Today Allscripts & Intuit announced a deal that will integrate Allscripts Practice Management with Intuit Quicken Health systems. Last week at the Health 2.0 Conference Intuit Quicken Health was one of the best demos because you could see how it really changes the patient’s experience. I can’t wait to see it working in combination with an EHR/PM system!

Instead of using CPT descriptions on EOBs they use descriptions patients can easily understand so they know what they’re paying for. It breaks down payments into easily understood math. If the patient doesn’t agree with something on the bill, they can fix errors right on the website. The patient is also able to pay straight from the website.

I saw that Midmark announced their new promotion IQology that is a great deal if you’re thinking about buying devices this year. Basically you get points when buy a device and can use those points to buy supplies or another device. So here’s the deal:

Eligible Products

• ECG – 4 Points
• Cart – 1 Points
• Spiro – 2 Points
• Holter – 6 Points
• Holter EX/EP – 8 Points
• Holter Recorder – 2 Points
• Stress – 8 Points
  

Incentive Products

• $100 Supplies – 1 Point
• $300 Supplies – 2 Points
• Laptop – 6 Points
• Desktop – 8 Points
• Cart – 4 Points
• Holter Recorder – 6 Points
• Spiro – 6 Points
• ECG – 12 Points
  

So when you buy 3 ECGs, you get the 4th one free. If you only want to buy an ECG, you get a cart for free. You buy a Spiro, you get a bunch of supplies for free. So if you’re thinking about buying a device for your EHR, now is a great time because there are fantastic deals. Contact your local Midmark rep for more info.

Today, Dell announced that they will be purchasing Perot Systems in order to improve Dell’s market share in the healthcare IT sector and increase Perot’s international presence. This is another major shift in the EHR market to include some of the big IT powerhouses, which this year has included SalesForce.com’s alliance with PracticeFusion and the eCW / Sam’s Club / Dell deal. As we predicted when ARRA came out, the high profile stimulus is going to continue to reshape the healthcare IT vendor make-up.

A year ago, the major player in NextGen hosting was Tellurian Networks with quite a few hosting clients. Tellurian started as a small hosting operation, and does an excellent job of capturing much of the new EHR ASP hosting market, growing quickly to a powerhouse within its niche. Tellurian was picked up by Perot Systems in November 2008 in a very smart acquisition. So now the customers who signed up for Tellurian will fall under Dell. With Dell’s immense resources, it will be such an exciting change for clients using the ASP model!

Last year, TempDev released our Free Flu Shot Clinic package. To help practices prepare for the coming flu season, the package has been updated to include the codes for the H1N1 vaccine.

The new package still requires only two clicks to document the vaccine, but these two clicks can now be configured to document both the seasonal flu vaccine and H1N1.

The package is also still free for all practices using NextGen! To schedule your free installation, simply fill out this online form.

Business Wire carried this interesting press release regarding NextGen’s continued success in the CHC / FQHC market. While this blog posting might read like an all out commercial for NextGen, I am sincerely impressed with NextGen’s ability to meet the needs of CHCs.

• Out of the box UDS reports, which gather the data directly from the EHR and EPM.
• An open data structure allows for query data to generate reports for grants and other sources of funding, critical for CHCs.
• The ability to customize templates to meet the specific needs of the patient population (which vary much more on the lower end of our country’s socio-economic spectrum) and gather custom data elements needed for grants.
• The flexibility of EPM to meet odd billing requirements oftentimes required by public payers.

With the go-live going well at the main facility, I spent the night at the second facility. The second facility is for inmates that are being housed for a longer period of time and does not include a booking department. This simplifies support, except that the second facility is much, much larger in both population and physical area.

We met with the staff and emphasized the benefits of the application, especially around minimizing documentation on the myriad of forms they currently use while also helping to ensure that tasks were not missed. This seemed to ally a lot of fears.

I went with the nurse who had the greatest number of assignments to complete. Interestingly, I recognized one of the inmate’s names who was booked the previous night. Just as planned, the protocol started in Booking had automatically followed the inmate as they were transferred to the second facility and was now showing on the nurse’s worklist. It was great to see the weeks of hard work pay off!

I happened to go to lunch (or whatever you call eating at midnight) at the same that a group of inmates was being released. Ironically, this is the first time I felt insecure being at a jail. The officers do such an excellent job of keeping the jails orderly and the inmates safely under control. But the group outside of the jail, waiting to pick up the released inmates, was almost in a riot-like frenzy. I never thought I’d feel safer inside the jail than outside of it!

As expected, our hands-on approach really turned things around for the second facility. The nurses were certainly still hesitant, but turned a corner when they began to see the benefits. This is my last night of go-live support, but now that the nurses are accepting of the application, the next nights’ trainers should have an easy time of maintaining the deployment.

All in all, this has been one of the smoothest go-lives I’ve been involved with. I attribute this to the excellent planning by our team, especially the time spent on workflows and developing the application to meet the unique needs of the jails. The life experiences gained from working in a custody environment also made this, surprisingly, one of the most fun implementations I’ve worked on. I’m looking forward to this November’s go-live when we can bring even more functionality to the users. Until then, I’m going to catch up on some sleep!

For the second night, the laptops were working well. As a result, we spent much of the night following the nurses around as they went from housing unit to housing unit. Once again, the major focus was on diabetic patients due to the number of fingersticks.

Jails often don’t follow normal hours. For example, breakfast at this jail starts at 2:30 am. This means that patients who need their morning finger stick prior to breakfast have to be woken prior to 2 am. If having to stick yourself and get an injection at 2 am every morning isn’t enough motivation to manage your diabetes, I don’t know what is.

Booking was even more exciting than last night. The inmates were much more argumentative, verbally accosting both each other and the officers. Interestingly, most of the nurses who I encountered in booking were female and of small stature. I wholeheartedly respect what they must endure on a daily basis.

As far as the EHR deployment, the nurses were again extremely positive. The templates, workflow, and interfaces are all holding up very well in practice. We had a few disconnects of the wireless when moving between housing units, but that’s to be expected when the walls are several inches of reinforced concrete!

We had a conference call with our colleagues who were implementing the other location, and they’re struggling getting the nurses on-board. Their approach has been much more hands-off; instead of literally following the nurses from housing area to housing area, they have been waiting in a central command center. I’m of the belief that the nurses are simply nervous about using the EHR and will come around with some additional hands on help. We’re going to flip-flop the teams tomorrow night to see if new faces and a more hands-on approach can turn things around. Keep your fingers crossed!

I’ve quickly realized that rolling out an EHR in a jail is remarkably different than any other setting: the staff is used to the unexpected. That makes them strangely open and accepting of change, even if they are uncomfortable with working with computers. The night took on an almost eerie quality as the nurses eagerly embraced the change. I wish all go-lives went this smoothly!

We chose to roll out in an interesting fashion: all patients who had a new complaint would be entered into the electronic system, with resulting orders, including recurring orders, being carried out electronically. This would allow for a naturally increasing roll-out as more patients were assessed. As the inmate population rolls over, all inmates will be quickly electronic.

The biggest issue of tonight’s roll-out was wireless at the main facility. The wireless drivers in the laptops was having trouble roaming from one access point to another. That portion of the project has been specifically carved out of the scope of our EHR roll-out, so I will not say anything further.

I spent most of my time in booking, while the rest of the project team helped the nurses in the housing unit. Booking at 2am is an exciting place. I had specifically visited booking at night so knew to expect the inebrietated, angry, and sobbing clientele. A couple “straight-laced” individuals came in, including a man in a full business suit, and I wanted so badly to ask “so, what are you in for”. Unfortunately, conversing with inmates is strongly discouraged.

The only thing I found disturbing about booking was the number of “frequent fliers” who knew the process all too well. Their relaxed, almost conversational demeanor reminded me of anyone else making small talk at their job. Certainly, an interesting commentary on our society.

The booking process itself wasn’t part of the roll-out, but the scope did include standardized procedures that had to be initiated by the nurses for a medical condition. The main standardized procedure used in booking is for diabetes, so the nurses started asking inmates if they were diabetic, even before asking their names. I encouraged them to continue their existing way of asking questions and not alter their clinical decision making based on the EHR.

I wish I had more to report, but tonight’s go live was extremely uneventful. There’s a large pub crawl going on tomorrow with students from the local college, so the next night should be much more interesting.

This week, I have the unusual privilege of bringing an EHR live in a custody health setting. In other words, I’m going to jail for three days. Oh, and I’m working the night shift!

I’ve been working with a large county health agency, which includes the outpatient portion of a public hospital, community clinics, and custody health services. The roll-out has gone well, with 180 providers live on the EHR in 6 months. My piece has been implementing a development methodology that allows the organization to roll-out extremely quickly while still ensuring the providers’ needs are met. I’ve also helped with the development work directly.

This next phase is bringing live 200 nurses who provide a blend of outpatient and inpatient services. They’re responsible for supporting physician clinics, delivering medication and treatment, triaging patient complaints, and medical intake. The nurses have a tough job, which they perform 24-hours a day, 7 days a week.

We’ve done our development work on NextGen EHR, including the build for the hospitals, clinics, and jail. NextGen has been a great choice, enabling ng us to meet very distinct and unique needs while allowing for seamless sharing of patient data throughout the organization. For the jail, we essentially turned NextGen into an inpatient CPOE; a role it is handling extremely well.

This week’s roll out is of the triage and treatment administration templates. Later in the Fall, we will be rolling out medication administration and medical intake. The final phase, next Winter, is for mental health and the infirmary.

Due to limited resources, everyone on the project has been asked to help out with this next phase of the go-live. Since I don’t have a family (well, besides my cat) and enjoy experiencing the stranger sides of life (albeit from a distance), I volunteered for the night shift. Starting tonight, I’ll be working 7pm to 7am in the Jail… and I’ll be blogging about it.

For confidentiality and security reasons, I am going to be vague and leave out many details. I’m sure I’ll still have plenty to write about!  Keep checking back for more information.

Last Thursday, Dr. Blumenthal announced that meaningful use will be finalized by mid or late Spring 2010. Turns out that often quoted December 31st date is actually for a draft, after which there will be 60 days for comments and then additional revisions.

Frustrated, I went back to the initial enabling legislation in ARRA and found the following requirement:

3004(b)(1) Not later than December 31, 2009, the Secretary shall… adopt an initial set of standards, implementation specifications, and certification criteria…

I didn’t see any other language stating that the date could be pushed back. I follow the legislation pretty closely, but its certainly possible that additional legislation has been passed that extended the due date for the criteria. If so, please comment and let me know!

Regardless, pushing the date to late Spring 2010 means that the criteria might not be finalized until as late as June 20, 2010. That would provide 6 months for EHR vendors to finalize their development, receive certification, and bring their products to market. In that case, even the most agile, well funded vendors will have an impossible task before them.

As time progresses, it is continuing to look more and more like meaningful use will need to be incredibly simplistic, at least for 2011. This would be the minimum mentioned in our white paper on the stimulus and this previous blog post; a far cry from the draft definitions released back in June.