June 23, 2008

1. EMR Docs Few in Number, but Happy, Especially When Hospitals Foot the Bill

Facts and Background

A New England Journal of Medicine article published Wednesday reports the results of a large-scale physician study of EMR usage. Only 4% of doctors reported having advanced systems, with cost being identified as a barrier. However, respondents reported a high satisfaction rate with their EMRs and indicated that they provide value in patient care.

Opinion

The bottom line: EMR users report significant patient care benefits, but doctors want someone else to pay for those systems, preferably that someone who benefits financially from their use.

Musings

• Unlike NAHIT, which simply says that EHRs are anything certified by CCHIT, the survey actually broke out specifically functionality of "basic" and "fully functional" EHR systems, using a panel of experts and the IOM's framework. That's a heck of a lot better definition than ONCHIT got for its BearingPoint terminology definition money.
• Immediate respondents were paid $20 and non-respondents got a follow-up letter and another $40, lending credibility to the "good things come to those who wait" theory.
• Odd: the survey excluded DOs, who are fully equivalent to allopathic practitioners (MD) in every state. Sounds like some Boston bias crept in. DOs are not chiropractors, after all.
• The survey also didn't ask questions about whether the doctors find the time and effort required to use EMRs is worth it.
• Biggest flaw: the survey didn't distinguish "having" from "using" EMRs. It did not also distinguish usage at the practice level. The survey didn't take patient load into account, so 4% of doctors doesn't mean 4% of patient visits.
• Most important pro-EMR finding: even basic EMR users reported clinical benefits, with large percentages of respondents reporting that the system had helped them avoid prescribing drugs to which patients were allergic, to be aware of importabt lab results, and avoiding drug interactions. However, these are the simple, no-pain EMR functions, not the challenging capabilities like documentation. Perhaps EMR adoption should be stratified by function and value, i.e. just getting everyone using functions that grab the low-hanging fruit like this would be a big step.
• Everybody knows that doctors could practice better medicine given extra time, with or without EMRs. The challenge is the same: to get those who benefit from better care to pony up for it, whether it's EMRs or having more time to listen to patients and perhaps NOT prescribe or treat when it's unnecessary.
• Given the small number of respondents who reported EMR use, it's probably unwise (but also inevitable) to extrapolate the reported benefits and satisfaction.
• This was an expensive study (after all, the government was involved) and it answers a few questions while introducing some new ones. Broad measures aside, the real question is this: what would it take to get individual, average doctors to implement and use EMRs? Who benefits and who pays? Does the design of EMRs require too much physician time?

2. Cattails Sprout in Marshfield

Facts and Background

Wisconsin governor Jim Doyle announced Friday that 12-hospital Ministry Health Care will implement the CattailsMD clinical system developed by Marshfield Clinic.

Opinion

It's interesting that the clinic's ambulatory EHR product is apparently headed for commercialization. Also, while the announcement doesn't say specifically, it's pretty obvious that CattailsMD is an outpatient-only system that won't replace Ministry's inpatient systems, which should have been stated more clearly.

Musings

• This is an ambitious project, estimated to take 3-5 years.
• Self-development projects like CattailsMD always raise the question: do better products result when users build their own vs. vendors doing it for them? The likely outcome: some vendor with deep pockets (GE?) will license it.
• The biggest challenge that non-IT folks would never suspect: meshing the cultures of two organizations that are aligned in some says, but likely to conflict in others.
• At least we know now why Marshield Clinic bothered to get CCHIT certification for a homegrown, internal product.

3. MEDecision: We'll Take 4x Share Price Any Day, Even From Our Customer

Facts and Background

Publicly traded case management systems vendor MEDecision, Inc. of Wayne, PA announced Wednesday that it will be acquired by Health Care Service Corp., a Chicago-based insurance plan operator and its largest customer, for $121 million, quadruple the current share price.

Opinion

MEDicision shares closed at $1.71 on Tuesday. HCSC offered $7 in cash for a money-losing company with only $46 million in revenue, negative cash flow, and shaky prospects. Sounds like a terrible deal for HCSC, other than the fact that HCSC is MEDecision's biggest customer, accounting for 25% of the company's revenue, according to its May 10-Q. That means it was paying $10 million a year to MEDecision already, so maybe it made sense to just buy the company outright, especially if its future was uncertain and its technology was mission critical to HCSC.

Musings

• MEDecision founder, chairman, and CEO David St. Clair will pocket $13 million in cash from the deal.
• MEDecision will continue to operate independently, selling its wares to the competitors of its parent company (in theory, anyway).
• HCSC announced last year that it was developing Blue Care Connection to merge its patient data into a single system. That application uses MEDecision's Patient Clinical Summary application to integrate clinical information and recommend treatment options to doctors.
• The MEDecision acquisition could signal an interest in developing an even more functional, yet proprietary, clinical data exchange system for physician providers of HCSC's Blue Cross plans.

Subscriber Name: %%Name%%
Subscriber E-Mail: %%emailaddress%%
Subscribe Date: %%subscribedate%%
Unsubscribe

© 2008 HIStalk. All rights reserved.