Too big to fail comes to mind when I think of Allscripts. That’s the way the company was painted when it made news on June 9, 2010, after announcing it had bought Eclipsys.
Needless to say, the last two years have not produced the expected milk and honey for the vendor, which currently occupies the largest footprint in the ambulatory EHR market. Poor quarterly reports, board member infighting and firings and a pile of implementation troubles stemming from far too many systems currently running have made for a mess of a time.
What’s ironic about everything that’s going on with the company now is that at the time it was announced, the Allscripts deal with Eclipsys was game changing for those of us in the vendor space. No one will admit it publicly (other than me, here), but when this merger was announced in 2010, there were many executives at competitive companies wondering just how long their respective business ventures would still be around because of the move.
At the time, I worked for what was then considered the third or fourth largest EHR/PM in the space and the Allscripts news sent wave of shock and perhaps a bit of panic through my office. We braced for the worst and hoped for the best, and started to develop strategies akin to what might have been implemented at the Alamo.
It was hard not to feel the pressure. A great EHR army was coming and we stood in its path to greatness.
“The combination of Allscripts and Eclipsys will create a clear leader in healthcare information technology, with the most comprehensive solution offering for healthcare organizations of every size and setting.
“By combining the leading physician-office and post-acute care solutions from Allscripts with Eclipsys’s leading enterprise solutions for hospitals and health systems, the combined company will offer a single platform of clinical, financial, connectivity and information solutions. The combined company’s client base will include over 180,000 U.S. physicians, 1,500 hospitals, and nearly 10,000 nursing homes, hospices, home care and other post-acute organizations. The combined company will be positioned to connect physicians, other care providers and patients wherever care is provided-in the hospital, in small or large physician practices, in extended care facilities, or in a patient’s home – resulting in the unique ability to deliver a single patient record and a seamless patient experience.”
Even at our best, this new entity was a behemoth far larger than even our marketing folks and their clever wit could help us position our way out of. So we held our breath, and, I bet like a lot of vendors, we waited …
It’s easy to cast stones when you know where they should be thrown based on the luxury of hindsight, but I said from the beginning of all this – to the president of our company and to her executive support team including the then SVP of marketing – that the one weakness of Allscripts was that it was being positioned as too big to fail.
But before long, the fear started to subside and we slowly began to realize we were receiving more than our fair share of scraps; in fact, we were actually at the banquet table along with the likes of others who, like us, previously must have wondered how much of a future we’d actually have left. In the end, we were still closing deals. All vendors kept signing deals. Finally, the fear abated and the “promise” of what was to come never came.
Certainly, Allscripts hasn’t failed in wanting to go private, it just needs to find a private place to go for awhile where it can sort out its problems, do away with some of its product overabundance and cut the proverbial fat without having to continually find ways to report positive balance sheets.
Even if it proves too big to fail, there’s nothing stopping it from stumbling backward from time to time.
Encouraging patient engagement at the practice level has gotten to be such a popular and all-encompassing subject in recent months that I’ve begun to see a great deal of editorial coverage dedicated to the topic.
In said pieces, columnists offers some practical advice to practice leaders for engaging their patients. Some of it is pretty much common sense while much of it just makes for good customer relations.
Perhaps what’s most telling, though, is that in the age of connectivity and mobility, where we are always on and part of one another’s lives because of technology and devices, it seems as if we have forgotten how to communicate with one another in a one-to-one, face-to-face environment.
My dad was a small business owner and I grew up in his shop. He wasn’t the most graceful individual, but he understood one thing: Without customers, we didn’t pay our bills and in a small town, a grouch was often on the outs and rarely part of the fold. The fact that he kept re-iterating that the customer was “always” right meant something. It stood for something and that “something” was that when our customers came to us they expected a certain level of service and to be treated with a great deal of respect.
He knew, as I do now, that the customer technically can’t “always” be right. It’s just not possible. You can make every concession possible to please your customers, but, in the end, there are going to be those that you can’t keep. And that’s okay.
But, when several editorials are written to coach us how patients should be engaged at the point of care, it’s easy to see that we certainly do live in a different time than even I can remember growing up in not so long ago.
That said here are a few tiny bits of sage advice I thought worthy of passing on.
According to Audrey McLaughlin’s recent post in Physicians Practice, “A great attitude in customer service can be very simple: Choose to be thankful for every patient that walks through your door, whether you are the receptionist, the nurse, the medical assistant, the doctor, office manager or bill collector. You must thank every person that comes in for choosing your medical practice. Let them know that you are grateful that they are there.”
McLaughlin should know. She’s an RN. She’s gained the following insights through experience, and given her confidence in these points, I assume she’s correct.
As she says, integrate an attitude of gratitude into all areas of the patient engagement including during appointment scheduling, telephone calls, check in and check out. Offering a sincere thank you goes a long way for stopping in or arriving on time will go a long way and can help set a positive tone for the visit.
If a patient is late for an appointment, a simple “Thanks for making it in,” goes a long way. But, as with all things that mean something, sincerity is key, she says. The sincerity should not end at the welcome desk, but should flow along through the exam room and back through to check out.
Start to finish, a patient should feel welcomed and appreciated, McLaughlin says.
But she’s not the only one saying such things. On the contrary, this seems to be a movement. Phil Colpas, editor of Health Management Technology recently posted his own blog entry on the same subject.
His take? A smiling staff means a healthier hospital. In his post, Colpas sites a recent study by the organization The Forum: Business Results through People, which states that “delivering better customer experiences starts with developing satisfied employees.”
As Colpas surmises, “In healthcare, the patients are the customers.” An astute observation, and quite true, even if often overlooked.
Healthcare leaders then, to find success, should (quoting Colpas), “Cultivate an environment that encourages employees to feel a part of and actively engage in the processes of patient care and meaningful-use compliance – and all that entails.”
Doing so should encourage a greater level of patient engagement, which is good for all and benefits not only the patient but the practice by driving future “sales” through increased word of mouth referrals, more return visits and patients that are likely to pay on time and invest more in their care.
The customer may not always be right, but making them feel like they are will go a long way toward building your practice into the success you want it to be.
It might take nothing more than a smile and some sincerity.
There is little doubt that I’m addicted to health start ups.
Everything about their underdog stories implores me to want to know more about their stories: who they are, what they do, why they do it and what, ultimately, they can do to improve the healthcare landscape.
My excitement lies in discovering the passion behind the company and why its leaders work so hard to bring their vision to the market.
Meddik is one such new venture attempting to establish itself in healthcare, with a particular focus on the patient consumer. It offers a place where people can check out questions, stories and products, and share their experiences through a “personalized health network” comprised of people who have gone through similar health issues, diagnosis and conditions.
According to its site, “Meddik is the first of its kind to combine machine learning and user-submitted content for the betterment of health, leading to a more informed and empowered patient. Our mission is to tap into the power of the masses, discovering new insights and ultimately accelerating the pace of innovation.”
At its most basic, Meddik is a community where people with healthcare questions can get together, discuss topics and offer insight. It’s different than some other sites, like WebMD, in that it doesn’t just use algorithms to compile data through a robotic search for an individual’s query.
Users can search through a list of topics that are already posted to the site to see what others have already said, or they can begin their own discussion about their own topic. They can search by gender, condition or symptom, treatments or procedures.
The topics to choose from are almost overwhelming. Here are a few: eating gluten free, how to choose a psychologist, dealing with a parent’s depression, diagnoses with celiacs, and so and so forth.
But here are a few things that make the site seem so much more advanced than what’s available now.
First, of all the submissions on the site you can “boost” the information you find helpful. According to Meddik, doing so increases the chances that people who are going through the same or similar issues as you will find that submission.
Next, you can discuss and leave comments with thoughts or suggestions about a topic or condition.
Users can also mark an item “Not Helpful” if it is not helpful or not relevant to their condition based on their search. In addition, according to Meddik, the more submissions that exist, the better the system can draw meaningful conclusions that can lead to future health innovation, or so says Meddik.
And probably the reason for its being, and the reason for this post, simply comes down to this (the passion for the thing): “The power of Meddik increases at an exponential rate the more users that exist. Imagine how fast we could change health if the entire world worked together.”
Collaboration is kind of a tech-like way of saying, “Let’s play together because when we do, things will go well.”
Meddick seems like a great collaboration tool, especially for patient consumers. If the company can hang on and engage users, there’s a good chance that it could engage patients more in their overall care, which seems a pretty good place to take this experiment.
Dr. Brooks, in Tutwiler, returning from a house call early in her career.
I’ve known Dr. Anne Brooks for nearly three years and I consider her a friend. She’s always receptive, available and willing to lend an ear, and offers insight I can only hope to have one day.
Plus, her stories are chronicle-like and filled with wit, humor and poignancy. And she’s got a tomb’s worth of them she could tell, and probably should. But, perhaps she doesn’t have the time. She’s too busy caring for the folks of her adopted hometown of Tutwiler, Mississippi.
Dr. Brooks is a nun. She’s taken a vow of poverty. In Tutwiler, she’s needed it. The people here are part of the one of the poorest in the United States. Patients pay for their care, if they can, with vegetables or other goods. Some times they drop a few bucks on the counter, but it’s a guarantee that by the end of the year, the clinic – Tutwiler Clinic – is going to be significantly short of operating funds.
More than 75 percent of its operating funds come from donations by individuals and grants. Those who wish can contribute through a PayPal donate button on the clinic’s site.
The Tutwiler Clinic is a nonprofit founded in 1983 by Dr. Brooks, D.O. and three other Sisters of the Holy Names. Its purpose is to provide wholistic healthcare in Tallahatchie County, located in the middle of the Mississippi Delta. According to its site, the median household income in the county is $18,800, while the US poverty level for a family of four is set at $20,650.
Two-thirds of the clinic’s new patients have no Medicare or Medicaid or other health coverage assistance. To say Brooks has operated the clinic as a personal mission for the last 20 years is no understatement.
The clinic is her calling; Tutwiler is her home.
She became a physician at age 40, following a career in education. However, for 17 years prior, from the time she became a nun, she was confined to a wheelchair because of what had been diagnosed as severe rheumatoid arthritis. She eventually met a physician in Clearwater, Florida, who asked to treat her and through osteopathic methods and acupuncture, eventually she was out of the chair and walking again.
The same doctor to help treat her was the same physician who encouraged her to join him in the medical ranks. She acquiesced and eventually began to study.
When she graduated, she wandered around the south through Mississippi, Louisiana and Florida seeking a clinic to serve. Next, she wrote several letters to towns that were in medically deprived areas offering her services. Tutwiler was only community to respond.
The town gave her a few funds to refurbish the clinic that had been shuttered since the early 1960s and she opened it in August 1983. By January she was seeing more than 700 patients a month. The clinic had a segregated waiting area when she arrived, but she immediately changed tat.
She serves as medical director and chief administrator at the Tutwiler Clinic, serving about 8,500 patients a year. She also is Chief of the Department of Medicine at the Northwest Mississippi Regional Medical Center in Clarksdale, where she has also is on the board of trustees and has served as Chief of Staff.
She is one of three doctors in the county, and currently mentors two medical students. She admits that she is desperate for another doctor at the clinic, which has a staff of 30.
She prays every day for anew doctor to join their staff, but to date (she’s been searching nonstop for months) she’s received little interest.
Sister Anne Brooks recently with a young patient at the Tutwiler Clinic.
Brooks is a country doctor in so many ways, like you’d imagine from the 19th century: she makes house calls, and has seen the greatest level of poverty and unhealthful living. Her heart seems to explode with passion for those she cares for and the folks she cares for often suffer from sever chronic conditions, such obesity and diabetes, because of lack of quality nutrition because of their poverty.
She prays a lot for them. When she’s not praying, the 74-year-old who works 12 hour days, most days a week. She believes in wholistic care — taking care of the whole person and enabling a person to care for themselves.
When not providing care, she and her staff run a Habitat for Humanity program that has built 37 homes, and she also started a second-hand clothing store and a community center, with a gym and library and helps residents learn everything from life skills like cooking, to earning a GED, to staying fit with Zumba. To fund the community center, they sell locally made quilts.
Even though she lives in a world seemingly lost, if not a little forgotten, she’s dedicated the Tutwiler Clinic to employing the most current tools to ensure her patients receive the best care possible.
As such, she utilizes an electronic health record.
In her 20 years as a physician, “Care has changed in many, many ways,” she said recently.
There are new forms of care, new understandings of how various body systems that medicine can affect, and, most notable to her, are genome studies and the potential for tailoring medicine to a specific patient.
“You know, every direction you turn, especially in your area of expertise, there are new and exciting ideas about integrating medical records seamlessly into patient care,” she said, “or should it be the other way around?”
Perhaps it makes no matter. Machine at her side or not, she still knows how to provide the best care she knows how to provide, and the people she cares for are blessed to have her at home in her community. In many cases, they owe her their lives; at the very least she should be given some thanks.
Perhaps that’s why the American Osteopathic Foundation recently named her the 2012 physician of the year.
Any mention of money and people’s ears seem to perk. Work, for the money, on the other hand, seems to stifle a person’s desire to embark on the profitable journey.
“Money here.”
“What’s that, you say? Money? Where?”
“Well, I’m glad you asked. By taking the following simple steps, by performing the following tasks, you might be able to save your practice time and money.”
“Tasks? ‘Might?’”
“Right.”
“How much?”
Shoulder shrug…
“See ya.”
The above over dramatization is courtesy of yours truly. Stellar dialogue, wouldn’t you say? Among my many talents. I’m actually a playwright. No, really. Published and everything.
Anyway, getting to the point, it seems that not matter where we turn, in this new healthcare environment where there seem to be opportunities for ‘49ers where ever you turn, someone is trying to tell you how to produce more profitability or efficiency for your practice.
Despite the zingers, there really are a few good pieces of advice out there that do seem to make sense, but, yes, you’ll need to put in a little time and work.
Here’s one example, courtesy of Carol Stryker and Physicians Practice magazine. According to Stryker, 30 percent of any activity is wasted. Thus, as she so eloquently writes, “The more useless labor you can eliminate, the bigger the increase in productivity and the fewer mistakes. A careful review of some or all of the processes in a medical office can generally be expected to yield productivity gains of at least 30 percent in the areas addressed.”
So, to eliminate wasted work and improve efficiency, which improves profitability, establish a process and iron out the wrinkles. The following six steps will help, she says.
1. Choose a process to streamline. One that is causing problems will most likely be easy to identify and will probably already will be taking your attention.
2. Answer this question, Stryker says: “What should the process accomplish and why is that important?” She encourages practice leaders to clearly identity the purpose and value of the process and write it down. “This is the yardstick for future evaluations. This is the only aspect of the project that the physician(s) cannot delegate or outsource,” she said.
3. Write down the steps to follow, in order. Once all the steps are documented, walk them through them to be certain you have not left anything out. Add what you left out and walk through again. Repeat until all steps have been captured.
4. For each step, ask the group: “What does this have to do with the goal?” If nothing, eliminate it. If not much, eliminate it or combine it with another step.
“Is another step performing the same function?” If so, which one produces the best outcome? Eliminate the less effective step.
“Is there a better way?” Do you have a tool, not available when the process was first developed, that gets the job done more effectively and/or efficiently?
“Could a step be added that would have a positive impact on a subsequent step?”
5. For the amended process, ask: “Are any additional steps necessary? If something will be printed now that was not printed before, what will be done with the paper?
“Are the steps in the most logical order?” Examine alternative sequencing as a possible improvement to the process.
“Is the process intuitive?” Will it be easy for the person doing the work to remember or to engage?
“Are any steps error-prone?” What can be done to eliminate error? If it can’t be done away with, what can be done to validate the step was done properly?
Repeat from Step 5 until satisfied with the proposed process.
6. Once the improved process is implemented, choose another process and repeat the analysis. Continue until satisfied with the way the office works.
According to Stryker, “The only difficulty is finding the time and discipline to perform an analysis of a process and implement improvements. Each successful project frees up resources and makes it easier to address another process. Morale improves because office operations are improving. Stress decreases because there is actually time to do what needs to be done. Staff turnover goes down and profits go up.”
And hopefully, once all of the steps in the process have been completed, you’ll find yourself with more time, a more efficient practice and you’ll identify ways to free up a little extra cash.
For some, it’s frightening time to be in healthcare.
Given the continual changes related to reform and reimbursements, compounded by the fact that independent practices are being gobbled up by hospital systems and independent practitioners are becoming employees, but a new study commissioned by The Physicians Foundation say that roughly 60 percent of physicians would quit the profession or retire today if given the opportunity.
This is no new trend. And as noted in HealthLeaders Media report, that’s what makes this latest piece of data so much more shocking.
What’s also somewhat shocking about the Physicians Foundation study, which featured more than 13,000 physicians, is that the results clearly reflect this sentiment – that physicians are frustrated with the overwhelming pressure facing them – and that they would rather get out than picture themselves as professional caregivers for the long haul.
Certainly, this is not insignificant. These are not your typical professionals working a job, taking an hour lunch and then heading home to the family. It’s not like they’re working in one field one week and they decide to try a new job at a different company the next week. These are highly educated professionals who have dedicated their lives to a cause and a belief that they could make a difference by helping people “get better.” Simply put, they’ve made a lifelong decision to practice medicine that the majority could sooner walk away from.
Apparently, physicians just don’t feel they are being heard. They feel their opinions don’t matter so the only way they may have to make themselves heard is to pack up and hit the road.
Because of the pressure they face from regulation, reduced reimbursements and providing greater quality at a lesser cost, many feel alienated, and some are beginning to do something about it.
For starters, they’re reducing or eliminating the number of Medicare and Medicaid patients they’re seeing. Some are leaving private practice (some by choice, others not) and becoming employees where they’ll have fewer managerial worries than if they were to stay put in their practices. After all, employees are hired to do a job; managers are required to solve most of a business’ problems. Employed physicians are employed because, for the most part, they got tired of trying to solve the world’s problems.
But, according to the study, becoming an employee is not viewed as a positive move. Especially for what has traditionally been a fiercely independent population.
What’s most troubling about this study is that most physicians just want out. They want to turn in their white coats and head for the sunset. They want to come to Florida, where the sun always shines, hit the beach and play with sand between their toes. (I made that last part up.)
Here’s the heart of it, and I quote the HealthLeaders story: “We found that 60 percent said they would retire today if given the opportunity. What was worrisome is that this is up from 45 percent in 2008,” Walker Ray, MD, vice president of the nonprofit foundation. “We also know from the survey that we disaggregated it into certain categories, 47 percent of physicians under 40 said they would retire today if given the opportunity.”
Almost half of physicians under age 40 would board the windows and find another way to pay their student loans.
Half!
In some cases, there are certainly doctors among this population that just got into practice. These are the physicians who are supposed to be changing the way, setting the new normal for the industry; unabashedly accepting that this is the new world order of things and the hells bells, we’re in it to win it.
If this is indeed the truth, that so many young physicians are wondering why they spent so much time in school and spending so much money on their educations just so they could become employees of the “state,” the future doesn’t see that much different than the present and we have bigger problems that we’re anticipating.
Dr. Eugene Heslin has always loved technology. In his 20 years in practice, he’s embraced it. From the start, in 1992, he brought in a practice management system when he opened his practice’s doors.
Since then, the practice has grown to a five-physician group of family practitioners serving more than 14,000 patients is Saugerties, New York — about 100 miles north of New York City — and has added an electronic health record system to the mix.
The “home-grown” practice serves patients ranging from younger than one month to older than 107; from near life to near death, and everything in between. Physicians at the practice, Bridge Street Family Practice, see the whole gambit and provide care to a lot of people using technology to do so, Dr. Heslin said recently.
Heslin is a self-proclaimed technology advocate. As far as he’s concerned, it provides clear benefits at the practice level, and, ultimately, improves patient care.
“Technology is exponentially changing the practice of care, and I consider it a tool much the same as my stethoscope or my reflex hammer,” he said. “I’ve pretty much given up my desk for my laptop.”
He spoke to me as he sat on a train headed to the City where was able to access his EHR remotely and send a few messages to the practice and patients. He also reviewed a few records and handled some administrative work all from his laptop.
“The access to information is much improved. I’m practicing smarter because I am able to access information in my time instead of sitting with a pile of paper charts,” he said.
His is a story similar to others. When he implemented the EHR he got rid of the paper, found time for other more important things than paperwork and now provides care from anywhere. Because he’s connected, he can interact directly with his patients through his EHR’s patient portal, which patients seem to like.
But the real power of his EHR is in its ability to help track and manage the patient population’s health and outcomes. Though there is much that can be done in an electronic system that can also be done using a paper record, this is just not one of those things, he said.
He’s now in control of all the patient data in his practice and it’s truly helping improve patient’s lives, especially those with chronic conditions.
“The true power of EHRs for the majority of physicians is that we’re going to need this data, and the only way to gather the data is to do so electronically,” he said.
A lover of technology, Heslin is not brand loyal and he’s not married to any system. He’s on his second EHR and he’s seen or tested several of the market’s top names. Each does some things very well, but not everything.
But as the market continues to change and with adoption recently reaching 70 percent of all physicians, Heslin said that the systems are going to be standard equipment for any practice in the near future.
Certainly that comes as no surprise, he admits. What’s next, he said, is interoperability of the each of the different vendor’s systems so that information can easily flow from one to another. Ultimately, the data contained in each must be controlled by the physician rather than by the vendor.
Care givers need to be able to move data within the health sphere, with each system offering point-to-point communication abilities that are far more advanced than today’s version of glorified email.
As the landscape continues to embrace electronic records, the data extracted will become more robust and provide for better modeling of care. Perhaps one day, the technology will begin to allow for a bit of predictive analysis, he said, at which point care can become about prevention of disease rather than about fighting existing conditions.
Essentially, if people can be kept out of the hospital or from exhaustive care programs, resources can be reallocated and eventually saved.
Heslin’s are not predictions of a country doctor hoping for the best through the use of technology. In the health IT community he has some clout. A board member (he’s actually treasurer) of the New York eHealth Collaborative (NYeC), he’s part of one of the most proactive groups in the United States working to improve care.
NYeC works to educate the healthcare industry and those in need of treatment, with a goal of elevating the level of general understanding as to how health IT can improve care. He’s part of the public/private partnership that’s working to move healthcare forward with health IT. Everyone, like himself, has an opportunity to participate, he said, which strengthens the movement.
New York is a complex place, though. There’s a great deal of diversity in the care and cultural spectrum. However, if a successful program to move health policy forward can be built here, it can be built anywhere, he said.
And if the policies lead to better care outcomes, more engagement from the community and its professionals, then real change can be accomplished, and all of the efforts made over the course of the last several years will be worth it, he said.
What might be considered somewhat of a sizeable victory for the world of Health IT can be found in the recent announcement made by writer Ken Terry on the pages of InformationWeek in his article, “EHR Adoption Passes The Tipping Point.”
According to Terry’s article in which he features a report from CapSite, electronic health records are now being used by about 70 percent of physicians.
Really, this is no small achievement and should be celebrated by all of us in health IT. The promise of the technology is being realized, and federal incentives aside, I believe physicians are clearly standing behind the fact that EHRs do in fact create more efficient, streamlined care that will help produce better care outcomes and improve lives.
Clearly, as a community, we have decided that as an industry, it’s time to move forward like many of the other giants of our age, like banking and web commerce. Technology is paramount, mobility is a requirement and access is no longer optional.
Patients realize the importance of access to data and they (we), are skeptical by nature. We want to be coddled and to be assured that everything is going to be okay. Like children, we are growing more comfortable with the fact that with an electronic, connected system we are able to make better decisions, can more easily engage and, frankly, can better educate ourselves when needed.
And I believe we are educating ourselves, especially when it comes to the value of these electronic systems.
This education is helping us, as patients, encourage our care providers to adopt electronic health records. Personally, I don’t believe, meaningful use is sole reason behind the increased adoption. A large portion, yes, but, obviously, not the only thing driving adoption. As consumer patients, we’re helping drive change in healthcare, and through this partnership, there are many great things coming.
The first of which is the news that as far as adoption of electronic health records, we’ve finally reached a passing grade.
As we continue moving forward with adoption, I’m looking forward to seeing more of what’s to come. I’m excited to see what the data collected tells us and how it can be used to drive care; and
I’m anxious to see what’s next as we begin to enter the post-EHR era.
It’s a good time to be here; an exciting time indeed.
