In the context of one of my earlier blog postings about the EMR needs assessment (http://www.waident.com/blog/viewpost/460) I wanted to take a moment to reiterate the need for a process both in EMR selection and in ongoing use.  Rather than thinking about how to convert a paper process into an electronic one, think about process improvements instead.  Setting goals for how the EMR system can provide more timely information, including alerts for the physician and other staff, will be a meaningful step towards recognizing value with your EMR system.  The key being not to overlook anyone in your process, as everyone has some impact on the medical practice workflow.

Here is an interesting article that provides some insight on how physicians are using EMR’s in the context of meaningful use:

Meaningful Metrics: The Patient Experience & the Baseline

I have talked with many physicians and practice managers in small and midsized practices across specialties about their thoughts and concerns on the path to EHR selection, implementation and meaningful use.  Some of these conversations steer toward waiting to see what their affiliated hospital will do.  While alignment with the affiliated hospital is certainly an important aspect of the EHR for the medical practice, the ongoing concern must be continuous process improvement within the practice.  Meaningful use can be part of the even bigger picture of your practice.  This is not only a change from paper to electronic but also provides more sophisticated and timely information.  The challenge many times is getting buy-in to the idea that everyone will be creating a new process and it does not happen overnight or even after a 3-day “go-live” with the EHR system.  The bottom line is that if everyone in the medical practice buys-in to defining and developing the new process within the EHR, there can be real benefits to making this leap.  If you have ongoing concerns about achieving meaningful use within the practice, here is an interesting article on the concerns that CIO’s of the hospitals have in this process:

Survey: 80% of CIO’s concerned about meeting Meaningful Use standards in time

With the ongoing interest in achieving “meaningful use” with EHR systems – here is a link to the new CMS (Centers for Medicare and Medicaid Services) resources website for EHR Incentives Programs:

http://www.cms.gov/EHRIncentivePrograms/

Until recently I've never sold anything on eBay, Craigslist, or any other auction type site. I never wanted to spend the time and effort to deal with selling my old stuff and having to then work with the buyer to ship it and get the payment. Years ago I looked in to the Sell It On eBay stores, but they just had a piles of junk all over the store, no sense of customer service, and no one seemed to care about the things I wanted to sell - not to mention they charge 40% plus expenses to sell my junk.

I avoided the whole eBay thing like the plague  - until now. My paradigm shift happened earlier this year when a client wanted to sell some old server and networking equipment. All of it was nearly 10 years old, off the books so no value to the client at all. For us to sell the equipment on eBay, it would have cost more for our time to sell it then we expected to make. We checked in to recycling it all and that turned out to be a $1,500 expense (the client had a lot of old equipment....). We were in a lose/lose situation. Luckily I mentioned my predicament to my uncle, who, unbeknownst to me, has a side business of selling things on eBay/Craiglist for people and companies. I was intrigued.

As it turned out, he "gets it" and could do what I needed in a much better way. As part of his business, he handles everything - from picking up the items for sale, taking pictures, custom boxing and all of the shipping, coordinating the item pickup if local, and even cleaning the items up for the highest resale value. He also charges a much more reasonable 30% plus the usual eBay/PayPal fees while adding so much value and customer service, that it is well worth the money.

So for my client it was a win/win. They went from having to spend $1,500 to recycle the equipment to making over $1,500 from the resale. The client experience went so well that I figured I would try selling some old things I had around the house. When I was young, single, and in college I used to be a professional photographer and used to ride an Italian 10 speed racing bike. I had not touched the bike in close to 20 years (I bought a mountain bike years ago) nor had I touched the camera gear since I did not have a dark room any longer and digital has been the new standard for years. I figured no one cared about old 35 mm camera equipment or an old dirty bike. I was hoping to get a a couple of hundred bucks tops, but with no effort on my side, it look like my items will sell for close to a grand. Heck, much of the things I sold I bought used 20 years ago and I got more than what I had originally paid.

It turns out that Glen has sold pretty much everything from cars, motor-homes, antiques, to computer equipment. Want to sell some old stuff and don't want to deal with it? Do what I do and let Glen take care of it all for you. His contact information is below.

Glen Griessler
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Cell - 630 854-7839
http://shop.ebay.com/victorianhome1875/m.html

Google Goggles - Visual Search for Android smartphones (http://www.google.com/mobile/goggles/) - I first downloaded this application a couple of months ago and never really looked at it. Now it is one of my favorite apps of the moment. Why you say? Well for starters I wanted an app that would allow me to point my smartphone camera at a business card and make it strip the text and create a Contact with the information. It does this pretty well. Not perfect, but way easier than having to enter all of the data from scratch. Google Goggles also does visual search by pointing the camera at something and pressing a button, it will check Google for anything that matches. For example, with my kids found a caterpillar in the yard so I got my phone, snapped a Google Goggle shot, and it told me what kind it was and all of the details of a Google search. Pretty amazing.

mint - Finance and budgeting tool (http://www.mint.com/) - No one likes to spend the time monitoring their home finance activity and managing a budget. This free web service may do the trick. It is fairly simple to setup and use, and it will even be proactive and let you know when you can save money, send out alerts, and even give advice on choosing a better option. I'm giving it a try and so far it works well.

Not sure if you have seen or read anything about copier related security breaches, but it seems to be the talk of the town lately. Nowadays, copiers have hard drives and every copy, scan, and print job that is done is stored on that drive. Sell or give away your copier and you give away all of your copier data as well. I would think that most hard drives hold months, or even years worth of data, so this could be a huge security concern for a lot of companies.

Definitely something to worry about when getting rid of an old copier.

Waident's Director of Managed Care Bob Green wrote something on this topic last month which can be seen here. His article also includes a link to a good CBS News story on the topic with some real world examples. http://www.waident.com/blog/viewpost/459

I have long been an advocate for considering the business process as a whole to identify opportunities for improvement and to establish a business case.  I have talked with physicians and practice managers who share the opinion that the goal of the practice is to get the doctor in front of as many patients as possible every day.  However, it is interesting how sometimes the other aspects of the operation in the practice can diminish that concerted effort when it comes to the bottom line in the financial statements every month. 

A real pain point within the operations I hear about time and again is collections.  After all, it is money that the physicians should have earned by providing care.  But what happens when people in the practice think more like individuals than as a whole practice?  The answer is that gaps develop and grow between people and their processes.  Technology, such as an EHR system, can be a great tool for creating efficiencies within the practice.  But those efficiencies are only as strong as your underlying processes for delivering care, managing collections, and every other aspect of the practice. 

One key point that we consistently talk about with our clients involves the alignment of their technology with the strategy of the practice.  The key here is that the strategy must be in place and everyone has to buy-in for best practices to evolve.  Consistently measuring your process through key performance indicator reports will then facilitate improvements.  Technology can help people become more efficient, but it’s only as good as the underlying processes.  We provide our clients with a variety of performance reports for their technology.  Further, we make time to discuss this information and the implications with them as well.  What makes this work is a shared vision and commitment between our clients and us. 

Here is an interesting article from someone I know and trust, Rosemarie Nelson, regarding the big picture view of collections for your practice:

How Big Is Your Collections Gap?

In my conversations regarding technology with healthcare professionals, privacy and security throughout the business/clinical process is a common source of pain.  After all, whether a medical practice is well into the use of an EHR or at some stage of selection/implementation, the business process is critical to determining how effective technology will be as a tool for everyone.  Each person in the practice has important responsibilities to fulfill and that, in many cases, requires access to patient records in some level of detail.  Having a concise technology management and use policy can go a long way in the development of best practices within the practice for concerns such as privacy and security because technology does have implications on both your people and processes.  The point is that whatever your process is today, using an EHR can be a great tool when it is surrounded by sound technology management policies for the practice.  What’s more, this is an ongoing process with much iteration.

Here are some interesting statistics regarding breaches of healthcare data and other personal information:

P2P Networks a Treasure Trove of Leaked Health Care Data, Study Finds

I have been having more conversations every month about the use and value of social networking sites for interacting with patients.  One of the concerns that I hear  time and again from healthcare professionals is apprehension regarding protecting patient privacy.  While privacy is always important, there are real benefits to being able to share insight with patients in an asynchronous environment. 

Consider the implications of using a social site as a resource tool for the physician to share with patients whenever they choose to view it – especially when the office is closed.   Telemedicine is a term that for some remains obscure in application within the physician-patient interaction.  I use my blog posts to share information with the people who I know and trust in healthcare.  Some people have even asked me why I share so much information.  The answer is that behind the scenes it’s actually a two-way street among my healthcare peers, clients and me and it makes all of us better off. 

Below is a link to an interesting article which gives examples of using social networks like Facebook and Twitter to interact with patients.  Whether or not you agree with this type of exchange with health information I think you’ll at least find this thought provoking:

E-Health and Web 2.0:  The Doctor will Tweet You Now

Have you been through some EMR demos lately?  I’ve been working with practices in various stages of EMR selection and use and one of the common themes that I’ve noticed is “buyer’s remorse”.  With all of the hype associated with the HITECH stimulus, it seems an interesting climate has developed – vendors talk about their CCHIT certification and then you should just buy their stuff.  Since many physicians would qualify for this incentive, assuming they have all the pieces in place for meaningful use, it’s just a matter of making the purchase of an EMR system and paving the road to receive those annual incentive dollars. 

But with so many EMR vendors out there, how can a practice make a commitment to buy and implement?  The answer may seem a bit counterintuitive at first, but these vendors should be qualifying for your business through a needs assessment of your practice.  Now you may be asking:  What about the demo?  The key here is that a demo is important, but it’s a later step in the process of evaluating these vendors.  The first step is to define from your current process what you expect the EMR system to do for every aspect of your practice and every step of your process.  Don’t be afraid to put the onus on these EMR vendors to qualify for your business before you invite them for that visit to your office.  By defining your specific expectations up front, you’ll find that you are much more likely to know what to expect when you begin implementation and are on the road to qualifying for that great incentive.

We feel that the needs assessment process is often ignored, but is extremely important in helping acquire the best EMR system for our clients. Because of this, we work closely with our clients to develop a robust needs assessment and have even created a template to be used to help the process be as painless as possible. We understand that our clients are busy, but they are the only ones who can specify in detail their business process and needs. Together we can set the expectations with the needs assessment and facilitate a confident selection process.  Going forward, we allow the practice to focus on their patients rather than worrying about their technology.