Ken Terry

Despite state laws and class-action settlements, many insurers still force doctors to take plans they don't want.

Payers' efforts to measure and report on physician performance draw fire from the AMA and AAFP.

Going online with pharmacies can save you time and improve patient care, but liability issues may increase.

Information exchange between U.S. hospitals and community physicians is still fairly primitive. So it's surprising that a continuing care retirement community has taken the lead in establishing interoperability with a non-related-hospital.

Despite the rising competition from companies offering certified EHRs for half of what the name-brand vendors charge, some of the latter say they have no plans to lower their prices.

Doctors have nothing but praise for a government program that helps them adopt electronic health records.

Making patient data easily accessible across healthcare systems and to physicians in their offices has been a persistent challenge for many hospitals. The main problem is that the data resides in many disparate databases that are generated by incompatible types of software. Bigger hospitals with deep pockets have solved the problem by hiring vendors to integrate their systems so that they can offer viewable data to physicians and administrators. But many hospitals have not done that, and even healthcare systems that have done it are jointly offering a single web portal for physicians in only a few markets.

Eight months after the government relaxed the Stark restrictions on hospital donations of EHRs to physicians, the Memorial Hermann Health Network Providers IPA in Houston, TX, has announced plans to help around 1,300 staff physicians gain access to remotely hosted EHR and practice management software from eClinicalWorks. The IPA?s subsidy, to be funded mostly by the hospital system, will cover about half the cost of the software, says Scott Fenn, CEO of the IPA. This appears to be the largest?and one of the first?examples of hospitals taking advantage of the Stark exception.

That's what West Virginia's Medicaid program is aiming for. But in the process, physicians may be put in a very bad place.

When the HIPAA electronic transaction standards went into effect in October 2003, they were expected to simplify administrative transactions in healthcare. But instead, they merely clogged up the works (Medical Economics, "Not getting paid? Blame HIPAA," June 4, 2004). The key problem was that the payers hadn't reprogrammed their information systems to accept standard transactions. Instead, they issued hundreds of "companion guides" that tweaked the standards to fit each of their systems.

The technology for health plans to process claims online in real time has been available for several years (Medical Economics, "Claims in, approval out—in seconds," July 9, 2001). But until recently, there hasn't been any compelling reason for plans to invest in that when they could hold onto physicians' money instead. Now, however, the advent of health savings accounts and the growth of patient cost-sharing have prompted several plans to take a second look at real-time claims adjudication. The idea is to tell patients what they owe at the point of care, so that their payments can be deducted automatically from their health savings accounts or flexible spending accounts.

Three very different practices embark on their EHR journey with different approaches. We'll follow them over the next year so that you can learn from their experience.

Stark allows unrelated practices in the same building to share ancillaries. But you need to tread very carefully.

While the recent Stark rule changes, in theory, allow hospitals to help doctors acquire EHRs, few have moved to take advantage of them. "It's like they've got the music playing, but nobody's jumping on the dance floor yet," observes Tim Gutshall, MD, clinical coordinator of the Iowa Foundation for Medical Care, a Medicare Quality Improvement Organization. One reason is that the nonprofits are still waiting for the IRS to say whether they can subsidize EHRs without losing their tax exemption (Infotech Bulletin, Oct. 27). In late November, the AHA asked the IRS to clarify that point, so we may be hearing from the feds soon.

The EHR Vendors Association has elected Don Schoen, CEO of MediNotes, as its new chairman, and GE executive Hugh Zettel as vice chairman. They succeed co-chairs Charlene Underwood, director of government and industry affairs for Siemens, and Andrew Ury, MD, CEO of Practice Partner.

There's no longer any excuse not to get your CME. By going online, you can earn credits at your convenience, anywhere, for free.

A new reimbursement method based on case rates seeks to go where P4P hasn't.

The Delaware Health Information Network recently agreed to use software from Medicity as its connectivity hub, according to Health Data Management (Oct. 23, 2006). Medicity has subcontracted with Perot Systems to provide a data center, help desk and outreach training services.

EHR vendor MediNotes and Per-Se Technologies, another software vendor, have created a "best of breed" information system for small practices. Physicians who use Per-Se's Medisoft and Lytec practice management systems can now add MediNotes' EHR without having to purchase an interface between the two. Of course, the systems are still interfaced, which means they don't use a single database and are not fully integrated. But if you have a problem with the interface or either system, says MediNotes' Don Schoen, you can go one of the companies' resellers and get help.

New Hampshire Governor John Lynch has become the latest governor to call on all physicians in his state to start e-prescribing by a certain date (Nashua Telegraph, Oct. 20, 2006). Following the lead of the chief executives of Illinois and Rhode Island, Lynch wants all New Hampshire doctors to send prescriptions online to pharmacies by October 2007.

You don't have an e-prescribing program, but wish you could reduce the number of pharmacy calls regarding refills? Help may be on the way. Navimedix, a national company that provides web-based, health plan-sponsored administrative services, recently started offering a free service that connects physician offices online with pharmacies for prescription renewals, patient drug histories, and formulary lookups. The only thing physicians have to do is allow Navimedix to include some patient care messages from plans and disease management companies on the refill queries from pharmacies.

The government-backed Certification Commission for Healthcare Information Technology (CCHIT) recently certified 11 EHRs that met its criteria for functionality, security, reliability, and interoperability. Including these products, CCHIT has now certified a total of 33 EHRs

A management services organization can take some hassles off your back, but there's a price. Make sure you know what you're getting into.

A review of studies of EHR penetration concludes that about a quarter of U.S. physicians are now using some kind of electronic health record in ambulatory settings (Health Affairs Web Exclusive, Oct. 11, 2006). However, the researchers from Harvard University and George Washington University point out that only 9 percent of physicians used EHR systems with advanced functions such as electronic prescribing. Furthermore, they cite a large disparity between adoption rates in large and small practices.

The Misys Center for Community Health Leadership, an affiliate of the big software vendor, is ready to give $10 million worth of Misys products to communities that want to build health information networks. Hospitals, physician practices, home health agencies, and community organizations can apply for grants through the end of the year. The applicants need to state how their projects would promote connectivity among local healthcare providers, and they have to be willing to participate in studies of return on investment.

In the absence of countervailing action from an election-crazed Congress, the new federal rules allowing hospitals to help physicians acquire health IT went into effect Oct. 10. Under the new exception to the Stark self-referral law and a new safe harbor to the Anti-Kickback Law, hospitals and group practices can donate up to 85 percent of the value of EHRs, e-prescribing systems, and technical support to physicians under certain conditions (Medical Economics, "Feds to hospitals: It's OK to help docs get IT," Aug. 18, 2006).

The Hawaii Medical Service Association, a Blues plan, will invest $20 million over the next three years to help physicians acquire EHRs. The association will pay up to half the cost or up to $20,000 per physician, according to iHealthBeat, a publication of the California Healthcare Foundation. Previously, the Hawaii Blues subsidized e-prescribing systems and negotiated a 40 percent-off discount deal on Allscripts EHRs (Medical Economics, "EHRs: Where do payers fit in?" Feb. 17, 2006).

That's what some payers think. For the past year, Shared Health, a subsidiary of Blue Cross Blue Shield of Tennessee, has been offering doctors an online community health record that now encompasses nearly 2 million patients, or about a third of the state?s population. Included in the electronic record are claims data from all providers who treat a patient, as well as lab results from reference labs and medication histories from PBMs (Medical Economics, The rocky road to RHIOs," Feb. 17, 2006). Among the patients in the database are all Medicaid recipients, 600,000 people in the Blues? fully insured plans, and the Tennessee-based workforce of Nissan North America.

Among the winners of HIMSS? 2006 Davies Awards are two primary-care practices that have gone the extra mile in health IT, Alpenglow Medical of Fort Collins, CO, and Piedmont Physicians Group of Atlanta.

With the Department of Health and Human Services on the verge of implementing its previously announced exceptions to the Stark rules and the Anti-Kickback Law, a new survey shows that the majority of physicians would welcome help from a hospital in implementing EHRs or e-prescribing systems.