to electronically communicate about health matters and giving him authority to discuss medical issues over email. The form, he said, ensures that he's in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA) designed to protect the privacy of health information. HIPAA compliance is the main concern raised by doctors who don't email.

The law requires that electronic communication related to an individual's health is protected and secure, said Jane Thorpe, an associate professor of health policy at George Washington University. If someone communicates protected health information electronically through a phone or other mobile device, Ms. Thorpe said, "it needs to be in a secure system," such as one that encrypts messages or through a secure portal. Personal email such as Gmail, she said, is "absolutely problematic."

As part of the federal government's stimulus act, physicians are being encouraged through financial incentives to use electronic medical records. One part of that effort includes the use of secure messaging to share health information with patients through, say, an online portal.

Source: The Wall Street Journal, March 26, 2013.

Technology and Health Care

Mon, 11 Feb 2013 11:25:59 GMT

By Toni Brayer, MD

One of my tennis friends asked me about new innovative smart phone technology and why it hasn't been embraced in health care. She had just watched a video about Dr. Eric Topol, Chief Academic Officer at Scripps Health in San Diego, and his demonstrations of how a smart phone could monitor blood sugar, take EKGs and cardiac ultrasounds, and really deliver health care to the patient at home.

My friend's question, "If this technology is here, why isn't it being used?"

According to Dr. Topol, new apps for the smart phones could eliminate 80% of echocardiograms that are done in facilities at costs between $300 and $1500 each. Having patients come into the office when they experience symptoms or for diabetics to get their blood sugar regulated could be eliminated. New technology could be data driven and personalized and save millions of wasted dollars in health care. So why is medicine so far behind the innovation curve?

The answer: No-one pays for it.

Why aren't all physicians using email to communicate with patients and save them an office visit? The politically correct answer is "remote medicine is not as good as seeing the patient in person and making sure the diagnosis is correct". The real answer is: No-one pays for it.

United States health care has complicated payment systems for work done. The payor for health care services is either Medicare/Medicaid (CMS) or hundreds of different (for-profit) insurance companies. CMS sets the payment rules that everyone follows. Medicare and all insurers will only pay for face to face visits. Reimbursement is for doing more and the more you do the more you get.

The doctor that tries to save a patient time and travel by covering a number of problems in one office visit will not be rewarded and, in fact, will be reimbursed less. If you do a skin biopsy on the same day you do a visit for arthritis flare, CMS and insurance companies will not pay for both things. Do them on separate face to face visit days and... voila!... a better reimbursement for your time and skill.

Email, remote monitoring, remote echocardiograms, discussing tests via a smart phone are freebies. No patient visit means no reimbursement. The cost of putting in high technology is borne by the physician too.

Most physicians and hospitals and surgery centers and labs and pharmacies are happy with this status quo. There is great fear of change and so we continue to spend more on health care than any nation in the world. We do wasteful mass screenings and 1/3 of all prescriptions are a waste. People who need care are not getting it and others are getting too much that they don't need.

ObamaCare is trying to make some gradual changes by supporting pilot programs to change the way healthcare is delivered. But it is slow going and innovative answers are out there. If we could just figure out how to pay for services, while using new cost-saving technology we would all be following Dr. Topol's future dream.

Originally published in EverythingHealth, February 10, 2013.

Toni Brayer, MD is an internist and Chief Medical Officer for Sutter Health West Bay Region. A SFMS member since 1987, Dr. Brayer has served as President, CMA delegate, Editor of San Francisco Medicine, and on numerous committees over the years. She is a Fellow of the American College of Physicians and an Assistant Clinical Professor at UCSF. Dr. Brayer blogs at EverythingHealth.net.

Organized Medicine Advocate for Delay in Meaningful Use Rules

Wed, 16 Jan 2013 14:51:07 GMT

Leading medical groups have called on the Department of Health and Human Services (HHS) to delay implementation of Stage 3 of meaningful use of electronic health records (EHRs), saying providers are still trying to implement Stages 1 and 2.

"Meaningful use" refers to provisions in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use electronic health records in a meaningful way that significantly improves clinical care.

The American Medical Association, which called for a delay in implementation, said the meaningful use program has helped kick start EHR use but noted there are still technical, financial, regulatory, and operational challenges that must be dealt with first.

The American College of Physicians wrote in its comments that Stage 3 measures don't focus enough on patient outcomes, although that was supposed to be their goal. Instead, HHS' measures are a growing collection of functional metrics.

The Association of American Medical Colleges wrote that Stage 3 requirements should strike a balance between imposing difficult measures without having a negative impact on patient care for those providers who don't meet such measures.

In its comments on proposed Stage 3 requirements issued by HHS, the American Academy of Family Physicians called for a delay in implementation until at least 2017, adding it also wants to delay or eliminate penalties for the third and final stage of the EHR incentive program.

HHS finalized its regulations for Stage 2 in August, requiring that physicians complete that stage by October 1, 2014 or face a 1% penalty from Medicare. That was a 9-month delay from its original deadline.

A finalized Stage 3 rule should be released later this year.

Source: Medpage Today, January 15, 2013.

ICD-10: Everything You Know Is About To Change

Mon, 12 Nov 2012 15:23:56 GMT

The transition to ICD-10 is one of the most daunting regulatory requirements ever imposed on physicians. Not only will the number of diagnosis codes dramatically increase from 16,000 ICD-9 codes to 68,000 ICD-10 codes, new formatting and documentation requirements will impact numerous medical office processes and personnel. While the compliance date for ICD-10 implementation of October 1, 2014 may seem far away, physicians are encouraged to start planning for ICD-10 and 5010 transition immediately.

About ICD-10

ICD-10-CM/PCS (International Classification of Diseases, 10^th Edition, Clinical Modification/Procedure Coding System) consists of two parts:

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS is only for use in all U.S. inpatient hospital settings. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

Who Needs to Transition

ICD-10 will affect diagnosis and inpatient procedure coding for all health providers covered by HIPAA. Everyone covered by HIPAA who transmits electronic claims must also switch to version 5010 transaction standards. The change to ICD-10 does not affect CPT coding for outpatient procedures.

ICD-10 diagnosis codes must be used for all health care services provided in the U.S. on or after October 1, 2013. Claims with ICD-9 codes for services provided on or after October 1, 2014 cannot be paid.

Training

SFMS/CMA have partnered with AAPC, the nation’s largest medical training and credentialing association, to offer ICD-10 training to our members. Join us on December 5, from 12:15 pm to 1:45pm, for a free webinar about ICD-10 and how it will impact your practice. Topics covered include:

Key differences between ICD-9 and ICD-10
Scope of ICD-10 transition in a typical medical practice
Key steps in planning a successful transition
Resources to assist you

Click here to view the list of ICD-10 webinars/workshops available to members.

Additional Resources

General ICD-10 Information

CMS-0013-P—HIPAA Administrative Simplification: Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PMS

Transactions and Code Sets Regulations

ICD-10 Basics for Medical Practices

Talking To Your Vendors about ICD-10 and Version 5010 - Tips for Medical Practices

ICD-10 Transition FAQs

Call for Advisory Committee Nominations – California Health eQuality Initiative

Wed, 03 Oct 2012 12:28:20 GMT

The Institute for Population Health Improvement launched the California Health eQuality (CHeQ) initiative in September 2012. Building on previous activities, CHeQ seeks to urgently improve healthcare quality and care coordination by using health information exchange (HIE) technology to facilitate the safe and rapid flow of information among physician offices, hospitals and other healthcare settings.

Through a 16-month, $17.5 million interagency agreement with the California Health and Human Services Agency (CHHS), CHeQ will develop and implement HIE programs according to the state's Cooperative Grant Agreement with the federal Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services.

CHeQ's programs will promote healthcare quality and care coordination by expanding the capacity to exchange health information or access to Direct, a simple, standards-based way for senders to push secure encrypted health information directly to trusted recipients over the Internet. CHeQ also will improve sharing of immunization, laboratory and care-related information and provide tools to assist caregivers identify private, secure, standardized and trusted systems. CheQ is especially interested in promoting HIE development and deployment for improving healthcare quality and care coordination in underserved communities and in leveraging its resources with those of community-based organizations.

To assist CHeQ’s leadership in making strategic and tactical decisions, IPHI will appoint a statewide CHeQ HIE Advisory Committee. This Committee is expected to be composed of approximately nine persons who have demonstrated expertise and experience in the subject matter and who are familiar with the diverse settings and circumstances in which HIE must operate in California. The CHeQ HIE Advisory Committee will be augmented with various standing and ad hoc topic- or task-specific subcommittees that will be convened, as needed. Through these and other activities, we are seeking to establish a California HIE ecosystem that will support the maturation of health information exchange in California and that will evolve with the rapidly changing nature of the technology and many other circumstances attendant to health information exchange. Through this notice IPHI is seeking nominations for members of this Advisory Committee.

How to Apply

To be considered for membership on the CHeQ HIE Advisory Committee, please email the following to iphi@ucdmc.ucdavis.edu by 5:00 pm PST, October 26, 2012:

completed nomination form;
200-word maximum summary biosketch suitable for use in announcements, on the IPHI web site, etc.;
letter of interest and/or short biography highlighting experience relevant to the expertise described below (no more than two pages; anything more than two pages will not be reviewed) [optional].

- health information exchange in California and/or nationally (public, enterprise, or both);
- policy and/or front-line experience using health information technology (HIT) to improve quality of care;
- consumer engagement and healthcare quality;
- promotion of quality and/or HIT standards; and/or
- health informatics and/or and healthcare quality improvement, generally.

Please note that nominations for the CHeQ HIE Advisory Committee membership are for individuals, not organizations.

Time Commitment

The Advisory Committee will meet as frequently as needed, but at least three times in-person and twice by conference call during the 16-month period of the contract. Advisory Committee members also will be asked to review materials and provide feedback via e-mail.

Physicians Input Needed for CALHIPSO Data Analytics/EHR Program; Stipends Available

Tue, 17 Jul 2012 16:15:06 GMT

All SFMS physician members are invited to participate in a focus group regarding CalHIPSO’s (SFMS/CMA’s non-profit partner to provide assistance in EHR adoption for physicians) development of a Data Analytics Pilot Project. The new CALHIPSO project is intended to offer physicians, medical groups, and other health care organizations the ability to extract and analyze their own electronic health information in whatever manner may be desired for the purposes of quality assurance/improvement. To ensure that this project reflects the needs and desires of physicians, CALHIPSO is seeking feedback from physicians through participation in an in-person or a webinar-based focus group. Please see below for available times.

Goals

Gain an understanding of the challenges clinical and operational leaders face in making timely, accurate operations and business decisions
Develop an understanding of your perspectives on various clinical analytics tools if any
Understand how you and your organization currently collect and utilize clinical and business intelligence-related information if at all
Understand how you would relatively prioritize clinical analytics areas
Determine the qualities you most desire or require in a clinical analytics

Focus Group Dates/Times

Each session requires a commitment to attend for two hours, either in person or via a webinar as follows:

IN-PERSON: Monday, July 31, 5:30 – 7:30 pm, at ACCMA headquarters in Oakland
WEBINAR**: Tuesday, July 31, 12:00 – 2 pm
WEBINAR**: Thursday, August 2, 5:30 – 7:30 pm

**Participants in the webinar must have access to a phone line and computer with high speed internet.

Compensation

Participants in the webinar focus groups will receive a $150 stipend. Participants in the in-person focus group will receive $250.

Registration

Please note advance registration is required to participate in the focus groups.

California Physicians' EHR Systems Fall Short of Meaningful Use Criteria

Mon, 18 Jun 2012 11:49:04 GMT

Although most California physicians use electronic health record systems, only 30% of them use EHR systems that have the ability to meet the requirements of the meaningful use program, according to a report by UCSF researchers.

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.

The report summarizes findings from a 2011 survey that UCSF and the California Medical Board conducted for the California Department of Health Care Services and the California HealthCare Foundation.

Report Findings

71% of surveyed California physicians said they use an EHR system at their main practice location (Modern Physician, 6/15);
61% said they use an EHR system that allows them to record clinical notes; and,
45% said they use an EHR system that allows them to generate reports of quality indicators such as the percentage of patients with diabetes who received recommended lab tests.

California physicians at larger health care organizations were more likely to report having an EHR system than physicians at smaller practices, the report found. The report also found that more than half of surveyed California physicians who qualified for EHR incentive payments from Medi-Cal—California's Medicaid program—did not believe they were eligible for the payments. Click here to view the 35-page report.

Recommendations

The report's authors recommended that California officials and policymakers:

Encourage EHR use among small physician practices;
Educate physicians about eligibility criteria for Medi-Cal incentive payments;
Emphasize the importance of using EHR systems that meet the meaningful use requirements; and,
Evaluate whether EHR availability and meaningful use attestation increased after Medi-Cal incentive payments were distributed (Modern Physician, 6/15).

Resources

SFMS has partnered with the California Health Information Partnership and Services (CalHIPSO) and Lumetra to assist our physician members with EHR selection and implementation.

CalHIPSO is a non-profit, vendor-neutral organization that provides technical assistance, guidance, and information on best practices to support and accelerate providers’ efforts to become meaningful users of certified EHR technology. As a federally designed Regional Extension Center (REC), CalHIPSO is working with ten Local Extension Centers (LECs)—Lumetra is the San Francisco LEC—to ensure the availability of local technical assistance, guidance, and information on best practices to support safety net providers in Northern and Southern California in the attainment of Stage 1 meaningful use of EHRs.

Help is available to physicians in all stages of EHR adoption, including:

EHR project management
Consultation on vendor selection
Strategic counsel on practice/workflow redesign
Support on system implementation, health information exchange (HIE), and privacy/security
Resources on patient education on EHRs

SFMS members: For assistance with EHR please contact SFMS, or contact CALHIPSO or Lumetra directly (contact info listed below).
Lumetra: Jeff Gutman or (415) 677-8447

CalHIPSO: Kent Waldsmith or (510) 302-3364

Source: California Healthline, June 18, 2012.

5010 Format Required for Electronic Claims Beginning July 1

Tue, 12 Jun 2012 14:52:20 GMT

The deadline for transitioning electronic transactions to the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards is July 1, 2012. The Centers for Medicare & Medicaid Services (CMS) had previously moved back the enforcement date to allow the industry more time to convert to the new format. CMS now believes that a sufficient number of practices have effectively made the transition and physicians will begin seeing rejected claims as of July 1, if they are not submitted in the new format. You will be required to conduct electronic transactions such as claims submissions, eligibility verification, claims status, remittance advice and referral authorizations using the updated transaction standards.

If you have not successfully converted your programs to 5010, consider using the free CMS software programs PC-Ace Pro 32 (for Medicare claim submission) and EasyPrint (for Medicare electronic remittances). Both programs are available for download from the Palmetto GBA website, www.palmettogba.com/j1b. Click on EDI in the left menu, then on "Software and Manuals."

Commercial payors will also require practices to submit electronic claims in 5010 format on July 1.

SFMS/CMA surveyed the major payors in California to determine their claim submission requirements. While some did require 5010 on January 1, others allowed for contingencies.

Click here to access our member-only reference guide to help with transitioning to 5010 as well as a list of requirements by payor.

Doctors Quick to Integrate Tablet Use into Practice

Tue, 05 Jun 2012 09:00:00 GMT

Study found 62% of physicians own tablet computers, and they are finding creative ways to integrate them into patient interactions and other aspects of medicine.

3 Trends in Physician Online Activity

When a patient enters an exam room at the Wake Forest Baptist Medical Center’s Downtown Health Plaza, a general internal medicine outpatient clinic in Winston-Salem, NC, the visit starts out the usual way. A nurse takes the patient’s vitals, reviews the medical record and says the doctor will be in shortly. What happens next was not typical even two years ago and shows the impact that tablet computers have had on practice life in a very short time.

Before the nurse leaves the exam room, she hands the patient an Apple iPad and queues up one of more than 30 video modules, a choice made based on the patient’s condition or health concerns. The patient then passes the time between the nurse’s visit and the doctor’s arrival watching an educational video. James Wofford, MD, an internist and clinic chief at the Downtown Health Plaza, said the introduction of the iPad helps in teaching a poorer, less-educated patient population about health during what otherwise might be wasted time.

Physician adoption of tablet computers has grown rapidly, according to Manhattan Research’s “Taking the Pulse U.S. 2012” survey of 3,015 physicians in 25 specialties. The survey, conducted in the first three months of 2012, found that 62% of physicians owned a tablet computer, up from 27% in 2011, the first full year after the introduction of the iPad set off the newest wave of tablets. Of the 62% who own tablets, half use them at the point of care. By comparison, most surveys put electronic health record use by physicians at around 50%, and that has required federal incentive programs to help get adoption to that mark.

“I believe docs with an iPad ran to the iPad,” said Lewis Hofmann, MD, a family physician in a two-doctor, hospital-owned practice in the Washington area. “Most docs on an EHR right now were probably dragged to it. No one had to pay me to buy my iPad.”

It helps that tablet computers, compared with EHRs, are inherently mobile and inexpensive. A tablet computer usually doesn’t cost more than $800 at the high end, while an EHR could run in the tens or hundreds of thousands of dollars depending on the model. Doctors also can adapt tablets to their use, unlike EHRs, which tend to force physicians to change the way they work. Physicians are among the many app developers, including the American Medical Association, offering products that make tablets more practical for work.

Monique Levy, vice president of research at Manhattan, said the findings on tablet adoption and use show that “we can finally put to rest this whole idea that physicians are Luddites. When it makes sense, it’s usable, and it gives them something, they’re going to do it quickly.”

Not Just Bigger Smartphones

Frances Dare, senior executive with Accenture Health, a consulting and research firm, said physicians quickly realized that tablets are “so much more than a smaller version of the computer.” Because tablets are portable, multifaceted communication devices, combined with a camera, bar-code reader, video player, research tool and apps for just about anything, physicians value their convenience.

They also find that tablets are more than just oversized smartphones. They see so many benefits that they now engage with patients and one another in ways that didn’t exist before, Dare said.

Eric Goldberg, MD, an internist with the Murray Hill Medical Group in New York, said it is technically possible to do some things he now does on his tablet with a smartphone, but it isn’t practical due to the limited screen size. With his tablet, he can gain remote access to his EHR and view or enter patient data at the point of care, eliminating the scrap pieces of paper he used to collect in his pockets with information he later entered into the EHR on a computer.

Having that remote access has been especially helpful when he is on call. He can make more informed decisions by having a patient’s information at his fingertips.

Source: American Medical News, June 4, 2012.

3 Trends in Physician Online Activity

Manhattan Research’s “Taking the Pulse U.S. 2012” survey of 3,015 physicians in 25 specialties didn’t ask only about tablet computing use. Among other conclusions:

Physicians with three screens (tablets, smartphones and desktops/laptops) spend more time online on each device and go online more often during the workday than physicians with one or two screens.
Adoption of physician-only social networks remained flat from 2011 to 2012. Physicians reach out more frequently to and are more influenced by colleagues they formed relationships with at school or at work than peers they first connected with online.
More than two-thirds of physicians use video to learn and keep up-to-date with clinical information.

Source: “Taking the Pulse U.S. 2012,” Manhattan Research

HealthShare Bay Area Founding Members to Form Health Information Exchange

Tue, 10 Apr 2012 15:25:11 GMT

Eighteen Bay Area health care organizations will be founding members of the region’s first community health information exchange (HIE) program, HealthShare Bay Area (HSBA).

The founding 18:

Alameda-Contra Costa Medical Association
Alameda County Community Health Center Network
Alameda County Medical Center
Brown & Toland Physicians
California Pacific Medical Center
Glide Health Services
Haight Ashbury-Walden House
Hill Physicians Medical Group
John Muir Health
John Muir Physician Network
Lyon-Martin Health Services
Mission Neighborhood Health Center
North East Medical Services
St. Anthony Medical Clinic
San Francisco Department of Public Health
San Francisco Medical Society
South of Market Health Center
Women’s Community Clinic

The HealthShare Bay Area HIE will provide a secure, safe, and interoperable method for exchanging patient health information among providers of care and patients in the San Francisco Bay Area.

In the coming weeks, the founding members will form a governing board for the HIE. The board will then contract with a vendor that will provide the technical infrastructure for the exchange. The chosen technology will operate according to robust data privacy and security standards.

The governing board will also be tasked with securing additional funding for HSBA. The HIE’s four-year, $11 million startup and operating cost will come primarily from the founding members’ participation fees. Additional federal and private grants will be sought to supplement expenses as HSBA develops. New members joining the exchange in the coming months will provide additional revenue.

HealthShare Bay Area began as a grass-roots community initiative. In August of 2009, the California eHealth Collaborative brought together various San Francisco parties interested in creating a HIE within the city. This meeting was precipitated in large part by the passing of the American Reinvestment and Recovery Act (ARRA), which allocated $20 billion for the deployment of health information technology. The ARRA also calls for medical organizations to participate in HIEs.

In March of 2010, a governing committee was formed under the auspices of the San Francisco Medical Society Community Service Foundation. A similar movement was also underway in the East Bay – the Alameda-Contra Costa Health Information Organization, fostered by the Alameda-Contra Costa Medical Association. That fall, the San Francisco and East Bay groups joined forces. In April of 2011, the effort officially became HealthShare Bay Area.

California to help health providers secure Medicaid incentive payments for demonstrating meaningful use.

Wed, 04 Apr 2012 14:04:22 GMT

California has set a goal of having 10,000 eligible health care providers by June receive Medicaid incentive payments for demonstrating meaningful use of certified electronic health records, according to a CMS blog post published recently by National Coordinator for Health IT Farzad Mostashari and CMS Acting Administrator Marilyn Tavenner.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

Nationwide Goals
In the blog post, Mostashari and Tavenner wrote that they have set a goal of helping 100,000 health care providers qualify for Medicare or Medicaid incentive payments this year.

As of February, more than 59,000 eligible health care professionals and more than 2,000 hospitals had received Medicare or Medicaid incentive payments, they noted.

States’ Progress
Mostashari and Tavenner wrote that many states, including California, “are partnering with local stakeholder organizations to make sure providers get the help and encouragement to achieve ‘meaningful use’ and assistance with overcoming any barriers that are blocking their progress”.

EHR Assistance
SFMS is partnering with Regional and Local Extension Centers to provide assistance with EHR adoption and implementation. REC and LEC support and serve health care providers to help them quickly become adept and meaningful users of EHRs. The target audience of RECs is primary care clinicians, but many RECs offer assistance to specialists, as well. If you need assistance as you look into transitioning to EHRs and participating in the CMS EHR Incentive Programs, consider contacting:

California Health Information Partnership and Services Organization (CalHIPSO)
www.calhipso.org
(888) 589-4897

Lumetra, San Francisco Local Extension Center
www.lumetrasolutions.com
(415) 677-2081

Assistance with EHR Adoption

Wed, 07 Mar 2012 15:55:27 GMT

Are you a primary care provider looking for assistance with Meaningful Use and EHR? SFMS is partnering with Lumetra, a local extension center for San Francisco, to fill available slots for priority primary care providers (PPCPs) to receive subsidized services from CalHIPSO.

These openings will be competitive and enrolled on a first come first serve basis. The following conditions apply:

The referred provider must be eligible for CalHIPSO services and MUST be able to reach Meaningful Use - No specialists.
All of the enrollment spots (M1 credit) have been already filled. We are looking to replace Bay Area providers who have been enrolled, but have let us know that they will not be going live and/or reaching Meaningful Use.
Since theses providers serve as replacements for providers who had already earned enrollment credit, we will not be able to pay the medical society for their enrollments.

Please contact Jeff Gutman at jgutman@lumetrasolutions.com or (415) 677-8447 to enroll reserve providers. The eligible Bay Area counties include San Francisco, San Mateo, Santa Cruz, Monterey, Contra Costa, Alameda, Santa Clara, San Benito, San Joaquin, Stanislaus, and Merced.

CMS Releases New Health IT 'Meaningful Use' Rules

Fri, 24 Feb 2012 12:36:37 GMT

It’s time to take electronic health records to the next level. CMS on Thursday released their second-stage guidelines for “meaningful use” of electronic records, which advocates say have the potential to reduce medical errors and streamline care.

The proposed rules require doctors and hospitals to significantly step up their usage, as well as better engage patients and improve the transferability of records. Under the proposed Stage 2 standards, hospitals as well as eligible professionals—the latter category includes physicians not employed by hospitals—would have to use Computerized physician order entry (CPOE) for more than 60% of medication, laboratory and radiology orders, double the share required under the Stage 1 standards.

The CPOE requirement is one of more than a dozen core objectives that hospitals and EPs would have to meet as part of demonstrating their meaningful use of electronic health-record systems, which would make them eligible to receive federal health IT incentive payments. Other core objectives for both hospitals and EPs include the use of electronic prescribing for more than 50% of prescriptions issued, the recording of demographic data for more than 50% of patients, recording of vital signs in more than 80% of patient encounters and recording smoking status for more than 80% of patients.

In an effort to promote electronic engagement with patients, Stage 2 would require that more than 50% of patients be provided online access to their health information and demonstrate that more than 10% had actually accessed that information. Among the proposed menu objectives for EPs are electronic recording of family health history for more than 20% of patients, successful ongoing transmission of syndromic surveillance data, successful ongoing transmission of cancer case information and successful ongoing transmission of data to a specialized cancer registry. For hospitals, menu objectives include electronic recording of advance directives for more than 50% of patients and the use of electronic prescribing for more than 50% of discharge prescriptions.

San Francisco to start Health Information Exchange

Tue, 21 Feb 2012 14:35:13 GMT

HealthShare Bay Area is a health information exchange that will electronically link health records within the San Francisco medical community, as well as the greater Bay Area. Exchange of this data is expected to improve efficiency of healthcare delivery, decrease costs, and ultimately improve patient care within San Francisco. The San Francisco Business Times published an article in its recent issue that discussed HealthShare Bay Area and prominently mentioned SFMS.

By Chris Rauber

Behind closed doors, a number of San Francisco hospitals and medical groups are working with the San Francisco Medical Society and the city’s Department of Public Health to launch a health information exchange linking local emergency rooms and other clinical sites. By 2015, participants expect to invest nearly $11.7 million in the effort, dubbed HealthShare Bay Area, designed to improve quality while cutting administrative and unnecessary clinical costs.

The initial group of participants includes the medical society; Dignity Health (formerly Catholic Healthcare West) and its two San Francisco hospitals, St. Mary’s Medical Center and Saint Francis Memorial Hospital; San Francisco General Hospital and the city’s network of community health clinics; Brown & Toland Physicians; Hill Physicians Medical Group; UC San Francisco; Chinese Hospital Association; California Pacific Medical Center and the Mayor’s Office. Insiders say the only big players not to sign on are the VA Hospital and Kaiser Permanente, although Kaiser is sitting in on meetings.

The initiative has been housed under the Medical Society umbrella, but is looking to gain independent nonprofit status. It’s also signing up participants in San Mateo County and the Easy Bay, including John Muir Health. The project—co-chaired by Dr. Arieh Rosenbaum, a hospitalist affiliated with CPMC, and Dr. Amy Berlin—isn’t talking publicly yet about its plans, but expects to in coming months. A business plan dated Nov. 2, 2011, said HealthShare Bay Area hopes to raise $1.25 million in grants and $475,000 in seed money from founding organizations to fuel its first two years of operation, and to be self-sustaining by 2013.

Source: San Francisco Business Times, February 17, 2012.

CMS EHR Information Center Updates

Thu, 09 Feb 2012 11:17:24 GMT

CMS has recently updated previously-posted FAQs and added new FAQs on several incentive program topics, including reporting periods and incentive payments. Answers to common questions about disbursing 2011 incentive payments, reporting periods, determining Medicaid patient volume are now posted on the site.

The Electronic Health Record (EHR) Information Center Interactive Voice Response (IVR) system has also been enhanced to provide users with an increased number of options and services to make accessing and reviewing data easier than ever before.

For eligible professionals, eligible hospitals, or critical access hospitals (CAHs), the revised functionality vastly improves the efficiency in obtaining desired information, while also offering a more varied amount of information and options for callers. Providers can now obtain information through an extensive IVR Self-Service option. Included in this option is a reinforced privacy protection module that requires your individual National Provider Identifier (NPI), the last five digits of your Tax Identification Number (TIN), and your EHR registration ID. Once accepted, this newly enhanced Self-Service tool allows you to:

Obtain registration status
Acquire attestation status
Review payment information
Check progress towards meeting the $24,000 threshold amount

Users may access these new options by dialing (888) 734-6433, pressing 3 for Self-Service, and entering the authentication elements. These options will be available on the IVR effective February 16, 2012.

EHR Information Center Hours of Operation: 7:30am-6:30pm CT, Monday through Friday, except federal holidays. Please note that General Information and Self-Service options may be reached via IVR 24 hours a day, except during periods of planned system maintenance or upgrades.

More California Doctors Submitting Electronic Prescriptions

Thu, 09 Feb 2012 10:42:27 GMT

The percentage of California physicians who electronically prescribe medications has increased steadily over the last few years, according to a report from Cal eConnect, the agency that oversees health information exchange in California. The report found that about 25% of California's physicians currently e-prescribe, up from 3% in 2007. However, the report notes that only about 16% of eligible prescriptions are sent electronically, even though most California pharmacies are set up to receive e-prescriptions.

Source: California Healthline, February 9, 2012.

Free Assistance with EHR and Meaningful Use

Mon, 06 Feb 2012 16:27:52 GMT

SFMS has partnered with the California Health Information Partnership and Services (CalHIPSO) to assist our physician members with EHR implementation.

CalHIPSO is a non-profit, vendor-neutral organization that provides technical assistance, guidance, and information on best practices to support and accelerate providers’ efforts to become meaningful users of certified EHR technology. As a federally designed Regional Extension Center (REC), CalHIPSO is working with ten Local Extension Centers (LECs)—Lumetra is the San Francisco LEC—to ensure the availability of assistanceand information on best practices to support safety net providers in Northern and Southern California in the attainment of Stage 1 meaningful use of EHRs.

Bay area priority primary care providers still have the opportunity to receive subsidized technical services to implement and effectively use an EHR.

Receive technical assistance with your EHR Implementation from CalHIPSO and a network of skilled professionals who can help you make informed decisions.
Access to CalHIPSO’s EHR vendor contracts, which include reduced pricing and pre-negotiated contract terms
Educational webinars on Meaningful Use, privacy and security, EHR incentive programs, REC membership, and more!
Discounted HIPAA privacy and security compliance program tools through PrivaPlan
Obtain assistance demonstrating Stage 1 Meaningful Use

Join CalHIPSO by February 29, and membership is free through 2014. Visit www.CalHIPSO.org to enroll today.