Michigan Medicine, Volume 114, No. 5 by Michigan State Medical Society

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September / October 2015 • Volume 114 • No. 5

The Cost of Technology: Facing the Challenge

MSMS member A.J .Ronan, DO, is addressing the technology change and challenge head on, but not while wearing rose-colored glasses.

ALSO IN THIS ISSUE

• Michigan Care Improvement Registry Update • 2015 Annual Immunization Conferences • Telemedicine: Emerging Risks

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Committee on Publications September/October 2015 • Volume 114 • No. 5

COVER STORY

10 Cost of Technology: Changes and Challenges from Patient Portals to Electronic Health Records

by Veronica Gracia-Wing for Michigan State Medical Society

FEATURES

18 Telemedicine: Emerging Risks

by Richard Cahill, JD, Vice President and Associate General Counsel, The Doctors Company

COLUMNS

Ask Our Lawyer

By Daniel J. Schulte, JD Terms to Be Concerned About in EMR Purchasing / Financing Contracts

MDHHS Update

From the Michigan Department of Health and Human Services Michigan Care Improvement Registry Update and 2015 Annual Immunization Conferences

HIT Corner

by Sylvia D. Roemer, BSMT, CNMT, RSO, Healthcare Quality Improvement & Business Development, MPRO Breaking Up is Hard to Do, But It’s Time to Move On

President’s Perspective

By Rose Ramirez, MD What Is the Wealth of Technology Affording Us?

DEPARTMENTS

Obituaries

MSMS Board of Directors Disclosures

MSMS Foundation Education Course Offerings

The Marketplace

WealthCare Advisors

New MSMS Members

The mission of the Michigan State Medical Society is to promote a health care environment which supports physicians in caring for and enhancing the health of Michigan citizens through science, quality and ethics in the practice of medicine.

LYNN S. GRAY, MD, MPH, CHAIR, BERRIEN SPRINGS THEODORE B. JONES, MD, DETROIT BASSAM NASR, MD, MBA, PORT HURON

Managing Editor KEVIN MCFATRIDGE EMAIL: KMCFATRIDGE@MSMS.ORG

Publication Office Michigan State Medical Society PO Box 950, East Lansing, MI 48826-0950 517-337-1351 www.msms.org All communications on articles, news, exchanges and classified advertising should be sent to the above address, attn: Kevin McFatridge.

Display Advertising CARL MISCHKA Email: cmischka@msms.org Phone: 888-666-1491

Design / Layout STACY LOVE, REZÜBERANT! INC. Email: rezuberantdesign@gmail.com

Printing BRD PRINTING, LANSING, MI Email: lallen@brdprinting.com

Postmaster: Address Changes Michigan Medicine Hannah Dingwell PO Box 950, East Lansing, MI 48826-0950 Michigan Medicine, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan. The MSMS Committee on Publications is the editorial board of Michigan Medicine and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors. Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine reserves the right to accept or reject advertising copy. Products and services advertised in Michigan Medicine are neither endorsed nor warranteed by MSMS, with the exception of a few. Michigan Medicine (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2015 it is published in January/February, March/April, May/June, July/August, September/October and November/December. Second class postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110. Single copies, $10. Printed in USA. ©2015 Michigan State Medical Society

A S K

O U R

L AW Y E R

Terms to Be Concerned About in EMR Purchasing / Financing Contracts BY DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL ANSWER:

QUESTION:

Are there things I should look out for in EMR purchase and finance contracts, other than price?

“The only way to protect yourself is to thoroughly vet the EMR prior to purchase. This vetting should include not only what the EMR sales person is telling and showing you but must also include discussions with references…”

Daniel Schulte, JD, MSMS Legal Counsel, is a member of Kerr Russell Attorneys and Counselors

Everyone is price conscience when considering the purchase of an EMR. However, price is likely the least of your concerns. Here are other terms that should be more concerning.

ing the quality of the EMR, its fitness for your practice or otherwise. It is very likely that your EMR seller will not contractually stand behind the quality or fitness of their product.

Financing/leasing an EMR from someone other than the seller of the EMR

Damage Limitations

Very often, the seller of the EMR will have an arrangement with a finance or leasing company enabling you to finance the cost of the EMR through a loan or leasing transaction. This may seem to be just a convenience for you but can be problematic if the EMR DO es not perform as represented or for some other reason you desire to pursue a claim against the seller of the EMR. The loan repayments or lease payments will be required to be made to the lender or lessor whether or not the EMR actually functions as represented, is free of defects, properly integrates with your practice, etc. The financing or leasing transaction is entirely separate and distinct from the purchase transaction. You will have no right to discontinue making payment to the lender or lessor even if the EMR completely fails to operate.

Warranty Disclaimers Most EMR sellers provide no warranties that the EMR will function as it has been represented to function or even that the EMR is free of defects. In addition, EMR sellers routinely disclaim any warranty provided by law. You should carefully review your purchase agreement and/or your license agreement to determine the scope of the disclaimer. Most agreements provide that unless expressly stated (and there is usually nothing stated in the agreements) the seller of the EMR makes no warranty, representation or other promises regardMICHIGAN MEDICINE

In addition to failing to provide/disclaiming any warranty, EMR sellers disclaim liability for the damages or losses that you incur in any way connected with a failure of the EMR to perform as represented and/ or be a good fit for your practice. The limitation provision is sometimes absolute (i.e. there is no obligation to compensate you under any circumstances). Other times, the amount of the obligation is limited to what would be an unacceptably low amount that bears no relationship to the actual amount of the damages you have incurred (e.g. the amount you paid for the EMR, six months of license fees, etc.). It is unrealistic to expect to be able to adequately protect yourself against having to pay for an EMR that you discover DO es not work as represented and/or is not a good fit for your practice due to how EMR sellers DO business. The only way to protect yourself is to thoroughly vet the EMR prior to purchase. This vetting should include not only what the EMR sales person is telling and showing you but must also include discussions with references (e.g. speaking directly with representatives of practices similar to yours that have implemented the EMR.) It is absolutely critical to DO this due diligence prior to purchasing any EMR. Given the contract terms described above, which are typically included in EMR sales agreements, you will likely have little if any remedy upon your dissatisfaction with an EMR following its purchase. September / October 2015

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M D H H S

U P D AT E

Michigan Care Improvement Registry Update BY BEA SALADA, STATE MCIR COORDINATOR, MDHHS

he Michigan Care Improvement Registry (MCIR) is an immunization information system (IIS) developed by the State of Michigan to assist immunization providers with increasing vaccination rates in Michigan. The Michigan Department of Health and Human Services (MDHHS), Division of Immunization, maintains the IIS. A goal in the development process of MCIR was to ensure the creation of a reliable, accessible software tool allowing for statewide consolidation and assessment of immunization records throughout the lifespan. Consolidation and assessment of records help to ensure accurate forecasting of current and future vaccine needs, resulting in the reduction of missed vaccination opportunities as well as reducing the possibility of over-administration. MCIR immunization forecasting is based on the Advisory Committee on Immunization Practices (ACIP) immunization schedule for assessment. This assessment simplifies the complexity of the schedule for the clinical needs of the individual. MCIR contains in excess of 114 million shot records which encompass over 9.2 million patient records. It is designed to give immunization providers, both public and private, access to immunization records from anywhere in the state. Currently there are more than 6,000 healthcare facilities (including hospitals, pediatric clinics, family practice clinics, OB/GYN, pharmacies, and migrant and tribal clinics), 200 public health clinics, along with schools and daycares, which utilize immunization information stored in MCIR. Since MCIR’s inception in 1994, it has undergone continuous development and refinement. This process has allowed MCIR to become an important tool for Michigan’s providers and for public health in their efforts to enhance vaccination coverage rates. As part of the State’s ongoing development efforts, refinement of MCIR HL7 messaging standards is a critical component of this process. HL7 (Health Level Seven International) is a set of standards, formats, and definitions for exchanging and developing electronic health records (EHRs). HL7 messaging for MCIR has considerable value to providers and public health immunization programs. Currently, MCIR will return an automatic update response to a provider’s EHR whenever a record of a patient belonging to that provider site is updated. This type of HL7 message is called a Vaccine Record Update (VXU). MCIR currently receives HL7 messages from 1,761

immunization service providers that use 24 different electronic health record (EHR) systems. These HL7 messages supply provider sites with updated patient records in real time. Data quality assurance is a critical component of MCIR. Advanced edit check software has been developed in MCIR that generates provider/vendor reports addressing the quality of the HL7 messaging format. The MCIR Data Quality Assessment (DQA) tool measures data quality of electronic transfers in real time and tracks changes in quality over time. This tool is highly sensitive, detecting changes to data quality for the provider, allowing for corrections to be made to data files. This tool allows for detection of systematic changes that may have happened to an EHR. A team of MCIR business analysts works with EHR Vendors and IT support staff from health systems and private providers to test messages in order to certify data accuracy of their product prior to transition to a production environment. MCIR Regional Staff also provide help desk support to providers. In addition to VXU messages, the Division of Immunization has been piloting HL7 Query by Parameter (QBP) capabilities through the Health Information Exchange infrastructure. QBP messages will allow a provider to query MCIR and receive demographic information on a single patient, along with a list of the immunizations received plus an evaluated history and forecast indicating when the next dose is due. Currently six of the twenty-four EHR vendors sending HL7 messages (VXUs) to MCIR have indicated to their customers that they have the ability to query an IIS. The MCIR team is comprised of a staff of dedicated individuals with a proven ability for leadership in the field of IIS registry implementation and innovation. The team uses a collaborative approach to develop and implement design upgrades, and this collaborative approach will ensure the long-term success and sustainability of MCIR. For additional information on useful tools that MCIR can provide for your office, go to www.mcir.org. The purpose of MCIR is not merely to be a warehouse for immunization records. Rather, the ultimate goal is that MCIR can be a tool used to assure that all individuals – of any age - are vaccinated in a timely manner, following the ACIP recommendations. The high quality data that the Immunization Program receives from MCIR aids in the optimal provision of care by immunization providers statewide. This, in turn, helps MDHHS to meet its mission of “putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life.” We wish to thank Michigan physicians and health care providers for your role in making MCIR an integral part of providing immunizations in our state. Our registry wouldn’t be a nationally-recognized success without your continued commitment to using MCIR in your practices to improve health care for Michigan families.

MICHIGAN MEDICINE

September / October 2015

Michigan’s 2015 Annual Immunization Conferences 6 6 6

Find out what’s new in immunizations! The MDHHS Regional Immunization Conferences have been offered annually for the past 21 years and consistently receive high ratings from attendees. Their primary goal is to update health care providers on immunization issues that affect people of all ages – from the very young to the very old. The one-day con-

Conference Dates & Locations n October 13 – Marquette, MI n October 15 – Gaylord, MI n November 3 – Lansing, MI

ference will provide participants with a variety of practice-man-

n November 5 – Grand Rapids, MI

agement tools, techniques and information that will help assure

n November 6 – Flint, MI

that all of their patients are fully immunized.

n November 17 – Kalamazoo, MI

Who Should Attend

n November 19 – Dearborn, MI

The conferences are appropriate for physicians, physician assistants, nurses, nurse practitioners, medical assistants, public health staff, pharmacists, medical and nursing students, and anyone interested in learning more about current immunization practice in Michigan. While the conferences are intended for all immunizing providers representing diverse health care settings, physicians’ offices, in particular, may benefit from this immunization update and networking opportunity. However, everyone is welcome to attend this conference, and health care professionals from a variety of settings will find this training opportunity beneficial.

n November 20 – Troy, MI

Registration The registration fee for conference attendees will be $50 per person and lunch will be included. The registration process begins September 10. Most of these conferences fill up in advance. Additional details – including the agenda and speaker information – are posted at www.michigan.gov/immunize > Health Care Professionals/Providers. Volume 114 • No. 5

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H I T

CO R N E R

Breaking Up Is Hard to Do, But It’s Time to Move On

lectronic Health Records (EHRs) have become an integral part of how providers practice medicine. There was a time, not too long ago, when EHRs were viewed as fancy “paper” charts; basically just another way of capturing and storing information with the goal of going paperless. Things have changed and EHR’s ability to intelligently organize a vast amount of information and make it readily available to providers at point-of-care is a real game changer in patient care, not to mention the analytics that can be utilized for population health strategies and gap analysis. EHRs will continue to grow and change and the move will be toward an emphasis on improving the doctor/patient interaction with data driven information for shared decision making, greater patient engagement and improved health.

What if you don’t have an EHR, or your current system just isn’t meeting your needs? You aren’t alone. Sixty percent of family physicians would not purchase their particular EHR again and a Black Book Rankings survey of nearly 17,000 EHR users in 2013 found that 31 percent would like to change vendors and 17 percent were planning to do so in the next 12 months. 1, 2 These stats shouldn’t scare you away from getting a new EHR, but they should be an alert that due diligence and careful consideration should be given to this tough decision so that your selection meets your current and future IT needs. Thoughtful planning is key to making the selection and implementation process as smooth as possible. First, make notes of the short-comings or flaws of your current EHR and then decide what you want the new EHR to do. Next, create your “shopping list”; decide what the must-haves are and what the nice-to-haves are. If you talk with your colleagues about their EHRs, keep an open mind and remain impartial, don’t make a decision based solely on someone else’s experiences, requirements or workflows. The many considerations can make the decision process seem overwhelming but focusing on the fundamental points will help. Our top five list of essential factors to consider when purchasing an EHR follows.

MICHIGAN MEDICINE

September / October 2015

The top five considerations when getting a new EHR: 1. Common Platform

Considered this if you belong to a physician organization or hospital system. Data sharing, transition of care and other functions will be easier between like systems but will the EHR have the functionality that best serves your practice’s needs and your financial commitment.

2. Cost

EHR costs can vary widely; however, there are many other cost factors to consider, such as: maintenance fees, interfaces, license fees, storage, upgrades, hardware, training, etc.

3. Data

Whether from a paper record or a legacy EHR, you must consider data conversion or data migration. What will your old data look like in your new EHR; will it populate correctly and be accurate? Manual data entry has a 2.3%-26.9% error rate! 3 Avoid manual entry, if at all possible.

4. Patient Portal

A robust portal is a must. Is it integrated into your EHR or do you need a third party? What kind of functionality do you want included so it is useful to the patient and your practice?

5. Training and Vendor Support

Don’t overlook these two factors they are vital. What kind of training is included? Is it face-to-face or on-line? What are the support hours-are they in your time zone?

Create a detailed list of questions to address with the vendors you have selected. Arrange demos based on your office case scenarios and take a close look at the system’s certification, platform and capabilities, and assess its usability. Have a clear understanding of how this system will fit with your practice’s workflow and/or specialty. Make sure you understand what is included in the cost and what is considered an additional fee – be sure to get this in writing and insist on 100% transparency from the vendors. Doing your research before purchasing a system will save a lot of money and aggravation over the long-term.

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Vendor-neutral resources to help guide your decision making process: The Office of the National Coordinator for Health Information Technology (ONC) certified health IT product list (check this site for current certification of EHRs and quality measures) HealthIT.gov - step-by-step guide for EHR selection/replacement Health Resources and Service Administration (HRSA) - selecting a certified EHR KLAS’* top five rated EHRs nationally by ease of functionality (1-10 providers): Cerner, Amazing Charts, SRSoft, Athenahealth and Greenway. *KLAS is an independent company aimed at improving healthcare technology by measuring vendor performance

_________________________ 1 Medical Economics EHR survey probes physician angst about adoption, use of technology. 2 Electronic health record sellers face make-or-break year of client ultimatums and revolts, reveals 2013 Black Book survey

http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2656002 3

The Cost of Technology: Facing the Challenge BY VERONICA GRACIA-WING FOR THE MICHIGAN STATE MEDICAL SOCIETY

2013 RAND Corporation study reported being able to provide high-quality health care as a primary driver of job satisfaction among physicians. Not surprisingly, obstacles to quality patient care were reported as a source of stress for doctors. “Physicians do want to embrace payment and delivery models, but they feel there is a great deal of confusion across parties,” says American Medical Association President Steven J. Stack, MD. “They feel there are insufficient resources, however, which starves them of the materials they need.” It’s no secret that physicians are most fulfilled in practice when they’ve done good work for healthier and happier lives. In many, if not a majority of cases, physicians feel strongly that electronic health records and the ever evolving health information technology requirements are a hindrance to that fulfillment, let alone quality care.

FIGURE 1:

Top 10 EHR Products in Michigan by Meaningful Use Attestation

“Medical providers in the United States are experiencing increasing pressure to rapidly adopt and effectively use EHRs and ancillary medical technology,” says Thomas Stringham, co-founder and CEO of Cientis Technologies. “As clinicians and their teams react to this pressure they are faced with the intimidating tasks of selecting and implementing one of the numerous EHR systems currently available.” In response to the need for credible information organized and presented by the medical profession, the American College of Physicians and Cientis Technologies partnered to create AmericanEHR Partners – a free, web-based resource for all practices and their office teams. AmericanEHR Partners is dedicated to the creation of an online community of clinicians who use information technology to deliver care to Americans. Through education, social media and the collection of peer

contributed data they organize information to facilitate optimal decision-making. To be certain the program is responsive to the needs of health care professionals in practice, AmericanEHR has invited all medical societies to be active participants in the product’s design in order to enhance its value and broaden its reach. As such, AmericanEHR Partners is working with a growing number of national and state professional organizations (18 and counting), including Michigan State Medical Society. Data from AmericanEHR shows in spite of the growing number of practices that have already adopted EHR systems, the fact that there is huge dissatisfaction amongst existing users means that there is also a steady churn of medical practices that continue to shop for replacements. “Over 50 percent of AmericanEHR respondents say they are considering a new system,” Stringham says.

Average Product Vendor Satisfaction Attestations Rating EpicCare Ambulatory Core EMR

Epic Systems Corporation

EpicCare Ambulatory 2014 Certified EHR Suite NextGen Ambulatory EHR

3.42

4773

Epic Systems Corporation

N/A

2949

NextGen Healthcare

3.00

2713

Allscripts Professional EHR

Allscripts

3.17

1739

eClinicalWorks

eClinicalWorks LLC

3.48

1640

Practice Fusion

3.59

615

Allscripts Enterprise EHR (Complete) Allscripts

N/A

566

WritePad

Addison Health Systems Inc.

N/A

514

PrimeSuite

Greenway Health LLC

3.40

475

OfficeMate/Exam/WRITER Eyefinity/Officemate

N/A

Source: http://www.americanehr.com/ratings/ehr_ratings/MU-Attestation-Data.aspx

MICHIGAN MEDICINE

September / October 2015

That being said, the EHR market is still relatively young, and there are glimmers of hope with practices that have invested in EHRs for the long haul. For example, in a recent American EHR survey 53 percent of respondents who used their EHR system for more than five years reported a positive effect on time spent processing prescriptions and refills. In Michigan, the top 10 EHR products sorted by Meaningful Use Attestation are shown in Figure 1, below left. Alternatively, the Top 10 EHR products in Michigan sorted by Satisfaction are shown in Figure 2, below right. Stringham notes the following changes and challenges physicians should be aware of:

CHANGES • Patient-centered medical homes have been demonstrating improved care (still being studied, but trends are good, Stringham says). • The leading reason for switching systems, cited by 44 percent of practices, is product issues.

CHALLENGES • EHR satisfaction declining. • Meaningful Use Measures are difficult and place additional workloads on providers. • Burden of data entry. • Reduced patient interactions. • Poor interoperability between systems.

FIGURE 2:

Top Ten EHR Products in Michigan by Satisfaction

Average Product Vendor Satisfaction Attestations Rating Praxis EMR

Infor-Med Corporation

4.42

Practice Management System

Waiting Room Solutions

4.38

Sevocity

Sevocity - A division of

Conceptual MindWorks Inc.

4.30

Amazing Charts

Amazing Charts.com Inc.

4.07

164

RxNT EHR

Networking Technology dba RxNT

3.96

130

e-MDs Solution Series

e-MDs

3.79

129

NexTech Practice 2012

NexTech Systems Inc.

3.78

NexTech Practice 2011

NexTech Systems Inc.

3.78

Acumen EHR

Acumen Physician Solutions

3.76

SpringCharts EHR

Spring Medical Systems Inc.

3.70

2011 Waiting Room Solutions Web Based EHR and

Source: http://www.americanehr.com/ratings/ehr_ratings/MU-Attestation-Data.aspx

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“Physicians need to be aware of the importance that training plays in their long-term success and understand that physicians who are involved in the selection of their system have a much stronger affinity for it,” Stringham says. AmericanEHR has a number of tools to help medical practices with EHR readiness, selection, adoption and ongoing efficient use, all of which can be accessed by signing up for a free AmericanEHR account: • Readiness Assessment Tool • EHR Top 10 Ratings by Category • EHR Comparison • EHR Advanced Search • Meaningful Use Attestation Data EHR systems offer the promise of greater efficiency and improved patient care, but there are some key points for providers to keep in mind, according to Stringham: • Diligent planning and selection of EHR is necessary • Adequate training is necessary • EHR satisfaction improves over time • Ancillary technology such as mobile apps, and health exchanges can help improve the overall patient experience and quality of care A.J. Ronan, DO is addressing the technology change and challenge head on, but not while wearing rose-colored glasses. “When you mention the word cost to doctors they usually roll their eyes and start thinking about cancelling a vacation, keeping their car one more year and changing the venue for the annual Christmas party,” Doctor Ronan says. Doctor Ronan, a family medicine physician in Lansing, Mich,, also represents MSMS on the Michigan Health Information Network (MiHIN) board. 12

“There seems to be no end in sight for technology costs to our practice and in the world of health care, it’s what you have to do to get paid for all the work that you do,” he adds. Doctor Ronan is reflective on the evolution of payment technology. Years ago, third party payors made it difficult to get paid through manual claims forms, enticing physicians with quicker claims payments if filed electronically, but then said the number of claims and the number of codes they review are so numerous that claims payments slowed down anyway. Then came electronic scheduling, and after that, electronic records. Now the industry has moved to patient portals or patient medical records. “I was very progressive 12 years ago and adopted e-prescribing and patient messaging when it was not even required because I thought it was a better way to practice,” says Doctor Ronan. “The costs were minimal initially (but have added up), and it was a great way to make our practice stand out.” Doctor Ronan explains that technology has gone from a minor expense to a major expense for most practices and it’s not just a cost in terms of dollars, but also the cost in man-hours that’s tremendous. “I think technology has saved a lot of hours for my staff, but not necessarily for the doctors and the monetary benefits have been pretty negligible. I don’t think we have lost money in this endeavor, but I think we will not appreciate the fruits of this labor for many more years to come.” Doctor Ronan’s practice has been on board implementing technology for over a decade. At Lake Lansing Family Practice, they MICHIGAN MEDICINE

message with patients via a HIPAA compliant patient portal called RelayHealth.com. This allows patients to give a heads up on topics they would like to discuss at the next office visit or to review labs and tweak care plans between office visits. “We have been doing electronic prescribing of medications and renewing medications automatically, so patients don’t miss doses for weeks while they are trying to get in,” says Doctor Ronan. “We allow our patients to contact us online to schedule appointments. All of the messaging results in over 350 fewer phone calls to the office each month.” The practice is also working with the Great Lakes Health Connect, a health information exchange. This connection allows dozens of x-ray, MRI, CT and ultrasound results to go into provider in-boxes allowing more efficient patient care. It also saves the practice’s records staff a couple of hours per day in sorting and labeling patient records. Another tool Doctor Ronan uses is a patient registry called MD-Datacorp, where patient registries tell third party payors what tests, studies and medications patient are getting from the office to ensure they are receiving the best standard of care. Lake Lansing Family Practice has additional interfaces to local laboratories for immediate results which link with the patient chart so no errors are made in filing the results. All technology use and implementation aside, Doctor Ronan is honest about the challenges cost poses to his practice. “IT went from an incidental cost 10 years ago - almost a novelty - to one of the most expensive monthly costs in the office. We find that it can get way out of control in a hurry.” Doctor Ronan has found most of the IT support and service industry is learning alongside physicians and practices, and is pretty understanding when they explain where they’re coming from in terms of the pain of cost. A little creativity can go a long way, too. Doctor Ronan’s practice looks at patients in terms of a population of people who share similar problems, and use technology to group patients into categories to serve that population’s needs better overall. September / October 2015

“As an example, we always performed poorly on adolescent vaccinations,” says Doctor Ronan. “Now we run reports out of the state registry for vaccines and are able to offer vaccinations services during routine office visits.” As Doctor Ronan explains, he, like many physicians, hasn’t found one go-to resource for health information technology quite yet. “We have utilized the Michigan State Medical Society, MiHIN, the American Osteopathic Association, the American Medical Association, Medical Economics, our own IT support at KI Technology and our software vendors at McKesson/Practice Partners and AllScripts.” One of the best things Doctor Ronan says his practice has done is to go to the annual vendor support group meetings, where he met up with and contracted for software support with a value added resaler.

portal is over 12 years old too and offering less service and functionality than it did 12 years ago, so I’m looking for something more robust, but you have to be careful about making changes. I would only change something if it was clearly an improvement and would help the practice achieve long term goals.”

“We started using EHR in our practice over five years ago, which was a big cost to start with. We went with a local small business to support them and to have easy access in case we needed help. It worked out up to recently, but now with newer government rules we are finding it increasingly hard to fulfill those requirements.

For all of the practices finding success with technology, there are still a great deal that struggle substantially to meet the changing demands and challenges. For Flint, Mich. OB-GYN Mona Hardas, MD, the first thing that comes to mind when she hears the phrase ‘cost of technology’ is “now what?”

Neither Doctor Hardas’ staff and nor her EHR are well equipped to handle those requirements.

“The cost of running a practice is rising every day,” she says.

“We now have to invest in a new EHR, which will not only be expensive financially, but will also be time consuming for me and my staff. That means seeing less number of patients until we get used to it, which means decreased earnings.”

Doctor Hardas runs a small solo practice and explains that surviving with decreasing reimbursement and increasing cost is challenging.

As she looks at the cost of a new EHR, she says the only way she can afford it at this time is by decreasing staff.

As for advice to colleagues, Doctor Ronan says this:

“I think first and foremost, you need to have a budget. This budget needs to be reasonable for the IT service to do their job and for your practice to swallow. Secondly, you need to review your cost sheet at least every quarter and see how far off the budget you have gone.” This problem of setting a budget of a certain percentage of revenue, then straying from it is a common one. He also advises to not do it by yourself. “It’s a team approach. Don’t make any snap decisions. If it sounds too good to be true, it probably is. Talk to other customers using the product already and talk to the technical people who answer complaints and questions. That’s where the truth is,” he says, with an apology to salespeople. Not one to slouch, Doctor Ronan is sure to not be complacent with the technology in his office. “We have had our EHR for nine years now and I went into this with the mind set that if I got at least five to eight years out of the system, I did well. We have had our PM/ billing system for over 12 years and, again, if you get more than 10 years out of that, you’re doing something right. Our patient Volume 114 • No. 5

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“The staff I have has been with me five to 15 years and now I will have to let someone go, as I will not be able to pay both monthly EHR bills and a salary. This is not fair but I don’t see any other solution.” Doctor Hardas’ struggles with costs, like so many physicians, are not for lack of utilizing resources. She works constantly with a MSMS representative, who has been helping in the selection of the right EHR and also looks to other physicians in the area to see where they’ve been successful. She says the idea behind using the technology is very attractive, but has been very different in practice in her area. “We are spending more time entering the data on the computer than doing clinical work. The three hospitals in my area all have different EHRs, which are all different from mine. In the last few years I have spent more time learning those different systems than doing any clinical CME courses.” In talking to other physicians, Doctor Hardas realizes she’s hardly alone in her frustrations and concerns. “I’m worried about the future of my practice and how long can I survive as a solo physician. I like my independence and my patients

love one-on-one care. I would hate to join a hospital practice, but if the cost keeps going at this rate, it’s the only way out as I see it.” The American Medical Association is very tuned in to the concerns of those like Doctor Hardas. “I want our physicians to hear and to know that we live their frustration,” says AMA President Steven J. Stack, MD. “As president of the AMA, along with my colleagues who work hard everyday, we know and understand physician frustrations with the challenges and the need to make things better. Your voices are heard on this issue and your input is valued and shared.” It’s in response to the wide spread sense of policy makers not hearing or listening to the very sincere and legitimate concerns of physicians on the front line of EHR, that the AMA organized a town hall meeting on July 20 of this year in Atlanta, Ga. The event provided the opportunity for physicians to tell their stories about how technology is helping or hindering. Another AMA initiative addressing the burden of modern medicine is STEPS Forward, an effort to address physician burnout, including that over technology. AMA STEPS

MICHIGAN MEDICINE

Forward is an interactive practice transformation series offering innovative strategies that will allow physicians and their staff to thrive in the evolving health care environment by working smarter, not harder. Physicians looking to refocus their practice can turn to AMA STEPS Forward for proven, physician-developed strategies for confronting common challenges in busy medical practices and devoting more time to caring for patients. Doctor Stack acknowledges that times are challenging because of the intense pace, but reminds physicians they can also be exciting, and encourages them to think about the possibilities with managing information electronically. Physicians will be able to do work from any number of locations that are more convenient as the tools get better and better. Patients can get their health information more readily, making scarce physician knowledge available to more people. “It’s somewhat painful to live through it because we’re asked to change at a pace that is uncomfortable, but we do live in exciting times. Science fiction is here today - we’re living in the creation of it all and it’s an awesome opportunity.”

September / October 2015

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September / October 2015

MSMS Board of Directors Disclosures House of Delegates Resolution 25-13 states that “MSMS annually provide Michigan physicians with a list of all officers, officials, candidates and staff who receive money as salary or non-patient care compensation from Blue Cross Blue Shield of Michigan (BCBSM) or any other insurer, medical product company or its affiliates annually in Michigan Medicine.”

Following are the disclosures of the MSMS Board of Directors, officers and staff: Mohammed A. Arsiwala, MD – None David M. Krhovsky, MD – None Anita R. Avery, MD – James C. Mitchiner, MD, MPH – None Outside physician reviewer, Priority Health Debasish Mridha, MD – Pfizer Peter Baumann, MD, MPA – None S. “Bobby” Mukkamala, MD – None John E. Billi, MD – None Bassam H. Nasr, MD, MBA – None T. Jann Caison-Sorey, MD, MSA, MBA – Donald R. Peven, MD – None Population-based Health Care Chronic Rose M. Ramirez, MD – None Condition programs, BCBSM Venkat K. Rao, MD – None Adrian J. Christie, MD – None James J. Rice, MD – None Betty S. Chu, MD, MBA – None Richard C. Schultz, MD – None Sandro K. Cinti, MD – None John J. H. Schwarz, MD – None Pino D. Colone, MD – None David A. Share, MD, MPH – Senior Vice President, Craig T. Coccia, MD – None Value Partnerships, BCBSM Stephen N. Dallas, MD, MA – None M. Salim Siddiqui, MD – Varian Medical Systems Amit Ghose, MD – None James H. Sondheimer, MD – None Cheryl Gibson Fountain, MD – None F. Remington Sprague, MD – None James D. Grant, MD – Board of Directors, J. Mark Tuthill, MD – None Blue Cross Blue Shield of Michigan Todd K. VanHeest, MD – None Lynn S. Gray, MD, MPH – None David T. Walsworth, MD, FAAFP – None Alexander A. Harris – None John A. Waters, MD – None Jeffrey E. Jacobs, MD – None David P. Wood, Jr., MD – None Theodore B. Jones, MD – None Mark C. Komorowski, MD – None

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Value-Based Contracts: We provide solutions that are equal parts powerful and personal.

T H E

D O C TO R S

CO M PA N Y

Telemedicine: Emerging Risks BY RICHARD CAHILL, JD, VICE PRESIDENT AND ASSOCIATE GENERAL COUNSEL, THE DOCTORS COMPANY

n Hamilton County Hospital in rural Kansas, a human-size robot wanders the hall with cameras and a tablet mounted at eye level. By using this device, doctors from across the county can view and

treat patients remotely.1 In another venue, the medical group has asked to use Skype to communicate and evaluate patients remotely. While these remarkable technologies hold great promise, they can also create significant liability risks. Do you understand the limits and possible risks of using these technologies?

MICHIGAN MEDICINE

The concept of telemedicine has evolved rapidly over the last 20 years and has now become part of everyday vocabulary. With the advent of the Internet, new platforms have expanded the use and effectiveness of telemedicine and enhanced the delivery of healthcare across the country. However, numerous federal and state statutes have been enacted that pose significant risks to medical practitioners who engage in any form of telemedicine.

Telemedicine Defined Telemedicine involves the delivery of healthcare to patients in remote locations and to underserved patient populations through a variety of electronic modalities, including audio-visual, online, and wireless applicaSeptember / October 2015

tions. Depending on the need, telemedicine can provide remote monitoring as well as real-time interactions with physicians and mid-level practitioners. The advantages of telemedicine include improved access to medical care and consultation in rural areas, more efficient treatment plan implementation, cost savings for patients, and increased patient satisfaction. Many medical specialties—including cardiology, pathology, psychiatry, and radiology, among others—have embraced the concept on a national basis.

Security and Privacy Issues Despite the obvious advantages of using various forms of telemedicine, the medical community must become knowledgeable about federal and state regulatory policies and requirements that can affect its practices. For example, the Health Insurance Portability and Accountability Act (HIPAA) is particularly relevant. Enacted by Congress and subsequently signed into law by President Clinton in 1996, HIPAA has two principal components: Title I protects healthcare coverage for individuals when they change employment or lose their jobs. Title II established, for the first time, national standards for the electronic transmission of patient health information and the prevention of healthcare fraud and abuse. The Privacy Rule, which became effective in 2003, regulates the use and disclosure of personal health information (PHI). PHI concerns health status, care, or payment and is very broadly interpreted to include such common identifiers as name, date of birth, Social Security number, and residence address. The Privacy Rule identifies certain types of authorized disclosures that are either mandatory (including patient requests and legally imposed duties to report) or permissive (including uses to facilitate treatment, healthcare operations, or payment). Under the United States Department of Justice, the Office of Civil Rights (OCR) is authorized to conduct investigations and impose monetary sanctions for violations. Congress significantly expanded the scope of HIPAA in the American Recovery and Reinvestment Act of 2009. Title XIII, commonly referred to as HITECH (the Health Information Technology for Economic and Clinical Health Act), introduced government-mandated requirements for breach notification, authorized random audits by the OCR, imposed substantially enhanced penalties for statutory violations, and specified that all Volume 114 • No. 5

transmissions of PHI must be “secure.” Secure has been interpreted to mean that such communications will be encrypted. In the first year of enforcement, the OCR reported the recovery of more than $7 billion in penalties and fines. With the advent of electronic health records (EHRs), the transmission of PHI between patients and providers, providers and payers, and among providers has significantly increased. Practices that engage in any form of electronic data transfers, including telemedicine, must strictly comply with the various statutory requirements of HIPAA and HITECH or risk an OCR investigation and potential fines.

Professional Liability And finally, professional liability policies generally specify that indemnity coverage is only available for a claim that occurs in a specific territory or jurisdiction. A physician sued in a state other than the covered territory may find that no coverage is available to either defend the claim or pay indemnity if there is an adverse judgment.

Patient Safety Tips • Comply with HIPAA, HITECH, and state-specific laws when transmitting all PHI. • Ask your system vendor to provide training to you and your staff on how to protect and secure your data.

Licensing Issues Historically, physicians and other healthcare professionals have been licensed exclusively by state boards of practice. Physicians who engage in telemedicine across state lines, therefore, face a number of serious considerations. The scope of practice is generally determined by the location of the patient. Laws governing the practice of medicine vary significantly among the states. Providing care, including the prescription of medication and other controlled substances, to a patient located in a different jurisdiction requires the practitioner to satisfy the licensing requirements of the state in which the patient is located. Without proper licensure, adverse consequences might include criminal prosecution for the unlicensed practice of medicine, disciplinary action by a medical board, and mandatory reporting to the National Practitioner Data Bank, as well as to CMS, professional medical societies, and private payers. Additionally, adverse findings or actions by any of these entities may require self-reporting to state boards or other entities on subsequent credentialing applications for staff privileges. A physician who provides medical care across state lines through any form of telemedicine may also be subject to a potential malpractice suit in the event a claim is filed in the jurisdiction where the patient resides, rather than in the jurisdiction where the provider maintains his or her offices. Undoubtedly, the standard of care will be determined by experts familiar with the community practices in the jurisdiction where the patient is located. Arguably, any tort reform statutes that exist in the jurisdiction where the suit is filed may not be available to a provider who is not licensed in that state. MICHIGAN MEDICINE

• Ensure robust and reliable highspeed broadband connectivity to support clinical functions. • Check practice requirements and legal limitations in states where you anticipate providing care to patients. Understand reimbursement practices for telemedicine services. • Use telemedicine carefully— and understand any limitations on the reliability and accuracy of the information. • Communicate directly with your professional liability insurer to make certain that your policy extends coverage to all jurisdictions where you provide services. Weiner LJ. Weighing telehealth’s pros and cons. HealthLeaders Media website.http://healthleadersmedia.com/content/HR-307025/Weighing- Telehealths-Prosand-Cons. Accessed September 29, 2014.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. Reprinted with permission. ©2015 The Doctors Company (www.thedoctors.com). This article originally appeared in The Doctor’s Advocate, fourth quarter 2014.

Patients trust you. You can trust Kerr Russell. A successful practice requires more than talented individuals and a desire to heal. Let Kerr Russell provide the legal insight needed to manage and grow your business. ENTITY FORMATION • BUSINESS MATTERS • EMPLOYMENT CONTRACTS • PURCHASE / SALE OF OWNERSHIP INTERESTS • MALPRACTICE AND ALL OTHER COMMERCIAL LITIGATION • APPEALS • MEDICAL STAFF PRIVILEGE DISPUTES HOSPITAL RELATIONS RELATIONS MATTERS MATTERS • • HEALTHCARE HEALTHCARE FRAUD FRAUD DEFENSE DEFENSE • • LICENSING LICENSING AND AND OTHER OTHER REGULATORY REGULATORY MATTERS MATTERS HOSPITAL

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500 Woodward Avenue, Suite 2500 Detroit, Michigan 48226 T: 313.961.0200 / F: 313.961.0388

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September / October 2015

You put them first. We put you first. Get a discount on select Sprint monthly service because of where you work.

Discount for employees of

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Bring this flyer with your coupon code and proof of employment to your nearest Sprint store

*HCVRT_ZZZ* Activ. Fee: $36/line. Credit approval req. Early Termination Fee (sprint.com/etf): After 14 days, up to $350/line. SDP Discount: Avail. for eligible company employees, org. members or agency employees (ongoing verification). Discount subject to change according to the company’s, org.’s or agency’s agreement with Sprint and is avail. upon request for select monthly svc charges. Discount only applies to Talk 450 and primary line on Talk Share 700; and data service for Sprint Family Share Pack, Sprint $60 Unlimited Plan and Unlimited, My Way, Unlimited Plus Plan and Sprint Family Share Plus plans. Not avail. with no credit check offers or Mobile Hotspot add-on. Sprint Buyback: Offer ends 09/30/15. Limit of 5 returned devices per active mobile number during one 12 month period, 3 per transaction. Phone must be deactivated and all personal data deleted before recycling. Device will not be returned. Credit varies depending on phone condition and valuation. Credit applied to store purchase or account within 3 invoices. Also available at sprintbuyback.com. Other Terms: Offers and coverage not available everywhere or for all devices/networks. Restrictions apply. See store or sprint.com for details. ©2015 Sprint. All rights reserved. Sprint and the logo are trademarks of Sprint. Other marks are the property of their respective owners. N065134 MV1234567

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September / October 2015

Fall 2015 Education Course Offerings On-Demand Webinars

Practice Transformation

 Physician Executive Development • Health Care Law for Physicians in ACO’s • Medicaid Issues and Trends: Outlook for 2014 and Beyond • In Search of Joy in Practice: Innovations in Patient Centered Care • From Physician to Physician Leader • Inter-Professionalism: Cultivating Collaboration • Financial Information Analysis, Budget Development and Monitoring  Choosing Wisely  Balancing Pain Management and Prescription Medication Abuse: Chronic Pain and Addiction  CDL-Medical Examiner Course  Legalities and Practicalities of HIT • Cyber Security: Issues & Liability Coverage • Engaging Patients on Their Own Turf: Using Websites and Social Media  Summary of the Affordable Care Act  HIPAA Security Rule  End of Life Concerns & Considerations  What’s New in Labor & Employment Law  Preparing for the Medicare Physician Value-Based Payment Modifier  Understanding and Preventing Identity Theft in Your Practice  Stepping Up to Stage 2  Physician On-line Rating and Reviews: Do’s and Don’ts  Patient Portals as a Tool for Patient Engagement

 150th MSMS Scientific Meeting

Please visit www.msms.org/eo for complete listing.

Continental breakfast & lunch will be provided Dates: Wed-Sat, October 21-24, 2015 Morning, afternoon and evening clinical courses available. Location: The Somerset Inn, Troy Contact: Marianne Ben-Hamza (517) 336-7581 or mbenhamza@msms.org Intended for: Physicians and all other health care professionals

 Symposium on Retirement Planning Dinner will be provided

Date: Wed, October 21, 2015 Location: Somerset Inn, Troy Contact: Caryl Markzon (517) 336-7575 or cmarkzon@msms.org Intended for: Retired physicians, physicians planning for retirement, spouses and office managers

If you have questions need more information, or to register for a webinar, conference or program please: • Visit www.msms.org/eo • Call MSMS Registrar at 517-336-7581

Recruiting is hard work. We can help. Medical Opportunities in Michigan connects Physicians, Physician Assistants & Nurse Practitioners with Michigan’s healthcare employers. Private practice memberships begin at $500.

Educational Conferences  ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care Continental breakfast and lunch will be provided

Date: Wednesday, October 21, 2015 Location: Somerset Inn, Troy Contact: Caryl Markzon (517) 336-7575 or cmarkzon@msms.org Intended for: Physicians, executives, office administrators and all other health care professionals Volume 114 • No. 5

MOM is a service of the Michigan Health Council

800-479-1666 MICHIGAN MEDICINE

miMOM.org 23

OCTOBER 20-24, 2015 SOMERSET INN, TROY, MI Physicians of all specialties, residents, students, nurses and other health care professionals are invited to join the Michigan State Medical Society Foundation at its 150th Annual Scientific Meeting (ASM). Take this opportunity to collaborate with colleagues, see the latest our medical industry vendors have to offer, and learn about the cutting-edge clinical advances from local and national experts. With up to 28.75 AMA PRA Category 1 CreditsTM in more than 30 sessions, the 150th ASM will show you the innovations and and trends in medicine and health. Check out the 150th ASM’s new features:

Take advantage of FREE learning opportunities provided through ASM, totaling 6.25 AMA PRA Category 1 CreditsTM: • Tuesday: Evening dinner session on Payment Reform • Wednesday: Plenary Session: H.U.H.? How to Understand Health Literacy and Improve Patient Care and evening dinner session on ER/LA Opioid REMS • Thursday: Plenary Session: Fostering Emotional Well-being: Choosing not to Burnout! • Friday: William Beaumont Lecture - Emerging and Re-emerging Infectious Diseases: the Perpetual Challenge to Global Health

• New course times with earlier evening sessions; • Free leadership evening session on Tuesday; • Afternoon Plenary sessions on Wednesday and Thursday; and, • Interactive Saturday case study session.

MICHIGAN MEDICINE

September / October 2015

Has Technology Made You Richer? BY NICOLE GOPOIAN, JD, CFP®

echnology has transformed the financial services industry in numerous ways. Your cellphone allows you to get information immediately, and from almost anywhere. You can get stock quotes or execute trades with the touch of a few buttons - it’s quite remarkable. Has this innovation made you wealthier? Has it moved you closer to achieving your goals? The answer to these questions is “Probably not.”

Technology advancements changed the landscape by leveling the playing field in two significant ways: 1. Consumers can buy and sell securities directly without relying on a broker to complete the transaction. 2. Consumers now have access to the same information as brokers.

Technology advancements changed the landscape by leveling the playing field in two significant ways. First, consumers can buy and sell securities directly without relying on a broker to complete the transaction. In the old days, a retail investor had to go through a broker to buy an investment like a stock or bond. Brokers provided a barrier to entry and individuals had to pay transaction fees for access. Second, consumers now have access to the same information as brokers. Before the internet, brokers used to get information a day before it was in print for the public, and could use that information to execute trades. Recent innovations have helped consumers have access to more information and have changed the industry for the better. Technology has enabled investors to manage their own investments. But that doesn’t mean they should. Human beings have handicaps. There’s a whole field of study on behavioral finance that addresses why most humans make poor investment decisions regardless of information or access. A pioneer in financial planning says “If investing was easy, everyone would be rich.” Being a good investor boils down to managing human behavior. The human brain is wired to sense danger. To many, the fear associated with losses can be much greater than the joy created by gains. When the market is volatile, people sense danger. Survival tendencies kick in and human instinct is to retreat. Humans

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are wired to make poor investment decisions in this circumstance. They sell low and buy high to avoid the threat of danger. The media can compound this phenomenon by creating hysteria and a gloom and doom outlook. It makes for good TV and it’s easy to jump on the bandwagon when you hear the message 24/7. With the technological innovations available, some investors have turned to a robot or computer as a substitute for a financial advisor. This strategy is flawed. A robot cannot effectively manage human behavior like a living, breathing financial planner. Planning is centered on understanding, and robots lack the ability to do so. A robot does not have an awareness of values or needs - and why they are meaningful. It cannot use judgment. A robot operates in black and white. The world has a lot of gray. The robot only knows what the investor tells it, and it uses that data to form conclusions. The robot may receive imperfect information because the investor’s perspective can be skewed based on their environment, perceptions, or even their mood. A robot cannot peel back the layers to determine an investor’s true values. And sometimes, when investors are afraid or concerned, they want someone to talk with. Humans need contact with other humans. You cannot look a robot in the eyes. Or hear their voice and know that you’re making a sound decision for you and your family. Similar to the medical field, technology has brought great advancement to the financial services industry. But at the end of the day we still need doctors - and financial planners. Nicole Gopoian, JD, CFP® is an advisor at WealthCare Advisors, LLC – an MSMS joint venture.

T H E

M A R K E T P L A C E »

WANTED PHYSICIAN Detroit Area

» JOB POSTING « MEDICAL CONSULTANT

Tri-State Occupational Medicine, Inc. (TSOM) is looking for physicians to join their group to perform disability evaluations in east Detroit. Full-time ad part-time opportunities available. No treatment is recommended or performed. No call, no weekends and no emergencies. Full-time physicians work 3-4 days a week. Physicians working for us have various bakcgrounds and training including General Practice, IM, FP, Pediatrics, Pain Mgt., Surgery, Orthopedics, Neurosurgery and Cardiology. Training and all administrative needs incluidng scheduling, transcription, assisting and billing are provided. Interested physicians must have a current MI medical license and in good standing. TSOM has an excellent reputation for providing Consultative Evaluations for numerous state disability offices.

DON’T RENT – Own Your Own office

Contact: Susan Gladys / susang@tsom.com phone 866-929-8766 / fax 866-712-5202

Why pay rent to someone else—own your office! 1079 sq. ft. suite in Farmington Hills in med/dent bldg. EZ access to all Xways. 248-637-9700.

Disability Determination Service (DDS) for Social Security Administration is seeking physicians on a part time basis to provide expert advice on disability claims by reviewing and recommending the disability determination. DDS offers extensive orientation in the disability process, a flexible work schedule, an opportunity to provide service in your community, and a highly automated case processing system. The Social Security Disability programs provide benefits to persons with severe disabilities whose impairments prevent them from performing gainful work. Disability claims are administered through the State DDS. Openings are available in Kalamazoo, Traverse City and Detroit. Candidates should possess excellent analytical and communication skills, as well as good computer navigation skills. An MD or DO degree and State of Michigan physician license is required. Clinical experience is preferred.

» Contact Lorrie Waddell 269-337-3432. »

MICHIGAN MEDICINE

September / October 2015

Family Practices n Allen Park: Retired Orthopedic Surgeon offering turn key operation. Full PT Lab, receive patient files, lots of potential for a very low price asking $50,000. n East Pointe Primary Care: Near I94 and Kelly Road. 3 Exam rooms, 2 year old practice. Asking $60,000 includes equipment/goodwill and transition. Real estate available. n Farmington Hills: Long established Internal Medicine Practice, 10 Mile/Middlebelt area. Free standing building, 5 exam rooms, lab, x-ray. Very close to Botsford, St. Maryâ&#x20AC;&#x2122;s, and Providence Novi. Asking $175,000 for practice. n Garden City Internal Med Practice: Long established, majority of patients Medicare. Fully equipped, grossing in excess of $200,000 annually. Asking $70,000. n Mexican Town Detroit: 20 year old Primary Care Clinic. Staff is fluent in multiple languages. Seller financing available, priced to sell, work as you pay terms. Never in 25 years have I had the opportunity to offer more flexible terms. Price reduced to $589,000 for everything including real estate. n Lincoln Park: Walk-in clinic. Very visible, long established, seeing approximately 40 patients daily. Approx. gross income $800,000. Asking $250,000 for practice and $350,000 for real estate. n Podiatry Practices Detroit: 2 locations, very successful, grossing in excess of 600,000 annually. Fully equipped. Asking $300,000 for both locations. Real estate available. n Westside Detroit, Primary Care Practice: Established 2005, grossing in excess of $500,000 annually. Fully equipped. Asking $200,000 owner wants to retire.

Medical Buildings For Sale or Lease n Pontiac: Large professional medical building. Three story, suites 5005,000 sq. ft. Across from hospital, acres of parking. VERY REASONABLE rates/terms or buy building for $250,000. n West Side Detroit: 8,000 square feet, multi suites, fully leased. $60,000 pos. cash flow excellent. Brick, single story asking $500,000 or lease for $1.00 square foot plus utilities.

For more details contact our practice specialist at Union Reality:

Joe Zrenchik, Broker 248-240-2141 (cell) joezrenchik@yahoo.com 248-919-0037 (office) Thinking about retirement, relocation or expansion of your medical practice? We have buyers and sellers for primary care, internal medicine and cardiology practices.

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STAFF PHYSICIAN - FERRIS STATE UNIVERSITY To provide: • Primary care in a team-oriented approach to a diverse student population and their dependents age two (2) years and older, including diagnosis and treatment of acute and chronic illnesses and injuries, making appropriate referrals when warranted and/or determined by established care standards. • Diagnosis and treatment for minor work-related injuries for University employees along with patient education. To serve as Medical Director and supervise: • The clinical practice of medical staff including mid-level providers, nurses and medical assistants. To collaborate and work in partnership: • With staff on improving programs, policies, protocols, procedures and educational materials through continuous quality improvement. • Within the division to integrate the work of the Birkam Health Center into the mission, vision and core values of the University.

Required: • Satisfactory completion of clinical internship and/or residency in an accredited hospital and/or clinic setting in Family Medicine and/or Internal Medicine. • Applied and demonstrated knowledge of adolescent medicine and gynecological health; also familiarity with treatment of sexually transmitted infections and disease. • Experience in electronic medical record keeping. • Experience in providing supervision of mid-level providers and/or nurses and/or medical assistants. • Possession of valid unrestricted license to practice in current state jurisdiction and license eligibility in the State of Michigan. • CPR/ALS certification. • Michigan DEA license or eligibility within 30 days of hire.

For a complete posting or to apply, access the electronic applicant system by logging on to http://employment.ferris.edu. Ferris State University is sincerely committed to being a truly diverse institution and actively seeks applications from women, minorities and other underrepresented groups. An Equal Opportunity/Affirmative Action employer.

MICHIGAN MEDICINE

September / October 2015

Welcome New MSMS Members! The first mental health assessment tool that immediately delivers test results Improve Patient Care: GreenLight tests serve as a first line of defense, an early warning system for the detection of mental illness.

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A free iPad and training are included when you sign up.

To get started, please visit www.greenlight.md. It’s a GO with GreenLight

Volume 114 • No. 5

Michael Banka, MD Muskegon Kathleen Behler, MD Grand Traverse David Bidle, MD Marquette/Alger Joseph Blount, MD Oakland Cassie Bluhm, DO Marquette/Alger Ryan Bogart, DO Jackson Natalie Brown, MD, PhD Grand Traverse Jacques-Brett Burgess, MD Grand Traverse Mark Byland, MD Grand Traverse Samia Cheema, DO Jackson Kelly Covell, DO Grand Traverse Jean Craig, MD Kent Sandra Dettmann, MD Kent Michael DeWeerd, MD Newaygo Timothy Dickson, MD Oakland Ralph Duman, MD Chippewa/Mackinac Leonard Dunikoski, III, DO Ottawa Adrienne Edgren, DO Grand Traverse Robert Egan, MD Wayne Timothy Ekpo, DO Jackson Patrick Friedli, MD Grand Traverse Courtney Garlick, MD Muskegon Vernesa Gazic, MD Kent Douglas Gentry, MD Grand Traverse Robert Graham, DO Isabella/Clare Derek Grossman, DO Grand Traverse Omar Haqqani, MD Midland Jason Hawkins, DO Jackson Sara Hinkley, DO Kent Nicholas Holzemer, MD Washtenaw Laura Howe, MD Grand Traverse

MICHIGAN MEDICINE

David Hunter, MD Grand Traverse Omar Kashlan, MD Genessee J.David Kaurich, MD Muskegon William Kern, MD Grand Traverse Elizabeth Kowal, MD Kent Timothy Kowaleski, DO Jackson Benjamin Lamphere, MD Grand Traverse William Lange, MD Grand Traverse Charles Lapo, II, MD, JD Manistee Katherine Lazet, DO Marquette/Alger Joseph Lessard, DO Grand Traverse Karrin Licht, MD Grand Traverse Erik Lindstrom, MD Grand Traverse Brian Lishawa, MD Grand Traverse John Lorentson, MD Grand Traverse Jennifer Lyon, DO Grand Traverse Samuel Mackenzie, MD, PhD Washtenaw John Macnowski, III, MD Grand Traverse Damon Maes, MD Grand Traverse Gary Mally, DO Muskegon Joseph Marous, MD Muskegon Marc Mastropaolo, DO Wayne Thomas McElwee, MD Grand Traverse Mary Meram, DO Jackson John Montgomery, MD Washtenaw Paul Mulvey, DO Jackson Dan Nguyen, MD Washtenaw Darren Nisly, DO Jackson Christopher O’Connor, MD Marquette/Alger Olufunmilola Ogbonlowo, MD Genessee Kevin Orr, DO Ingham

Eleni Papalekas, MD Oakland Archana Patel, MD Muskegon Joanna Pease, DO Macomb Mark Pennington, MD Muskegon Juliette Perzhinsky, MD Saginaw Angela Pohl, DO Grand Traverse Albert Quiery, Jr, MD Washtenaw Christina Regelsberger, DO Jackson Amy Robertson, MD Grand Traverse Stephanie Rutterbush, MD Marquette/Alger Edward Sara, MD Muskegon Praveen Sateesh, MD Kent Adrian Seah, MD Grand Traverse Colleen Shank, DO, MPH Jackson Robert Sigworth, MD Grand Traverse James Sitek, DO Grand Traverse Douglas Slater, MD Grand Traverse John Stephenson, DO Muskegon David Straight, MD Grand Traverse Selcuk Uremek, DO Jackson Jason VanAntwerp, MD Marquette/Alger Daniel Vickers, DO Muskegon John Visser, MD Kent Justin Voorhees, MD Kent Lawrence Warbasse, III, MD Grand Traverse Suzanne West, MD Kent Morgan Wise, DO Wayne Hal Yost, DO Grand Traverse James Zeratsky, MD Grand Traverse Michael Ziter, MD Grand Traverse Brenda Zook, MD Kent

P R E S I D E N T ’ S

P E R S P E C T I V E

What Is the Wealth of Technology Affording Us?

still remember the one to two inch thick charts that held the records and valuable medical information about my patients. We had piles of them everywhere and I think it took one full-time medical records clerk to manage them. They were heavy, took up way too much space and were often illegible.

When I left a hospital employed physician group to open my own practice in 2004, I took a leap of faith and purchased an electronic medical record. When the office opened, all patient data and history were entered into the EMR and we were officially early adopters! (I could also remind everyone about bag phones, Palm Pilots, and the rather large voice pagers we used to wear when on call! However, let’s fast forward to 2015 and beyond.) We now live in a world of patient record data entry at point of care and the ability to integrate the information throughout an entire health system. When a patient enters the specialist’s office for a consult, the specialist has the luxury of knowing the patient history and why the patient is there. Lab results, imaging studies and other crucial information are immediately available. When the patient returns to the PCP office, the consultation is legible and communication is timely. We are sharing information regionally via health information exchanges and these tools will help us to achieve our goals of population health. The downside of using information technology to improve the quality of care and safety for the patient has been the clunky, slow process of entering data into the record and the volume of information we may need to skim to obtain one or two important pieces of data to make decisions about diagnosis and treatment. Physicians have 30

BY ROSE RAMIREZ, MD been frustrated with the time required to enter information into the EMR and the loss in productivity. Despite this, in 2013 when the American Medical Association commissioned the Rand Corporation to do a study on physician practice sustainability, the results showed that 80 percent of physicians did not want to go back to paper charts.

portant information to help with the diagnosis instead of jumping into an expensive cardiac workup or from driving straight to the emergency department.

When I see patients in my office, I carry a wireless laptop into the room. I turn the screen so the patient can see when I am discussing lab results or a report. Soon, more of my rooms will have a large screen monitor so the patient and I can sit side by side to review important information, discuss the treatment plan and use educational resources when needed.

The disruptive innovation of information technology is changing the business model of health care. While it’s true that patients will still need a surgeon to remove an infected appendix; more and more consumers are now consulting the web first, via their mobile devices if they are feeling sick. They can get needed medical advice while still in their pajamas and have medication delivered to their home.

I carry my iPhone in my pocket and use a number of apps at point of care to decide if a patient still needs to be on a statin, for example. A few of my favorite apps include CVRiskAssist, Epocrates, GoodRx and ePSS. I often consult UpToDate for diagnostic dilemmas and treatment options. If you look to the app store on your phone, you will see that patients have access to thousands of apps that help them know when they are ovulating, understand anatomy, get 24/7 access to online urgent care, interpret lab results, manage their diabetes and much more. One of Apple’s newest creations is an app called Apple Research Kit. The app is a software framework made specifically for medical research. Apple hopes to leverage the 700 million iPhones sold to gather information to promote medical research and are already working with several high profile research institutions. Another cool app is Cardiograph. If a patient is feeling palpitations, they can place their finger over the camera on the phone and record a pattern that works as a rhythm strip. This app is not perfect, but it allows the patient to be empowered to gather imMICHIGAN MEDICINE

iHealth, maker of various iPhone connected health care accessories will enable patients to gather information on their iPhone and to sync data with the new iOS 8 Health app.

The mobile devices have unlimited potential to assist patients in making healthier choices for themselves and their families. As physicians, we must stay engaged with our patients and support their efforts to get safe and scientifically sound health care. The explosion of new mobile medical technology is one more way to make health care more accessible and affordable and it does not replace a strong patient-doctor relationship. Many people cannot find true healing without the critical human touch. Doctor Ramirez, a Kent County family physician, is president of the Michigan State Medical Society

September / October 2015