AC Group`s 2007 Annual Report The Digital Medical Office of the

Transcription

AC Group’s 2007 Annual Report
The Digital Medical Office of the Future
Computer Systems for the Physician’s Office
May 2007
Comprehensive Report on:
Overview of Physician adoption
The Six Levels of Physician IT Maturity
Practice Management Marketplace
Secured Internet
Document Image Management
PDA and Mobile Healthcare
Electronic Medical Record Functionality
Electronic Medical Health Marketplace
Regional Healthcare Information Organizations
Mark R. Anderson, CPHIMS, FHIMSS
Healthcare IT Futurist
AC Group, Inc.
(v) 281-413-5572
[email protected]
www.acgroup.org
More about the Author
Mr. Anderson is one of the nation's premier IT research futurists dedicated to health care. He is one of
the leading national speakers on healthcare and physician practices and has spoken at more than 350
conferences and meetings since 2000. He has spent the last 30+ years focusing on Healthcare – not
just technology questions, but strategic, policy, and organizational considerations. He tracks industry
trends, conducts member surveys and case studies, assesses best practices, and performs
benchmarking studies.
Besides serving at the CEO of AC Group, Mr. Anderson served as the interim CIO for the Taconic IPA
in 2004-05 (a 500 practice, 2,300+ physician IPA located in upper New York). Prior to joining AC
Group, Inc. in February of 2000, Mr. Anderson was the worldwide head and VP of healthcare for META
Group, Inc., the Chief Information Officer (CIO) with West Tennessee Healthcare, the Corporate CIO for
the Sisters of Charity of Nazareth Health System, the Corporate Internal IT Consultant with the Sisters
of Providence (SOP) Hospitals, and the Executive Director for Management Services for Denver Health
and Hospitals and Harris County Hospital District.
His experience includes 32+ years working with Healthcare organizations, 20+ years working with physician offices, 7 years in
the development of physician-based MSO’s, 17 years with multi-facility Health Care organizations, 15 years Administrative
Executive Team experience, 6 years as a member of the Corporate Executive Team, and 9 years in healthcare turnaround
consulting. Mr. Anderson received his BS in Business, is completing his MBA in Health Care Administration, and is a Fellow
with HIMSS. Additionally, he serves on numerous healthcare advisory positions and has developed programs including:

Developer of the Six-levels of Healthcare IT for Hospitals and the Physician Office
Researcher and producer of the 2002-2007 EMR Functional rating system
Advisory Board and Content Chairman - Healthcare IT Outsourcing Summit, 2002, 2003, 2004, 2005
Advisory Board and Content Chairman - Patient Safety and CPOE Summit, 2002, 2003, 2004, 2005
Advisory Board and Content Chairman – Consumer Driven Healthcare Conference, 2003, 2004
Advisory Board and CPOE Chairman - Reducing Medication Errors, 2003, 2004, 2005
Advisory Board of TETHIC 2003, 2004, 2005
Advisory Board of NMHCC 2000, 2001, 2002, 2003, 2004, 2005
Advisory Board of TCBI Healthcare Conference 2000, 2001, 2002, 2003, 2004, 2005
Advisory Board of TEPR and MRI, 2000, 2001, 2002, 2003, 2004, 2005
Past President of Local HIMSS Boards – Houston, Tennessee, Southwest TX
Editorial Board of Healthcare Informatics 2001, 2002, 2003, 2004, 2005
Judge, MSHUG ISA, 1999-2005, TEPR Awards, 2001-2002, TETHIE 2003-05, HDSC 2003-05
National HIMSS Chapters Committee 2001, 2002, 2003, 2004
National HIMSS Fellows Committee 2001, 2002, 2004
National HIMSS Programs Workgroup Committee 2001, 2002, 2003, 2004
More about AC Group:
AC Group, Inc. (ACG), formed in 1996, is a healthcare technology advisory and research firm designed to save participants
precious time and resources in their technology decision-making. AC Group is one of the leading companies, specializing
in the evaluation, selection, and ranking of vendors in the PMS/EMR/EHR healthcare marketplace. Twice per year, AC
Group publishes a detailed report on vendor PMS/EHR functional, usability, and company viability. This evaluation
decision tool has been used by more than 5,000 physicians since 2002. Additionally, AC Group has conducted more than
100 PMS/EHR searches, selections, and contract negotiations for small physician offices to large IPA since 2003.
More than 500 healthcare organizations worldwide have approached their most critical IT challenges with the help of
trusted advisors from ACG. Since 1972, ACG advisors have been helping healthcare professionals make better strategic
and tactical decisions. This unmatched combination of market research and real-world healthcare assessment gives
clients the tools they need to eliminate wasteful technology spending, avoid the inefficiency of trial and error, and discover
a superior alternative to "guess" decisions. For our healthcare physician clients, ACG provides independent advisory and
consultative services designed to assist physicians in evaluating and selecting technology to enable the creation of the
“The Digital Medical Office of the Future”.
Please review the attached document, feel free to contact me if you have further questions.
Houston office (281) 413-5572 or by e-mail at [email protected]
Are You Ready To Embrace
Newer Technologies?
AC Group, Inc. (AC Group), formed in 1996, is a healthcare technology advisory and research firm designed to save
participants precious time and resources in their technology decision-making. AC Group is one of the leading
companies, specializing in the evaluation, selection, and ranking of vendors in the PMS/EMR/EHR healthcare
marketplace. For the last three years, AC Group has produced an annual report on the Digital Medical Office and the
use of Technology by physicians. This comprehensive report includes detailed reviews of the Mobile Healthcare,
Document Imaging, and EMR marketplace. The report also includes the most comprehensive evaluation of vendor
EMR functionality to date - more than 5,000 questions. This evaluation decision tool has been used by more than
25,000 physicians since 2002. Additionally, AC Group has conducted more than 100 PMS/EHR searches, selections,
and contract negotiations for small physician offices to large IPAs since 2003.
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How do you determine if you are ready to “leap” into the EMR or replace your PMS application?
Can you always believe what the vendor tells you?
Where does a group go to find third-party independent evaluations of vendor’s functionality, financial
viability, customer support, and overall best price?
How can you determine if there is a quantified return on investment (ROI)?
How can you leverage the use of an EMR or new PMS to improve reimbursement, improve quantified clinical
quality, and reduce malpractice costs?
Who can you turn to for third-party independent advice?
The answer: AC Group’s Physician Technology Evaluations
Our Advisory and Consultative offerings are numerous, and can be customized to your practice’s unique
priorities. As you will see later on in this document, the pricing is based on the size of the practice and the
number of days selected. Unlike other consultants that represent vendors, AC Group is neutral and we never
receive compensation based on the vendor selected – we are third-party advisors to your practice. I believe that
to thrive in the healthcare market, every physician group should have interaction with independent Healthcare IT
futurists who do not represent any companies. Our proposal gives you the opportunity to interact with one of the
top healthcare IT analysts and futurists throughout the project. To assist your organization, we have created
five options:
Option 1 – Educational Update – For those organizations that are just starting the process of considering newer
Technologies or just need a third-party independent review, AC Group can provide your practice organization with an
educational update on the “Digital Medical Office” of the future
Option 2 -Technology Briefing and Readiness Review - AC Group can provide your practice with a technology
briefing and readiness review. Under this option, Mark Anderson will come to your practice, meet with members of
the practice, will present information on technology and software options and will conduct a brief operational review of
your practice’s readiness.
Option 3 - Contract Negotiations – For those practices that have already made up their mind on which application
they would like to purchase and install, AC Group can assist with contract review and negotiations. Probably the most
tedious and important step of the entire process is contract negotiations.
Option 4 - Vendor Search/Selection and Contract Negotiations – AC Group can become your advisor on the
project. Under this option, one of our experienced consultants will be available for conference calls to discuss which
vendors you should consider based on 10 operational considerations.
Option 5 - Operational Assessment, Vendor Search/Selection and Contract Negotiations - AC Group can
provide your practice with a comprehensive program to ensure that your practice selects the best system(s). Under
this option, an experienced consultant will come to your practice, meet with your practice representatives, present
information on technology and software options, conduct an operational review of your practice’s readiness, and will
assist with the numerous tasks required to select the right system. This option includes all tasks described in Option 4
and, in addition, on-site consulting for operational review and vendor demonstrations.
AC Group, Inc.
Introduction - Page 3
Last Updated: 05/20/07
Table of Contents
Section
Description
Page
1
Overview of the Physician Technology Marketplace
6 – 36
2
Six Levels of Physician IT Maturity
37 – 39
3
Level 1 – Practice Management Systems
40 – 69
4
Level 2 – Secured Internet Connectivity
70 – 77
5
Level 3 – Document Image Management
78 – 97
6
Level 4 – PDA and Mobile Healthcare
98 – 121
7
Level 5 – Electronic Medical Records
122 – 144
8
EMR Spending and Financial Conditions
145 – 152
9
Choosing the Right EMR
153 – 158
10
Detailed Comprehensive Review of selected Vendor EMR
applications
159 – 179
11
EMR Performance Testing And Demo Scripts
180 – 205
12
EMR Pricing and Costs
206 – 210
13
Financial Questions for EMR Application Vendors
211 – 213
14
Listing of Participating EMR Vendors
214 – 231
15
EHR Road Map
232 – 237
16
Practice Protocols
238 – 259
17
Case for Improvement
260 – 261
18
Assessing Your Practice Discoveries and Actions
262 – 263
19
Measure 3rd Next Available Appointment
264 – 268
20
EHR Implementation Team
269 – 272
21
Change Management and Quality Improvement Processes
273 – 273
AC Group, Inc.
Table of Contents
Section
Description
Page
22
Implementation Critical Success Factors
274 – 277
23
How to Improve Access
278 – 291
24
Contracting with the IT Vendor
292 – 305
25
Implementation Phased Checklist
306 – 307
26
Common Implementation Issues
308 – 310
27
Redesigning the System
311 - 314
AC Group, Inc.
Chapter 1 – Market Overview
A. Introduction:
Let’s move past today and imagine that it is January 2007. It is not beyond reason that a visit to a doctor’s office
will be as streamlined as connecting through a portal on the Internet to schedule an appointment. Admissions
happen via voice command and thumbprint technology. Diagnostics are ordered based on information during
admissions. Examination rooms equipped with personal computer stations or wireless tablet computers will enable
the physician to view a patient’s medical record with the click of a mouse or an electronic pen. Lab results will be
available immediately for viewing during the examination. Prescriptions can be entered in via voice command and
filled immediately by your pharmacy. Billings will happen automatically and electronically … and it is not out of the
question that electronic payments to the practice’s bank account could happen within 48 hours of an office visit.
Physician practices, like all of healthcare, have been reluctant to spend
appropriate dollars on technologies to improve operations.
In today’s
environment, physicians are being challenged to practice medicine and
run a profitable business.
Decreasing reimbursements and lower net
profits have forced radical changes in practice management and have
accelerated the adoption of technology beyond the basic billing office.
Many companies have created technological solutions addressing various
“pain points” within healthcare. These companies have focused on areas
in which they perceived to be inefficient and in need of automation. A staggering myriad of solutions is available to
medical practices, making it necessary to wade through the options to find the best solution.
The challenge for now is to find a foundation of technology that will enable you, the physician or healthcare
information manager to build a complete solution in the future. The foundation must be based on a strong Practice
Management System (PMS) and newer technologies that enable the practice to automate the clinical processing
within the practice. Seeking product differentiation, leading PMS vendors are rolling out an ever-widening array of
optional modules and are tailoring PMS to meet the rapidly changing needs of the practice management system
market. Top EHR vendors and now adding PMS functionality for small, midsize, and large group medical practices
and the fast-growing management services organization (MSO) and Independent Physician Associations (IPA)
market. This trend will continue through 2008 as group practice consolidation accelerates and the average practice
size continues to grow.
For the past 20 years, the healthcare marketplace has used numerous terms to describe the electronic capture of
patient specific clinical, financial, and demographic data. In the 1980’s the term Electronic Patient Record (EPR)
became popular. The EPR included silos of information collected with hospital departments and in the ambulatory
setting. Many times, the EPR included only patient laboratory data. In others, radiology data could be stored in
separate EPRs, nursing documentation in others, and physician documentation in a third. EPR did not include
comprehensive clinical knowledge based protocols and alerts based on the patient age, sex, and general medical
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history. The industry needed one system that maintained all of the patient’s medical records in one unformed
system no matter where the data was collected. The industry needed a patient centered Electronic Medical Record
(EMR).
The new EMRs provided all of the functionality of the older EPRs but consolidated the silos of information into one
common format. Through this consolidation, clinical decision support, formulary compliance, medical necessity
checking, and automated Evaluation and Management (E & M) coding based on Medicare’s 1998 rule set were
added.
However until 2003, many organizations still maintained separate silos of information, separating hospital
data from physician-based clinical data. One reason was the lack of clear data exchange standards. The future of
healthcare documentation is now under a new term called community-based Electronic Health Records (EHR).
The EHR includes all components of the EPR and EMR plus the ability to
combine data from multiple organizations via a new standard classified
as the Continuity of Care Record (CCR).
The EHR allows care
providers to view information from multiple sources in one common view
plus the addition of the patient’s Personal Health Record (PHR). The
PHR allows the patient to record “health” related indicators via a
personalized web site. This data includes patient’s social and medical
history, family history, and daily recording of clinical information between
medical visits to the care giver. This new combined EPR, EMR, and PHR all reflect the future of healthcare – the
EHR. However, to secure the data, every healthcare provider must ensure that their data system meets all of the
new compliance requirements for recording storage, security, and confidentially. Comprehensive community-based
EHR solutions enable:
•
Integrated view of all patient information across multiple patient, clinical, and financial systems.
•
Improved system security and privacy for adherence to regulatory requirements.
Healthcare in the United States is at the beginning of a technology revolution as previously paper based processes
moves online. The challenge for now is to find new delivery technologies that will enable the physician, hospital, or
Integrated Delivery Network, to build a complete solution that enables the Digital Medical Office of the Future to
become reality. The foundation is likely a clinical information management tool that serves as the connecting point
or collection device for all of the technology deployed within the healthcare delivery marketplace. Today, we call this
technology “Electronic Medical Records (EMR) and Electronic Health Records (EHR).”
This repository of
information will enable the care provider access to information that flows into, or out of, a community. Healthcare
end users need to ask themselves whether all of this patient information could reside in one system.
The answer is yes.
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However before you run out and purchase such as system, you may want to research the amount of “local support”
that each of the vendors provide. We have found that there is a direct correlation between the type and amount of
support provided, especially local support, and end-user satisfaction. In fact, 89% of the practices that were very
happy or extremely happy with their EMR also indicated that they had local support for the product. Conversely,
76% of the practices that were not satisfied with their product had no local support – the support was provided by a
national office located outside of 2-hour driving range.
During the 1990’s companies like Medical Manager (WebMD), Compusence, NDC (Lytec and Medisoft) and
Millbrook developed an extension network of local sales and support executives, aka, Value-added resellers
(VARs). These VAR’s sold the products locally and provided local support for the applications. Physicians became
use to having representatives visiting their offices on a routine schedule to insure that everything was operating
effectively.
Other healthcare professions like pharmacy detail representatives and office supply store
representatives followed the same model. Today however, many of the technology applications are being sold via
internet “web casts” and in 38% of the cases, the physicians never meets the technology company’s sales
representative until after the sale. This model of sales and support is cost-effective to the software vendor, but we
wonder how effective this method will be in the long-term for the physician’s practice.
To insure that a practice makes the right technology decision, we recommend three standard protocols:
1. Obtain advice from outside experts in the healthcare software and technology Field – those with extensive
software knowledge and the ability to rank the various vendors based on specific criteria.
2. Look towards vendors that provide local support for their product – within 100 miles of your central office
location. If they do not provide local support, clearly understand “how” you will be supported.
3. For small practices with < 10 physicians, consider an ASP options in order to decrease risks and to insure
adequate technology overview.
Many companies have created technological solutions addressing various “points of pain” within healthcare. These
companies have focused on areas in which they perceived to be inefficient and in need of automation. A staggering
myriad of solutions is available to medical practices, making it necessary to wade through the options to find the
best solution.
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B.
3rd Party Independent Evaluations
The current pressures in the industry for increased efficiency and better care delivery, coupled with significant
advances in technology and applications, have enabled EHRs to take center stage. The challenge with EHRs is that
it is very difficult for the average physician practice to effectively evaluate its’ options. Physicians are looking for a
3rd party independent evaluation of the various EMR/EHR offerings in the marketplace today. To evaluate how well
and completely each of these offerings meets the real needs of physicians, AC Group, Inc. conducted semi-annual
evaluations in Spring of 2002, 2003, 2004, 2005, and 2006 and then again in October of 2003, 2004 and 2005. The
AC Group technology functionality report is based on 48 months of research and the cumulative results of a 90page questionnaire distributed to each participating vendor. The EHR survey includes 2,300 functional questions
divided into 47 categories, while the PMS survey includes over 1,000 functionality questions divided into 26
categories.
The 47 functional categories included a section on the Institute of Medicine’s (IOM) requirements for a
computerized patient record (CPR), along with functional questions relating to operational areas including
prescriptions, charge capture, dictation, interface with laboratories, physician order entry, decision support and
alerts, security, personal health records, reporting and documentation. To assist the physician community, the AC
Group report quantifies six specific components necessary to ensure that a physician or a group of physicians have
made the right choice. The components include:
1. Product Functionality – How well a product meets the basic requirements of a comprehensive EHR based
on the guidelines of the Institute of Medicine and the detailed comprehensive survey of functionality based
on AC Group’s 2,800+ EHR functionality survey.
2. End-User Satisfaction – How well a company performs in relation to “End-User Satisfaction” surveys
conducted by independent analyst firms such as AAFP such as KLAS (http://www.healthcomputing.com/)
and AC Group, Inc. (www.acgroup.org)
3. Company Financial Viability – The strength of a company in relationship to their annual revenues,
profitability, and percentage of revenues that are placed back into future development.
4. Client Base – The strength of the company’s EHR client base and their ability to understand and meet the
needs of their current and future clients.
5. Technology – The strength of the Ear’s use of proven technology that enables a practice to become a digital
office of the future.
6. Price – The total price of the solution should be considered when making a decision – not just the price of
the software.
Practices should determine the “Total Cost of Ownership” (TCO) when evaluating the
numerous potential solutions.
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Through AC Group's research, we have learned that, while having the appropriate level of functionality is critical,
providers require a vendor that will support and continue to develop the product. Therefore, the 2007 report
employs a point system based on a combination of the following major sets of criteria: functionality,
company size, client base, end-user satisfaction and price. This point system provides a more comprehensive
view of the ability of the end-user to derive benefits from the product. Each set of criteria has been weighted, and
each vendor was assigned a “Total Weighted Point Value”. Additionally, in the 2007 report, AC Group divided the
rankings based on the following product types:
o
EHR Vendors – Full EMR capability, with internet-based Personal Health Records, health maintenance
tracking, proven interoperability with other EMR vendors, national clinical standard couplers, and clinical
decision support with nationally recognized alerts, etc. The application must have interfaces to multiple Practice
Management Systems. We further divided this category between large multi-specialty clinics and stand-alone
practices.
o
EMR Vendors – Full charting and Document Imaging Management, along with e-Rx with formulary tracking by
healthplans, automated E&M coding and verification, medical necessity checking by CPT and Diagnostic codes,
comprehensive orders and results reporting, with integrated workflow routing and tracking. The application
must have interfaces to multiple Practice Management Systems.
o
Charting Vendors – Ability to simplify the charting requirements, as specified by many of the medical societies
and the IOM. Advanced functionality must include orders and results reporting, problem list and e-Rx tracking.
The product does NOT have to have advanced nationally recognized alerts and clinical decision support. The
application must have interfaces to multiple Practice Management Systems.
o
Document Imaging Management (DIM) Vendors – Ability to scan and store paper documents by patient and
by sub-folder, along with the ability to electronically receive and file documents that are received either
electronically or by fax, including Lab results, transcribed reports, and hospital ADT information. The DIM must
have integrated routing and workflow capabilities and interfaces to multiple Practice Management Systems.
o
Community Health Record (CHR) Vendors – These vendors may not have a full functioning EMR but provide
the interoperability functions of an EMR-Light along with the ability to maintain a community health record via a
community clinical and demographic data exchange. Advance functionality includes reporting and tracking of
orders, results, e-Rx, allergies, and problem lists, among others. The product should maintain a community
master patient index, based on numerous inputs, including hospitals, healthplans, and numerous physician
practice management systems. The Community Health Record vendor must also be working with various
EMR/EHR vendors, to ensure effective clinical data exchange, following national standards like CCR or other
recognized future interoperability standards.
o
FQHC – In May of 2006, AC Group added a new category for Federally Qualified Health Centers (FCHC) since
these centers require more government reporting and clinical oversight.
o
In May of 2005, ACG added also a new category for Integrated PMS and EMR vendors – Our research has
shown that more than 72% of the selections in 2005 have been for both Practice Management and EMR/EHR
applications. Starting in 2005, ACG started tracking those vendors that provide a tightly interfaced or integrated
solution.
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The AC Group selection methodology provides physicians with a simple methodology that they can use to help
reduce the number of choices. According to our research, the number of vendors that state that they sell an
ambulatory EHR is currently over 250 – too many for any one physician to consider.
Through the use of this
methodology, practices can reduce the number of potential choices to the top 5 to 10 EHR/PMS products – based
on their specific requirements.
Continuing in 2006, AC Group will be “Validating” vendor application. The purpose of the detailed analysis is to
determine which vendors meet the functionality to be considered a “Validated EHR” today and to determine which
vendors who, with future development, could have a “Validated EHR” in the next couple of years. Vendor Products
that receive a minimum rating of 85% are routinely reviewed for validation by AC Group. Other vendors have
excellent charting systems and document imaging systems, but in many cases, do not have the necessary clinical
alerts, clinical knowledge based databases, and may not have the Clinical Decision Support (CDS) necessary to
improve care and to document improvements in clinical outcomes. They still provide excellent benefits, but should
NOT be considered a clinically driven EHR.
The 47 functional categories include sections on the Institute of Medicine’s (IOM) requirements for a computerized
patient record (CPR), along with functional questions relating to operational areas including prescriptions, charge
capture, dictation, interface with laboratories, physician order entry, decision support and alerts, security, Personal
Health Records, reporting and documentation. Back in 2005, AC Group added new categories relating to RHIOs,
Disease Management, Specialty EMR content, Medical Devices Interfaces, Evidence-based reference content,
Practice / Community Portal Capabilities, and Registry Functions. The EMR/EHR evaluation includes a weighted
point value for each of the 2,745 questions, based on the following criteria:
o
The current product doesn’t offer this functionality
o
The current product provides the functionality for an additional cost
o
The current product provides the functionality from a third party
o
A future product enhancement in the next three months will provide the functionality
o
A future product enhancement in the next six months will provide the functionality
o
A future product enhancement in the next year will provide the functionality
o
The product provides the functionality currently
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C.
Installation, Training, and Support
As mentioned earlier, the various EMR vendors provide a variety of installation, training and support activities. In
10% of the cases, vendors provide NO on-site support or training – everything is handled via the internet and via
phone calls.
Of those that do provide on-site training, 32% provide < 10 hours per physician, 33% provide
between 10 and 24 hours per physician, 9% provide between 25 and 40 hours per physician, and only 6% provide
more than 40 hours of training per physician.
To insure an effective installation, physicians must insure that they receive the required man-hours necessary to
maximize the usefulness of the new EMR product.
If the practice receives inadequate training, the lost in
productivity could cost the practice as much as $50,000 per physician per year. Additionally, practices need help
maximizing workflow and reorganizing activities based on the functionality provided by the software application. For
many vendors, it’s almost like buying a car. The sales person sells you a car and tells you how to operate the radio
and the door locks. The sales person does NOT teach you how to drive and does not provide you with the road
map to get from the showroom back to your practice. You are on your own to figure that out. Based on a survey of
69 EMR vendors, < 15% actually work with you and your practice and teach you how to drive – the remaining 85%
leave the learning up to the practice.
The EMR marketplace needs more local organizations that can provide local installation, training, configuration, and
on-going support. These organizations can be Independent Physician Associations (IPAs), Management Service
Organizations (MSOs), Physician/Hospital Organizations (PHO) and Value-added resellers (VARs). This collection
of organizations can organize and provide superior market intelligence and technology support for local physician
groups. One such group is the Taconic IPA, located in the Hudson Valley, NY.
Under the leadership of John Blair, M.D., the Taconic IPA has
established
the
Taconic
Healthcare
Information
Network
and
Community (THINC) collaboration. In short, THINC is a collaborative
approach that brings together the healthplans, employers, hospitals,
and physicians with the single goal of improving clinical quality while
reducing the cost of healthcare for all parties. The project involves the
capturing of clinical data at the point of care for up to 2,300 physicians
who serve more than 1.2 million individuals throughout the Hudson
Valley, NY. The program is intended to create a set of standardized
quality measures across the plans, making it easier for physicians to participate in the program, and validating the
measures. According to Dr Blair, “The Taconic IPA will provide on-site support for newer technologies for any and
all of their physicians via collaboration with a company specific designed to provide knowledge and local support MedAllies”. Under the support model, each physician receives up to 80 hours of installation, configuration, training,
and support the first year and between 40-60 hours of on-going support each additional year. The purpose of
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MedAllies is to insure that physician practices maximize the value of their new technology via on-site support and
workflow redesign.
Another model being developed is a regional organization call Pro Practica, Inc. located near Cleveland, OH. Pro
Practica‘s mission is to enable independent physicians to recapture control of their practice by streamlining
administrative functions and clinical documentation, improving compliance with government and payer mandates,
and addressing practice liability issues. Their product, StreamlineMD, offers several practice management tools. At
its heart is an electronic medical records system (“EMR”), which enables doctors to perform, among others, tasks
such as (1) automating the verification of patients’ insurance coverage, (2) ordering and renewing prescriptions
online, and (3) keeping patient records in secure and shareable electronic format. Unlike typical EMR vendors,
there focus is on service, not on software. Pro Practica is providing access to all of the tools a practice needs via
an ASP model.
D.
ASP – Application Service Providers
In the acronym-laden world of healthcare, ASP (application service provider) is one of the most frequently heard--being
the most popular member of a vocabulary categorizing the various service providers that have come into existence as a
result of the Internet. As the tech phenomenon continues to shake out, successful service providers are settling into a
role of broader responsibility in their customers' organizations, thereby demonstrating their true value. BSPs (business
solution/service providers) are the next step in evolution of the ASP model. These companies let healthcare
organizations outsource entire segments of their business, not just one certain aspect, allowing them to concentrate on
their core competencies. Examples include, technology support outsourcing, supply tracking and re-ordering,
accounting services, and billing and collection services
ASPs offer many advantages, particularly to small practices with fewer than 15 physicians. They allow IT spending to
take place in increments rather than in one large licensing and implementation expense. But perhaps their biggest
benefit is that they permit tremendous flexibility. Organizations are able to implement solutions quickly; affect plan,
privacy and functionality changes fairly quickly; and even change technology providers without delay. An ASP scales
one IT professional across three or four companies, depending on the application and the complexity. Another obvious
benefit is the total cost of ownership. It’s a lot less costly to run equipment in an ASP model than having to have
everything in-house. Another key advantage is you can get work done more quickly. Physicians can make a decision
and know it’s going to be done and dealt with right away.
The ASP pricing model, like everything else, varies based on the services that are provided. In most cases, a physician
can contract for a flat monthly fee of between $400 and $1,000 per month for a complete EMR application. However,
the price varies for installation, training, and initial configuration. Some vendors require “consultative” fees upfront,
instead of building into the monthly contract. Of course you still have all of the hardware and networking requirements.
These are traditionally included in the monthly software costs, but can be added as a monthly lease cost. In all cases,
physicians must look at a 3-year total-cost-of-ownership model when considering either a purchase or an ASP model.
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E.
Adoption rates of PMS and EMR
For the past 20 years, physicians have been automating portions of their practice. In the 1980’s through the 1990’s,
physicians selected and installed Practice Management Systems (PMS).
Although these applications were
fundamentally designed to track patient demographic, insurance, and payment information, their real benefit was
the electronic printing and subsequent electronic transmission of patient claims to insurers. In 1990, Medicare
created new incentives accelerating the adoption of PMS through its policy of reimbursing electronic ahead of paper
claims submissions.
From 1985 to 2002 the number of physicians with PMS increased from 10% to almost 95%.
( 1)
Starting in the late
1990’s, physicians searched for additional systems designed to improve the management of their practices. New
applications called Electronic Medical Records (EMR), Document Management, Lab Interfaces, Electronic
Dictations, and physician Internet access were reviewed and adopted, albeit at a slower pace than PMS. Among
these applications EMR appeared to hold the most promise as a breakthrough technology that might improve
practice efficiency.
Occurring simultaneously with the increasing sophistication of EMR function was the health care industry’s
increasing emphasis on medical error reduction, improved clinical documentation and level of service coding.
EMR’s ability to facilitate a typewritten, legible, well-formatted note that is available to all providers within a health
care system held the promise of making patients care easier and more efficient. During this early era, affordable
office-based EMRs offered a broad range of functionality. At one end of the spectrum were systems that offered
little more than a typewritten chart. All the information was present as free "text" with little structure and capacity for
searching or sorting clinical information. Free text could be entered by scanning existing documents, routine
dictation, or in some cases using voice-recognition to capture the information. The main advantages of this system
are the speed of data entry, limited disruption of provider documentation practices and workflow, and often lower
cost. In contrast, a number of EMRs require clinical encounter data entry through a series of structured pick lists or
templates. Although more time consuming to enter data this way, integration of information into a structured
database facilitates subsequent queries and report writing.
In 1995, healthcare IT experts optimistically predicted that more than 50% of physicians would purchase an
Electronic Medical Record for their practice by the end of 2000
(2)
. However, by 2000 a combination of technology
issues, reimbursement issues, and the difficulty of justifying the capital costs of the EMR based on the return on
3)
investment (ROI) left the estimated percentage of physician users at only 6% across all practice environments. (
1 2002-2004 TEPR Report conducted by the Medical Records Institute.
2 2004 Annual Survey of physician adoption rates by AC Group, Inc. (3,935 physician practices)
3 2000 TEPR Survey conducted by the Medical Records Institute.
AC Group, Inc.
Chapter 1 - Page 14
This low figure further concealed a significant discrepancy between users in large institutions and multi-specialty clinics
and those in small office practice. According to one study, by the summer of 2002, 38% of all university and staff-model
(Kaiser, Mayo, etc) physicians were using an EMR compared to less than 1% of community-based physicians. (4)
The authors think that the experts missed their projections primarily because they underestimated how fundamentally
EMR adoption changes the way a physician works. In addition, they were overly optimistic on the performance and speed
of introduction of the so called “killer applications” (voice recognition, intelligent charge capture, pharmacy formulary
management) that were critical to the EMR’s streamlining of workflow and return on investment. Physicians are far more
likely to adopt changes that improve either their financial income, practice efficiency, or enhances the quality of patient
care. Accordingly, automation of the physician practice is mostly likely to occur if the following principles are a central part
of the implementation strategy.
•
Create an incremental approach towards office automation
•
Make sure the EMR integrates with minimal disruption of existing work flow
•
EMR must either improve efficiency or reduce costs.
The physician market represents over 880,000 individuals in the US market alone. Over 85% of these physicians work in
active practices that treat on-going patients in an ambulatory setting. The other +15% is working in non-patient care
settings or is primarily involved in education and research. When evaluating physician needs and spending, we first must
look at different market segments based on the practice size and the number of physicians within each practice size. As
shown below, AC Group has attempted to divide the 206,000 physician practices into eight discrete markets.
Market Segment
Total number of
Practices
Avg No of
Physicians
per Practice
Total Physicians
per Market
Segmentation
% of Total
Physicians
A
1 to 2 Physicians
183,434
1.25
229,293
28.3%
B
2 to 5 Physicians
10,106
3.30
33,350
4.1%
C
6 - 9 Physicians
6,482
7.50
48,615
6.0%
D
10 to 49 Physicians
3,834
29.05
111,378
13.8%
E
50 to 99 Physicians
1,235
74.40
91,884
11.3%
F
100 to 249 Physicians
312
143.13
44,657
5.5%
G
Large Practices & Teaching
Organizations
754
243.40
183,524
22.7%
I
Non practicing Physicians
67,000
8.3%
809,699
100.0%
Total
206,157
4 2002 Presentation of EMR usage, TEPR conference, Seattle WA, May 10, 2002
AC Group, Inc.
Chapter 1 - Page 15
The vendor community traditionally wants to sell to the large practices, those with over 250 physicians. However,
the market share is very small, since there is only an estimated 1.3% of the practices with more than 50
physicians. The bulk of the practices are in the 1 – 9 physician practice size. As shown on the table on the next
page, 93% of the active practices have less than 6 physicians within the group. Additionally, 96% of the practices
have less than 10 active physicians. Therefore, it would appear that the market opportunity for EMR’s would be in
the small physician marketplace.
% of Total Physicians
% of Practicing
Physicians
% of Practices
1 to 2 Physicians
28.3%
30.9%
89.0%
2 to 5 Physicians
4.1%
4.5%
4.9%
6 - 9 Physicians
6.0%
6.5%
3.1%
10 to 49 Physicians
13.8%
15.0%
1.9%
50 to 99 Physicians
11.3%
12.4%
0.6%
5.5%
6.0%
0.2%
Large Practices and Teaching
Organizations
22.7%
24.7%
0.4%
Non practicing Physicians
8.3%
100.0%
100.0%
Market Segment
Total
100.0%
However, the vendor community has realized for years that selling to small physician groups was not as profitable
as selling to mid-size and large practices. The overall cost of “sales” is relatively the same for a $40,000 sale as a
$500,000 sale. The only real difference is in the sales commission, and thus, the sales team would prefer to sell to
large practices. But can 50 vendors survive on only 10% of the potential population? The answer is no. The
healthcare industry only requires between 5 and 10 vendors in each of the market segments, not the 50 to 150 we
have today.
Therefore, the market will create winners and the market with crush vendors who have weak
functionality, limited marketing funds, and vendors that cannot prove long term financial viability.
AC Group, Inc.
Chapter 1 - Page 16
F.
Spending Trends:
Spending on technology by physicians has tripled since the 1990’s and is expected to triple again in the next four
years.
The majority of the increase will incur in the upper three levels of IT Maturity (Physician interaction). We
believe that the average physician will be spending upwards to $10,000 for an EMR, $3,000 for other related
technology applications, and an average of $4,000 for installation, training, and configuration.
Once you add
hardware, networks, and mobile devices, the average physician will be spending more than $25,000 on technology.
For those practices that are looking for a combined EHR and PMS, the average price will exceed $30,000.
However, in an ASP model, the average physician can obtain a complete Digital Medical Office of the Future for
around $800.00 per month.
Until 2006, the majority of new technology sales were for internet applications and EMR/EHR applications.
However, in 2006 we saw a major change in the belief that a practice’s current practice management system would
indeed meet the practice’s future needs. In 2003, less than 9% of practices were looking to replace their older PMS
application.
In 2006 the ratio increased to 29%.
Additionally, 60% of the healthcare EHR vendors
have reported major increases in combined EHR
and PMS sales in 2006, a 72% increase over 2004.
For our clients, we have experience a major change
in physician preference in technology. In 2004, only
12% of our clients where interested in a combined
PMS and EHR application.
In 2006, the ratio
increased to over 90%.
So
what
created
the
change
in
physician
preference? A study of 2,312 physician showed that
58% of physicians were interested in investing in a comprehensive EHR within the next 24 months – although many
barrier to adoption where indicated. Of that 58% of the physicians, 83% indicated that they wanted to replace their
current PMS for the following reasons:
•
59% indicated that they believed the product no longer met their needs
•
74% wanted to have a combined PMS/EHR from the same vendor to reduce the risk of ineffective
interfaces.
•
63% wanted to have a fully integrated PMS/EHR with one combined database to insure maximum
efficiency.
•
37% indicated that their current PMS product was no longer being supported by any vendor.
AC Group, Inc.
Chapter 1 - Page 17
However, the question is always, “who” will be purchasing. Once again, AC Group has developed their annual
market segmentation table on future spending for EMR’s based on the nine market segments. Given the number of
practices, and the current EMR penetration rates that vary from 9.4% to 32%, the number of potential sales of new
EMR installations is estimated at around 190,000 practices which represents almost 659,000 active physicians.
Market Segment
% of Practices
Estimated EMR
Penetration
Installed EHR
Physicians
Installed EHR
Practices
A
1 to 2 Physicians
89.0%
7.10%
16,280
13,024
B
2 to 5 Physicians
4.9%
9.20%
3,068
930
C
6 - 9 Physicians
3.1%
9.70%
4,716
629
D
10 to 49 Physicians
1.9%
14.10%
15,704
541
E
50 to 99 Physicians
0.6%
17.40%
15,988
215
F
0.2%
24.80%
11,075
77
G
Large Practices & Teaching
Organizations
0.4%
33.10%
60,746
250
Total
100.0%
15.8%
127,577
15,665
Once we understand the market size by segment, we can start estimating the potential revenues for EMR
applications over the next 4 years. We estimate that the healthcare industry could spend up to $3.6B on EMR
applications in the 4 years plus an additional $3.4B on hardware related products and almost $1.4B on
implementation and training. However, this assumes that physician EHR adoption will increase from an average of
18.7% to over 80% by 2009. This is a big assumption since it appears that the adoption rate is increasing by only
32% per year. Therefore, if the current trend continues, the total adoption rate will only be around 52% by 2010.
So what will it take to increase EHR adoption? The industry must create financial incentives for physician adoption.
Without financial incentives, the US EHR market will never exceed 50%.
AC Group, Inc.
Chapter 1 - Page 18
Estimated EMR
Software Revenues
2008 - 12
Market Segment
Estimated EMR
Implementation and
Training Revenues
2008-12
Estimated EMR
Hardware/Network
Revenues 2008-12
A
1 to 2 Physicians
$
1,723,092,478
$
886,132,967
$
810,867,048
B
2 to 5 Physicians
$
222,684,208
$
125,971,533
$
104,792,569
C
6 - 9 Physicians
$
264,130,287
$
164,359,148
$
124,296,605
D
10 to 49 Physicians
$
465,164,286
$
318,401,223
$
218,900,841
E
50 to 99 Physicians
$
377,393,775
$
284,155,313
$
177,597,071
F
$
185,539,075
$
139,700,010
$
87,312,506
G
Large Practices &
Teaching
Organizations
$
814,013,422
$
612,904,224
$
383,065,140
Total
$
4,052,017,531
$
2,531,624,416
$
1,906,831,779
The majority of the expenditures will be in the practices within 10 to 99 physicians followed by the 6-9 physician
groups and the large clinics with over 100 physicians. However, this still leaves almost $2.0B being spent by small
practices with < 5 physicians. When we add annual support costs, upgrades, and other annual expenditures, the
overall market opportunity is closer to $9.0 B over the next 4-5 years.
Along with capital purchases, practices are usually required to pay between 13% to 22% of the software costs each
year for product upgrades and product support. Therefore over a six year period, the average practice pays for the
entire system again and again. However, without support, the practice has a 73% chance of technology problems.
These problems can create operational and clinical issues, which could bankrupt the practice if the corrections are
not made within a timely manner.
For most established EHR vendors, support fees represent between 35% to
65% of their annual revenues. For Practice Management vendors, support fees represent between 52% to 90% of
their annual revenues.
As shown on the next page, support revenues over the next four years could exceed $1B if EHR adoption increases
to the 80% range. However, if the adoption rate is below 50%, support revenues will average of $700M per year by
2008.
AC Group, Inc.
Chapter 1 - Page 19
Market Segment
Estimated EMR
Support Revenues
2008-12
Total New Sales Market
2008-12
Total New Sales plus
Annual Support 2008 12
A
1 to 2 Physicians
$
682,344,621
$
3,420,092,493
$
4,102,437,114
B
2 to 5 Physicians
$
88,182,947
$
453,448,310
$
541,631,256
C
6 - 9 Physicians
$
104,595,593
$
552,786,040
$
657,381,633
D
10 to 49 Physicians
$
184,205,057
$
1,002,466,349
$
1,186,671,407
E
50 to 99 Physicians
$
149,447,935
$
839,146,158
$
988,594,093
F
100 to 249
Physicians
$
73,473,474
$
412,551,591
$
486,025,065
G
250+ Physicians
$
322,349,315
$
1,809,982,786
$
2,132,332,101
$
1,604,598,942
$
8,490,473,727
$ 10,095,072,669
Total
Based on our projections, we estimate the ambulatory marketplace for New EHR products could exceed $8.1B
within the next four years with an 60% adoption rate and less than $4M if the adoption rate maintains the current
32% increase per year. Total spending for new EHR products and support could exceed $11B within the next four
years.
AC Group, Inc.
Chapter 1 - Page 20
As we mentioned, the industry MUST change, before the adoption rate can exceed 50%. With new Pay-forPerformance (P4P) programs, government incentives, malpractice incentives, and new requirements for clinical
reporting, physicians will need to convert to newer technology to stay in business.
Total Ambulatory Technology Spending Assuming a 32% annual increase
2006
2008
2010
2012
EMR
$
347,889,887
$
477,583,236
$
655,626,267
$
900,043,739
PMS
$
195,371,296
$
242,416,704
$
300,790,647
$
373,221,034
Other
$
21,561,980
$
28,461,813
$
37,569,594
$
49,591,864
Hardware
$
270,069,243
$
367,991,123
$
500,927,916
$
681,261,966
Support
$
464,621,437
$
665,582,955
$
934,667,552
$
1,295,408,900
Total
$
1,299,513,843
$
1,782,035,832
$
2,429,581,975
$
3,299,527,503
G. What is happening today in the Health Care Industry and What Is Not Working?
In many practices, a core technology package, such as billing and/or scheduling software, serves as the center of
the practice’s management system. Point-of-care technology is not being widely utilized. When there is an attempt
by management to add modules to the existing system, the usual process involves calling the company who
developed the core technology to see if they offer a module such as prescriptions or patient records software.
Many times, the answer is no. Sometime the initial answer is no, but for a large fee, they may develop one. In
some cases, when the company does, in fact, offer add-on modules, those modules do not offer the same strength
as the original, core technology.
The hope for practices is that there are non-proprietary solutions being built by a variety of companies. The fact
that they are not proprietary makes them more powerful for the consumer. It allows a practice the freedom to shop
for and choose the best scheduling package, the best billing package, the best patient record package, the best
prescription package, and the best diagnostics package. And usually these programs come from different vendors.
The problem today is not so much in the multitude of offerings. The programs are out there. But once you have all
of these best-of-breed modules, are they going to integrate and work together, giving you seamless and
uninterrupted service that doesn’t require a patient’s name and address to be entered in five different packages?
AC Group, Inc.
Chapter 1 - Page 21
H. Setting the Standards for Integration
Over 1,000 companies in the market today provide technology solutions for practices. They are all generating a
different type of solution and generating many questions for you, the consumer. Relatively few have the long-term
vision of being a complete solution. Advances in hardware and software are bringing technologies focused on
patient care to the forefront. Technologies such as Prescription Modules, Diagnostic Programs, Document Imaging
Systems, and Computerized Patient Records are more readily available and are being offered by a multitude of
companies all touting to be the best.
As technology continues to develop at an exponential rate, how do you know your investments today will still be
viable tomorrow? How do you know you won’t wind up with a Beta Recorder in the corner when the rest of the
world has embraced the VCR? The questions are numerous: what to buy, when to buy and how to make it all work
together. And behind these concerns lies the ultimate question: Who is going go deliver the complete solution?
Because of so many options, no one company has provided a complete solution. The solution will come from
integrating the best-of-breed packages that serve your individual needs.
And at the heart of the integrated solution will lie the key communication tool of the medical practice: the patient
record. In all of the stages in dealing with a patient, from the initial patient encounter to when the insurance
company sends the check and everything in between … in all of these stages, there is one communication tool that
is present … the patient chart.
That won’t change in 2007. Our method of accessing the chart may change, and, we expect, will become more
efficient. But the chart will remain the center of the process, because in healthcare, the patient will always be the
center of why we exist.
AC Group, Inc.
Chapter 1 - Page 22
I.
Government Involvement in the Market
The Office of the National Coordinator for Health Information Technology (ONC) is responsible for coordinating
federal activities relating to health information technology. These covered health information technology activities
are defined as any effort in the federal government that meets one or more of the following criteria:
1. Efforts that use federal funds to design, develop, standardize, implement, maintain, operate, and/or
enhance HIT (e.g., software, hardware or other technology) that is used inside or outside the federal
government to deliver, monitor, improve, supply information to, interface with, or use information from a
patient care encounter, including financial, clinical, or other information.
2. Efforts that use federal funds for projects or programs that evaluate, research, study, or otherwise assess
the use, benefit, cost, consequences, or other aspects of the HIT defined in #1.
3. Efforts that use federal funds to educate, teach, train, or address human factors about or relating to the HIT
described in #1.
4. Policies, rules, reports, advisories, or other documents that describe, discuss, or influence the use of the
HIT defined in #1.
5. Partnerships, grants, contracts, initiatives, or awards between the federal government and its contractors
with non-federal organizations, including state or local governments or agencies, private companies, or
other entities that relate to HIT defined in #1.
6. Knowledge management of the experiences gained from HIT implementation across large, distributed
health care networks such as DoD, VA, and the IHS will be brought to a central, accessible point.
Many different components of the federal government touch upon health care, so federal leadership in HIT needs to
be focused and coordinated. While there is some integration of these efforts, until recently there has been neither a
single voice for this effort nor a holistic set of goals for change. The National Coordinator for Health Information
Technology has been given the responsibility for coordinating HIT efforts throughout the federal government. As
part of the outreach effort, the programs, projects, and policies that involve HIT are being compiled.
According to the FHA initiative and budget documents submitted to the Office of Management and Budget, total
federal spending on HIT was over $900 million in FY2004. A list of identified federal HIT programs follows.
AC Group, Inc.
Chapter 1 - Page 23
Agency/
Organization
Title of HIT Initiative
Description of Activities
Assistant Secretary for Planning & Evaluation (ASPE)
ASPE
National Committee on Vital and
Health Statistics (NCVHS)
Policy development and development of standards.
ASPE
National Health Information
Infrastructure (NHII)
The NHII is an initiative to improve the effectiveness, efficiency,
and overall quality of health and health care in the United States - a comprehensive knowledge-based network of interoperable
systems of clinical, public health, and personal health information
that would improve decision making by making health information
available when and where it is needed. (NHII has been
incorporated into ONCHIT).
ASPE
EHRs in Post-Acute and LongTerm Care
ASPE has contracted with the University of Colorado Health
Sciences Center to evaluate the current status of electronic
health information systems (EHIS) and electronic health records
(EHRs) in post-acute and long-term care (PAC/LTC) settings.
The project team has reviewed literature, conducted telephone
interviews, and completed site visits to providers that have
implemented EHIS/EHRs in PAC/LTC. The project also
contracted with Apelon to conduct a pilot study of the issues of
conforming the nursing home minimum data set (MDS v.2) to CHI
standards.
ASPE
Conforming the Nursing Home
Minimum Data Set v.3 to CHIEndorsed Standards
ASPE and CMS will partner on a project to conform the MDS v.3
to CHI-endorsed standards.
AC Group, Inc.
Chapter 1 - Page 24
Office of the National Coordinator for Health Information Technology (ONC)
ONCHIT Consolidated Health Informatics
Initiative (CHI)
The goal of CHI is to establish federal health information
interoperability standards as the basis for electronic health data
transfer in all activities and projects and among all agencies and
departments. The first phase involved establishing a set of existing
clinical vocabularies and messaging standards enabling federal
agencies to build interoperable federal health data systems.
ONCHIT Federal Health Architecture
(FHA)
TheFHA program will define an overarching framework and
methodology that allows initiatives throughout several federal agencies
to proceed coherently, establishing the target and standards for
interoperability and communication that will unify the federal health
community. The FHA will establish a government-wide road map to
achieve the federal health community's mission through optimal
performance of its core business processes within an efficient IT
environment.
Council on the Application of Health Information Technology (CAHIT)
CAHIT
Coordination HL7 balloting
CAHIT staff coordinated the HHS engagement with regard to the HL7
Electronic Health Record Special Interest Group.
CAHIT
EHR Acceleration Efforts
CAHIT staff coordinated a series of planning meetings to best position
pertinent departmental HIT activities (either current or future) that hold
the promise of accelerating EHR adoption.
CAHIT
CHI Standards
CAHIT staff and membership, via council meetings, activities, and staff
briefings ensured the universal integration of CHI standards in HHS
agency activities and programs.
AC Group, Inc.
Chapter 1 - Page 25
Agency for Healthcare Research and Quality (AHRQ)
AHRQ Transforming Healthcare Quality THQIT is a series of three grant programs (RFAs) released in FY04. The
Through Information Technology RFAs include the following: 1) demonstrating the value of HIT, 2)
(THQIT)
planning grants for future HIT implementations, and 3) providing HIT
implementation grants for partnerships of three or more entities.
AHRQ State and Regional Health IT
Demonstrations
AHRQ awarded 5 contracts to establish and implement state and
regional demonstrations of interoperable health information systems.
AHRQ Health Information Technology
Resource Center (HITRC)
The Health Information Technology Resource Center (HITRC) will
provide a state-of-the-art service center for grantees and organizations
that are engaged in health IT diffusion activities (e.g., research, diffusion,
or adoption).
AHRQ Coordination with CMS Medicare AHRQ will be supporting a five-year evaluation of CMS’s MCMP
Care Management Performance demonstration project to explore the integration of EHRs in the
(MCMP) Demonstration Project ambulatory environment.
AHRQ Indian Health Service (IHS) Resource and Patient
Management System (RPMS)
AHRQ recently provided funding to the IHS to support needed
enhancements to the IHS EHR. This investment will help to create a
user-friendly data system that can provide community-specific health
care data as well as track the health status of the patient population.
AHRQ Patient Safety Health Care
Information Technology Data
Standards Program: Standards
and Interoperability
This work on health data standards, done in coordination with the ASPE,
will focus of the following four areas: 1) voluntary industry clinical
messaging and terminology standards, 2) national standard
nomenclature for drugs and biological products, 3) standards related to
comprehensive clinical terminology, and 4) nomenclature and research
related to accelerating the adoption of interoperable HIT systems.
AHRQ Evidence Based Practice Center AHRQ's EPC Program has embarked on a 13-month program to explore
(EPC) - Evaluation of the
and determine the evidence base associated with certain HIT functions.
Evidence Regarding Select
Health IT Functions
AC Group, Inc.
Chapter 1 - Page 26
Centers for Medicare and Medicaid Services (CMS)
CMS Doctors' Office Quality Information Technology (DOQIT)
A special study to develop an approach to promoting adoption and use of
information technologies in the physician office and reporting of
information to Quality Improvement Organizations (QIOs).
CMS VistA – Office EHR
Modify / repackage VistA (the Veteran's Administration EHR software) for
the physician office setting.
CMS Medicare Care Management
Performance Demonstration
Establish a three-year, pay-for-performance pilot with physicians to
promote the adoption and effective use of HIT to improve the quality of
patient care for chronically ill Medicare patients. CMS will offer financial
incentives to physician offices that meet performance standards in delivery
systems and outcomes.
CMS Medicare Health Care Quality
Demonstration Program
Section 646 of the Medicare Modernization Act (MMA) mandates a 5-year
demonstration program under which CMS will test major changes to
improve quality of care while increasing efficiency across an entire health
care system. The Demonstration recognizes the use of health IT to
improve quality.
CMS Physician self-referral exception: Removes the regulatory barrier to allow for the furnishing of technology
Phase II of physician self-referral items or services to physicians to enable their participation in communityregulations includes exception
wide health information systems.
for community-wide health
information systems
CMS E-prescribing hearings to
develop, adopt, recognize, or
modify initial e-prescribing
standards. Pilot project to test
initial standards.
Participate in NCVHS hearings regarding e-prescribing standards in 2004
and 2005. Develop, adopt, recognize, or modify initial uniform standards
not later than Sept. 1, 2005. During 2006 calendar year, conduct pilot
project to test initial e-prescribing standards, unless the Secretary
determines the industry has adequate experience with such standards.
CMS EHR Focus Groups
Pacific Consulting Group, under contract with CMS, will conduct 12 focus
groups of providers to identify the issues and barriers that would prevent
them from using electronic medical records, and suggestions they may
have for addressing these issues. The focus groups will be organized as
follows: three Part A, three Part B, three durable medical equipment (DME)
providers, two rural providers, and one billing agent. Six of these focus
groups will be in person, while six will meet via conference call. Focus
groups are planned for the following cities: Boston or New York City,
Florida or Atlanta, Chicago, Denver, San Francisco.
CMS CMS Virtual Call Center
The goal of CMS' Virtual Call Center is to improve beneficiary telephone
customer service through the implementation of various initiatives for
efficient and effective handling of all types of inquiries. The first phase
involves, among other things, improvements in the Web-based application
that allows phone representatives to retrieve clinical information about the
beneficiary (such as date of last pap smear or colonoscopy). The second
phase involves allowing beneficiaries to access clinical information about
themselves through a Web-based application.
AC Group, Inc.
Chapter 1 - Page 27
Food and Drug Administration (FDA)
FDA Structured Product Labeling
(SPL) for prescription products
(e.g., accessible drug
information)
The SPL provides information found in the approved FDA drug label or
package insert in a computer-readable format for use in electronic
prescribing and decision support.
FDA Bar Coding for Prescription
Products
Standardized labeling.
National Institutes of Health
NIH National Library of Medicine Grants for Research, Training,
and Access to Informatics
Resources
Research grants and contracts for advanced computer technologies to
facilitate access, storage, and use of biomedical information, and for the
value derived from the adoption, diffusion, and utilization of HIT.
Resources
Support for training of informatics researchers and developers.
Resources
Support for Integrated Advanced Information Networks (IAIMS), Internet
connections, and access to digital libraries.
NIH National Library of Medicine Development and
Implementation of Controlled
Clinical Vocabularies
Support for, and development of, selected CHI standard clinical
vocabularies to enable ongoing maintenance and free use within the United
States.
NIH National Library of Medicine Development and
Implementation of Controlled
Clinical Vocabularies
Uniform distribution and mapping of HIPAA code sets, CHI standard
vocabularies, HL7 code sets, and other important vocabularies within the
UMLS Metathesaurus.
NIH National Electronic Clinical
Trials and Research (NECTAR)
Network
NIH plans to develop NECTAR, which will link research sites and ultimately
create a “national network of networks,” in coordination with the national
health information network, by which research information and findings will
be shared and scientific collaborations facilitated. NECTAR includes a
research workflow model, a common lexicon of standard vocabularies to
describe medical and scientific events, and analytical and dissemination
tools.
NIH Cancer Biomedical Informatics
Grid (caBIG)
caBIG is a virtual cancer research network of interconnected data,
individuals, and organizations that will create a common, widely distributed
infrastructure that facilitates the sharing of data and applications and
thereby enhances productivity and efficiency of research. caBIG
infrastructure is based on HHS CHI standards. caBIG is being pursued as a
pilot program that involves NCI’s caCORE central resources, over 40 of
NCI’s cancer centers, and the FDA. The NCI has created a standardssupporting infrastructure called caCORE. It is composed of HHS-established
controlled vocabularies, standard data elements, and domain models.
AC Group, Inc.
Chapter 1 - Page 28
Indian Health Service
IHS Integrated Behavioral Health
System (BH)
The BH graphical user interface software application that includes the ability
to track services provided by social work, alcohol/substance abuse
counselors, psychologists, and psychiatrists. Application includes suicide
tracking system (with bi-directional notification within HIPAA guidelines) as
well as embedded guidelines. The requirements determination has been
completed and the software development process will begin in FY04.
IHS Patient Account Management
System (PAMS)
The PAMS is an enhanced third-party billing system.
IHS Clinical Indicator Reporting
System (CIRS)
The CIRS is a robust reporting system that tracks over 40 indicators in a
standard reporting format. The standards reporting format is a delimited file
that exports locally into Excel and can be exported for regional aggregation.
IHS Integrated Case Management
System
An integrated case management application is being developed to facilitate
three views of data: patient, provider, and population health. These systems
will allow for integration of varied disease case management applications
that currently exist (diabetes, asthma, immunizations, etc.).
IHS National Data Warehouse
Initiative
This Initiative is developing a data warehouse for use by epidemiologists, as
well as clinical quality in order to enable analyses on quality improvement
and interface with the clinical indicator reporting system.
IHS Resource and Patient
Management System (RPMS)
RPMS is the hospital information system utilized by 49 hospitals, 221 health
centers, 120 health stations, and 170 Alaska village clinics.
IHS IHS - EHR Initiative
IHS-EHR provides order entry, results reporting, encounter documentation,
and other clinical functionality to IHS, tribal, and urban Indian health care
providers. IHS-EHR is a component of the Resource and Patient
Management System (RPMS), IHS's enterprise health information system.
AC Group, Inc.
Chapter 1 - Page 29
Health Services and Resource Administration
HRSA Shared Integrated Management
Information Systems (SIMIS)/
Information and Communication
Technology (ICT)
The SIMIS/ICT provides hardware, software, and support services for
integration of practice management systems among federally supported
health centers (SIMIS), and integration of electronic health records with
practice management systems at consolidated health centers (ICT).
HRSA Integrated Services
Development Initiative (ISDI)
The program supports integration efforts in five areas one of which is
information management.
HRSA Healthy Communities Access
Program (HCAP)
The HCAP is a community-based program to develop or strengthen health
care safety net delivery systems through providing an infrastructure that
will coordinate health care for the uninsured. Development of information
systems is fundamental to supporting coordination of efforts that increase
access to care.
HRSA Sentinel Centers Network
(SCN)
The SCN is investing in the information systems of participant health
centers and networks to provide timely, patient-level data to inform policy
decisions and quality improvement activities across all health centers.
HRSA Patient Electronic Care System
(PECS)
The PECS is a program that is developing patient registry information
systems for centers participating in the Health Disparities Collaboratives.
HRSA Office for the Advancement of
Telehealth grants (OAT)
Grants support for community-based activities in informatics, electronic
medical records, and telemedicine, including telepharmacy.
HRSA Office of Rural Health Policy
Network Development Grants
The Network Development Grants are designed to further ongoing
collaborative relationships among health care organizations by funding
rural health networks that focus on integrating, clinical, information,
administrative, and financial systems across members.
HRSA CAREWare
CAREWare is a patient, encounter-level software application distributed to
HIV/Aids Bureau (HAB) grantees and providers of HIV care to help them
manage, monitor, and report on all clinical and supportive care services.
The software was originally built in Microsoft Access, but is now being
developed in dotNET to enable Internet and wide-area connectivity of care
providers and grantees. CAREWare is also being developed for use
internationally (in Africa especially) under the President’s Emergency Plan
for AIDS Relief.
AC Group, Inc.
Chapter 1 - Page 30
Centers for Disease Control and Prevention
CDC
The CDC is working to advance public health activities through standardsbased information systems. These systems need to work with each other
and with clinical care systems to support public health needs. Through
PHIN, the CDC and its public and private partners have been advancing
software components and data and technical specifications that are
compatible with federal standards activities such as CHI, NCVHS, and
eGov.
CDC PHIN: National Electronic
Disease Surveillance System
(NEDSS)
NEDSS is an initiative that promotes the use of data and information system
standards to advance the development of efficient, integrated, and
interoperable surveillance systems at federal, state, and local levels.
CDC PHIN: National HealthCare
Safety Network System
PHIN is an Internet-based system to collect patient data on measures of
health care quality.
CDC Public Health Monitoring
Most pubic health surveillance and monitoring systems, either directly or
indirectly, get some data from clinical care activities. These data are used to
facilitate public health surveillance through the timely and efficient transfer
and processing of appropriate public health, laboratory, and clinical care
data. Vital statistics systems also at times get data that originate in other
places in the health system.
CDC Clinically Oriented National
Center for Health Care
Statistics (NCHS) Monitoring
National Health Care surveys provide a picture of how health care is
delivered in the U.S. by collecting data from hospitals, emergency and
outpatient departments, ambulatory surgery centers, nursing homes, officebased physicians, home health agencies, hospices, and others on a
periodic basis. These surveys address measurement of diagnosis and
treatment, characteristics of health care providers, trends in use of services,
characteristics of patients, patterns of disease, use of drugs and other
treatments, and emergence of alternative care sites.
CDC Public Health Preparedness
Systems
Preparedness activities such as early event detection, quantification of
outbreak or event magnitude, localization of an event, investigation of event
etiology, the management of possible cases, the laboratory confirmation of
true cases, the tracing of communicable disease contacts, the
administration of vaccines, prophylaxis, and isolation all potentially interact
with clinical-care data and systems. The PHIN standards have been
requirements of the CDC and HRSA preparedness supplements to help see
that the over 2 billion in preparedness funds that have gone to state and
local health departments and hospitals can meet these information
exchange goals.
CDC EPI-X
EPI-X is the CDC’s Web-based communications solution for public health
professionals. Through EPI-X, CDC officials, state and local health
departments, poison control centers, and other public health professionals
can access and share preliminary health surveillance information quickly
and securely. Users can also be actively notified of breaking health events
as they occur. Key features of EPI-X include scientific and editorial support,
controlled user access, digital credentials and authentication, rapid outbreak
reporting, peer-to-peer consultation, and CDC-assisted coordination of
investigations.
AC Group, Inc.
Chapter 1 - Page 31
Department of Commerce
DoC
Technology Opportunities
Program
Technology Opportunities Program awards matching grants that
demonstrate how digital networks assist in the delivery of health care,
public health services, and a wide variety of other local services.
Department of Defense / Veterans Affairs Initiatives
DoD/VA Joint Plan for the Electronic
Health Record (JPEHR)
The JPEHR will provide interoperability between the two health
information systems of VA and DoD. The plan provides for the exchange
of health data by the departments and development of a health
information infrastructure and architecture supported by common data,
communications, security, and software standards and highperformance health information systems. The plan will support Healthy
People (federal), Federal Health Information Exchange (FHIE), Clinical
Data Repository/Health Data Repository (CHDR), Consolidated Mail
Outpatient Pharmacy (CMOP), Lab Data Sharing and Interoperability
(LDSI), and the Centralized Credentials Quality Assurance System
(CCQAS)/VetPro, Scheduling, and E-portal Systems. (Joint DoD and VA
funding.)
DoD/VA Telehealth
Development and adoption of telehealth capabilities within the DoD
Military Health System (MHS) and the VA continues to advance. The
steady increase in cooperation between the two agencies allows for
further leveraging of assets, knowledge, and development of integrated
or interoperable programs. There are six joint telehealth initiatives in
progress: VA/DoD Imaging Subgroup, Teleradiology, Telepsychiatry,
Hawaii Integrated Federal Health Care Partnership, Alaska Federal
Health Care Access Network, Case Management (Diabetes), and eLearning.
AC Group, Inc.
Chapter 1 - Page 32
Department of Defense (DoD) Initiatives
DoD Clinical Information Technology
Program Office (CITPO)
CITPO is an acquisition office for centrally managed MHS clinical IT
systems that support the delivery of health services throughout the MHS.
The following are CITPO projects: Composite Health Care System II
(CHCSII), Composite Health Care System Legacy, Clinical Information
System (CIS), Preventive Health Care Application (PHCA), Defense Blood
Standard System (DBSS), Defense Occupational and Environmental
Health Readiness System (DOEHRS), Encoder Grouper (EG), Special
Needs Program Management Information System (SNPMIS), TRICARE
Online (TOL), Nutrition Management Information System (NMIS), and
Veterinary Services Information Management System (VSIMS).
DoD Defense Medical Logistics
Standard Support (DMLSS)
DMLSS replaces aging military departments' (Army, Navy, and Air Force
MilDeps) specific legacy medical logistics systems with one standard DoD
medical logistics system. DMLSS also manages Joint Medical Asset
Repository (JMAR), Customer Support on the Web (CSW), Facility
Management (FM), Customer Area Inventory Management (CAIM),
Equipment & Technology Management (E&TM), Stockroom/Readiness
Inventory Management (SRIM), Assemblage Management (AM), Universal
Data Repository (UDR), Prime Vendor Program (PV), DMLSS - Wholesale
(DMLSS - W), Customer Demand Management Information Application
(CDMIA), National Mail Order Pharmacy (NMOP), Readiness Application
(RMA), Medical Electronic Customer Assistance (MECA), Distribution and
Pricing (DAPA) Management System (MS), and Electronic Catalog
(ECAT).
DoD Executive Information/Decision
Support (EI/DS)
The EI/DS program provides timely, accurate, and appropriate decision
information supporting the TRICARE Management Activity (TMA) and DoD
MHS mission. The EI/DS program currently consists of a data warehouse
and several operational data marts supporting nearly 3,000 system users,
providing a robust database and suite of decision support tools to
empower the effective management of MHS health care operations. The
EI/DS systems support decision making by senior MHS personnel and
post-decision monitoring of the effects of decisions. EI/DS products
include: MHS Management Analysis and Reporting Tool (MHS MART),
Managed Care Forecasting and Analysis System (MCFAS), Population
Health Operational Tracking and Optimization (PHOTO), Medical
Surveillance, TMA Reporting Tools (TMART), CHAMPUS/TRICARE
Medical Information System (CMIS), CHAMPUS/TRICARE Utilization
Reporting and Evaluation Systems (CURES), Care Detail Information
System (CDIS), and Patient Encounter Processing and Reporting (PEPR).
DoD Resources Information
Technology Program Office
(RITPO)
The RITPO initiative is a project that consists of a family of capabilityspecific applications/systems that support the MHS "Manage the Business"
and "Access to Care" and information technology requirements. The
RITPO project scope includes providing information technology support for
MHS personnel, scheduling, workload forecasting, and patient safety
initiatives. The following are RITPO projects: Defense Medical Human
Resources System - internet (DMHRSi), Central Credentials Quality
Assurance System (CCQAS), Enterprise Wide Scheduling and
Registration (EWS-R), Enterprise Wide Workload Forecasting (EWF),
Patient Safety Reporting (PSR), and Patient Accounting System (PAS).
AC Group, Inc.
Chapter 1 - Page 33
DoD Expense Assignment System IV
(EAS IV)
EAS IV is a standard DoD cost accounting/assignment information
technology system that consists of a cost-assignment application and a
data repository. The system receives information electronically from a
variety of DoD financial, manpower, and workload systems, and allocates
this expense information to Medical Treatment Facility/Dental Treatment
Facility (MTF/DTF) direct and indirect work centers.
DoD Theater Medical Information
Program (TMIP)
TMIP provides a seamless, interoperable medical information system to
support theater health services during combat or contingency operations
within and across all echelons of care. The primary goal is to provide a
global capability linking theater medical information databases and
integration centers that are accessible to the warfighter anywhere, any
time to support the mission. TMIP includes the following programs:
Composite Health Care System in the Theater of Operations (CHCS NT),
Composite Health Care System II - Theater (CHCS II-T), TRANSCOM
Regulating and Command and Control Evacuation System (TRAC2ES),
Defense Medical Logistics Standard Support Assemblage Management
(DMLSS-AM), Medical Analysis Tool (MAT), Shipboard Non-Tactical
Automated Data Processing Program Automated Medical System (SAMS),
Medical Surveillance System (MSS), and Defense Blood Standard System
(DBSS).
DoD Third Party Outpatient Collection TPOCS is the MHS information system used to bill for ambulatory
System (TPOCS)
services.
DoD Telehealth
AC Group, Inc.
The use of electronic information and telecommunications technologies to
provide or support clinical health care, patient and professional healthrelated education, public health and health administration when distance
separates the participants. Current projects include Business cases, eLearning, Policy, Teleconsultation, Pediatric Consultation, Telecardiology,
Teledermatology, TeleENT, Tele Mental Health, Teleneurosurgery,
Teleorthopedics, Telepathology, Teleradiology, Telementoring, and
Telemonitoring.
Chapter 1 - Page 34
Department of Veterans Affairs Initiatives
VA
Joint [VA/DoD] Patient Electronic The JPEHR plan will provide interoperability between the two health
Health Record (JPEHR)
information systems of VA and DoD. The plan provides for the exchange
of health data by the departments and development of a health information
infrastructure and architecture supported by common data,
communications, security and software standards, and high-performance
health information systems. (See FHIE.)
VA
Allocation Resource Center
(ARC) (Health Resources
Management)*
The ARC provides IT services for systems designed to support the VHA
CFO's ability to develop, implement, and maintain resource allocation
methodologies; gather and report on financial aspects of patient workload
and cost; classify patients based on care and diagnosis rendered; and
train and provide information to management officials throughout VA.
VA
Fee Basis Replacement (FBR)*
The FBR will replace a claims-processing system used by VA that
processes claims made by veterans and providers for non-VA care. The
new system will ensure effective and efficient authorization and payment
processing for all non-VA care, including state and home health care and
community nursing home programs.
VA
Patient Financial Services
System (PFSS)*
The PFSS will create a comprehensive business solution for revenue
improvement utilizing improved business practices, commercial software,
and enhanced VA clinical applications.
VA
Health Enrollment
Health Enrollment includes functionality to accept and process veterans’
applications for enrollment, share veterans’ eligibility and enrollment data
with all VA health care facilities involved in veterans' care, manage
veterans' enrollment correspondence and telephone inquiries, and support
national reporting and analysis of enrollment data.
VA
Federal Health Information
Exchange (FHIE)
Provides current and historical data feeds electronically from CHCS I to
the FHIE repository node on selected data types for active-duty, retired,
and separated service members.
VA
Health Data Repository (HDR)
Defined as a repository of clinical information normally residing on one or
more independent platforms for use by clinicians and other personnel in
support of patient-centric care.
VA
Pharmacy Reengineering and IT
Support
Facilitates improved VA pharmacy operations, customer service, and
patient safety, concurrent with pursuit of full re-engineering of VA
pharmacy applications.
VA
Scheduling Replacement
Will develop a next-generation appointment application based on business
process re-engineering and the Institute for Health Care Improvement
guidelines for open and advanced access to care models.
VA
VistA Imaging
Will provide complete online patient data to health care providers, increase
clinician productivity, facilitate medical decision making, and improve
quality of care.
VA
VistA Laboratory IS System
Reengineering
Will enhance the VA Laboratory Service's information technology system
and associated business processes to address current deficiencies and
meet future needs.
VA
VistA Legacy (includes staff)
The operating system software platform and technical infrastructure
(associated with clinical operations) on which VA health care facilities
operate their software applications.
AC Group, Inc.
Chapter 1 - Page 35
VA
Health Infrastructure
The health infrastructure is primarily a hardware-refresh project designed
to put VA general office automation support servers, workstations, and
peripherals on a 4-year replacement schedule. It will consolidate the
services of several smaller computer facilities into an existing larger
computer facility on newer hardware, providing greater reliability while
reducing overall computer space and IT staff. It will establish a working
contingency plan for the consolidated site.
Department of Homeland Security
DHS National Biosurveillance
Integration System (NBIS)
J.
NBIS will combine health data from CDC, agricultural data from the USDA,
food data from a combination of USDA and HHS, and environmental
monitoring from BioWatch to improve detection and response.
Conclusion:
Technology is only a tool and if used effectively can improve the flow of information and potentially improve the
efficiency of the physician’s practice. However in reality, if “change” is not embraced, the probability of success is
very low. We learned in the 1980’s that we needed to change the process of billing for services – or we would not
be paid in a timely and effective manner. Therefore, the practice of medicine, from the business point of view,
changed. Now with newer technologies, government regulations, and the right financial incentive, physicians will
begin embracing new levels of technology that were not available just 5 years ago. But where does a physician in a
small practice turn to learn about the 100’s of technology choices? The physician can spend hours searching and
evaluating all of the opportunities. Or maybe in the near future, physicians will be able to look towards leaders within
their own medical specialty for guidance and knowledge.
AC Group, Inc.
Chapter 1 - Page 36
Chapter 2
6 – Levels of Healthcare IT
A.
A New View of Technology
Practices need to divide the implementation of technology into manageable
steps or Phases. The concept of an “Incremental” technology approach
separates the implementation of Practice Management Systems, Internet
capabilities, Document Management, hand-held devices, and the vision of a
complete Electronic Medical Record System into easily managed steps.
The original concept, developed by Mr. Mark Anderson, Healthcare IT Futurist
with AC Group, Inc., creates a six stage evaluation and implementation plan
that rates each provider’s IT maturity level, strengths, weaknesses and critical
survival criteria. Mr. Anderson’s research indicates that by 2007 healthcare providers that have not reached at
least stage five in the healthcare technology maturity level will begin losing market share because of higher
operating costs and inability to clearly document clinical outcomes.
AC Group’s healthcare technology matrix includes six stages that determine a provider’s IT readiness to meet
the needs of the patient/member market.
The six stages build on one another, beginning with basic IT
infrastructure and low-level applications such as billing applications, progressing in a logical series of
increasingly advanced IT applications, and culminating in sophisticated clinical outcomes and disease
management applications. The first three phases interact more with the front office operations while the last
three phases represent a direct interaction by the physician. The six stages are:
General
Basis Description
Description
Physician Uses System for Review only
Practice
Physicians have installed basic billing and accounting applications.
1
Management
Level
2
Secured
Internet
Capability
Physicians have installed Level 1 plus have a basic web site. The web site is usually
limited to information regarding the practice.
Some physicians will also
communication with colleagues via email.
3
Document
Image
Management
(DIM)
Physicians have installed Level 1 and 2 and have begun receiving lab results,
dictations, and ER records from hospitals electronically. Since most patient records
are paper based, level 3 practices have begun scanning paper documents into a
comprehensive Document Image System. Physicians use the system for viewing of
records only.
AC Group, Inc.
Chapter 2 - Page 37
Chapter 2
Physician Uses System for Direct Entry of Patient Data
B.
4
Hand-Held
and PDA
applications
Levels 1-3 installed. Level 4 is where the physician starts interacting with the computer
system. Through the use of hand-held devices like Personal Digital Assistants (PDAs),
physicians interact with real-time patient data. The applications include reviewing daily
schedules, formulary look-ups, simple charge capture, e-prescribing, etc. Most the
data is updated by the physician, the information is uploaded to the practice’s
computer system via wireless or cradled connections.
5
Electronic
Medical
Records
(EMR)
Levels 1 - 4 along with a comprehensive database of the patient’s financial, clinical and
demographic data, tied together by one seamless electronic backbone. The core EMR
allows physicians to enter history and physical information, notes, vital signs, etc.
Allows for Physician Order Entry (POE) with Clinical Decision Support based on
Knowledge based protocols.
6
Clinical
Trails,
Outcomes
Measurement
All applications have been installed (1-5). The physician enhances his/her practice
through the use of clinical outcomes to improve care and implementation of disease
management programs.
Where are we today?
6-Levels of Healthcare IT Maturity
Based on a survey of 3,476 physicians, the majority of
physicians (90%) have installed a Practice Management
internet capability for communication with other colleagues,
have some form of web site, and in 14% of the practices, the
front office is able to check a patient’s eligibility and benefits
via an interactive web site with selected payers (Level 2). Only
30% of the physicians have access to electronic forms and
paper via a document management system (Level 3). The
mobile healthcare marketplace (Level 4) has been one of the
% o f P h ysician s U sin g
System (Level 1). Almost 50% of the physicians have secured
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Practice
Management
Secured Internet
Connectivity
Document
Management
Mobile
EMR
L1
L2
L3
L4
L5
Clinical
Trials
L6
Exhibit 2
hottest markets in the past three years. However although
many physicians have such a device for personal use, less than 21% routinely use it for collecting and reporting of
clinical and/or charge capture data. The level that everyone has been talking about since the TEPR conference in
Seattle (May 2002) has been the Electronic Medical Record (EMR) application. The EMR incorporates the patient’s
demographic and insurance data with the patient’s clinical information (Level 5). The clinical information includes
vital signs, history and physical notations, allergies and medications, physician progress notes, ancillary orders and
results, etc.
Although EMRs have been promoted for over a decade, < 10% of physicians use EMRs in their
practice today. The final level (Level 6) incorporates all of the first 5 levels, Clinical Decision Support, Knowledge
AC Group, Inc.
Chapter 2 - Page 38
Chapter 2
Based Systems for tracking patient clinical outcomes, clinical quality, disease management, and allows the
physician to interact electronically and seamlessly with internal or external clinical trials. Today, < 4% of physicians
has any seamless electronic interaction for patient clinical outcomes and quality.
C.
The Future of Automation?
Based on physician interviews, recent return on investment (ROI) studies, government regulations including HIPAA,
insurance payment trends, and the rate of physician adoption of newer technologies is likely to escalate in the next
three years. As shown on Exhibit 3, almost 98% of physicians will embrace Practice Management Systems by
2005, almost 80% will communicate with selected
patients, their colleagues and 70% of health plans via
6 Levels of IT Maturity
a secured internet browser, and 73% will have a
Document Image Management System for the sharing
By 2005, mobile healthcare (Level 4) will be used by
40% of the physicians for direct entry of prescription
information, intelligent charge capture and coding,
results reporting review and confirmation, and for
direct entry of physician notes. EMR (Level 5) adoption
% of Physicians using Technology
of paper and electronically generated clinical data.
100%
Practice
Management
Secured Internet
Connectivity
80%
Document
Management
60%
Mobile
EMR
40%
Clinical
Trials
20%
0%
has been very slow over the past decade. The main
reasons appear to be cost, functionality, and viability of
the vendors. We believe that this will change starting
L1
L2
L3
L4
2003
L5
L6
2005
Exhibit 3
in 2003 when more studies were be published that outlines the benefits of EMR, both to the physician and the
patients. In addition, health insurance payers may begin subsidizing physicians that use EMRs. In fact one study,
conducted by AC Group, showed that on average, physicians that use an EMR had a 9.4% lower Medical Loss
Ratio per case mix adjusted DRG and ambulatory ICD-9 than non-users of EMRs.
Additionally, another
unpublished study by AC Group showed that physicians that used a EMRs improved their documentation and
through the use clinical decision support and knowledge based protocols, reduced the number of malpractice
claims. This resulted in a reduction in malpractice costs by 16.3%.
To truly understand the physician’s marketplace, we have to
explore each of the six levels of technology.
AC Group, Inc.
Chapter 2 - Page 39
Chapter 3
Overview:
Physician practices, like all of healthcare, have been reluctant to spend appropriate dollars on technologies to
improve operations. In today’s environment, physicians are being challenged to practice medicine and run a
profitable business. Decreasing reimbursements and lower net profits have forced radical changes in practice
management and have accelerated the adoption of technology beyond the basic billing office. Many companies
have created technological solutions addressing various “pain points” within healthcare. These companies have
focused on areas in which they perceived to be inefficient and in need of automation. A staggering myriad of
solutions is available to medical practices, making it necessary to wade through the options to find the best
solution.
We are at the beginning of the technology revolution in healthcare. The challenge for now is to find a foundation of
technology that will enable you, the physician or healthcare information manager to build a complete solution in the
future. The foundation must be based on a strong Practice Management System (PMS). Seeking product
differentiation, leading PMS vendors are rolling out an ever-widening array of optional modules and are tailoring
PMS to meet the rapidly changing needs of the practice management system market. Top PMS vendors offer
multiple versions for small, midsize, and large group medical practices, and the fast-growing management services
organization (MSO) market. This trend will continue through 2006 as group practice consolidation accelerates and
the average practice size continues to grow.
Practice Management Systems
Many physicians are coming to the realization that their current practice management systems are not performing
basic front-office functions as well as they could be. Other factors are also pushing group practices to hunt for new
systems: Mergers, consolidations, and IPA’s are causing newly consolidated groups to look for one common
practice management system. Some group practices that have been using older, text-heavy Unix-based systems
that run on dumb terminals are investigating newer, client/server or web-based systems designed to run on
personal computers. These new systems present information more graphically because they use Microsoft
Windows. Because many physicians and their support staffs use PCs running Windows at home, these newgeneration systems are attractive for their ease of use. However, group practices have to guard against acquiring
new technology just because it is new. Other factors should be considered, including company viability, end-user
satisfaction, and overall functionality. Once a practice has concluded that its old system no longer can meet its
needs, it must determine exactly what functions it must acquire, evaluate vendors' systems and negotiate the best
www.acgroup.org
Chapter 3 - Page 40
Chapter 3
possible deal. By carefully moving through these steps, physicians can avoid paying for-and then having to live
with-a system that does not meet their needs.
To make sure they buy the right software, physicians need to develop effective purchasing strategies. According to
the CIO of the Taconic IPA (3,000+ physicians), “Today, technology decisions must be based on “knowledge”
rather than just guess work. Companies like AC Group, POMIS, and KLAS are conducting independent third party
reviews of vendor applications, end-user satisfaction, product functionality, and company viability. These reports
take the “guess-work” out of decision-making and streamline the selection process.
Practice Management Systems (PMS) have been widely used by physicians since the late 1990’s when Medicare
started paying faster if a physician submitted a patient’s insurance claim electronically. The critical issue today is,
“What is the standard functionality of a PMS application. As shown below, a survey of the top 30 PMS vendors
indicated that most PMS applications today have the same functionality when it comes to necessary functions.
Standard PMS Functionality
Critical issue: What is “standard” functionality?
Necessary Functions
Registration
Patient Scheduling
Accounts Receivable
Encounter Tracking
Electronic claim submit
Collections Management
Referrals
Master Patient Index
Resource Scheduling
Coordination of Benefits
Claims Processing
Inbound capitation
Referral Management
Paperless Collection
Worker’s Compensation
Remittance Processing
www.acgroup.org
95%
95%
90%
90%
90%
87%
87%
85%
85%
82%
82%
82%
82%
77%
77%
75%
Chapter 3 - Page 41
Optional Functions
HIS linkage
Enrollment / Eligibility
Outbound capitation
Occupational medicine
Contract management
MCIS linkage
Encoding support
Rules-based scheduling
Residency billing
DME billing (education)
Risk pool management
Medical records
Electronic funds transfer
72%
70%
70%
66%
64%
64%
64%
59%
59%
59%
51%
46%
24%
Chapter 3
Selecting the right PMS application:
Job No. 1 for group practice administrators is determining whether their organization needs a new physician
practice management system. This decision should be made with care and expert advice. Consider this: More than
1,500 U.S. vendors sell physician practice management systems, according to Vinson Hudson, president of
Jewson Enterprises, a Texas-based research and consulting firm who produce the POMIS report. As a result,
group practices need to keep their guard up-and carefully analyze whether the time is right for them to be looking
for a new practice management system.
The challenge for most physicians is selecting the right PMS application based on specific functionality by category
of functionality. According to the October 2005 report from Healthcare Informatics, there are at least 260 vendors
selling Practice Management Systems to small, medium, and large physician practices here in the United States. To
assist the physician community, a few studies have been conducted by neutral third parties. The following pages
describe the results of the studies.
1. AC Group, Inc. PMS Study – Physician Offices
During May of 2007, Mark R. Anderson from AC Group, Inc. conducted an analysis of the top eleven vendors who
sell to practices. The criteria that AC Group, Inc. evaluated included:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Accounts payable management
Accounts receivable management
Ad Hoc Report Writer
Appointment scheduling
Appointment Scheduling/Recall
Audit trails
Billing - Family
Billing - Insurance
Billing - Patient
Billing/ accounts receivable
Budget Forecasting/Modeling
Call Schedules for Physicians
Capitation Rate Setting Development
Chart Tracking
Claims Adjudication-Managed Care
Clinical data repository
Clinical encounter management
Coding support
Collections
Contract Management
Coordination of benefits
Cost Accounting
www.acgroup.org
Chapter 3 - Page 42
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Data security
Decision support tools
EDI Claims Processing
EDI Clearinghouse
Electronic Claims Submission
Electronic Posting of Remittance Advices
Electronic claims processing
Electronic data interchange
Electronic remittance capabilities
Electronic signature of reports
Employee Policies Manual Development
Encoding support
Encounter tracking
Enrollment and eligibility
Fixed Assets
Fully integrated quality care guidelines with
compliance tracking
General Ledger
HMO roster management
Hospital Information system links
Hospital-Physician Integration
HR Management
Income Distribution
Chapter 3
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Incoming/Outgoing referral tracking
Insurance Claim Processing - Paper
Integrated claims adjudication
Integrated clinical and financial system
Interface to elec. imaging processing
Inter face to speech recognition
Inter face to wireless/ handheld devices
Interfaces with other systems
Inventory/Purchasing
Labor Utilization/Staffing
Managed Care Reporting/Prepaid/HMO
Marketing Analysis/Demographics
Master patient index
Materials Management
Management Reporting
Practice Analysis/Daily Audit
MSO Reporting
Multiple Payor Privileges
Online eligibility
Online lab orders/ results reporting
Online prescribing
Open item audit trail listing by line item
Order entry
Outcomes measures
Patient demographics
Patient education/ guidelines
Patient flow tracking
Patient Mix
Patient scheduling
Payroll
Physician Productivity
Prescription assistance
Prescription tracking
Purchase orders
Referral Management
Relative Value Scales
Rules-based scheduling
Specialty practice management system
Spreadsheet
Supports MPI roll-up functions
Transcription
Treatment authorization
Treatment referral authorization
Utilization and quality management
Utilization management
Word Processing
Workers' Compensation
Other:
•
•
•
•
•
•
Coding - ICD-9, CPT-4
Coding - SNOMED
Other Coding Support
Patient Education Features
Prescription Assistance
Report Generator
Technology:
•
•
•
•
Encryption Technology
Object-oriented Technology
Smart Card Technology
SQL-based Technology
Each of the functional areas (which included over 1,000 functional questions) was assigned a weighted point value
based on perceived value to the practice. The 31 applications that were evaluated included:
1. AcerMed EMR
2. Allscripts Healthcare
Solutions
3. Bond Technologies, LLC
4. Cerner
5. Company Technologies
Corporation
6. eCast Corporation
7. eClinicalWorks
8. e-MDs
9. Epic Systems Corporation
10. GE Practice Solutions
11. Greenway Medical
12. Health Highway
www.acgroup.org
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
HealthMatics
McKesson Corporation
McKesson Practice Partner
MCS-Medical
Communication Systems,
Inc.
MedcomSoft
Medinformatix, Inc
Meditab Software, Inc.
MedNet Systems
meridianEMR, Inc.
Misys plc
NextGen Healthcare
Information Systems, Inc.
Chapter 3 - Page 43
24. OD Professional
25. OmniMD ( A Division of
Integrated Systems Inc.)
26. PracticeXpert
27. Pro Practica, Inc.
28. PULSE SYSTEMS INC.
29. Sage
30. SSIMED
31. SynaMed, LLC
Chapter 3
Total Overall PMS Functionality:
The results of the study (Exhibit 4) showed that McKesson Practice Partner, NextGen Healthcare Information
Systems, Inc., HealthMatics; eClinicalWorks, Allscripts Healthcare Solutions, and Epic Systems Corporation. The
products offered by GE Healthcare are also very strong. However, GE Healthcare does not want their functionality
ratings published in this report. The results were based on the responses of the vendors and do not necessary
represent 3rd party certified working functionality.
Total PMS Functions
100%
Practice Partner
NextGen
HealthMatics
95%
eCW
Allscripts
90%
Epic
Greenway
MCS
85%
AcerMed
McKesson
80%
Misys
e-MDs
Meditab
75%
Sage
PracticeXpert
MedcomSoft
70%
PMS
www.acgroup.org
Chapter 3 - Page 44
CTC
Chapter 3
Large Multi-Specialty Clinics
The companies that traditionally sell to large multi-specialty clinics are usually different than those who sell to
traditional practice practices. For the large groups with more than 100 care-givers, Epic Systems, NextGen and
IDX Corporation ( GE Healthcare) appear to have the highest percentage of administrative and billing functionality
(Exhibit 5).
Total PMS Functions
Large Practice > 100 Providers
100%
95%
NextGen
90%
eCW
Allscripts
Epic
85%
McKesson
Misys
Sage
80%
PracticeXpert
CTC
75%
70%
PMS
www.acgroup.org
Chapter 3 - Page 45
Chapter 3
Mid-Sized Practices
The companies that traditionally sell to mid-sized practices are usually different than those who sell to individual
physicians or large group practices. For practices with 20-99 Physicians McKesson Practice Partner, NextGen,
eClinicalworks, HealthMatics 9Allscripts) and Misys appear to have the highest percentage of administrative and
billing functionality (Exhibit 6). Once again GE Healthcare also has strong products but they will not allow us to
publish their functionality ratings.
Total PMS Functions
Mid-Sized Practice (19 - 99 Providers)
100%
Practice Partner
98%
NextGen
96%
HealthMatics
eCW
94%
Allscripts
92%
Greenway
90%
MCS
88%
AcerMed
McKesson
86%
Misys
84%
Pro Practica
82%
PULSE
80%
Cerner
PMS
OmniMD
2
www.acgroup.org
Chapter 3 - Page 46
Chapter 3
Small-Sized Practices
The companies that traditionally sell to small practices are usually different than those who sell to individual
physicians or large group practices. For practices with 3-19 Physicians McKesson Practice Partner, NextGen,
eClinicalworks, HealthMatics (Allscripts) and Misys appear to have the highest percentage of administrative and
billing functionality (Exhibit 7). Once again GE Healthcare also has strong products but they will not allow us to
publish their functionality ratings.
Total PMS Functions
Small Practice (3-19 Providers)
100%
Practice Partner
NextGen
98%
HealthMatics
96%
eCW
94%
Bond
92%
Greenway
MCS
90%
AcerMed
88%
McKesson
86%
Misys
Pro Practica
84%
PULSE
82%
e-MDs
80%
Cerner
PMS
www.acgroup.org
Chapter 3 - Page 47
OmniMD
Chapter 3
Individual Physicians
The companies that traditionally sell to individual practices are usually different than those who sell to group
practices. For individual physicians (1-2) McKesson Practice Partner, NextGen, eClinicalworks, HealthMatics
(Allscripts), Bond Medical, MCS and SynaMed appear to have the highest percentage of administrative and billing
functionality (Exhibit 8). There are other small physician PMS applications offered by McKesson (MediSoft and
Lytec) but McKesson has not provided us with their specific functionality for testing. Once again GE Healthcare
also has strong products but they will not allow us to publish their functionality ratings.
Total PMS Functions
Individual Providers (1 – 2
Providers)
100%
Practice Partner
98%
HealthMatics
96%
eCW
94%
Bond
92%
Greenway
90%
SynaMed
88%
MCS
86%
AcerMed
84%
Pro Practica
82%
PULSE
80%
PMS
www.acgroup.org
Chapter 3 - Page 48
e-MDs
Chapter 3
2. Microsoft/AAFP Study
Of the 3,247 physicians surveyed for the 2005 Leadership Survey conducted by AC Group, Inc. 74 percent
indicated that improving operating efficiencies was their primary workplace concern. To help doctors better
manage information and, in the process, deliver higher quality care, Microsoft teamed up with the American
Academy of Family Physicians (AAFP) to evaluate nine practice-management software programs. "Practice
management software" is the term for software developed specifically to increase efficiencies by automating
billing, insurance claims, appointments and other office tasks.
The resulting software guide, announced in April of 2002 (therefore now 3 years old) at the AAFP's Annual
Leadership Forum in Kansas City, Mo., offered doctors the information they need to determine what software
works best for their practice. The vendors' software was subjected to intensive review in the functional, technical
and financial/corporate areas. The functional evaluation determined the presence or absence of 57 key
functionalities. The technical evaluation included an on-site visit by a team of technical experts from Microsoft to
the vendor's premises, detailed discussions with the vendor's technical team, a close examination of the
architecture of the product, its design, and the methodology for building and testing it.
Over the course of more than two years and based on the needs and requirements of family physicians, Microsoft
and the AAFP evaluated the practice management software on criteria including:
•
The quality of software functionality
•
How well it meets the needs of family physicians
•
The quality of the software's technical architecture
•
The reliability of the software
•
The maker's use of industry technology standards
•
Customer satisfaction
•
The financial viability of each vendor.
Vendors evaluated in the guide included Compusense (now owned by A4/Allscripts), e-MDs, Greenway Medical
Technologies, InfoSys, MedStar Systems, NextGen Healthcare Information Systems, Millbrook (now owned by
GE Healthcare), PerfectPractice.MD and Visionary Medical Systems. Both Microsoft and the AAFP consider the
report a buyer's guide rather than an endorsement of specific product.
The practice management software products of these nine vendors were subjected to intensive review in the
functional, technical and financial/corporate areas. The functional evaluation determined the presence or absence
www.acgroup.org
Chapter 3 - Page 49
Chapter 3
of 57 key functionalities. The technical evaluation included an on-site visit by a team of technical experts from
Microsoft to the vendor's premises, detailed discussions with the vendor's technical team, a close examination of
the architecture of the product, its design, and the methodology for building and testing it. The purpose of this
detailed examination was to ensure that the technology is reliable, secure, and supportable, that it is capable of
working with other modern technologies including the Internet, and that it fits the environment of physician offices.
The financial evaluation involved detailed examination of the vendor's financial statements, accounting methods,
customer base, growth projections, operating procedures, and potential future liability. The goal of this in-depth
review was to measure each vendor’s financial and basic operational sustainability and predictability in a
challenging economic environment. Scores on each of these three areas were converted to a 0 to 100 scale. A
simple average of these three scaled scores was calculated for the composite rating of each vendor.
All of the vendors offered nearly all of the key functions sought, ranging from 88% to 98%. However, there were
large variances between vendors on both the technical and the financial/corporate evaluations. To provide a more
comprehensive single measure to compare PMS suites, they developed a composite of the evaluations of the
above characteristics by averaging the scores for the individual evaluations. Based on this composite score, four
companies scored above 75 on a scale of 0 to 100: A4 (CompuSense), Greenway, GE (Millbrook), and NextGen.
The AAFP urged physicians preparing to purchase a practice management software system to consider the
relative importance of these three factors to their own situation and needs.
Top 9 Practice Management Systems –
AAFP/Microsoft Study
Functionality Rating
100.0
97.5
95.0
92.5
90.0
87.5
85.0
82.5
80.0
investing
in
practice
management
Nextgen
software is not the purchase of an
GE
undifferentiated commodity, subject only
A4
Perfect Practice
to price considerations. If that were the
Info Sys
case, we would not see the vendors
Medstar
investing
Visonary
product’s
e-MD
Exhibit 6
According to the AAFP/Microsoft study,
Greenway
in
improvements
architecture,
in
their
design
and
reliability. Quite to the contrary, their
technical evaluations would seem to
suggest that this is the arena in which customers are won or lost. But choosing a PMS vendor based solely on the
product’s technical merits ignores the question of vendor sustainability in a crowded market. In the end, a careful
balancing of risks and trade-offs will point the user to the right PMS vendor to meet his or her needs.
www.acgroup.org
Chapter 3 - Page 50
Chapter 3
PMS Case Study:
For the 12-provider Diagnostic Cardiology Associates (DCA), the decision to seek out a replacement system was
a relatively easy one to make. According to Dean Rombach, the decision to replace our older text-base PMS,
and the sequential selection and installation was very time-consuming, but well worth it. DCA chose one of the
up and coming vendors, Microsys Computing, Inc. According to Dean, “Microsys provided a functionality rich
product, on-time and on-schedule. For the past five years, Microsys has provided superior service and support
and have routinuly customized the PMS application to meet DCA’s ever changing requirements.
Selecting the right PMS application
Job No. 1 for group practice administrators is determining whether their organization needs a new physician
practice management system. This decision should be made with care and expert advice. Consider this: More
than 1,500 U.S. vendors sell physician practice management systems, according to Vinson Hudson, president of
Jewson Enterprises, a Texas-based research and consulting firm who produce the POMIS report. . As a result,
group practices need to keep their guard up-and carefully analyze whether the time is right for them to be looking
for a new practice management system.
One company that is getting a lot of notice lately is Youngstown, OH based, Microsys Computing, Inc. Microsys
has received numerous 3rd party validations and awards during the past year. In the KLAS 2003 PMS report, an
organization that measures end-user satifaction, Microsys rated highest for overall performance indicators
(60.56) and received first place ratings in:
o
o
o
o
o
Helps Job Performance
-Implementation within Budget/Cost
-Money’s Worth
-Proactive service
-Product Quality Rating
o
o
o
o
o
-Quality of Custom work
-Quality of documentation
-Quality of releases/updates
-Worth the effort/improved productivity
-Would buy it again
In regards to product functionality, Microsys was a finalist in the TEPR 2003 awards, and received extremely
high marks on the annual POMIS report. Out of a maximum of 10, Microsys received the following rankings:
o
o
o
o
Rated Exceptional Cost (9.35),
Product/Services Maturity (9.40)
Implementation (9.10)
o
o
o
Overall customer satisfaction (9.28)
Technological Fit (9.55)
Functionality (9.75)
Customer support (9.75)
www.acgroup.org
Chapter 3 - Page 51
Chapter 3
Over the course of more than two years and based on the needs and requirements of physicians, AC Group
evaluated various practice management software solutions based on specific criteria including:
•
The quality of software functionality
•
How well it meets the needs of family physicians
•
The quality of the software's technical architecture
•
The reliability of the software
•
The maker's use of industry technology standards
•
Customer satisfaction
•
The financial viability of each vendor.
Overall, Microsys received the highest rating (5-Stars) from AC Group, Inc. Microsys’ practice management
solution was subjected to intensive review in the functional, technical and financial/corporate areas. The
functional evaluation determined the presence or absence of 90 key functionalities. The technical evaluation
included detailed reviews of the architecture of the product, its design, and the methodology for building and
testing it. The purpose of this detailed examination was to ensure that the technology is reliable, secure, and
supportable, that it is capable of working with other modern technologies including the Internet, and that it fits the
environment of physician offices. The financial evaluation involved detailed examination of the vendor's financial
statements, accounting methods, customer base, growth projections, operating procedures, and potential future
liability. The goal of this in-depth review was to measure a vendor’s financial and basic operational sustainability
and predictability in a challenging economic environment. During the process, Tom Ferkovic with SS & G
Healthcare Services LLC indicated that Microsys provided a great product that allowed his group to support
multi-practices from a single location. According to Tom, “Microsys provided an easy to learn and easy to use
system with superior functionality and great on-going support.”
Conclusion:
Technology is only a tool and if used effectively can improve the flow of information and potentially improve the
efficiency of the physician’s practice. However in reality, if “change” is not embraced, the probability of success is
very low. We learned in the 1980’s that we needed to change the process of billing for services – or we would
not be paid in a timely and effective manner. Therefore, the practice of medicine, from the business point of view,
changed. Now with newer technologies, government regulations, and the right financial incentive, physicians will
begin embracing new levels of technology that were not available just 5 years ago. But where does a physician
in a small practice turn to learn about the 100’s of technology choices? The physician can spend hours searching
and evaluating all of the opportunities. Or maybe in the near future, physicians will be able to look towards
leaders within their own medical specialty for guidance and knowledge.
www.acgroup.org
Chapter 3 - Page 52
Chapter 3
3. Jewson Enterprises
Founded in August 1973 by Vinson J. Hudson and Jewel C. Hudson, Jewson Enterprises produces an annual
report on the PMS marketplace. The company provides market research, industry analyses, and competitive
intelligence advice to medical practices and information technology vendors seeking advantage through market
knowledge. The company also provides a national and international reputation for excellence, objectivity, and
confidentiality in its research analysis, and for identifying market dynamics and strategic visions that is best suited
to the development of business and technology needs.
Jewson Enterprises™ (JE) is built on the strategic use of professionals intimately knowledgeable on industry
events, trends, and facts. This is reflected in its high quality market research and analyses; products/services,
hassle-free customer service; and, most important, timely delivery of reliable knowledge when you need it. JE
specializes in the following:
o
The POMIS Report© - An seven-chapter subscription database on physician’s office information
system solutions (ISS), industry demographics, market analyses, trends, technology utilization, and
competitive analysis.
o
Ambulatory Care Setting Clinical Information Systems Report© - , ambulatory care setting
clinical information systems report separated from The POMIS Report that analyzes the market for
computer-based patient records systems and associated applications.
o
The Satisfaction Rating Directory of POMIS Vendors (The SRD©) – An unbiased, primary
purchasers source for medical practices who are considering first-time purchase, enhancement, or
replacement of an ambulatory care setting ISS. Hundreds of vendors have been give a unique
satisfaction rating based on nine essential selection criteria.
o
POMIS IQ Report – A quarterly digest of pertinent industry dynamics. These dynamics include minimarket analysis, industry analysis, analyst’s strategic visions, and an interesting area called “Hearsay
Research.”
o
Personalized Advisory Services – A customized executive seminar-type presentation to focus
corporate planning executives toward existing and emerging opportunities. We perform
business/market plan evaluations, due diligence projects, customized market research, organized
executive brainstorming, speaking engagements, and brokering acquisition and merger deals.
JE is hub to a successful industry competitive intelligence-gathering network of people and organizations whose
intellectual assets are organized in its POMIS Knowledge Base. The flexibility of its business model delivers a
www.acgroup.org
Chapter 3 - Page 53
Chapter 3
kind of market research and analysis firms without walls – a virtual industry knowledge base. JE’s POMIS
Knowledge Base is a comprehensive representation of the industry’s competitive intelligence professional.
The POMIS Report has raised its bar of value.
o
o
Presents a scenario analysis of possible futures in the industry.
o
Presents a separate volume that analyzes only the ambulatory care setting computer-based patient
records (or EMR) systems marketplace.
o
o
Presents The SRD – the most comprehensive database of POMIS vendors in the U.S.
o
New approach to competitors’ analysis that uses strategic group analysis of POMIS vendors and a
scenario analysis that uses specific methodological approaches that looks at how the future POMIS
industry could look based on trends, events, and surprises.
Strategies of the leading 10 firms in terms of revenue, such as Misys Healthcare Systems, IDX
o
Systems Corporation, and Medical Manager Health Systems/WebMD, is stressed but sustainable.
New companies, such as Amicore and GE Medical Systems, are challenging existing POMIS vendors
with large footprints, creating competitive scares.
o
Surveys indicate that clinical (e.g., physician CPOE, e-prescribing via the Internet, EMRs/CPRs, etc.)
purchases will be significant between 2003 and 2005, dramatic between 2005 and 2007, and
widespread after 2007. Practice management systems from new vendors and large established
vendors based on Windows-based and ASP-based delivery configurations may significantly begin to
enhance legacy systems.
o
HIPAA enforcement will drive small and medium-sized physician organizations to seek the help of
their information technology solutions vendor.
o
POMIS vendor population will continue to decline within a highly competitive marketplace.
o
Revenues earned by the vendor population will continue to increase at attractive double-digit
compound annual growth rates.
Presents an industry analysis that expands on physician organization distribution, physician
organization expenditures through a 5-year forecast, technological analysis, trends and events, and a
strategic group analysis in the Competitors Analysis section.
The POMIS Report is loaded with strategic information to help you refine your goals of market
success.
www.acgroup.org
Chapter 3 - Page 54
Chapter 3
2006 Edition
POMIS Vendor
Database
Volume 2
2006 Edition
POMIS Market
Analysis
Volume 1
2006 Edition
POMIS ACS-CPR
Analysis
Volume 3
Physician’s Office Management
& Medical Information Systems
Industry information technology
solutions vendor database.
Physician’s Office Management &
Medical Information Systems
Industry Essential Knowledge for
Business and Strategic Planning.
Physician’s Office Management
& Medical Information Systems
Industry report on EMRs/CPRs
and related clinical components
for Business and Strategic
Planning
Client & Subscriber Profile
Jewson Enterprises (JE) primarily targets POMIS vendors and physician provider organizations. Market demand
during 1996 has expanded the client base of companies, executives, and strategic planners into other industries.
JE’s clients are described as follows: private physicians, group practices, application software innovators,
corporate acquisition seekers, investment bankers, practice management consultants, publishers, drug firms,
computer manufacturers, hospitals, health care transaction processing firms, blue cross and blue shield plans,
commercial insurers, etc.
The following matrix describes JE’s mix of clients & business:
Clients
Application Software Innovators
Blue Cross & Blue Shield Plans
Commercial Insurers
Computer Manufacturers
Corporate Acquisition Seekers
Drug Firms
Healthcare Transaction Processing Firms
Hospitals
Information System Solutions Vendors
Investment Bankers
Medical Practices
Practice Management Consultants
Private Physicians
Publishers
www.acgroup.org
POMIS
Report
√
√
√
√
√
√
√
√
√
√
√
Chapter 3 - Page 55
POMIS
IQ
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Partnering
Assistance
√
√
√
√
√
√
√
-
Advisory
Service
√
√
√
√
√
√
√
√
√
√
√
√
Chapter 3
The POMIS Industry
The physician’s office management and medical information systems (POMISSM) industry consists of all
ambulatory care settings, medical offices, managed care plans, and the vendors of information system solutions
who serve them. The major market segments of physician’s offices are:
•
•
•
•
Traditional Solo & 2-physicians
practices
Traditional group practices
Hospital-based practices
Academic medical centers
•
•
•
Managed care plans
Free-standing ambulatory care centers
Integrated Delivery Networks
The segments of vendors of information system solutions are:
•
•
•
Systems vendors – Personal computers, workstations, midranges, and mainframes
Service organizations – Billing services and outsourcing services
Application Service Providers – ASP or Web Services
The POMIS Report History
•
The initial POMIS analysis report was called the Computerized Physician's-Office Medical Information
Systems (POMIS) database and published in 1968. It was a joint venture with Creative Strategies
International and Jewson Enterprises. More than 230 vendors were investigated in an undefined industry;
that edition was the first of its kind to furnish in-depth information on a broad range of vendors, healthcare
policy makers, and health services institutions within the medical and health care industry. Although the 1968
edition was acknowledged as a qualified success, the one serious shortcoming was that it did not provide
answers to data presented.
•
By 1985, Jewson Enterprises™’ POMISSM Report was well established. It analyzed facts and numbers that
could be used by corporate product development decision-makers. It included discussions by marketing
experts, whose professional commentaries address issues that corporate management needed in order to
understand how to be successful in their targeted market segments.
•
This report included survey results of more than 600 vendors and more than 2,000 medical offices.
Information in that study provided value to both the POMIS vendor and medical provider.
•
TM
In 1990 and 1991, Jewson Enterprises published the POMIS U.S. Analysis Report from its POMIS
Knowledge Base. It was designed to assist marketing organizations with growth and penetration into the
industry. The report answers three basic questions: (1) What is the size and growth of the market; (2) What is
the growth rate of the market in installations and revenues; (3) What are the potential bases by which defined
markets might be segmented; and (4) What is the structure of the competitive environment?
•
The 1992 base year report, called The POMIS U.S. ANALYSIS REPORT PACKAGE, described strategies
and visions on how vendors are selling information systems solutions as a cost-effective way to lower costs
and increase revenues. It described what types of medical offices are likely to acquire, enhance, or replace
systems; what types of support and services they are likely to buy; where market growth is likely to occur by
1997; how much of each market segment is currently computerized; where expansion possibilities are likely to
occur; and how healthcare legislation and reimbursement issues are likely to effect each market segment.
www.acgroup.org
Chapter 3 - Page 56
Chapter 3
The SRD©
Included is The Satisfaction Rating Directory of POMIS Vendors (The SRD). The SRD is the unbiased, primary
purchaser’s source for medical practices that are considering a first-time purchase, enhancement, or replacement
of a medical office ISS. It is a database of U.S. physician practice information system vendors and software
publishers. The database has several tables that can be used and is used for analysis.
The SRD features numerous vendors who have withstood an independent Satisfaction Rating process and
scored on (1) nine essential selection criteria, (2) an overall satisfaction rating, (3) an overall expectation score,
and (4) a satisfaction-to-expectation ratio. Each vendor's profile is presented with the following data elements:
POMIS VENDOR PROFILE AND SATISFACTIONS RATINGS – PUBLISHED REPORT PROFILES DATA
ELEMENTS
Company Name
Parent Name
Address1
Address2
City, State
Postal Code
Voice Number
Toll-free Number
Fax Number
E-Mail
Website
Ownership
Year Entered Business
Geographical Coverage
Revenue Range
Number of Employees
Number of Sales and Service Offices
Number of Total Customer Accounts
Number of Physicians With Customers
Distribution Channels:
• Direct Sales
• Value-Added Resellers
• Sales Representatives
• Telemarketing
• Dealers
• Distributors
• Mail Order
• International Sales
• Managed Care Information Systems
• CPR/EMR/HER Systems
• Other Systems
Company Management Team
Satisfaction Rating Summary
• Overall Customer Satisfaction Rating
• Expectation Score
• Satisfaction-to-Expectation Score
• Application Implementation
• Breadth of Products/Services
• Cost
• Customer Support
• Functionality
• Product/Service Maturity
• Regional Presence
• Technological Fit
• Vendor Stability
Technology Platforms For Solutions
General Description of Pricing/Costs
Type of Customers Targeted
Products/Services Delivery Types:
• Computer Systems
• Billing Services
• Outsourcing Services
• Application Service Providers
Information Technology Solutions Offered:
• Practice Management Systems
Products & Applications Descriptions
• Company Name
• Product/Service Name
• Major Category
• Method of Delivery
• Product/Service Description
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Chapter 3 - Page 57
Vendor General Write-up
• Overall Description
• Alliances
• Implementation Description
• Differentiation Comments
• Analyst Comments
Chapter 3
Physician Practice Database
This database contains more than 11,000 physician organizations from 3-physicians practices and greater. JE
uses this database to perform satisfaction ratings on a random basis. The value of this database lies in its
potential for business. Few have a database that has qualified contacts. Here is its format:
Data Type
Description
Field Name
practice_tag
practice_name
contact_name
AutoNumber
Text
Text
address1
address2
city
state
postal_code
voice
fax
tollfree
email
web_address
practice_type
specialties
physician_size
extender_size
MCPlives_covered
pomis_name
pomis_vendor
contract_start
financial_apps
administrative_apps
managed_care_apps
medical_apps
EDI_connectivity
amc
ed
od
HMO
IPA-HMO
PPO
ppmc
application_detail
sites
comments
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Number
Number
Number
Text
Text
Text
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Memo
Number
Memo
Medical Office Satisfaction Rating Respondent Identifier
Medical office practice name
Name of contact and other executives (e.g., CEO, CIO, Administrator,
etc.)
Address1 of Medical Office
Address2 of Medical Office
City of Medical Office
State of Medical Office
Zip code of medical office
Telephone Number of Medical Office
Fax Number of Medical Office
Tollfree Number of Medical Office
E_Mail of Medical Office
Website address of medical office practice
Type of medical office practice
Type of specialties within practice
Number of physicians in practice
Number of physician extenders (e.g., NPs, PAs) in practice
Number of patient lives covered under managed care plan contract
Name of Vendor's System and/or Solution
Name of vendor
Month and/or year that practice contracted for system/solution
Financial applications in vendor's system/solution
Administrative applications in vendor’s system/solution
Managed care plan applications in vendor's system/solution
Medical and clinical applications in vendor's system/solution
EDI and communications applications
Is the practice affiliated with an academic medical center?
Is the practice an emergency department?
Is the practice an outpatient department?
Is the practice a Health Maintenance Organization?
Is the practice an IPA-HMO
Is the practice a PPO?
Is the practice a physician practice management company?
Any detail descriptions of the applications from the vendor
Number of remote sites
Additional information to characterize practice
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Chapter 3 - Page 58
Chapter 3
Competitive Intelligence A Strategic Imperative
During the pre-1990s when POMIS markets were expanding, many vendors could sustain sales growth merely by
maintaining constant market share. But the 1990s are different, as will be the next millennium. Many major
market segments are declining in number but increasing in the size of individual revenue opportunities.
Vendors today are eagerly eyeing each other’s sales volume and customer accounts to insure their survival. It’s a
jungle out there. “It’s a wonder how you keep from going under.” Therefore, the vendor that does not anticipate
and effectively plan for increasingly tough competition will become legitimate prey in the medical practice
marketplace.
To thwart your competition, market trends indicate that you should develop a strategic competitive intelligence
system that uses available information about industry dynamics and competitors to allow you to exploit
marketplace weaknesses.
There is nothing sinister with vendors engaged in competitive intelligence. Vendors who implemented a system
are not doing anything immoral or illegal. Instead, they are exercising their right to obtain and analyze market
information that is publicly available but varying in known sources.
This is not industrial espionage, which JE abhors. Espionage seeks to obtain private, confidential, and/or
proprietary information that is not freely available to all; frequently it employs illegal methods to achieve its ends.
But the tools of competitive business intelligence consist largely of extracting information from a variety of
published, or third party data sources.
To be successful, an intelligence system must have senior management commitment as facilitators. They should
delegate one person (item 1 below) with full responsibility for the system. That person could be a marketing or
corporate planning executive whose responsibilities could be described in Exhibit 3-2.
The explanation of Exhibit 2 is as follows:
1. The competitive intelligence professional (CIP) is fully responsible for the system. This responsibility
will be shared with a Director who assumes operational responsibility.
2. Definition of information requirements – Definition of information requirements could be complex for
anyone or company just getting started. JE has been doing it for nearly 30 years. Therefore, this
description is organized to show what steps JE performs. Here are the key steps:
a. Identify current and potential POMIS vendors. JE has cultivated several reliable sources. But
contact with state and local medical societies and associations is a good starting point. When
contacting vendors, ask them who their competition is. Lastly, telephone books in large libraries
indicate small vendors.
b. What analysis offers value to current and prospective clients? JE gets its clients to discuss their
concerns and needs. This information is used format The POMIS Report, as well as our research
focus.
c. Define POMIS industry broadly in terms of major market segments rather than by products.
d. Define vendors that make alternative solutions to traditional POMIS, or even emerging industries,
such as banking, pharmaceutical, etc.
e. Pay attention to the POMIS industry within 2-3 years of the base year. For instance, 2000-2002
indicates reduced profitability and increased competition causing many companies to seek more
attractive opportunities.
f. Analyze POMIS industry to include vendors of systems and component applications, as well as
partners of vendors. Look at internal agreements and/or contracts, competitive product
performance (e.g., quality, specifications and delivery methods), R&D (including patients filed,
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Chapter 3 - Page 59
Chapter 3
3.
4.
5.
6.
7.
8.
9.
10.
11.
new product development, research focus), channels of distribution, sales and marketing regions,
sales force analysis, marketing, finance, and personnel.
g. Contact knowledgeable executives in charge of planning areas to identify current and potential
competitors. Focus on the POMIS 100 vendors (the top ten vendors in revenues) to address the
following questions.
• What do they want to know about competitors?
• What business are you in?
• Who are the industry peripheral suppliers and partners?
• What do they supply and the extent of goodwill between suppliers and competitors?
• What are the competitive product and service performance (e.g., quality specifications,
application implementation)?
• What is the size of R&D (e.g., patients filed, new product development, research focus)?
• What is the state of system integration program (e.g., efficiency of operation)?
• What distribution channel is used (e.g., method, number of offices)?
• What are the estimated sales and profits by MSA, by system lines, etc.?
• What sales force has they (e.g., how many, salary levels, level of expertise, morale,
geographic placement)?
• What is their marketing level (e.g., number of individuals, media strategy and execution,
pricing policy, trade terms and relationships, promotion, historical strategy evolution)?
• What is the financial support (e.g., reputation, extent of leverage, ratio analysis, profitability
performance, cash flow)?
• Who are its personnel (e.g., psychological and performance profiles of key personnel)?
Data Search – Primary data is obtained from questionnaires/interviews with vendors and physician
organizations. Other data search sources are libraries, SEC, Newspapers, computer databases,
specialists, network, and competitors’ products and services descriptions. Current questionnaires are
shown in Appendices A and B.
Sources Databases – Within the POMIS DATABASE in Microsoft Access format, the following
sources are used:
a. Table - IDS/N Sources – A source of integrated delivery systems and networks.
b. Table – Internet Sources – A source of Internet sources for the POMIS industry.
c. Table – PUBLICATIONS – A database of publications that JE uses for information in The POMIS
Report.
d. Table – Rating Contact – A database of physician organizations that JE uses for surveying
ratings and general needs assessments.
Data Acquisition –A great deal of useful information is readily available, even though some requires
persistent digging. Various disjointed data/information is obtained from competitors, press releases,
investment analyses, competing vendors, consultants, customers of competitors, information
databases, and trade associations. Competitive information is available from three sources:
a. What competitors say about them?
b. What third parties say about competitors?
c. What individuals within organizations have observed.
Data Organization – Organize data acquired into categories based on markets or functional areas.
Discard information that is unrelated to need.
Information Generation – Preparation for rapid response
Tactical Response – Anticipate through query experience what information should be ready for rapid
response.
Catalog Information – Index information by functional areas. Circulate among clients for review.
Their comments will provide the basis to help responding rapidly to competitive information requests.
Response to Query – Determine appropriate method to response to query.
Competitive Strategy Analysis – Assess competitive weaknesses and make informed estimates of
their strategic decisions. Make a strategic review annually. Differentiate between the objectives and
strategies of corporate parents and individual business units.
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Chapter 3 - Page 60
Chapter 3
12. Business Planning Reports – Prepare planning reports for dissemination to appropriate parties.
13. Customer Satisfaction Index Analysis – Perform an analysis of the customer satisfaction survey and
analyze results.
14. Customer Satisfaction Rating Report – Prepare reports.
15. Modification from Early Warning Systems – Review the impact of strategies relative to trends, events,
and early warning signs.
Exhibit 2. POMIS Strategic Competitive Information System
CIP & Regional Information
Gatherers
1
Definition of Information
Requirements
2
¾ The POMIS Report
¾ The SRD
¾ The ACS Clinical Report
4
3
Date Search
Source Database
Data Acquisition
5
Data Organization
6
7
8
Information Generation
Tactical Response
9
10
Catalog Information
Response to Inquiry
11
12
Competitive Strategy Analysis
Consumer Satisfaction Index
Analysis
Business Planning Reports
13
14
Customer Satisfaction Rating
Reports
15
Modification of Current
Business Strategy
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Chapter 3 - Page 61
Chapter 3
Jewson Enterprises’ Business and Analyst’s Code of Ethics
Since Mr. Hudson and Jewson Enterprises™ maintain insider knowledge of several organizations through
hundreds of non-disclosure agreements, the owners have stipulated the following code of ethics based on Mr.
Hudson’s membership in the Society of Professional Intelligence Professionals.
o
o
o
To continually strive to increase the recognition and respect of the profession.
To comply with all applicable laws, domestic and international.
To accurately disclose all relevant information, including one’s identity and organization, prior to all
interviews.
o
o
o
o
To fully respect all requests for confidentiality of information.
To avoid conflicts of interest in fulfilling one’s duties.
To provide honest and realistic recommendations and conclusions in the execution of one’s duties.
To promote this code of ethics within one’s company, with third-party contractors and within the entire
profession.
o
To faithfully adhere to and abide by one’s company policies, objectives, and guidelines.
More information can be obtained by contacting Vince Hudson at:
6425 South IH-35, Suite 105-177 ♦ Austin, TX 78744
Message Center: 650-368-6570
Direct Voice: 512-445-5050, Ext 505
E-mail: [email protected]
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4.
Listing of Practice Management System Vendors:
Code: P = Purchase, L = Lease (ASP), B = Both (Purchase or Lease)
A4 Health Systems • HealthMatics PM (P, L, B)
Cary, N.C. • (888) 672-3282 • www.a4healthsystems.com
AcerMed Inc. • MERRIT System (P, L, B)
Irvine, Calif. • (800) 841-0008 • www.acermed.com
Advanced Data Systems • MedicsElite (P, B)
Maywood, N.J. • (800) 899-4237 • www.adsc.com
American HealthNet Inc. • Multiple products (P, L, B)
Omaha, Neb. • (800) 745-4712 • www.americanhealthnet.com
American Medical Software • Practice Management PLUS System (P, B)
Edwardsville, Ill. • (800) 423-8836 • www.americanmedical.com
Amicore • Amicore (B)
Andover, Mass. • (978) 691-3400 • www.amicore.com
athenahealth • athenaNet (L)
Waltham, Mass. • (781) 642-8800 • www.athenahealth.com
Avisena Inc. • Avisena Platform for Providers
Miami • (305) 446-8599 • www.avisena.com
Axolotl Corp. • Elysium Physician Practice Solutions (L)
Mountain View, Calif. • (888) 296-5685 • www.axolotl.com
Berdy Medical Systems Inc. • SmartClinic (L)
Saddle Brook, N.J. • (800) 662-3739 • www.BerdyMedical.com
C & S Research Corp. • ProVision (P)
King of Prussia, Pa. • (800) 545-8460 • www.csrc.com
CACTUS Software • Visual CACTUS
Prairie Village, Kan. • (800) 776-2305 • www.visualcactus.com
CAPCOM Inc. • McKesson Practice Point Manager (P, L, B)
Haddonfield, N.J. • (856) 428-0878 • www.capcomnet.com
CereSoft Inc. • EOBAgent (P, L)
Silver Spring, Md. • (301) 445-8413 • www.ceresoft.com
Cerner Corp. • PowerChart Office (B)
Kansas City, Mo. • (816) 221-1024 • www.cerner.com
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4.
Listing of Practice Management System Vendors (Continued)
CHARTCARE Inc. • TotalCare (P, L, B)
Lakewood, Wash. • (800) 438-1277 • www.chartcare.com
Clinic Pro Software • Clinic Pro Software (P)
Sedona, Ariz. • (866) 333-2776 • www.clinicpro.com
ComChart Medical Software • ComChart EMR (B)
Lowell, Mass. • (978) 441-3939 • www.comchart.com
Companion Technologies • MegaWest Practice Management Suite (P, L, B)
Columbia, S.C. • (800) 999-0788 • www.companiontechnologies.com
Complete Medical Systems Inc. • Winmed Professional (P, B)
Baton Rouge, La. • (800) 256-2803 • www.doctornetwork.com
CPSI • CPSI System (B)
Mobile, Ala. • (800) 711-2774 • www.cpsinet.com
CPU Medical Management Systems Inc. • MED/FM (P, L, B)
San Diego • (888) 224-4278 • www.cpumms.com
CureMD • CureMD (P, L, B)
New York • (877) 362-9549 • www.curemd.com
Dairyland Healthcare Solutions • DHS PPM System (P, L, B)
Glenwood, Minn. • (800) 323-6987 • www.dhsnet.com
DataTel Solutions Inc. • M.O.M.S. Medical Office Management System (B)
San Antonio • (210) 558-3733 • www.datatel-solutions.com
DeltaWare Systems Inc. • ICore Health (P, L, B)
Charlottetown, Prince Edward Island • (877) 201-6771 • www.deltaware.com
Doc-tor.com L.L.C. • Doc-tor.com (L)
Oakland, N.J. • (877) 505-1888 • www.Doc-tor.com
Doctor-Driven Systems Inc. • MD Hawkeye (B)
Newton, Mass. • (617) 332-3126 • www.doctor-driven.net
DrFirst.com Inc. • NextGen PMIS (P, L, B)
Rockville, Md. • (888) 271-9898 • www.drfirst.com
E*HealthLine.com Inc. • Integrated Practice Management System (P, L, B)
Sacramento, Calif. • (916) 924-8092 • www.ehealthline.com
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Chapter 3 - Page 64
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4.
e-MDs • topsBill (P, L, B)
Cedar Park, Texas • (888) 344-9836 • www.e-MDs.com
Electronic Healthcare Systems • CareRevolution (P, L, B)
Birmingham, Ala. • (888) 879-7302 • www.ehsmed.com
Electroniclaim • Electroniclaim Practice Management 2000 (P)
Mequon, Wis. • (888) 240-9985 • www.electroniclaim.com
Epic Systems Corp. • Epic Practice Management Suite (B)
Madison, Wis. • (608) 271-9000 • www.epicsystems.com
Experior Corp. • Medical Management System (P, L, B)
Fort Wayne, Ind. • (800) 595-2020 • www.experior.com
FemTrack by NC Consulting Inc. • FemTrack (P, B)
Chicago • (888) 462-4025 • www.femtrack.com
Greenway Medical Technologies • PrimeSuite (P, L)
Carrollton, Ga. • (770) 836-3100 • www.greenwaymedical.com
Health Care Data Systems, An FMT Company • ENTITY (P)
Syracuse, N.Y. • (800) 950-7111 • www.hcds.com
Health Care Software Inc. (HCS) • INTERACTANT (P)
Farmingdale, N.J. • (800) 524-1038 • www.hcsinteractant.com
Health Data Services • MedLedger (L)
Charlottesville, Va. • (800) 800-4021 • www.healthdataservices.com
HealthCentrics • HealthCentrics 3.0 (B)
Atlanta • (866) 609-5070 • www.healthcentrics.com
HealthCo Information Systems Inc. • Millbrook Practice Manager (P, L, B)
Tualitin, Ore. • (888) 740-7734 • www.healthcois.com
IDX Systems Corp. • Multiple products (P, L, B)
Burlington, Vt. • (802) 862-1022 • www.idx.com
iLIANT Corp. • The Medical Manager (L)
Tampa, Fla. • (813) 855-6880 • www.iliant.com
IMPAC Medical Systems Inc. • Multi-ACCESS (P)
Mountain View, Calif. • (888) 464-6722 • www.impac.com
Innovated Medical Corp. • The Patient Advocate (P)
South Bend, Ind. • (800) 956-8072 • www.InnovatedMedical.com
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Chapter 3 - Page 65
Chapter 3
4.
Insight Mgmt Systems Inc. • OmniTrack-Preventive Care and Disease Management
Encino, Calif. • (800) 643-0123 • www.insightmed.com
Intelligent Medical Systems Inc. • SmartDoctor (P, L, B)
Alpine, Texas • (800) 747-4154 • www.smartdoctor.com
Internexsys Corp. • Medical InfoManager (P)
Walpole, Mass. • (508) 668-7800 • www.internexsys.com
Keane Inc. • Keane Practice Management (P, L)
Melville, N.Y. • (800) 699-6773 • www.keane.com/hsd
Matrix Management Solutions • NextGen EPM (P, L, B)
Uniontown, Ohio • (330) 899-1275 • www.matrixmso.com
McKesson Information Solutions • Multiple products (P, L, B)
Alpharetta, Ga. • (800) 981-8601 • www.infosolutions.mckesson.com
MD/Win Corp. • Millbrook Practice Manager 2002 (P, L, B)
Raleigh, N.C. • (800) 849-2750 • www.mdwincorp.com
MDanywhere Technologies Inc. • MDAPRACTICE (P, L, B)
Baltimore • (877) 632-4488 • www.mdanywhere.com
MDinteractive • MDinteractive (P, L, B)
Brookline, Mass. • (617) 233-6854 • www.mdinteractive.com
MDTechnologies Inc. • MedTopia (L)
Baton Rouge, La. • (800) 290-1657 • www.mdtechnologies.com
MedAptus Inc. • In Hand Suite (P, L, B)
Boston • (617) 523-1221 • www.MedAptus.com
MedcomSoft • MedcomSoft Record (P, L)
Toronto • (416) 443-8788 • www.medcomsoft.com
Medical Central Online • Medical Practice Central & Local (L)
Highland Park, Ill. • (847) 266-9404 • www.medicalcentral.com
Medical Information Technology Inc. • Physician Practice Management (P)
Westwood, Mass. • (781) 821-3000 • www.meditech.com
Medical Manager Health Systems • The Medical Manager (P)
Tampa, Fla. • (800) 222-7701 • www.medicalmanager.com
Medifax-EDI Inc. • MedWare (P)
Nashville, Tenn. • (800) 819-5563 • www.medifax.com
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Chapter 3 - Page 66
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4.
Medinex Systems Inc. • Medinex Office (L)
Celebration, Fla. • (888) 580-1010 • www.medinex.com
HealthCare Data Inc. • Health Probe Professional (P, L, B)
Morgantown, Ind. • (765) 342-9947 • www.healthprobe.com
MedStar Systems LLC • MedStar (P, L, B)
Coral Springs, Fla. • (866) 775-7779 • www.MedStarSystems.com
MicroFour Inc. • PracticeStudio (P, L, B)
Amarillo, Texas • (800) 235-1856 • www.micro4.com
Microsys Computing Inc. • MicroMD (P, L, B)
Youngstown, Ohio • (800) 624-8832 • www.micromd.net
Millbrook Corp. • Millbrook Practice Manager (P, L, B)
Carrollton, Texas • (800) 645-0985 • www.millbrook.com
Misys Healthcare Systems • Misys Tiger (P, L, B)
Raleigh, N.C. • (800) 334-8534 • www.misyshealthcare.com
MMC Inc. • SECUR Practice System (P, L, B)
St. Louis • (800) 729-6627 • www.mmcs1.com
NDCHealth • Multiple products (P)
Atlanta • (800) 778-6711 • www.ndchealth.com
NextGen Healthcare Information Systems Inc. • NextGen EPM (P, L, B)
Horsham, Pa. • (215) 657-7010 • www.nextgen.com
NOVASOFT SANIDAD • Multiple products (B)
Rincon de la Victoria (malaga), Spain • +34 951 066 500 • www.gruponovasoft.com
OpTx Corp. • optxTOOLS (P)
Englewood, Colo. • (303) 623-7700 • www.healthierpractices.com
PDM Productive Data Management Inc. • Patient Information Management Solution (P)
Los Angeles • (323) 725-2904 • www.pdmsoftware.com
PenRad • MAMMOGRAPHY INFORMATION SYSTEM (MIS) (P)
Plymouth, Minn. • (763) 475-3388 • www.penrad.com
Per-Se Technologies • MedAxxis (P, L, B)
Atlanta • (877) 737-3773 • www.per-se.com
PerfectPractice MD • PracticeManager.MD (P, L, B)
Sandy, Utah • (800) 825-0224 • www.perfectpractice.md
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Chapter 3 - Page 67
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4.
Physician Micro Systems Inc. • Practice Partner (P, L, B)
Seattle • (800) 770-7674 • www.pmsi.com
Physician’s Computer Company (PCC) • Partner (P, L, B)
Winooski, Vt. • (800) 722-7708 • www.pcc.com
Point and Click Solutions Inc. • OpenSuite (P)
Burlington, Mass. • (781) 272-9800 • www.pointandclicksolutions.com
PracticeOne • PracticeOne Business Manager (P, L, B)
Vienna, Va. • (888) 294-0012 • www.practiceone.com
Precisely Write Corp. • DictationNet (L)
Brooklyn, Mich. • (800) 630-0076 • www.preciselywritecorp.com
Prodata Systems Inc. • Webselect ES (L)
Bothell, Wash. • (866) 487-8346 • www.prodata.com
PSIMED • PSIMED Medical Management System (P, L, B)
Santa Ana, Calif. • (714) 979-7653 • www.psimed-ambs.com
Pulse Systems Inc. • PulsePro Practice Management System (P, L, B)
Wichita, Kan. • (800) 444-0882 • www.pulseinc.com
QRS Inc. Healthcare Solutions • PARADIGM (P, L, B)
Knoxville, Tenn. • (800) 251-3188 • www.qrsparadigm.com
QuadaX Inc. • HARP Healthcare Accounts Receivable Processor (P, L, B)
Cleveland • (800) 929-3775 • www.quadax.com
Quick Notes Inc. • Multiple products (P, L, B)
Cooper City, Fla. • (800) 899-2468 • www.qnotes.com
RIS Logic Inc. • RIS Logic CS (P)
Solon, Ohio • (866) 747-5644 • www.rislogic.com
Riverview Software • PARADIGM (P, L, B)
Kittanning, Pa. • (724) 545-1317 • www.riverview-software.com
Scheye Group Ltd., The • Practice Value Enhancer
Chicago • (773) 989-9315
SECUREHEALTH • SECUREHEALTH PMS (P, L, B)
Burlington, Vt. • (802) 658-3860 • www.securehealth.cc
Soft-Aid Inc. • Multiple products (P, L, B)
Miami • (877) 763-8243 • www.soft-aid.com
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Chapter 3 - Page 68
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4.
Source Medical Solutions Inc. • Multiple products (B)
Birmingham, Ala. • (877) 687-2300 • www.sourcemed.net
SpectraSoft Inc. • AppointmentsPRO (P)
Tempe, Ariz. • (800) 889-0450 • www.ssoft.com
STI Computer Services Inc. • Perfect Care for Windows (P)
Norristown, Pa. • (800) 487-9135 • www.sticomputer.com
SynergyWare Data Management Systems • SYNERGYWARE DATA MANAGMENT SYSTEM
Philadelphia • (215) 284-1600 • www.synergyware.net
Third Millennium Healthcare Systems Inc. • i.suite (L)
Decatur, Ga. • (404) 687-2830 • www.tmhsi.com
Trellis Health Partners • Vera Practice Control (P)
Schaumburg, Ill. • (877) 778-8372 • www.trellishealth.com
Tricare Medical Resources Inc. • CompuMedic (P, L, B)
Tyler, Texas • (903) 592-0562 • www.tricare.com
TriZetto Group, The • Multiple products (L)
Newport Beach, Calif. • (949) 719-2200 • www.trizetto.com
Universal Medical Records • Virtual Medical Navigator (L)
Cortlandt Manor, N.Y. • (914) 737-7499 • www.universalmedicalrecord.com
VantageMed • Multiple products (P, L, B)
Rancho Cordova, Calif. • (877) 879-8633 • www.vantagemed.com
Virtual Clinician Inc. • Virtual Clinician Product Suite (L)
Chicago • (312) 829-1779 • www.virtualclinician.com
VitalWorks • VitalWorks Practice Manager Products (B)
Ridgefield, Conn. • (800) 278-0037 • www.vitalworks.com
WELLINX • WELLINX (P, L)
St. Louis • (866) 935-5269 • www.wellinx.com
Westland Medical Systems Inc. • e-Medsys (P, L, B)
Calabasas, Calif. • (877) 636-3797 • www.westlandmedical.com
Zybex Inc. • CyberMed (P, L, B)
San Diego • (800) 266-6334 • www.zybex.com
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Chapter 4
Connectivity – The Internet opens new doors… and may threaten old ones.
Currently, one of healthcare’s biggest challenges is the excessive cost, time and error relating to administration
and the exchange of basic information, which drives up the cost of patient care. From our research, approximately
33% of each healthcare dollar or over $400 billion in the aggregate, are spent on non-clinical patient care
expenses such as determining patient eligibility, approving referrals, reporting test results, and paying claims.
Healthcare communications are unusually inefficient partly because the nation’s 610,000 practicing physicians
tend to practice in groups that are very small, geographically dispersed, and unconnected by data lines. Most
healthcare participants currently rely on
paper
and
phone-based
methods
to
exchange critical information, which results
Information Exchange Patterns - Present
in errors and information bottlenecks and
causes
delays
healthcare
in
treating
communications
patients.
can
LAB
If
EMPLOYER
INSURANCE
COMPANY
HOSPITAL
be
improved, many kinds of administrative
expenses can be reduced.
SPECIALIST
PATIENT
DOCTOR
CREDIT CARD
COMPANY
In the highly connected world of e-business,
healthcare success will hinge on how well
healthcare entities are able to collaborate
OTHER INSURANCE
COMPANY & GOVT.
PHARMACY
BANK
Page 28
with other health-related organizations. Market pressures—including time-to-market, market efficiencies, and
rapidly emerging new business models—will reward those companies that are able to create, and automate,
tightly integrated business processes. The Internet is the key to effecting these inter-business application
collaborations. Over the past five years, the Internet has quickly evolved from a browser-based information tool
(1st generation) to a business-to-consumer (B2C) e-commerce enabled (2nd generation). Now the Internet is
entering its third and most important generation, business-to-business integration (B2Bi). This generation offers
significant potential that can be realized only when organizations achieve deep integration, seamlessly integrating
care chain processes deep inside one company with those inside another. As businesses move into the third
generation of the Internet (B2Bi), the World Wide Web begins to look more and more like an old technology
whose day has come and gone. The new age of the Internet is all about integrating businesses electronically,
rather than about HTML and browsers. In this generation, as in earlier generations, companies are faced with the
opportunity of distinguishing themselves leaders in the industry, and with the threat of falling quickly behind their
competition. Companies that move decisively into the B2Bi era will, in all likelihood, be paving their way to longterm survival and success.
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Perhaps no other industry places more demands on its practitioners and constituencies than healthcare.
Clinicians are asked to see more patients, improve care quality and control costs. And all healthcare
organizations are trying to manage risk through cost-effective point of care tools that actually work and can be
easily implemented. The key to addressing these issues is real time access to critical patient data, clinical
knowledge resources, practice rules and payer constraints. For decades, traditional system architectures have
been unable to deliver this information in real time.
Organizations today have a substantial investment in their information systems and packaged applications, such
as Managed care Information Systems (MCIS), Practice Management Systems (PMS), and Hospital Information
Systems (HIS). The landscape is one of disconnected and disparate information technology infrastructures—
residing on different hardware platforms, and utilizing a variety of data methods and communications formats—
that were never intended or designed to communicate externally with systems of other companies. To enable the
emerging B2Bi business model, isolated systems and applications must be integrated not only within an
enterprise, but also externally with strategic partners and customers.
EDI vendors provide two basic functions: format translation and electronic routing. The open Internet network, by
definition, performs electronic routing. Electronic formats for healthcare transactions are supposed to be
standardized by the government by 2002; after a several year phase in, if each end of a transaction uses the
government standard, and the Internet can route a transaction, the EDI intermediaries may add little or no value.
Double counting is commonplace in healthcare EDI and it’s basically legit. In the ideal case, a provider sends
a transaction to EDI vendor A, who formats and routes it to the appropriate payor. Unfortunately, if EDI vendor A
does not have a direct connection to the appropriate payor, they route it to EDI vendor B, who formats and routes
it to the appropriate payor. Since the transaction touches both EDI vendors, it is counted by each, and very
misleading. Make no mistake in this example, vendor B is in the stronger position; more often than not, vendor B
is NDC for pharmacy claims and Envoy for medical claims. No upstart (Internet or no Internet) can rapidly expand
direct connections to payors; switching costs are relatively high for payors.
Even the number of direct connections to payors can be misleading. Just as important as the number of
payor connections is who the connections are with. Envoy has connections with nearly all state Medicare
programs, which represents a huge share of total medical claims volume; since most other EDI vendors don’t
have this connection, Envoy would get the transaction from its competitors.
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The 21st century healthcare organization, rather than just managing incidents of illness, must customer- and
information-driven, Internet-linked to other healthcare entities and possess a thorough understanding of managing
the healthcare of specific populations.
By 2002/03, Information technology will become the critical element that
will provide healthcare organizations the differentiation necessary to flourish in an increasingly competitive
environment. While other industries typically spend 3-7 times more, as a percentage of their revenues on IT,
healthcare organizations must understand that this spending gap cannot last long. We believe that as competition
heats up, this spending gap will continue to close. During the next 3-5 years, we believe there will be certain
healthcare technology mega-trends. They include:
•
By 2003/04, healthcare organizations must become knowledge-driven. Like physicians and consumers,
healthcare management must become hungry to capture data, ensure its integrity and employ IT
throughout the organization to facilitate managing operations and care delivery. We believe IDN spending
will increase from 2.8% (% of revenues) in 1999 to > 7% by 2003/04.
•
By 2003/04, healthcare organizations will extend their expertise in identifying and understanding their
many types of customers. Because the customer can assume many forms, including patient, employer,
affiliated provider and insurer, the healthcare organization will use technology to segment those
customers and will develop tailored products. Finally, this healthcare organization will implement CRM
applications to improve customer’s service and satisfaction. Finally, by 2004, healthcare organizations will
establish benchmarks in customer service as other competitive service industries have achieved.
•
By 2005, healthcare organizations will transition to a “virtual" care network. These networks will involve a
wide range of independent but interconnected individuals and institutions. Today, boundaries among
multiple entities, systems and geographies are very apparent to patients and other customers. By 2006
virtual care networks, using conduits such as the Internet will provide a seamless and secure interface for
real-time interaction.
•
By 2005, payers will embrace comprehensive care management (CM), in which healthcare providers will
assume more risk and responsibility for the health of specific populations. CM will create demand for
tools to manage the risk, demand and cost-effectiveness of healthcare delivery. This model of healthcare
delivery assesses the risk of each patient as that person enters the network; characterizes patients by
their needs; tailors treatments for patients; helps create clinical pathways and protocols and tracks
caregiver compliance; and measures the efficacy and quality of care delivered. Spending on CM will
increase from $100M in 1999 to $2.1B by 2002/03.
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•
While having the data, maintaining its integrity and performing analyses are critical, ultimately the success
or failure of an organization is its willingness to actually use the data. While changing an organization's
hardware and software might take months, changing its culture is an ongoing process requires an almost
single-minded dedication by the healthcare organization.
•
The current patchwork of information systems will continue until better-integrated systems become
available.
•
The current applications of managed care information technology include claims management, contract
management, case management, risk management, outcomes reporting, member services, and benefits
management. However, HMOs now want to add provider profiling, provider credentialing, decision support,
EDI claims linkages, customer service, clinical protocols, data warehouse, case management, EDI eligibility
links, and automated medical records, to their information capabilities.
Connectivity - 2002 through 2005
Based on a survey of 257 physicians conducted
during this year’s TEPR conference in Seattle,
over 75% of the physicians surveyed indicated
that they use the internet for learning about drugs
and medical products.
However, only 13%
currently use the internet for filing insurance
claims directly to the various healthplans.
It
appears that the normal billing concept of
What Do Physicians Do
Online Today?
Learning about a drug or
other medical products
Learning about
disease treatments
Reading medical
publications
Filing insurance claims
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45%
20%
Using the PDR
today. Moreover, we believe that direct secured
2004 once the HIPAA regulations are enforced.
48%
Patient communication
computer to computer is still the preferred method
internet connectivity will increase to > 60% by
68%
Taking CME courses
Consulting with
colleagues
Participating in/
running clinical trials
submitting via a clearinghouse or via direct
75%
20%
19%
16%
12%
Percent total of 257 MDs surveyed
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Chapter 4
Case Studies:
Success Stories from Elysium Physicians,
By Dr. David Bales
While vacations are supposed to be a way to get away from it all, physicians may have those nagging medical
cases that pop into their minds—"Did Mrs. Jones's biopsy show anything? And, if so, did my colleagues pick up
on it and do something about it?" Those nagging questions never really leave my mind until I can personally do
something about it. With web-based clinical messaging™, those questions can be put to rest very rapidly.
My wife and I were cruising in the Caribbean when I discovered that the ship had a business center with an
Internet connection via satellite. The rates were very reasonable, so I checked some labs and forwarded them to
colleagues just to be able to say I had done it! This was about 20 miles off the coast of Cuba!
Later in the year, we had the opportunity to travel to China, and I found that the hotels also had business centers.
I was able to check on a biopsy—probably before the surgeon had seen it—and forward the information to not
only my colleague who was covering my practice, but to the specialist that I wanted the patient to see.
Most large hotels throughout the world have Internet access, and many airports have a "Laptop Lane." With the
time we now spend in airports after going through all of the security, it is very convenient to use your own laptop
or use their computers to catch up on various clinical messages. If your patients have access via a secure web
site (available from multiple sources including a benefit of AMA membership), you can check labs and notify them
of results. Or even fill prescriptions via the Web from thousands of miles away!
By Robert Keet, MD
For the 30 years the holy grail of medical informatics has been the "electronic medical record." Yet, despite the
advance of widespread computer technology with automation across most other industries, medical care remains
largely a paper process. The failure of the EMR is based on the fact that physicians receive data from diverse
sources, that data is not digitized, and there is no common index to unify the data into a single database. EMRs
have had to rely on solutions where all of the clinic data is entered into the system as part of the clinical
encounter. This is time consuming and interferes with the normal encounter process which is largely one of
personal interaction with the patient.
Physicians in Elysium Communities get a large part of their data electronically and uniquely identified by patient
across the data sources. While Elysium is sold to the data providers to automate their process of data delivery,
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Chapter 4
the physicians and their staff can use the Elysium data to begin to automate the process of data management and
lookup. If physicians add transcription to the Elysium data set they can create an electronic record that is
complete with encounter, laboratory and radiology data. Adding prescription, allergies, and problems completes
the key clinical data elements.
Scanning and indexing solutions are still too expensive to be practically utilized to store non-digitized data.
However, data access and data storage do not necessarily need to be combined and physician offices can take
advantage of significant workflow improvement by using the computer to access clinical data in the office, at the
hospital and at home. Starting with the management of the clinical inbox, physicians can progress to "chartless"
management of patient calls, prescription renewals, records transfer, and intra-office communication. A single
internet terminal in the physician workspace can allow significant improvement in the medical record process with
more ready access to data and fewer chart pulls. Adding terminals to examination areas will further improve
efficiency with less dependence on the paper chart.
The latest version of Elysium is designed to access patient data quickly and efficiently. From any clinical
document, physicians and their staff can navigate directly to:
1.
All of that patient's other clinical documents.
2.
All of the prescriptions written for that patient.
3.
Detailed patient demographics with a short list of medications, allergies, and problems.
4.
A cumulative view of the data currently viewed.
From any web location, physician and their staff can access all of the patients' clinical data quickly and efficiently.
In offices where the data elements are electronically annotated and managed, the staff can also access the status
of results including the associated instructions (e.g. "Advise patient of normal result") and annotations (e.g.
"Results normal").
Moving to an "EMR" using Elysium can proceed in a step wise fashion. First incoming data can be managed
electronically in a process akin to email. Intra-office electronic communication can be added and encounter data
included by signing up for an Elysium transcription service. Once the bulk of clinical data is Elysium based the
office can begin to use the "Electronic Chart" in lieu of the traditional chart pull. Committed offices can they add
the electronic delivery of prescription and orders and add allergies and problems to complete the electronic
database.
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The digital delivery of clinical data that is uniquely patient identified along with the tools to manage that data gives
physicians EMR functionality at minimal cost. The holy grail might be within reach.
By Dr. Mark Rosen
My staff and I are saving considerable time with the Elysium automatic prescription refill feature. Fielding
prescription-related phone calls used to be very time consuming. With the prescription management system my
staff simply looks up the patient and their prescription in Elysium and clicks refill—the system automatically
checks for interactions and duplications with current drugs, checks that the refill is not premature and sends the
online prescription to me for approval. I click an "Electronic Signature" button and it gets sent automatically via fax
to the patients' pharmacy. The prescription is logged in the patients' online record and can be printed the next
time the chart has to be pulled.
Elysium maintains a log of my patient's prescriptions allowing me to better prescribe for my patients. As many
patients take multiple drugs and most drugs being to difficult for patients to remember by name, a complete list is
critical. Elysium tracks what prescriptions my patients take and cautions me of interactions.
Elysium can be accessed from any computer or handheld with Web access, anytime—from my office, home,
hospital, a hotel room etc. Anytime access to patient prescription information has allowed me to better care for my
patients. When I am on call, I can easily look up patient information from my computer at home and effectively
prescribe for our group's patients. Elysium Prescription has integrated with Elysium Workstation, a product that
we have been using for several years to manage our clinical results. These two products are enabling us to build
an online patient record in an easy step-by-step approach.
Broad initiative
Clinical messaging and automation efficiency depends on the involvement and participation of all the hospitals,
labs and physician practices that comprise a healthcare community. As more providers enter the system, the
power of the technology must grow accordingly. Getting the system fully implemented in our community has been
an ongoing four-year process and part of a broad communitywide initiative.
As we convert more processes from paper to automation (prescription writing is the most recent example), our
office efficiency continues to grow. Progress is reflected in our ability to see more patients without increasing
clerical staff. We also are improving the patient experience by expediting care and expanding communications.
But for this level of automation to succeed and result in better care at lowercosts, there are three key
requirements.
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First, the system should be viewed and implemented from a communitywide perspective. This requires the
cooperation of all entities in the healthcare delivery system and implies the formation of a broadly charted entity to
guide the process and assure all interests are being satisfied. While this does not happen overnight, the final
results are well worth the effort and the wait.
Second, it's important to educate all the members of the healthcare team about the benefits of the new
technology. Healthcare in general has been slow to adopt computers--and the physician's office even slower yet.
However, there's no doubt that the future healthcare environment will require these technologies. Organizations
preparing for automation should begin an educational campaign for its professionals as soon as the goal is clear.
The final key to success is recognizing that today's information technology moves in a rapid sequence of
incremental innovations. Waiting on the sidelines for a final, total solution that integrates everything from the
patient record to back-end payer systems will mean missing out on significant benefits available today.
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Chapter 5
The ACG 2007 Annual Report
Computer Systems in the Physician’s Office
Level 3 – Digital Image Management
What is the Biggest Obstacle Facing Today’s Medical Practices?
Many physicians are frustrated in today’s paper-laden world. They are finding it difficult to spend quality time
caring for the patient, “doing what they went to medical school to do”, because of overwhelming paperwork.
Small- to medium-sized physician practices are smothered by decreasing reimbursements in the face of more
demanding services, growing volumes of patient loads, as well as burdensome regulations.
Indeed, many
practices are finding it difficult to cope with regulations such as HIPAA, backlogs of unpaid claims, and stacks and
stacks of Explanations of Benefits.
In the center of the storm lies the simple patient chart that is
passed from hand to hand, department to department,
oftentimes in a stressful environment. In one scenario alone, 20
to 30 minutes of precious office time can be wasted, leaving a
patient dissatisfied and the office staff stressed. Take the chart
of “Jane Doe”. Jane sees her doctor for a sore throat. She is
given a strep test, and is given a prescription for an antibiotic.
The next day she develops an itching sensation in her hands, so
she calls her doctor to see if that could possibly be due to the
antibiotic. When her call is taken, the staff member answering
the telephone has to put Jane on hold so she can find her chart, or in many cases, take a message and go
looking for the patient’s record. Jane’s chart could be in a number of locations the day after her office visit. Her
file could be in transcription, or in the lab getting strep test results put on it, or waiting to be filed back. It could be
in the billing office, if there is an outstanding balance. And then, once the staff member finds that record, she or
he calls the patient back and try to answer her question.
Physician’s need to take control of the Paper
Many practices are taking the lead in efforts to better serve their patients, help overcome shrinking
reimbursements through better overhead management, and develop computerized audit trails to keep up with
regulations. Susan Miller, Administrator for Family Practice Associates in Lexington, Kentucky, is one practice
manager who took charge of the situation, and through installation of a computerized patient record system, has
seen many benefits for the practice. According to Miller, “The medical record becomes a key communication tool”
at every level of the practice. Until 1999, Family Practice Associates’ office was computerized at the billing level
only.
Miller felt the burdens of endless paperwork and overflowing patient charts that many practices are
experiencing and decided to shop for a document imaging module that would interface with her existing billing
system and take her office to a “paperless” medical record environment.
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Criterion for Paperless Chart
Miller knew what she was looking for when she started shopping. The physicians needed a system that was
flexible and able to work with her existing system. The physicians needed a user-friendly system as easy to use
as clicking on mouse. Additionally, the physicians wanted the computerized patient chart to look exactly like the
paper chart the physicians were used to seeing. And above all, they wanted the system to have a Windowsbased, open architecture that would integrate with other packages for future expansion (One of the key elements
for success involved the way doctors would use the computerized patient chart). The doctors wanted to have
their patients’ charts look the way they were used to seeing them. In other words, they needed to be an exact
replica of the paper chart the physicians had used for years.
The solution – the selection of a document/digital image management (DIM) solution for computerized patient
records. DIMs are traditionally Windows-based proprietary application designed specifically for practices of 3 to
99 physicians, yet can be scalable to work for medical organizations of any size. The system scans a patient’s
entire record in a matter of seconds regardless of the size and color of the file’s papers. Scans can be two-sided,
and can even include insurance cards. The system scan and maintain X-rays, lab results, transcriptions and
other important documents into appropriate folders that are
easy to locate and retrieve. Searching for information is as
simple as entering a patient’s name, account number, or
social security number. Patient files are located instantly,
eliminating frantic searches for lost charts.
Document/Digital Image Management (DIM) applications
enable physicians to incrementally transcend into the
world of the paperless medical office using cost-effective
technologies. In most practices, growth of medical staff
automatically implies higher overhead costs because of
the need for hiring additional medical transcriptionists. The
added efficiency provided by DIM technology often eliminates these costs. By automating large areas of the
record-keeping process, DIM technology gives medical practices the power to leverage staff more effectively, and
to grow the business without growing the administrative support staff.
By re-creating the traditional medical chart folder in an electronic, "virtual" form, DIM technology makes chart
management easier and more efficient than previously possible. All information found in the traditional folder is
still present; only more organized and much easier to handle. Instead of sifting through layers of paperwork trying
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to find a certain piece of information, DIM, with traditional highly organized filing systems, allows the user to
quickly click through the patient's history for the desired information.
Also the traditional medical folder, in its physical form, has a tendency to get misplaced. With several different
people in an office all looking for the same file that was inadvertently placed in the closet or left at the doctor's
home, the efficiency of an office is hindered and less work gets done. DIM technology can be used to find,
research, or change any patient's chart from one or multiple PC stations in an office. And there's even an option
that allows remote access to data -- for example by a doctor working from home.
Physicians that have deployed DIM applications have found that speed is perhaps its finest feature. By
dramatically slashing the staff time necessary to transcribe, file and manage charts, the office frees up large
blocks of time for other responsibilities -- like seeing more patients. By eliminating the entire manual filing process
all together, proficient transcriptionists can double or triple the amount of information processed in a normal day.
There are many generic imaging solutions available for general use, but they cost anywhere from $80,000 to
$100,000. And then with the added customizations necessary for precise application in the Medical field, they
may cost an additional $20,000 to $30,000. Under those cost
conditions, imaging solutions are out of reach for the typical
medical practice.
Some practices use a more traditional Electronic Medical
Record system. While achieving a portion of the tasks fulfilled
by DIM technology, they fall short in the ease-of-use category.
An EMR is essentially an input program into which a physician
enters the patient's symptoms as they go along. However,
since most doctors are not inclined to change the way they
record patient information, these systems are not usually as
successful or efficient as expected.
By contrast, DIM technology is a highly affordable, industry-specific
alternative to the expensive scanning systems. By combining the attributes of high-end generic mass-scanning
equipment with the benefits of EMR applications, DIM vendors have created an unrivaled entity in the Medical
field.
DIM applications are designed to allow the user to include a wide range of materials in any DIM technology chart - including all paperwork related to that patient, x-rays, photos, insurance cards, related journal or periodical
articles or research information pertaining to a given patient's ailment. Not only is this information securely
archived in DIM technology, it is also accessible to all appropriate personnel.
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DIM technology is uniquely compatible to almost everything. Too often, medical scanning software packages limit
you to simply looking at the scanned document. After that the user is stuck. We have written the software in such
a way that not only is the information in DIM technology more manageable and efficient, it can also be imported to
other software applications. Users are not chained to the DIM technology system and always retain the rights and
ability to utilize their information elsewhere.
We should also stress the non-proprietary nature of DIM technology in relation to its compatibility. DIM technology
is based on Microsoft SQL software, which is very stable -- and widely used. Users do not need an DIM
technology -specific technician to save or rebuild their data in case of a dramatic problem. Patient data can almost
always be retrieved by virtually any SQL programmer.
DIM applications allow you to:
•
Effortlessly setup and expand customized patient charts
•
Instantaneously locate documents and file charts
•
Reduce or eliminate the need to search for charts
•
Eliminate courier costs related to transporting charts
•
Reduce the expense of chart supplies
•
Access a single chart by multiple people in multiple locations
•
Save transcription time and cost
•
Improve staff efficiency and morale
•
Save office space and storage costs; and
•
Begin use with minimal installation and training
DIM can be successfully connected with many of the most popular productivity programs. Microsoft products,
WordPerfect and Lotus products can all be launched within the DIM applications. A user doesn't have to switch
from application to application to get all the correct information into the chart. The appropriate applications are
available at the click of a mouse from inside most DIM applications. What's more, word processing, spreadsheet
or other documents created can be automatically saved in their proper place in the patient's chart -- saving
additional time and keeping things perfectly organized.
For health-care providers, the patient chart lies at the center of an operational storm. It is both the repository for
diverse types of information and the trigger for billing. Within a Healthcare Organization, many people may need
access to information in a chart at any given time to carry out clinical, administrative or billing functions. Yet the
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patient chart has traditionally existed in the form of a single folder, accessible to one person in one place at one
time. Furthermore, because the medical record has been paper-based, functions such as information retrieval,
HIPAA compliance tracking and organization of tasks become administratively burdensome. In addition, the
potential for error, such as lost or misfiled information, remains a significant concern without automated access to
information.
By making data traditionally found in the medical record available in an electronic, “virtual” form, DIM technology
makes patient information management easier and more efficient than was previously possible. With DIM, all
information kept in the traditional folder is still present, only in a more organized and easily accessible fashion.
Instead of sifting through layers of paperwork for the needed document, medical office personnel can quickly click
through DIM’s highly organized electronic filing system. Multiple people can access the information at the same
time – on-site or remotely via a secure web connection.
This feature will become more critical as web
technologies become more widely adopted and information more easily shared.
Hospitals who have deployed DIM applications have found that speed is perhaps the finest feature.
dramatically reduce the staff time needed to retrieve and manage information.
DIMs
For the administrative staff,
improved workflows and efficiencies on this scale result in lower labor costs and increased productivity.
Document management succeeds where EMRs may fall short
Some Healthcare Organizations use a more traditional EMR system to achieve the same document management
objective. However, these generally fall short in the ease-of-use category. An EMR is essentially an input
program into which a clinician enters the patient’s symptoms on an ongoing basis. Because most doctors are not
inclined to change the way they record patient information, EMR systems are typically not as successful or
efficient as expected.
In contrast, DIM technology is a highly affordable, industry-specific alternative to
addressing the access issue without introducing significant changes in the way a healthcare organization
operates.
DIM applications are designed to allow the user to include a wide range of materials in any electronic chart,
including all paperwork related to the patient’s care, clinical images, insurance cards, EOBs and related journal or
periodical articles and research.
Not only is this information securely archived in DIM technology, it is also
accessible to all appropriate personnel in a secure, password-protected environment.
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Case Study: Parkview Health System, Fort Wayne, IN
The executive team at Parkview Health System in Fort Wayne Indiana understands the need for technologies.
According to Maria Stolze, Director of HIM, “Parkview health recognizes the value and role of “information” in
achieving our mission and vision.
We will provide quality health services and improve the health of our
communities, only when, we can get the right information to the right place at the right time”. One business and
clinical issue that Parkview took a leading role in solving was related to problems with days in accounts
receivables (A/R).
As all executives know, days in accounts receivables adversely affects an organization’s bottom-line. The higher
the days in A/R, the higher the percentage of write-offs that are required. If a healthcare organization can reduce
A/R days by a minimum of 5%, a typical 300-bed hospital can improve cash flow by as much as $500,000.
However to reduce days in A/R, management must attach the problem from two fronts: the ability of the business
office to collect billable charges; and the ability of the Health Information Management (HIM) department to
complete the necessary coding and abstracting of each patient’s medical record in a minimal amount of time.
Studies conducted by AC Group, based in Spring Texas, have shown that the use of a comprehensive DIM
application, with the appropriate workflow in the Business Office, can help reduce A/R days by as much as 10%.
In the case of Parkview Health System, the executive team decided to tackle A/R days by providing a
comprehensive technology that would enable the organization’s HIM staff to code and abstract each patient’s
medical records from any location at any time. According to JCAHO, the hospital accreditation organization,
patient charts must be completed and signed off by every clinician involved in the case before a claim for payment
can be submitted. Additionally, JCAHO has established a threshold that states that a maximum of 50% of an
organization's patient charts must be completed within XX days of discharge from the hospital. Every day the
patient’s record is not complete, the hospital cannot bill for the services, and thus, adds days in A/R. Based on a
study of 3,421 hospitals during the summer of 2003, 42% of the hospitals experienced over 5 days in A/R relating
to the non-completion of patient records while only 18% of the hospitals have less than 3 days in A/R.
To help reduce the number of days in A/R, Parkview selected LanVision’s codingANYware solution.
The
codingANYware solution allows the HIM staff to access patient paper charts electronically from any location and
from their homes with the appropriate security passwords. Ms. Stolze knew that it was becoming very difficult to
find and retain good coders. She also wanted to allow coders to work remotely from home, thus, improving
employee satisfaction and productivity. Finally, she wanted a system that would allow the organization to
centralize the coding departments across multi-facility healthcare organizations. Parkview’s overall goals were to:
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•
Improved patient care through electronic access of other hospital patient records
•
Physician convenience and efficiency with automated chart completion
•
Convenience and efficiencies to high volume record review customers (QM).
•
Improved chart delinquency rate
•
Timely dictation of discharge summaries!!!
•
Reduction of AR
The LanVision codingANYware solution:
o
.Allows coding professionals to work at home efficiently: codingANYware provides efficient modes
of operation for both high speed and traditional dial-up connections.
o
Reduced reimbursement delays due to record contention: Patient medical record images are
online; therefore, codingANYware encourages movement away from the traditional serial
processing environment to a more parallel processing system which allows coding to continue
regardless of all the other whom else the paper needs chart.
o
Provides HIPAA compliant security. All codingANYware connections are encrypted and HIPAA
compliant. codingANYware provided Parkview with the beginnings of a totally HIPAA compliant
patient information repository.
o
Allowed Parkview to significantly reduce the travel and living expenses associated with
outsourcing of their coding backlog.
o
Provided direct integration with the organization’s 3M encoder and abstracting systems, thus
providing the HIM staff with full, integrated use of the encoder while viewing records online. Once
the coding is completed, the codes are uploaded to the 3M abstracting system.
LanVision offered Parkview a flexible workflow processing and management reporting system that provides them
an opportunity to streamline and maximize efficiency of the coding and abstracting functions. Based on user
defined criteria, such as financial class or patient type, work can now be automatically routed to specific coders.
For example Inpatient Medicare records are now routed to Parkview’s most experienced inpatient coders while
their Emergency Room charts can be routed to Parkview’s outpatient coders automatically. The LanVision's
codingANYware product provides Parkview with a central user interface from which the coder works cases. From
this central point, the Parkview coders can launch not only the imaged documents but also the coding system with
the necessary patient data already displaying. The coder can then code the chart without signing in and out of
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multiple applications and searching for patients in two different systems, thus providing a streamlined more
efficient way of completing the coding and abstracting process.
The HIPAA compliant security solution automatically imports codes to the hospital’s abstracting system and
allows for remote abstracting capability, thus eliminating the need to have a third person enter the codes into the
abstract system. The solution also enables Parkview to design custom work lists that automatically route cases
to specific coders allowing them to customize the application to the way they do business. Additionally, the QA
work queue allows Parkview to review and monitor coded caseloads based on their specific defined criteria.
Finally, LanVision supplies a powerful suite of management reports that will help you monitor performance in
order to maximize the efficiency of your department. As a result of implementing LanVision’s codingANYware
solution, Parkview has seen:
•
$5.8M reduction in Accounts Receivables
•
95% decrease coding backlogs
•
48% decrease Accounts Receivable Days relating to Medical Record delinquencies
•
Improve coder productivity by 30%
•
Significantly reduce outsourced coding costs by 100%
•
Reduced chart delinquency rates by 36%
•
Improved recruitment and retention of qualified coding professionals
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Medical Document Management – The Key to Building an EMR
During the Spring of 2003, AC Group, Inc. evaluated the top Document/Digital Management Software vendors
that were being sold to physician practices that ranged in size from 2 to 100 healthcare providers.
The survey
included 1,538 functional questions and was sent to 87 vendors that stated that they sold DIM applications to
physician practices.
The results of the survey indicated that only 2 vendors meet more than 80% of the
functionally requirements. These two vendors are Advanced Imaging Concepts (AIC), based in Louisville, Ky.
and a new product, labeled Smart DIM, located near Pittsburg, PA.
The other vendors either decided not to
participate because they were two busy, or in most cases, the product did not meet the majority of the DIM
requirements.
One of the major functionally requirement relates to the ease of indexing a complete chart, or individual pieces of
paper. Companies like AIC provide 1-click indexing which improves indexing quality and allows office staff to
index a 50 page chart in less than 1 minute. Another major functional requirement is sophisticated workflow
which automatically routes individual electronically stored documents to the appropriate care giver based on an
office’s workflow.
Without this type of functionality, the DIM only provides scanning, viewing, and printing
capability – NOT what a practice needs.
AIC’s Medical Document Management Solution
IMPACT.MD® is a medical document management solution that provides a cost-effective way to automate the
patient chart without requiring a paradigm shift for the way physicians practice medicine. IMPACT.MD accesses
patient data from the practice management system and serves as a single, flexible repository for all of the patientrelated paper that flows around the office, whether it is generated from within the office, such as office notes, or
outside the office, such as lab results and referral letters.
Perhaps most importantly, because it is an image and not text, the electronic chart looks exactly like the paper
chart the doctor currently uses. Office and clinical staff don’t have to change the way they work. Document
imaging systems are normally customized to fit the way the practice works … they aren’t templates that require
the practice to change its ways to suit the program.
So there is no need for drastic behavior changes.
Automation is incremental, allowing clinical and office staff to gradually build their system to a full-fledged EMR as
they are ready.
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IMPACT.MD also addresses many workflow issues. The imaged patient records can be simultaneously accessed
by multiple users and are fully portable and fully legible. The patient chart will never be lost because it sits in a
computer, not in a doctor’s trunk or on the billing clerk’s desk. It is easier to ensure the privacy of patient records,
because document imaging provides built-in safety and security measures that restrict user access as well as the
opportunity to create an automated audit trail of who accesses the records and when.
IMPACT.MD handles extraneous paper such as telephone message notes, outsourced diagnostics results,
consults, Explanation of Benefits (EOBs), and charts from other practices. Paper that isn’t generated in the
adopting organization’s system still has to reside somewhere. If EOBs are stuffed in boxes stacked in a file room,
the practice really isn’t paperless. But if the practice has a way to get labs, x-ray reports, EOBs and so forth into
its electronic medical record, it can eliminate the paper. IMPACT.MD uses high- speed scanning to get these
documents into the computer system and make them part of the permanent record. It does away with the extra
boxes piled up in a file room. Many practices using IMPACT.MD have put their chart rooms to more productive
use.
Once a practice has firmly established a paperless record, it is ready to integrate additional modules to the
system. In many cases, the next step is automating prescriptions. Some practices want to be able to see an
insurance company’s drug formulary, and see listings for alternative drugs, etc. Some practices simply want to
write a prescription electronically and have it reside in the electronic chart for easy access. Thanks to the
communications standards of HL7 and the open-architecture programs now available, practices can purchase a
prescription module that meets their specific needs. By adding a prescription module incrementally, a practice has
the freedom to buy the application it wants when it wants.
The pyramid reflects the order of the steps taken by most practices who automate. But prescriptions don’t have
to be the next module added after medical document imaging. A practice could move right into Physician Order
Entry. In other words, individual modules don’t depend upon each other to work. They can integrate back into
the practice management and document imaging systems and be added in any order the practice wants to add
them.
Any size practice can take advantage of technological efficiencies according to its own terms. While practice
managers are still dealing with a few resistant physicians, they don’t have to get bogged down into a major
system conversion. Adding components incrementally, as the practice is ready, allows smaller upfront capital
expense, a chance to evaluate results throughout the process, and a much better chance at overall success.
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DIM Case Study: Living Happily After the Installation
by Janet M. Connell, CMPE
Unexpected benefits results when a private group practice uses its medical document management system to
get rid of paper patient charts.
When Nephrology Associates of Kentuckiana, PSC, purchased a medical
document management system in 1999, we were literally drowning in paper. We are one of the only practices in
the Louisville, Kentucky area specializing in problems exclusive to kidneys. We had two specific issues that were
a nightmare for us: filing our hospital consult paperwork and dealing with EOBs.
We serve 12 area hospitals and see as many as 300 patient consults a week. Many of these patients never even
came into our office. It was too costly to make an individual paper chart for each of those consults, so we filed (or
rather crammed) each consult patient’s paperwork alphabetically into accordion folders that filled seven, 10-feetwide office shelves.
Added to that were onslaughts of EOBs that we received by the thousands per month. Because one EOB may
list 20 or more patients, we had to copy these and file them individually in the appropriate patient files. We receive
an average of 20 pended or rejected claims daily. It took us approximately 20 minutes to check and respond to
each rejected claim, and we checked every single one. That was at least 400 minutes (almost seven hours) a
day just spent on addressing rejected claims.
Satisfactory First Steps
In 1999, when we found IMPACT.MD, a medical document management system that lets authorized users scan
in paper and access it from a desktop, we were so grateful that it corrected those two situations that we coasted
with it for three years, satisfied with the filing improvements and increase in billings received. Without using the
system for anything else, we realized the following monetary benefits:
o
o
o
July 1999 added a physician: no additional administrative staff
In 2000 increased the amount of billings by 7%
Increased collection of fees by 9.2% (a 2.2 % overall increase in collections resulting in $91,000
extra income).
o
Decreased the amount of time spent responding to pended or rejected claims by 80%. (With
IMPACT.MD, it only takes four to five minutes to deal with a rejected claim instead of 20 minutes.)
o
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Saved several hours a day in EOB handling, resulting in an annual savings of at least $4,000.
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o
Eliminated seven, 10-ft. shelves that housed the accordion folders for hospital consults. Also
eliminated six, 5-drawer filing cabinets from the billing office.
o
The entire system paid for itself in under a year.
Pushing Away the Paper
After three years, the staff and I decided that we weren’t using our medical document imaging system to its fullest
capacity. IMPACT.MD is designed to hold all of the patient-related paper that flows around an organization,
whether it is generated from within the office, such as phone messages and office notes, or outside the office,
such as lab results and referral letters. The electronic chart can be accessed by authorized users instantly with
the click of a mouse from any workstation, which eliminates the need for paper records.
We did a study of our expenses. Our paper charts had six dividers and were custom-made in the factory. We
paid $25.00 per patient chart just for materials. That did not include the staff time spent creating the chart, filing
the chart, pulling the chart, re-filing the chart, and worrying about what went in which divider. With approximately
1,300 new patients a year, we are saving $32,500 in materials alone, not counting staff time. In 10 months we
have saved $60,000 on printed forms, letterhead, etc., that we sent to a professional printer.
We decided to eliminate paper charts by starting with new patients only. Our plan at first was simply to help our
office workload and decrease a few more expenses. However, the physicians started noticing the front desk using
the system to access charts. They were amazed at the increase in employee morale and the decrease in the
time that they had to wait for information. Soon the doctors suggested that we take the entire practice paperless
and get rid of all of the paper charts.
We started scanning in our 14,000 charts into the system and quickly realized there was much more information
in the chart to be scanned in than we originally thought because we have many long-term patients with very large
files. For example, our prescription refill requests were shingled (small pieces of paper taped in layers to one
piece of paper), and we would have to take those apart and scan in each individual refill request. That might
mean eight individual scanning efforts for one shingled piece of paper in one of the 14,000 charts. There was no
way we could realistically get every single archived item into the electronic system in a cost-effective manner.
I went back to the physicians and said: “Tell me what is essential to the chart and we will create a boilerplate of
the information to be scanned into the system. In return, we will put the paper charts in storage. If we need to
retrieve a chart for any reason, we will scan that entire chart into the system.” They agreed to this, and requested
all renal ultrasound results, lab reports within one year’s time, hospital admissions, dishcarges or consults within
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one year’s time, all office notes, the drug list, and a vital signs flow sheet be contained in the electronic chart.
Everything else remained archived in the paper version and was sent to outside storage. We literally emptied our
office of every single paper chart and only retrieved six paper charts from storage in one year, and those were
due to legal inquiries.
Maximizing Empty Medical Records Space
Once we got rid of our paper charts, we had an empty 10 x 12 medical records room. We decided to embark
upon a major renovation project that would shuffle our space around and utilize it to the utmost, as well as
maximize the efficiencies of being paperless and expand services to patients.
Many pre-End-Stage Renal Disease patients become anemic and normally make a time-consuming trip to the
hospital for an injection to treat the anemia. We had a nurse who gave those injections in our office in a limited
fashion because it was cumbersome and we were in tight quarters. We wanted to offer that to every patient who
needed it right in our office. In our renovation plans we created space for a full-time nurse to administer that
injection. In addition, we added two new exam rooms and a check-out window.
Because we are a nephrology practice and specialize in kidneys, many of our patients are seriously ill. Our
physicians did not feel it was appropriate to have a computer in the exam room under those circumstances. They
wanted to maintain the “personal touch” that we had always had, yet reap the benefits of a paperless
environment. IMPACT.MD, allowed us to do both. We set up PC workstations outside of the exam rooms and
assigned four physicians to each station. We also added two PCs in the lab area. The providers can view a
patient’s entire chart at any of those workstations.
In addition, each physician designed a mini chart within IMPACT.MD. A mini chart is a printable, stripped-down
version of the entire patient chart that can be customized to each individual’s preference for seeing certain
information from the chart. Each physician carries the patient’s mini chart into the exam room and makes notes
directly onto it, as well as taping dictation.
The paper mini chart and the dictation tape, along with the
appointment log, goes to transcription. Our transcriptionists type up the taped notes, scan in the mini chart and
the log, and are responsible for shredding the mini charts after everything has been entered into the system
electronically. This system is a good compromise for us, especially due to the serious illnesses of our patients. It
allows our physicians to rely on paper during the encounter, something they weren’t willing to give up, and we got
rid of our paper charts.
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3 New Doctors – No Additional Support Staff
When we started with IMPACT.MD in 1999, we had 11 physicians and 15 FTEs. We were already running an
efficient practice with a ratio of 1.5 support staff per physician. Many practices use an average of 4 to 5 FTEs for
every physician.
Today, we have 13 physicians and the 14th is signed-on to join us in 2004, with no additional
support staff. While our staff has grown to 19 FTEs, none are physician support, but rather hold billing, check-in,
and managerial positions. The bottom line is we have not added any support staff for the extra physicians and this
is due to the administrative efficiencies we are gleaning from utilizing IMPACT.MD as a paperless patient chart
system.
We back up our system on tape every night without fail, and this tape is taken off-site. We also have a redundant
power system in the server. Whether by luck or providence, we have never been down with IMPACT.MD. We
have had great success with this system and are still looking for ways to use it to save time and money.
Janet Connell is the administrator for Nephrology Associates of Kentuckiana, PSC and can be reached at
[email protected].
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Case Study
Getting Rid of Paper Charts and Saving a Million
by John Somers
We started out with a mission to reduce our dependence on paper. We will end up with no paper patient charts
and an average annual savings of at least $300,000 a year.
When I joined Bristol Park Medical Management in 2001 as Chief Operating Officer, part of my responsibilities
included improving operating efficiencies for a medical practice that had over 800 employees, 525 of which were
full-time.
Bristol Park has been in business for 42 years, providing primary care services for hundreds of
thousands of patients in Orange County, California. The 85 primary care physicians work from 11 medical office
and one business center, which include two urgent care centers. We have a constant need for access to a
medical record of any given patient at any given time. Handpicking a chart from 250,000 paper records was way
too cumbersome for practicing medicine in this millennium.
Overwhelmed with Paper
If I had to use one word to describe the paper flow of our Bristol Park Medical, it would be “constant”. We need
instant access to patient information resulting in constant pulling of charts, re-filing of charts, purging of charts.
The activity surrounding just one chart included a message to medical records that the chart was needed, pulling
the chart, logging it out, couriering it back and forth between locations and then back to the patient’s primary
location for service.
We have 65 doctors working per day. Each physician in the office sees about 25 patients a day. All of the charts
need to be pulled for each of those patients. Most of our physicians get at least 15 messages and refills each a
day, minimum. By conservative estimates, we had a minimum of 2,600 charts floating around the Bristol Park
campus on any given day. When you think about the constant paper movement with that much paper, you can
imagine the many opportunities for error. We had too many occurrences of lost charts and less than satisfactory
accessibility to the patient information.
Too Much Wasted Time
Then we had the wasted time spent handling charts. In prescription refills alone, we were in a constant state of
pushing paper. When we had an incoming prescription refill we would pull the incoming fax from the pharmacy.
We would then find the patient’s chart, make decisions on the refill, fax the information back to the pharmacy, two-
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hole punch the piece of paper so it could be put in the paper chart, and put the chart back in the chart shelf. This
took 10 minutes at the very least, per chart, with as much as 20 to 30 minutes if a chart was in flux and not so
easy to find.
When a telephone message came in to the office, it would be typed in, message would be printed in the records
room, a person would tear the message off the printer, take the message and pull the chart, take the chart to the
appropriate nurse or doctor, the provider would utilize the chart, make notes, forming yet another piece of paper,
file the paper into the chart, route the chart back to the records room and place the chart back on the shelf.
Another 10 – 20 minutes total (not counting the hours or days that the chart was truly floating around) of time
spent taking care of paper rather than patients.
Medical Document Imaging Replaced our Paper System
Our workflow in general needed to improve. I wanted to make sure that we always had access to patient
information, whether it was after hours, on weekends, during the lunch hour, during morning rounds, whenever.
Authorized users needed immediate access to crucial patient information regardless of their location in relation to
a paper chart. It was time to utilize technology and automate our paper records. We were ready to be rid of
paper.
We searched for a flexible computer system that would automate our patient records within the confines our
unique needs. We selected IMPACT.MD , a Windows-based, medical document imaging solution developed by
AIC for healthcare organizations. Using high-speed scanning, IMPACT.MD serves as a single repository for all of
the patient-related paper in an organization, such as phone messages, office notes, lab results and referral
letters. Once scanned in the system, the data, (that was once paper, but is now an exact replica on the computer
screen) can be organized and indexed just like a paper medical record. Authorized users can access patient
records instantly with the click of a mouse from any workstation, eliminating paper charts. The system was
flexible: the computerized charts could look exactly like our paper charts had, with the same tabs and format. It
also included extra features like one-click indexing, mini-charts, tasking, full annotations, electronic signatures,
HIPAA-friendly audit trails, and importing of transcription documents that made it attractive to Bristol Park.
Implementation in Phases
On March 1, 2003, we began our implementation and planning phases utilizing a team approach.
The
Implementation Team decided to go live site by site the first week of June 2003. Our goal was to create no new
paper charts for any new patient. Every new patient would become part of the computerized system. We aimed
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for scanning records on existing patients at a rate of four charts per doctor per day for scheduled patients, two to
three days ahead of the scheduled visit. Some of our smaller offices achieved as many as eight charts per
physician per day. And some of our offices with thick charts for each patient struggled just to get the four charts
scanned in.
We put PCs in every examination room that operate from one central network. Many doctors chose a flat panel
touchscreen to access patient charts. Others prefer a keyboard and mouse. In addition to the exam rooms, we
have workstations for nurses. Of course, the front office and medical records have access as well. Every
patient’s record is secure and only accessible by an authorized user. We set up Security Groups to determine
authorization levels. The system provides automatic audit trails that would be useful in the event of a HIPAA
audit. We could easily see who accessed a chart, when, and what part of the chart they accessed.
High-Speed Scanning
We purchased two types of high-speed Fujitsu scanners for the IMPACT.MD system: 25-page and 40-page
scanners. The large, 40-page scanners are used exclusively for chart conversion. Our average chart had 60
pieces of paper in it. It takes just two minutes to scan the entire chart into a main batch file in IMPACT.MD. From
there, a medical records person assigns the individual pages to their appropriate electronic tabs. The smaller
scanners deal with the day-to-day records maintenance: in-take records, insurance cards, drivers’ licenses, lab
results, or any paper generated that needs to be put into a patient’s file.
For the first 60 days, we brought in two additional people at each of our sites to help with the scanning workload,
to work on the chart conversions and to help keep the flow moving. In addition, we purchased a VRS-Co-fax
filter. We use many different colored forms. Purple and blue pages don’t scan well in a normal setting. If you got
to a purple page in the middle of a patient’s chart, you had to stop and adjust the setting on the scanner, scan in
that page, then change the setting back to the white papers. It became cumbersome and tedious. The VRS Cofax filter automatically sees the purple form, adjusts the setting, straightens out the paper and allows continuous
scanning. We don’t have to stop in the middle of a chart conversion to adjust anything. The VRS does it for us.
When we started this project, we were rolling out a site a week, and were scanning in approximately 350 charts
per day. At this rate, we estimated it would take 18 months to totally convert all of our charts. Very quickly, our
earliest conversion sites started to see results. When a patient who was seen on June 10 came back into the
office in August and no one had to pull a paper chart, yet the entire chart was accessed with the click of a mouse
and they never had to leave their workstation, they really began to like and appreciate the system and became
very enthused.
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Return on Investment
The benefits and return on investment with this system have wildly surpassed our original expectations. The
practice spent $690,000 for the entire system with $350,000 for hardware, including server, equipment for
communications, exam rooms and nurses stations, faxing hardware, scanners, etc., plus $28,000 for annual T-1
costs; $272,000 for software, including IMPACT.MD licenses, faxing and other software, and $40,000 for software
maintenance.
For year one we realized $250,000 in savings using conservative numbers: $330,000 in staff savings and
$150,000 in not creating any new paper charts, less $230,000 of amortized costs (one time equipment and
licensing costs of $690,000 were amortized over 3 years). As we move into year two, I estimate we will show
$550,000 in total savings, once all the charts are in and the practice is no longer using paper charts at all. Over a
period of three years, we will have saved at least $1million.
We will enjoy a complete return on investment within two years of implementing the system, and will begin to
realize significant annual savings thereafter.
We are saving in key areas such as:
•
$150,000 annually in no new charts.
•
$450,000 annually in staff time saved handling paper records.
John Somers is Chief Operating Officer for Bristol Park Medical Management, LP <www.bristolparkmed.com>, an
85-physician primary care practice based in Orange County, California and can be reached at
[email protected].
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How does a physician record, store, and manage diagnostic tests.
One company, Brentwood by Midmark, (TEPR award winner for Document Image Management) offers an
innovative solution that electronically acquires and digitally stores diagnostic back office tests for the medical
professional. For example, approximately 38 million ECGs are performed each year in the US. The IQmark
Diagnostic Workstation stores ECG data in 18Kb vs. 600Kb for scanned reports. Workstation incorporates the
latest in diagnostic hardware and software technology (ECG, Spirometry, Holter, Vital Signs) that offers the
medical professional a giant leap forward towards a paperless office.
The IQmark Diagnostic Workstation enables the user to digitally acquire diagnostic data from ECG, Spirometry,
Holter, and Vital Signs monitors and store the data electronically. The patient’s demographics are entered, the
patient is connected to the device, the program activates the device, and data is digitally transferred to the
database. For example, connect to a vital signs monitor to transfer blood pressure, pulse rate, temperature and
pulse oximetry results without manually entering the results.
Brentwood by Midmark’s Diagnostic Workstation Software offers a complete Patient Data Management Software
System that digitally stores many different diagnostic tests. Brentwood’s software is designed with Microsoft’s
open-architecture products in mind, offering capabilities such as EMR integration (using ActiveX controls),
networking, central database (MS SQL Server) and Access database options. The storage of physiological
measurements include: ECG, Spirometry, Holter, and connections to Welch Allyn diagnostic equipment.
As an entry level EMR, the Workstation allows the physician to
store, review, edit and delete all diagnostic tests acquired
through the Workstation. In addition, the doctor can store
patient demographics for quick retrieval for re-testing or
analysis. If the doctor has a network in place, the Workstation
will enable her to review tests in the comfort of her office while
the staff is acquiring data in examination rooms. If they only
want to test and have someone else over-read and analyze
the results, they can email the tests to a colleague. The
interfaces to additional modalities will make the Workstation a
central, necessary software package in the physician’s office.
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Vital Signs Workstation
For users that already have a Welch Allyn vital signs monitor (temperature, blood pressure, pulse rate, and pulse
oximetry), the Workstation enables them to digitally acquire, store and display the monitor’s results. Weight can
also be digitally acquired from Tanita ™ or seca ™ scales. The Workstation can be defined as the following:
1. Entry-level EMR for diagnostic tests — All users have the same privileges
2. Storage and management software for patient demographics and test results
3. Network capability — Multi-users each with full access to patient data records
4. Patient report transfer capability — Email, send to file, archive, delete, etc.
5. Allows interface to multiple modalities:
a. ECG
b. Spirometry
c. Holter
d. NiBP - Noninvasive Blood Pressure
e. Temperature
f. SpO2 - Pulse Oximetry
g. Static Pulse Rate
h. Weight
Brentwood used technology to reduce device weight from 15 lbs to less than 1 and eliminated A/C power
requirements. Connect to a pen-based computer for portability. Add a wireless network to enable network testing
for central storage and office-wide access to the results. Data is acquired through serial and USB ports.
Scalability is provided using Access, SQL or ActiveX interfaces. The program uses the latest development
software to maximize program efficiency and versatility (Windows 95/98/2000/NT/XP/Me).
For additional Information, contact
Brentwood by Midmark
3300 Fujita Street, Torrance, CA 90505
(800) 624-8950
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Chapter 6
Level 4 – Mobile and Hand-Held Technology
A.
Executive Summary:
Is the Medical Industry Ready for Wireless Devices, PDAs and PC Tablets? We contend the use of Wireless Device,
Personal Digital Assistants (PDAs), and PC Tablets by physicians at the point of care will become standard over the
next few years, potentially saving the healthcare industry > $50B per year.
The implications of the Wireless Internet for physicians are easy to imagine. Physicians are on the move all the time
and they have an intense and constant need for data to make decisions. Add to that, doctors’ proven acceptance of
new mobile technology.
On the other hand, physicians are only beginning to take advantage of the Internet to assist
them with their clinical practice. According to a recent Harris Interactive study entitled
“Computing in the Physician’s Practice,” an overwhelming majority of physicians are online
an average of six hours per week, but mostly from home and for personal use. Relatively
little time is spent looking for general clinical information or on clinical work related to their
patients.
Some 18% of physicians responding to a recent survey
said they use a hand-held computing device as an "integral" part of their daily
practice. Another 8% of physician respondents said they use hand-helds, but
mostly for personal activities, according to the survey of 834 practicing
Harris Interactive Survey
Key Findings
• 89% of physicians use the
Internet at the office or at home,
with the average online
physician using it six hours per
week.
in their practice and an additional 5% primarily used them for personal activities.
• 86% of physicians use cell
phones, and 15% use handheld
appliances, e.g. personal data
assistants (PDAs), like Palm
Pilots.
The survey does not specifically ask what work-related functions physicians
• 52% of physicians sometimes
use computers to receive the
results of laboratory tests.
physicians from the polling firm Harris Interactive, Rochester, N.Y. Two years
ago, a similar Harris survey showed 10% of physicians used hand-held devices
perform on hand-held devices. However, only 3% of responding physicians use
hand-helds to track clinical work for billing purposes, according to the survey. Some 49% of respondent’s record
billing codes on cards or notes and 27% record codes on a computer. Another 15% of responding physicians said
billing codes are automatically generated as part of a computerized clinical record taking process.
Overall use of hand-held devices is more common among physicians under age 45 (33% use rate) than among older
physicians (21% use rate), according to the survey. Wholly or partly hospital-based physicians use the devices more
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Chapter 6
than office-based physicians. The size of a physician practice also plays a role in determining how many physicians
use the device. Only 11% of responding physicians in a solo practice used hand-held devices in the course of their
work, while 25% of physicians in a practice of at least 25 members used them, according to the survey.
Some 11% of responding physicians who record notes manually or Dictation on to tapes expect to use a hand-held
device for recording within 18 months, according to the survey. Another 22% expect to use hand-helds for recording
notes within five years. "Given these expectations and the current rate of growth in the use of hand-helds over the last
two years, one can reasonably estimate that about half of all doctors will be using hand-held devices by 2004 or
2005," according to Harris Interactive. "However, this rate could be greatly increased if payers, hospitals or group
practices mandated their use." The polling firm notes that pressure on providers to reduce medical errors could
accelerate the adoption of hand-held computing devices.
B.
PDA Handheld Market Overview:
During the early 2000’s numerous technology vendors entered the healthcare PDA market. Each of these vendors
provided one or two of the functions list above. Only Allscripts Healthcare Solutions marketed a “complete” solution.
However, the majority of these PDA applications were not
integrated with the various practice management systems
(PMS) and electronic medical record (EMR) applications.
Therefore, a physician was required to re-enter all of the
information that was already captured by their office staff.
After the initial wave of adoption, the actual % of physician
using one of these systems decreased. A number of vendors
that were highly rated like ParkStone went out of business
within two years of their initial release.
Intergrated
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
One major factor that drove many of the stand alone vendors
2000
out of the market was the transition of the leading PMS and
EMR vendors that developed and launched integrated PDA applications.
2001
2002
2003
2004
2005
Integrating with EMR and PMS Applications
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In 2001, only 12% of the leading EMR
and/or PMS vendors offered integrated PDA application. By 2003, over 50% had integrated PDA applications. Based
on future plans, over 90% of the top EMR/PMS vendors will have integrated PDA applications by 2005. Therefore,
PDA applications that are not offered by PMS/EMR vendors or are not tightly integrated will fail, and will be replaced
throughout the market.
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Today, there are two basic operating systems for PDA devices – Palm OS, and Windows CE for the PC Pocket.
During the 1990’s PALM ruled the handheld and PDA market with a 90% share of the healthcare PDA market.
However, in 2001 when Compaq released their new PDA device labeled “Pocket PC IPAQ”, the market economics
began to change. In 2002, Palm’s new sales market decreased to 50% while IPAQ increased from almost nothing in
2000 to 30%. Based on a survey of 48 healthcare IT vendors, 46 or 95% have elected to build all of their new PDA
applications using Windows CE and the IPAQ product line. Based on this and other projections, we expect the IPAQ
to dominate the healthcare PDA market by 2004/05. Three of the main reasons are memory and processing speed,
color, and IPAC’s ability to record electronic dictations. As shown on the exhibit, the IPAQ increased their healthcare
market share from 1% in 1999 to 30% in 2002. Based on all projections from the various healthcare solution vendors,
we estimate that IPAQ will exceed PALM by 2003 with a 47.1% share, and the IPAQ could capture as much as 70%
of the healthcare marketplace by 2006.
90%
80%
70%
60%
2000
50%
2002
40%
2004
30%
2006
20%
10%
0%
Palm
IPAQ
Other
So while is IPAQ capturing the healthcare marketplace? Mostly because the top 40 healthcare IT applications
vendors have already switch their development plans to the Microsoft PC Pocket applications and that 90% of this top
healthcare application vendors have selected IPAQ as the device of choice.
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C.
Device Selection
In choosing devices for mission critical applications, consider scalability and robustness. If you purchase an
underpowered handheld simply because of the attractive hardware price, you may sacrifice the return on your much
larger infrastructure investment. Many organizations will find that different departments and divisions require different
devices. As stated earlier, start with the high-level business objectives, move to application requirements, and then
consider the most appropriate hardware platform. And still, there is the deployment of handhelds as companions to
laptop and notebook PCs. Handheld devices are increasingly augmenting, not replacing, portable PCs. Certain
functions such as serious document editing require mobile PCs.
The advent of handheld devices will further differentiate between luggable versus portable technology. Handheld
devices are often application specific devices. They may be extending a specific application, almost becoming an
appliance or utility. The burgeoning consumer handheld market has flourished largely as an extension of personal
information management. Today, organizations are looking to these same devices to extend supply chain
management, sales force automation, inventory management, facilities management, and point of care applications,
law enforcement, scientific data collection and production data collection.
Despite all being called PDAs, devices in the handheld computer category cover a very broad range of functionality,
from simple devices that are basically electronic organizers, to high-power products that rival the functionality of
laptops. And to make matters even more interesting, mobile technology is evolving so quickly that newer, more
advanced options are being introduced with amazing frequency.
To decide which device is best for you, there are a number of factors to consider, the outcome of which should help
you narrow down the field of candidates for your PDA dollar. As you begin to make choices as to which features are
important and which are optional, you will find the selection process becoming increasingly simple.
•
Color - Historically, color was one of those features that often dictated choice of device. Pocket PC’s were color,
Palm OS devices were not. Time has changed this though and manufactures have moved to more common
ground. Palm, Handspring, and Sony make color devices using the Palm OS while Compaq makes a
monochrome version of its Pocket PC device. People choosing color screens find the clearer display and
enhanced readability in low light environments to be the key benefits. Taking advantage of color displays as well,
although aside from games, color doesn't really change the performance. The noticeable disadvantages of color
are decreased battery life, and added size and weight of the device.
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•
Memory - On the surface, this seems to be a pretty straightforward comparison. Pocket PC devices generally
come with more memory that their Palm OS counterparts (32MB is common for Pocket PC devices compared to
8MB for most Palm OS devices). While this may not sound like much compared to the amount of memory on the
average desktop, it is important to note that all memory is not equal. For example, a reference work that may
need 10MB on a desktop may function perfectly well using only 1MB on a PDA. What is much more important
than the amount of memory that comes with the device is whether or not you can add more. Most Pocket PC
devices accommodate Compact Flash cards (the same kind of memory used in digital cameras) as do PDAs
made by TRGpro (which uses the Palm OS). Handspring devices can accept more memory through Springboard
modules (Handspring's propertary expansion port) and the new line of Palm devices incorporate the ability to add
memory as well.
•
Operating system - The most important aspect of the operating system is not who makes it, but what kinds of
software have been written to run on it (which is discussed next). If you are accustomed to using Windows on a
desktop, you may find the Pocket PC interface more familiar. However, it is not as efficient as the Palm OS as it
takes more processing power to run. This means faster processors are required which are more expensive.
•
Battery life - As has always been the case with portable computing, a device
is only good if it has the power to run. The monochrome Palm OS PDAs has a
distinct advantage with a pair of batteries lasting the better part of a month with
fairly regular use. A Pocket PC or Palm OS with color screens will exhaust the
batteries in a matter of days, if not hours with similar use. Most higher end
PDA's and all color devices have rechargeable batteries that help alleviate this
issue. Provided the device is placed in its cradle regularly, it will be a very rare
occurrence that the device goes dead. The only downside of this system is that
if
you don't have access to a cradle, there is no way to recharge the device (as
opposed to those where the batteries are replaced, which can be done
anywhere).
•
Speed - One of the benefits the streamlined design of the Palm OS provides is quick response time. Because the
operating system is quite simple and does not need to process colors (color models excluded of course), Palm OS
devices are very fast. Pocket PC devices on the other hand tend to be more sluggish as the processing required to
produce full-color, graphic intensive images is high. The speed on the newer models of Pocket PC devices is
dramatically improved over the older models and will likely continue to get even better.
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•
Data input - Almost without exception, handheld computers use a stylus for data input. If an integrated keyboard is a
must, your options are pretty limited. However, both Palm OS and Pocket PC devices have detachable keyboards,
which can be used for data entry. These add-ons generally cost between $50-$100 and can dramatically increase the
speed of data entry. For the more adventurous there are also a number of more esoteric options such as software that
is somewhat better at handwriting recognition and on handed keypads to experiment with.
•
Screen size - PDAs generally come with two basic screen sizes depending on whether you are interested in a
handheld PDA or a palmtop PDA. Handheld PDAs (Pocket PC, Palm, Handspring, etc.) have screens in the range of
2.5 x 3 inches. Palmtop PDAs on the other hand have larger screens; with dimensions starting at 2.5 x 6 inches up to
10-inch screens (a typical laptop screen averages around 12 inches). If the larger screen is a deciding factor, your
choices are going to be limited to a small selection of devices. It is also very important to note that most
manufacturers have stopped making palmtop sized devices due to the lack of demand so future product support and
software choices could be severely limited.
•
Expandability – The expandability of the newer PDAs is important to insure that your device will not become obsolete
too quickly. Expansion slots allow the addition of memory and accessories, thereby increasing the device’s
functionality without replacing it. Fortunately, almost every manufacturer makes a device with an expansion slot
meaning the choices are no longer limited to just one or two brands. The important factor to consider with respect to
expandability is the cost and selection of expansion modules. Make sure the device you select has the choices you
require and that the cost of those modules is not going to break your pocket book.
•
Price - PDAs range anywhere in price from $150 to $1,000 with physical size, memory and color being the most
influential factors in pricing. Devices based on the Palm OS tend to be at the low to mid range of this spectrum with
Pocket PC devices at the middle to higher end (this is primarily due to the extra memory and added functions that
come standard on a Pocket PC). If you are comfortable spending between $250 and $500, you will find a good
selection of PDAs using each of the three operating systems
The proliferation of PDAs within the medical profession will become the norm, in our view by 2003/04, especially
as other applications such as dictation, charge capture and lab ordering are added to software suites. We
estimate that > 45% of the Physicians and > 50% of other medical professionals will be utilizing PDA’s by 2005.
This equates to > 3M devices by 2005. For the medical professional, here are just a few of the things that can be
done with a PDA:
•
•
•
•
•
Patient tracking
Dictation
Receiving Alerts
Reviewing Lab Data
Drug Reference
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•
•
•
•
Simple organizational tasks
Internet access
Electronic prescription writing
Renewing Prescriptions
•
•
Billing, Charge Capture and
Correct Coding
Mobile ECG’s
Chapter 6
The following pages describe each of these applications
Patient Tracking
It is possible to keep simple profiles of patients including personal and demographic information. Or choose one
of the more advanced packages that allow for much more sophisticated tracking such as lab data, medical history
and prescriptions. Once entered in the PDA, patient information can be exchanged with other handheld users
using infrared beaming, ensuring all members of the care team have completed and up-to-date data. And by
synchronizing the PDA with a desktop computer, notes from the device can be immediately transferred to a
comprehensive medical software package.
•
View and manage office schedules from any Internet-enabled PC
•
Customize appointment types
•
Schedule multiple providers in the same practice
•
Use either as a standalone scheduling system or port over data from your existing scheduler
Dictation
Dictation restores mobility and convenience to the physician. Dictation
provides the functionality of a handheld digital recorder, incorporating
advanced capabilities such as Patient List information and Dictation
Templates. By setting new standards for medical dictation software, Dictation
has become an industry leader and "must have" tool for doctors in hospitals,
clinics and private practice.
Dictation uses the latest in Windows Pocket PC technology to record up to
three hours of digital voice files and forward them to the appropriate voice
server for transcription. This enables a doctor to complete his dictations
without being tied to a telephone for dictation and dictation ID entry. This
efficiency also lowers the cost for administrators by streamlining workflow
and intelligently processing voice files by flagging incomplete dictations or
dictations with invalid medical record numbers.
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Reviewing lab results
Healthcare providers can receive lab results at the point of care. Working seamlessly with an integrated Mobile
Patient Index, a lab retrieval system represents a significant opportunity to make workflow more efficient. No more
logging on to a computer to view labs, or sifting through paper records in a chart to find pertinent information.
Oftentimes, labs may be drawn at different times, run on different machines, and reported in different areas, such
as coagulation or bleeding lab tests. By customizing the application, healthcare providers can bring together, on
one screen, all labs for a particular patient's clinical condition. Also, users will be alerted to abnormal lab values,
and these abnormalities can be fed into a Mobile Patient Index and an Alert so that the user is alerted to this
abnormal value when viewing his or her patient list.
Lab will save you time by allowing you to access patient lab data efficiently, improve your quality of care by being
able to act immediately on critical lab results, and make clinical decisions quicker, leading to more efficient care
and the potential of decreased lengths of stay. Similar to the idea of receiving an alert, physicians can also
receive an alert about an urgent lab result. This enables the physician to make an immediate decision about any
action required. In addition, having access to this information on the fly can help avoid additional or repetitive
tests, saving both time and money.
Decision Support
Amongst the most popular uses of PDAs in maintaining a comprehensive and complete, drug reference. Rather
than carrying a cumbersome book, or making a side trip to the nearest nurse’s station, drug guides on handheld
computers provide up to date information on dosages, interactions, contraindications and cost.
•
The most widely accessed source of drug content used by over 200,000 healthcare professionals
•
Unbiased information provided by trusted third party resource
•
The number one source of drug reference information for pharmacists across the U.S.
•
Offers simplicity with an intuitive, menu-driven interface
•
Provides immediate access to critical drug reference information on your mobile handheld device
•
Ensures ease of use for busy physicians and healthcare professionals Includes regularly updated
information for over 3,000 drugs across 26 therapeutic classes
•
Search drug content by generic or brand name, or by therapeutic class
•
View dosing, contraindications, adverse reactions, mechanism of action and more
•
Reduces risk of drug-drug interactions and other related medical errors
•
Provides you with the critical information you need, when you need it
•
Integrates seamlessly with the prescribing module for easy access
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Chapter 6
Internet access
Virtually all PDAs offer the ability to access the Internet using either wired or wireless connections. This feature
provides the ability to access a virtually limitless amount of information from online archives, newsgroups and
other websites. There is also an increasing amount of content available on the Internet designed specifically for
PDAs (such as AvantGo, which provides updated content such as newspaper and magazine articles specifically
formatted for handheld devices). While the small size and screen resolution of PDAs does not make them ideal
for general web browsing, for quick trips to find relevant information they can prove extremely convenient.
Electronic Prescription
Prescription errors not only put patients at risk, they result in time consuming callbacks. Using a PDA,
prescriptions can be written electronically and then sent to a printer or directly to the pharmacy. More advanced
prescription programs even check formulary and drug interactions information.
•
Prescription automatically checked for insurance formulary compliance
•
Prescription automatically checked for prior adverse reactions and potential drug interactions.
•
Claim handled automatically on-line
•
Medication is pre-packaged with a tamper proof safety seal
•
Automated inventory management process
•
Time spent on process is time saved from answering pharmacy calls
•
Only most commonly prescribed medications kept in stock (size requirement is the size of typical
sample closet)
•
Add new patients to your handheld on the fly while doing rounds
•
Analyze your prescribing patterns
•
Customize your own drug list and create a favorites list of your most commonly prescribed drugs
•
Decreases pharmacy waiting time for your patients
•
Easily manage medication recalls
•
Eliminates medical errors resulting from misinterpreted handwriting
•
Lowers incidence of in-pharmacy drug switching
•
Maintain electronic and/or printed transaction records automatically
•
Maintain patient's preferred pharmacies
•
Order prescription refills from the prescription history reports
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•
Physicians using this tool typically save one to two hours each day by reducing pharmacy callbacks
and administrative tasks.
•
Record and track patient allergies
•
Reduces pharmacy-related phone calls to your office
•
Send signed prescriptions wirelessly to any pharmacy in the continental U.S.¹
•
The formulary lists, programmed into the system, are displayed in a format that encourages
physicians to choose the lowest cost medications.
•
The practice is notified in advance of pending prescription renewals.
•
The printed or electronically transferred prescription is legible.
•
The referral module customizes the referral generation process to managed care organizationspecific networks.
•
The system keeps a record of prescriptions and prints an updated medication sheet for the patient
chart.
•
The system prompts physicians to prescribe on-formulary for each individual patient.
•
View, sort and print medication histories
•
Write multiple prescriptions at the same time
•
Write prescriptions in as little as 3 seconds
Renewing a Prescription
One of the most time-consuming and frustrating endeavors for physicians is refilling prescriptions. A patient calls
a physician’s office with the request, which begins the string of phone calls, time on hold, relaying the same
information time and again to each person in the chain. If the physician is away from her office, there is an added
concern about making treatment decisions without complete information about patient allergies, other
medications, and history.
Imagine this scenario as told by Dr. Anderson, “I was driving in my car, and I received an alert on my cell phone.
A patient that I know needed a refill on his antibiotic. By pressing one button, I instantly faxed the renewal to his
retail pharmacy, updated his online medical record, and notified him by email that his request had been filled. It
was so fast and easy that I felt safe doing it while driving my car.”
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Chapter 6
Key Characteristics of an Electronic Prescription Writer
By Robert Keet, MD FACP
Healthcare practitioners have a professional mandate to prescribe the most appropriate, disease-specific
medication in a safe and efficacious manner. Each year, though, this becomes more complex. The number of
new medications increases exponentially each year with new entries for each class and new classes for each
disease. Each drug has its unique indications, contraindications, cross reactivity, complications, and costs.
Increasingly, drug-drug interactions present a major problem, reportedly occurring in 12% to 22% of
prescribed medications.1
Providers can no longer rely on memory for necessary details about familiar medications. They must
prescribe in the context of all medications a patient takes, including those prescribed by other physicians in
the community. In addition to indications, contraindications, and potential side effects, they must be aware of
drug-drug, drug-age, drug-allergy interactions, and which medications are covered by the patient's insurance.
The cost of managing the plethora of often-modified, insurance-specific formularies is rapidly driving up the
cost of care.
Several studies have shown that applying computing technology to prescription writing significantly reduces
the cost of medications while increasing the adherence to specific protocols.2 3 Computerized prescription
writing can provide tremendous benefit to both the healthcare provider and the patient.4 Despite the obvious
benefits, the use of computerized prescription writers is not widespread.
My healthcare community, which includes 135 physician offices, is implementing an electronic prescription
writer. The prescription writer is part of a project to automate the flow of clinical data between physicians and
their affiliated healthcare partners. The first stage of the project involved managing the flow of incoming
clinical data such as laboratory results, radiology results, and transcriptions. The data was digitized and
delivered to physicians' "inboxes," and tools were provided to manage those messages. The second stage of
the project automates the management of outgoing messages including authorizations, laboratory orders, and
prescriptions. Lessons learned during this effort provide insight into specific issues that must be addressed by
architects of automated prescription systems for healthcare providers.
A variety of papers and articles have addressed the design issues faced when implementing physician
automation in a single economic entity.5 This paper addresses the myriad of issues that must be considered
when designing a prescription writing system to meet the needs of physicians in multiple economic entities
linked only by a common community of patients.
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Chapter 6
Cross-Community Implementation
The typical patient sees a primary care physician and several specialists each year. An effective electronic
prescription writer must track all drugs prescribed by all physicians in the community and must perform
duplicate and interaction checking based on all drugs prescribed for that patient by multiple providers. The
prescription writer must provide adequate security, for example, to assure that physicians do not have access
to drug information for patients they are not managing. Finally, each prescription must be linked to a unique
patient identifier so that data can be appropriately transmitted across the system.
Our healthcare community created a "master patient index" (MPI) that identifies each patient and provides upto-date patient demographics, eligibility status, health plan, co-pay, and eligibility information. It also has the
capability to carry key clinical information including prescribed medications and allergies. The MPI database
entries are automatically generated and maintained from data included in incoming clinical messages, such
as laboratory results, and from outgoing messages, such as laboratory orders and prescriptions. The
database is replicated across the community and allows for rapid demographic look-up and unique
identification of clinical data (including prescriptions) and for checking for duplicate and interacting
medications.
Although we implemented a wide area network across the entire community to maintain the patient index and
to distribute clinical messages, healthcare communities today can take advantage of the Internet and Web
browser technology, thereby avoiding the high costs associated with the development of a community-wide
network. Using the Internet and Web browser technology, physicians and their staffs can easily access the
tools necessary to facilitate writing prescriptions. This includes linkages to expert databases, patient
demographic data, and medication history. Using an e-mail metaphor familiar to physicians and their staff,
prescriptions can be generated and delivered to the appropriate pharmacy.
Web technology faces two special considerations: security and speed. The U.S. Federal Government via the
Health Care Financing Administration (HCFA) is currently setting standards for the Web-based delivery of
clinical data.6 With encryption and appropriate authentication or identification, Web transmittal of clinical
prescription data should not be a problem.
Quick Response Time
Each day the average primary care physician writes 10 to 20 prescriptions and processes a similar number of
refills. Prescription writing generally occurs at the end of a patient encounter and must be done very rapidly.
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Chapter 6
Because of this, response time is critical in any point-of-service system. Since the speed of a browser-based
prescription writer is dependent on the data transfer bandwidth and the speed of the loading of pages, the
prescription writer must be designed with an eye to rapid loading and transfer of data, even if this requires
compromising on the quality of graphics.
In addition, physicians are very sensitive to the number of "mouse clicks" and text entry required to complete
a task. The physician must be able to quickly choose the appropriate drug and create the "Sig" (directions for
use).
Effortless, Intelligent Medication Choice
We found that physicians generally wish to choose a medication by name but appreciate the ability to find
medications by diagnosis and cost. Often physicians remember only the brand name, yet wish to prescribe
the generic alternative when available. Sometimes they do not know if the drug name is brand or generic, so
they must be able to choose drugs from one master list. Spelling is also often a problem; physicians may
remember only the first several letters of a drug name. Finally, physicians need guidance regarding the
specific strengths available for a medication.
For new medications, physicians often remember that a new drug is available in a specific class or for a
specific diagnosis but do not remember the specific name. Presenting the physician with drugs sorted by
FDA-approved diagnoses solves this problem. In short, choosing a medication should require minimal data
entry and not be dependent on knowledge of the drug's exact name or whether the name is a generic or
brand name. Once chosen, the physician should be presented with available strengths and guided to the
appropriate direction for use.
Formulary Linkage
Managed care has introduced a new dimension to prescribing a medication—selecting one that is covered by
the patient's insurance. Because formulary management directly impacts patient satisfaction and office
efficiency, it is of increasing concern to clinicians. Healthcare providers now spend more money on
medications than they do for primary medical care. This is an issue of significant economic importance.
Unfortunately, there is no single formulary of medications to use for a specific diagnosis. Instead, the
physician usually has several possible choices with costs related to the insurance carrier's contracted rates.
The appropriate drug choice thus depends on the patient's insurance and that company's current contracts—
a rapidly moving target. Providers should be warned when they prescribe a drug not on the patient's
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Chapter 6
insurance plan and should be presented with a list of alternative, plan-approved choices in the same drug
class. Providing this information at the time the prescription is written saves physicians, patients, and
pharmacies significant effort in changing non-formulary drugs to appropriate alternatives.
Physicians tend to prescribe a subset of medications repeatedly. In addition, they usually prescribe the same
number of tablets with the same directions and number of refills. The electronic prescription writer should
allow rapid completion of the prescription form for each physician's frequently prescribed drugs.
Expert Database Linkage
The complexity of prescription writing requires that clinicians have rapid access to expert knowledge. The
prescription writer should automatically check for drug duplicates and interactions as prescriptions are written.
Duplicate checking includes checking for the same drug as well as for similar drugs in the same class. We
have found that physicians wish to be warned but do not want that process to interfere with the completion of
the prescription. Often they are aware of the potential problem and do not want more details. When
interested, the physician would like the complete detail of the potential interaction including scientific
reference.
Prescription writers linked to expert databases such as Medi-Span allow this checking. Expert drug databases
can also provide physicians with specific prescribing details including the usual dosage, route of
administration, relationship to food, contraindications, and potential reactions. Average wholesale price data is
useful for choosing among otherwise equivalent drugs. Providing physicians with details of drug cost leads to
cost-effective improvement in prescribing patterns.7
Directions for Use and Patient Education
The ideal prescription writer provides defaults for appropriate usage directions. These defaults can come from
the physician's personal list for frequently prescribed drugs or from an expert database and can be easily
changed. The directions for use should drive other automation within the prescription process. For example,
the prescription writer can use the dose, strength, units prescribed, number of refills, and the directions for
use to calculate the date that the drug would normally require renewal. This date can drive other processes
including the renewal process and the tracking of patient compliance.
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Chapter 6
Finally, drug databases can provide drug-specific patient education in multiple languages. This includes
information about proper usage of the drug, contraindications, warnings, and precautions and can be printed
before the patient leaves the office.
Renewal Process
Our workflow analysis showed that the refill process is one of the most cumbersome and expensive
processes in a primary care physician's office. A typical primary care physician may receive 20 or more
requests for refills each day. These requests come from patients and pharmacies via phone, fax, and mail.
For each request, the office staff must obtain the chart, check and update the medication list, confirm the
dose, and present the data to the physician for approval. Once approved, the staff must update the chart and
transmit the refill approval to the patient or pharmacy by fax, phone, or mail. In a paper-based system, it is
cumbersome to determine if the drug is being refilled too soon and impossible to determine if it isn't being
refilled soon enough. Medication lists often become outdated or contain incorrect information regarding dose
or directions for use. For critical drugs such as Coumadin, this can lead to significant risk to the patient.
An automated prescription process must allow the staff to enter renewal requests for approval by the
physician. By choosing a drug from the prescribed list, a staff member should be able to initiate a renewal
with a single mouse click. The original dose, number, refills, and directions for use should be carried forward
to a new prescription with the date modified. This preliminary renewal request can then be deposited in the
physician's electronic inbox for approval.
If the system can calculate the expected renewal date based on the dose, strength, number, refills, and
directions for use, the staff and physician can quickly determine if the refill is occurring too soon or there if
evidence of non-compliance. If the dates of the patient's last visit and laboratory tests are also available, refill
checking can be even more comprehensive.
Provider Workgroups
Provider groups often centralize the process of prescription management and refills. An automated
prescription writer must function in the context of a group of healthcare providers and staff who work together
to manage this complex task. Provider workgroups can simply be call groups or may comprise all the
clinicians in an economic entity. Thus, the prescription process must take into account the fact that providers
often act clinically on behalf of each other. One clinician may write a prescription for another clinician's patient
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Chapter 6
or may refill medications on behalf of a colleague who is out of town. While prescriptions must be signed by
the generating provider, the regularly treating provider must have information about all drugs prescribed for
his patients. It is this provider who takes responsibility for the ongoing management of the patient's
medication.
Because staff members generally work with multiple providers, the refill process must allow staff to generate
prescriptions with direction to a specific provider for approval. Legally, an automated prescription writer should
allow only physicians or, where legal, mid-level providers to complete (sign) prescriptions; however normal
workflow mandates that prescriptions be prepared by the office staff.
Linking All Players
In an ideal world, physicians, pharmacies, and patients would all be electronically linked. While pharmacies
often have automated systems to track drugs and refills, clinicians typically deal with multiple pharmacies with
dissimilar systems. In recent years, online pharmacies have been proliferating on the Web, yet no simple
technology exists to link these services to provider or patient.
An automated prescription writer should have the ability to link to a variety of other computer systems. Refill
requests from the pharmacy should be delivered electronically to the responsible provider. Even the patient
could be brought into the loop with standard e-mail and Web tools. However, electronic prescriptions must
also easily interface with the world of paper, fax and e-mail. Incorporating prescription writing into a standard
communication infrastructure allows for maximum functionality now, with a growth path for the future.
Electronic prescriptions can easily be converted to fax and paper, thereby meeting the general needs of the
current work environment.
Implementation Process
The critical success factor for any new system is that it can be adopted in a gradual, non-disruptive manner.
In our healthcare community, we found that, wherever possible, it is best to introduce automation first with the
office staff. Once time savings are demonstrated, providers can gradually adapt to the new process.
Automating the time-consuming and expensive refill process first provides the most obvious gain for the effort.
A few key staff can be trained to enter refill requests from pharmacies and patients into the system. The
physicians can approve or reject these requests "online" in a process that requires minimal adjustment from
current procedures.
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Once the system has been primed with most of the drugs for each of the patients, clinicians can gradually
transform their prescription writing practice to one that is online. Providing automated alerts for drug
duplicates, interactions, and formulary non-compliance will encourage clinicians to use the system.
Conclusions
Prescription writing is one of the most complex tasks performed by physicians, demanding both detailed
knowledge of the patient's care and of drug usage. Treatment protocols are increasingly complex, and
providers are responsible for assuring that medications are prescribed appropriately and without adverse
interactions.
Several factors are coming together that will move physicians to more automated systems. First, the
complexity of medical care is increasing, making it difficult for physicians to maintain the knowledge base
necessary to provide quality care to their patients. Second, as computers have become more common and
less expensive, clinicians have begun to use them in their day-to-day work. A recent Gartner Group survey
found that 78% of physicians use the Internet. Finally, Internet and e-mail technologies are increasingly
sophisticated, and complex management tools can be built within this familiar environment to assist in the
delivery of healthcare.
Systems that give physicians immediate and direct feedback during the prescription process are most
effective in changing behavior and improving quality.8 Using tools built on communication platforms,
professionals can work together across a community to care for patients. Combining systems that generate
prescriptions, track medications, provide communication between providers, and link to expert databases
allows providers and their staffs to automate this process in the context of their usual workflow.
Dr. Keet has practiced Internal Medicine and Geriatrics in Santa Cruz, California for more than 20 years.
During the last four years, he served as chairman of the Steering Committee of physicians overseeing the
development of an automated clinical messaging network in his community. He consults with Axolotl Corp.
where he assists in the company's ongoing effort to provide clinical automation tools.
1.
Linnarsson R, Drug interactions in primary health care. A retrospective database study and its
implications for the design of a computerized decision support system, Scand J Prim Health Care
1993 Sep 11:3 181-6
2.
Grams RR, A primary care application of an integrated computer-based pharmacy system; J Med
Syst 1996 Dec; 20(6) : 413-22
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3.
Donald JB, Prescribing costs when computers are used to issue all prescriptions; BMJ 1989 Jul
1;299 (6990) : 28-30
4.
Schiff GD, Computerized prescribing: building the electronic infrastructure for better medication
usage, JAMA 1998 Apr 1;279(13) : 1024-9
5.
Chin HL, Implementation of a comprehensive computer-based patient record system in Kaiser
Permanente's Northwest Region, MD Comput 1997 Jan-Feb 14:1 41-5
6.
HCFA Internet Security Policy, Nov 24, 1998
7.
Donald JB, Prescribing costs when computers are used to issue all prescriptions, BMJ 1989 Jul 1
299:6690 28-30
8.
Soumerai SB, McLaughlin TJ, Avorn J, Quality assurance for drug prescribing, Qual Assur Health
Care 1990 2:1 37-58
Billing and Charge Capture
Outside of solutions that assist decision-making processes directly related to patient care, charge capture is one
of the more popular solutions. Particularly in this evolving era of healthcare reform and insurance regulations,
efficient and accurate billing is a necessity. The most basic of these types of solutions allow you to reference ICD9 (International Classification of Diseases, 9th Edition) and CPT (Current Procedural Terminology) codes so you
can complete your paper-based superbills more quickly.
The hottest and best received application on the market today in classified as “Intelligent Charge Capture”.
Unlike traditional charge capture systems that allow a physician to record daily charges, intelligent charge capture
provide the physician with undated “knowledge” on what individual healthplan require for proper coding and
charge reimbursement. Companies like MedAptus and Allscripts Healthcare Solutions are the two leaders in
developing and deploying intelligent charge capture systems.
•
HCFA data indicates practicing physicians are losing $25+billion per year in denied or reduced claims, a
direct result in inadequate documentation, while administrative expenses exceed 40% of gross physician
revenues.
•
Lost billings average $60,000 per year for each of the roughly 450,000 practicing physicians in the US.
When evaluating charge capture systems, there are numerous functions that should be examined.
Theses
include:
•
Does the system have prefigured superbills by specialty?
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•
Does the system customize the application to match the way you capture charges?
•
Does the system use in any care setting, including office or hospital?
•
Does the system display user-selected ICD-9, CPT and HCPCS codes?
•
Does the system add modifiers, visit notes, and return visit requests?
•
Does the system assign charges to CPT/HCPCS codes?
•
Does the system add new patients to the handheld when doing consultations?
•
Does the system reconcile today's patient list to make sure charges have been captured for each
one?
•
Does the system automatically sends charges to your billing/practice management system to be
processed the same day
•
Does the system check and confirm patient's insurance and co pay information?
•
Does the system track referral information?
•
Does the system view or print superbills (including physician's notes and return visit instructions)?
•
Does the system provide a calculator to help ensure your coding is in compliance with the newer
E&M (Evaluation and Management) coding recommendations?
•
Does the system prompt the physician for missing information required to meet specific level of
service?
•
Does the system suggest additional data that needs to be captured in order to meet the requirements
for the next level of service?
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Which Vendors provide the best Charge Capture Application? - Healthcare IT Application vendors provide
PDA functionality in many ways.
A few companies, like MedAptus, MDeverywhere, PatientKeeper, and
MDanywhere provide stand alone Charge Capture systems that can be interfaced with any Practice Management
System (PMS) and Electronic Medical Record (EMR) vendor applications.
Other companies like Allscripts
Healthcare Solution, NextGen, and WebMD, provide integrated PDA applications with there own PMS and EMR
applications. However, which vendors have the best Charge Capture System? Based on a recent survey of 56
healthcare IT vendors (self reported data, verified via demonstrations and site visits) that sell applications to
physician offices, the vendors with best Charge Capture systems are shown below:
Although the variations are limited in some cases, MedAptus and Nextgen are the clear leaders in Charge
Capture systems today. However the up and coming vendors, based on future functionality, will be Allscripts
Healthcare Solutions, MDeverywhere, and PatientKeeper. Finally, when selecting a Charge Capture Vendor,
organizations must also consider the financial viability of the company and additional functionality that might be
considered at a latter time.
100%
% of Requirements
98%
95%
93%
90%
88%
85%
Charge Capture & Coding
Nextgen
MD Anywhere
eClinical Works
PMSI
Allscripts
Medaptus
Patient Keeper
MD Everyw
Management and Financial Viability - When evaluating company management and financial stability,
healthcare organizations must consider numerous sources of information. In particular, most PDA application
vendors are not publicly traded, and therefore, financial and management strategies are hard to come by. In most
cases, company evaluations are based on industry and financial analysts, and are more based on opinion than
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real concrete data. However, as most will state, the various industry and financial analysts track the industry
closely, and although their judgments are not always correct, their influence over the industry creates visibility for
those vendors who stand out in regards in functionality, management capability, marketing and sales capability,
and vision to survive and thrive in the future.
100%
% of Requirements
90%
80%
70%
60%
50%
40%
30%
Managem ent and Com pany
Nextgen
MD Anywhere
eClinical Works
PMSI
Allscripts
Medaptus
Patient Keeper
MD Everywhere
Management and Company Rating:
Using this rating system, companies like NextGen, Allscripts Healthcare Solutions, MedAptus and PMSI are
recognized leaders in the Charge Capture Marketplace. Other companies may have strong functionality, but
without nationwide name recognition, companies like eClinicalworks, PatientKeeper, and MDeverywhere become
acquisition candidate for larger-national known companies.
Already, PatientKeeper has a direct relationship
with Cerner Corporation. This direct ownership relationship create great opportunities for Cerner sites (over 1,000
hospitals), but creates conflicts with the other large healthcare IT vendor organizations like McKesson, IDX,
Siemens, Meditech, Nextgen, GE Medical, etc.
MedAptus and MDeverywhere are neutral Charge Capture vendors with numerous relationships with IDX,
Siemens, McKesson, and GE Medical (Milbrook). This relationship benefits their companies and their clients
since they have already tested the required interfaces between the Charge Capture system and the healthcare
organization’s practice management system(s).
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Total Combine Charge Capture Rating System - When you combine ratings for functionality, management,
company, and PDA and Wireless Synchronization, the top vendors rating change slightly, but the top functional
applications remain at the top. As shown on the next page, the top vendors for charge capture remain NextGen,
Allscripts Healthcare Solutions and MedAptus.
However, based on an organization’s willingness to accept
minimal risk and depending on their future Practice Management Vendor, companies like MDeverywhere and
Patient Keeper would still make good choice for certain organizations.
Overall rating of Charge Capture Functionality, Management,
95%
93%
% of Requirements
90%
88%
85%
83%
80%
78%
75%
73%
70%
Total Charge Capture
Nextgen
MD Anywhere
eClinical Works
PMSI
Allscripts
Medaptus
Patient Keeper
MD Everywhere
Company, and PDA and Wireless Synchronization.
Charge Capture offers automated alternative to the traditionally cumbersome manual capture of charges for both
inpatient and ambulatory services. Physicians can efficiently capture charges for all services at the point of care.
Integration with practice management systems is essential. Physicians should be vary of “bolt on” or stand alone
PDA software applications that do not integrate with either the physician’s current EMR or PMS applications.
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PDAs provide an ideal way to keep track of procedures to ensure proper billing. Not only do they replace 3 X 5
cards and napkins as a medium for recording billing information, the electronic data can be transferred directly to
a desktop or hospital mainframe so all changes are accounted for and transcription errors are minimized
•
Get started faster with pre-configured superbills by specialty
•
Customize the application to match the way you capture charges
•
Use in any care setting, including office or hospital
•
Display user-selected ICD-9, CPT and HCPCS codes on your handheld
•
Add modifiers, visit notes, and return visit requests
•
Assign charges to CPT/HCPCS codes
•
·Reduce lost charge slips and superbills with mobile, electronic data capture
•
Add new patients on the fly to your handheld when doing consultations
•
Reconcile today's patient list to make sure charges have been captured for each one
•
Instantly send charges to your billing team to be processed the same day
•
Check and confirm patient's insurance and co pay information
•
Track referral information
•
View or print superbills (including physician's notes and return visit instructions)
•
Generate reports (no-show list, day's charges and cash receipts)
•
Helps you reduce lost revenue associated with unrecorded patient visits
•
Streamlines billing so that charges can be processed immediately
•
Assists your staff with managing office receipts and patient billing
Mobile ECG’s
The latest software product in the IQmark family elevates your ECG capabilities to a new, more efficient level of
portability, cost-savings and efficient patient care. When used in conjunction with the IQmark™ Digital ECG, the
new IQmark PDA lets you run hundreds of ECGs on a Pocket PC-based device - like the Compaq iPAQ® without the need and expense of transporting a large ECG cart from room to room.
The IQmark PDA is perfect for use in the office, clinics and medical centers as well as for remote and emergency
situations. You can evaluate live ECGs on the LCD screen, then simply click on “Save” to automatically store the
ECGs.
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Managing the ECG is very easy. Simply connect the PDA device to its docking station and the IQmark Sync will
automatically transfer the stored ECGs from the PDA device to the IQmark Diagnostic Workstation for
interpretation, measurements, editing and printing. IQmark Sync also works with Infrared (IR) or wireless network
connectivity.
Advantages
•
•
•
•
Capable of storing hundreds of patient ECGs
Works on Microsoft® Pocket PC 2002 platform
Small pocket size PDA (Personal Digital Assistant)
Download tests via standard docking station, IR or wireless network to the IQmark Diagnostic Workstation
for interpretation, editing, storage and management
Summary:
PDA devices are just that – another device to help the physician improve their effectiveness.
However, we do believe that
the PDA has limited functionality given the screen size. Information reviewing, charge capture, dictation, vital signs, and
prescription writing are applications that work well on a PDA. We do not believe that PDAs will be used for clinical charting of
physician notes, H & P, and template driven collection of detailed patient information. Numerous studies have shown that the
screen is too small for routine collection of detailed clinical information.
Additionally, the majority of the vendors plan on porting their clinical capture applications to a new device labeled the Microsoft
PC Tablet. The PC Tablet is expected to have built in wireless capability, integrated voice and hand writing recognition, touch
point technology like the PDA, full integrated digital dictation, and the device will be light weight, have a full active matrix color
screen, a longer battery life than the PDA and will be able to maintain 5,000 patient records on the expanded hard drive.
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