What are the risks involved in technology outsourcing?

March 4th, 2009

By Pascal Helou

New York, NY - Technology outsourcing is the process of having part or all your technology functions performed by a third-party firm. You need to consider all risks involved before you fire your technology staff and outsource you technology support functions to reduce costs. A study performed by the University of Missouri in 20001 reported that more than 35 percent of the outsourcing arrangements failed. What I advise is selective outsourcing. Keep enough of your expertise in-house, outsource what makes sense.

The main areas of concern are dependency and lack of control, information security and legal issues. Once you fire all your technology staff and make the switch, it becomes very difficult to change your mind, make changes or seek a new partner. The third party vendor will hold all the cards and you no longer have any in-house expertise. They in effect have all the power. The third party vendor can raise fees as contracts expire and you have no leverage to negotiate.

Dependency and Lack of Control - The first thing you loose when you outsource is control. The ability to make changes to the network, systems or any technology or service is greatly limited and may require a new contract.

Information Security - Any emails, documents, client lists, financials, documented competitive advantages, trade secrets, projects in the works are now in the hands of a third party. Any breach of your data can have severe detrimental impact on your image, company status and financial health. You have no way to know if the third party is taking proper steps to safeguards your data or are cutting their costs. Your data can easily be mishandled, lost or stolen and you may never be notified for fear of retribution. They may even use sub-contractors that have no interest in protecting your data and who may see an opportunity to make a quick profit from your private data files. This happens more with non-US based firms especially in India.

Legal Consequences - The legal consequences are the greatest threat to an organization that outsources its infrastructure. Most outsourcing firms offer services on a “as is” basis meaning they are not liable for the results of their services. If there is a breach of confidentiality, loss of data, the outsourcing firm is not liable.

Fiduciary Requirements – Any fiduciary requirements that you may have with your clients do not apply to a third party vendor. A careful assessment has to be reviewed of the risks before proceeding with a third party vendor.

Copyright Infringement - Copyright infringement is another potential liability when software is shared with the outsourced firm.

Conclusion

What I recommend is selective outsourcing. Keep the key knowledge in house and have a local outsourcing firm do the heavy lifting. Partner with a local credible technology firm that has as much to gain as you do from the arrangement. Speak to as many clients of the third party as possible who are in the same industry and are of similar size. You can always contact us and we will be happy to give you a free consultation and or point you in the right direction!

Endnotes

1 Gay, Charles E.; James Essinger; Inside Outsourcing: The Insider’s Guide to Managing Strategic Sourcing, London, Nicholas Brealey Publishing, 2000

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How to secure patient information in a medical practice

February 11th, 2009

By Pascal Helou

New York, NY - Security seems to be the last thing on a doctor’s minds when they open and run a practice. Security goes hand in hand with liability and HIPAA rules. Failure to comply with HIPAA can result in the following:

 

o     HIPAA allows both civil and criminal penalties, including fines and possible jail time.

o     HIPAA allows fines of up to $100 for each violation of the law, to a limit of $25,000 per year for violations of the same requirement.

o     Criminal sanctions for knowing misuse or disclosures carry fines of $50,000 to $250,000 and one to ten years imprisonment.

 

Having said that, there have been only a few fines actually imposed. The liability equation changes drastically depending on the types of patients you have. There are countless lawsuits where the staff is involved in leaking patient information to the media about celebrity patients.

 

Securing your office involves two main areas of focus: data that is paper based and data that is electronic. Paper based records need to be secured in locking storage rooms and or locking filing cabinets. All paper that contains patient information needs to be shredded. Unfortunately most practices that I perform an audit on do not shred their garbage where photocopies of patient IDs, credit cards, medical information end up when the printer, fax or copier do not perform properly. This is still the biggest threat and easiest to fix with a paper shredder.

 

EMR systems are great for office efficiencies but are more complex to secure.

The following is a basic outline to secure your medical practice and reduce your exposure to possible liabilities:

 

General Guidelines

  1. Determine all points of entry into your network (DSL, VPN, Dial-up modems).
  2. Make sure all entry point devices have passwords and are not set to factory defaults.
  3. Make sure you have a firewall installed between your network and the Internet. The firewall needs to also have a password that is not the factory default.
  4. Make sure all wireless access points have encryption enabled.
  5. Make sure all computers have screen savors with passwords. Also make sure the password is not taped to the screen! Still the most common breach.

 

Technical Guidelines (performed by a security expert)

  1. Run a network scan to determine how many computers and network devices are attached to the network. Removed all non-approved devices.
  2. Run a port scan on every network attached device to determine each device’s vulnerabilities. Close all non-required ports.
  3. Run a port scan on the firewall from outside the office to indentify any unsecured ports. Close all non-required ports.
  4. Review firewall logs for any intrusions. Reports any suspicious activity.
  5. Review workflow and how staff handles patient records. Make recommendations.
  6. Force staff to change passwords monthly. Don’t allow them to tape password to monitor.
  7. Standardize the desktops. A typical audit returns computers with Windows 95, Windows 98, NT, XP and Vista. Migrate all computers to one standard operating system such as Windows XP or Vista.
  8. Remove all non-work related software. Music and file sharing software pose risks.
  9. Check for remote desktop access software that users install to bypass the firewall and gain access to their desktop. (LogMeIn.com, GoToMyPc.com, VNC)
  10. Make sure computers have virus protection that is up to date.
  11. Make sure computers have a firewall running.
  12. Turn on the screen savor with password protection to protect against the cleaning staff.
  13. Make sure all patient information that is thrown in the trash is shredded.
  14. Create procedures to properly secure patient records. (Don’t leave a patient folder in an exam room. If you view patient records on a computer in the exam room, make sure you lock the screen when you step out. Don’t leave patient files in the back seat of your car.)

 

Once your network is secure, your attention needs to be focused on training and staff behavior. In just about every office I visit, the staff has downloaded music applications with some applications used to find music on the internet. What starts as a harmless act of simply trying to have music to pass the time on slow day’s turns into exposing the whole network to Trojans and Viruses. The computer is compromised even with the latest anti-virus software and firewall because the user was tricked into downloading harmless looking software bypassing all safeguards. The first thing the programs do is disable the anti-virus programs and Microsoft software updates. This leaves them free to propagate throughout the network.

 

Conclusion

Security is not a one time event. Security needs to be built into every process. I do a complete audit when I start a project and close all discovered vulnerabilities. Clients like a monthly or random security scan to discover if the new policies are being followed. You can always contact us and we will be happy to give you a free consultation and or point you in the right direction!

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What does it cost to process a patient?

January 11th, 2009

By Pascal Helou

 

 

New York, NY – The best way to dramatically reduce your costs is to fully understand where your costs are generated. The cost to process a patient is your single greatest costs other than your fixed costs such as equipment, rent, utilities and salaries. We need to determine the time spent by each person involved in processing a patient from the fist time the appointment is made to the payment of the encounter.

 

Focus on the following:

o     List all forms used for each step.

o     Identify who handles these forms and how much time they spend performing the process.

§         Time spent pulling, filing, and locating patient charts.

§         Handling prescription refill requests.

§         Mailing patient notes.

§         Processing patient check-in/check-out.

§         Transcribing dictation and recovering lost dictation due to misdirection or data corruption.

§         Time spent trying to locate lost charts.

 

The following table lists the typical steps involved from the time a patient calls for an appointment till the time the encounter is paid. Go through this table and add the time spent by each staff member at each step that applies.

 

Typical Patient workflow

Pre Patient visit

Physician

Clinician

Nurse

Front Office

Back Office

Other Staff

Admin

1.        patient calls and makes appointment

 

 

 

 

 

 

 

2.        scheduler gathers demographic information

 

 

 

 

 

 

 

3.        precertification is required if patient is covered by managed care

 

 

 

 

 

 

 

4.        process referring information if patient was referred

 

 

 

 

 

 

 

5.        patient folder is prepared

 

 

 

 

 

 

 

Patient Encounter

 

 

 

 

 

 

 

6.        insurance card copied, demographics verified

 

 

 

 

 

 

 

7.        medical assistant gathers vitals, allergies and current medications

 

 

 

 

 

 

 

8.        physician encounter

 

 

 

 

 

 

 

9.        patient scheduled for lab, tests, follow-up

 

 

 

 

 

 

 

10.     precertification is required if patient is covered by managed care

 

 

 

 

 

 

 

11.     ABN must be defined and signature required

 

 

 

 

 

 

 

12.     collect co-payment

 

 

 

 

 

 

 

Post Patient Visit

 

 

 

 

 

 

 

13.     physician documents patient encounter through dictation and/or notes

 

 

 

 

 

 

 

14.     physician interprets test/lab results

 

 

 

 

 

 

 

15.     nurse calls patient with lab/test results

 

 

 

 

 

 

 

16.     dictation transcribed by transcriptionist

 

 

 

 

 

 

 

17.     patient documentation forwarded to referring physician

 

 

 

 

 

 

 

18.     coding reconciles procedures and diagnoses

 

 

 

 

 

 

 

19.     claim filed to primary insurance

 

 

 

 

 

 

 

20.     patient receives primary EOB

 

 

 

 

 

 

 

21.     primary claim processed and adjusted

 

 

 

 

 

 

 

22.     claim filed to secondary insurance

 

 

 

 

 

 

 

23.     patient receives secondary EOB

 

 

 

 

 

 

 

24.     secondary claim processed and adjusted

 

 

 

 

 

 

 

25.     statement sent to patient

 

 

 

 

 

 

 

26.     patient receives statement

 

 

 

 

 

 

 

27.     billing staff handles patient questions and calls

 

 

 

 

 

 

 

28.     patient submits payment

 

 

 

 

 

 

 

29.     patient payment processed

 

 

 

 

 

 

 

30.     encounter paid

 

 

 

 

 

 

 

Total hours spent by each person involved in the process

 

 

 

 

 

 

 

Hourly rate for each person involved in process

 

 

 

 

 

 

 

Total cost in hours for person involved in process

Hourly rate x total hours spent by each person

 

 

 

 

 

 

 

Total cost to process a patient

(add the above row)

 

Number of patients process per month

 

Total costs to process patients

(number of patients per month x cost to process a patient)

 

 

Once you quantify the total cost to process a patient, you can begin to indentify the areas for the greatest potential for cost savings. Take a look at technologies such as EMR. Perform the same exercise with the notion that you have already implement the EMR solution. Run through the numbers again in the above chart with an EMR process flow to see what kind of savings you can expect.

 

You will see that the total cost to process patients can be reduced by 50%-85% by implementing an EMR system. Transcription costs can either be eliminated or drastically reduce in a well designed template system.

 

Conclusion
You cannot begin to reduce your costs unless you understand where your costs are coming from. Perform an audit and document everything involved in processing a patient including every system and form used. Once you determine where the greatest costs are generated, you can begin to look at technologies that will reduce those costs.

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How to hire a consultant for your medical practice for free?

December 11th, 2008

By Pascal Helou

New York, NY - Every medical practice can always benefit from an outside perspective on their business. The first thing that you must do is be honest with yourself. Change is not easy and you must be ready and willing to accept positive and negative criticism. A good consultant will tell you the truth, not exaggerate and give you options. They are on your side and are looking out for you, helping you avoid major mishaps, reduce costs and advise you of new technologies that can drastically improve efficiencies and increase your bottom line. I run my practice like an accounting or law firm but focus on business technology. The focus is always on how to align technology to help a practice run more efficiently, provide better services at a lower cost.

A question I am always asked is I am not sure I can afford this and how much does all this costs? The real question is whether you can afford to continue to do business as you currently are. Inefficiency can cost you hundreds of thousands each year while increasing your risks and reducing your bottom line. Proper use of technology results in increased efficiencies and higher profits. Increased efficiencies allow you to drastically reduce costs by having less staff or by having your staff do much more.

Here are the possible savings from implementing an EMR solution:

o     Labor cost savings of $40,250 per year per physicians: It costs $25,000 to $40,000 in labor costs per year per physician by not using an EMR solution and staying in paper. Switching to an EMR solution was demonstrated in a Congressional testimony in 1999 that will save $40,250 per year per physicians. A simple EMR solution can cost as little as $10,000, be implemented in 1-2 days and begin making money for you instantly.

o     Paper storage savings of $32,500 per year: A typical space used to store the paper records is on average 500ft2. The average costs for space in NYC of $65 per square foot leads to savings of $32,500 per year. An EMR solution eliminates this expense.

o     Transcription cost savings of $36,000 per year per physicians: A well designed template system in an EMR can eliminated or drastically reduce transcription costs.

o     There are many other costs such as reduced errors, increased collections do to less time required to access information, less risk and lost files.

A 3 provider office yearly savings after implementing an EMR = $261,250 in first year and $1,306,250 after 5 years.

Conclusion
The biggest hurdle you have is to jump in since you are already paying for working inefficiently. Make the investment and start saving hundreds of thousands each year!

The best way to proceed is to hire a local business technology expert to review your office and perform an audit. A technology expert who works with many similar practices can bring tremendous value and insight from other practice implementations, systems and failures. Just like you rely on an accountant for your accounting needs, rely on a business technology advisor for all your technology needs. The key is finding the right set of skills in a technology advisor.

The best technology advisors will have deep knowledge of your business needs, understand the breath of technology that is used in a medical practice, are not tied to any particular solution or technology, are attentive to your needs and are flexible and creative in their solutions. Most of all, they need to have that illusive skill that few true technology experts have, people skills!

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How to properly select the best medical practice software

November 11th, 2008

By Pascal Helou

 

New York, NY - Selecting medical practice software falls in the following categories:

o     Someone (doctor, office managers) knows someone that has similar software and they “like” it.

o     Vendors are invited to give proposals but the process of comparing the proposals is challenging at best. It is very difficult for non-area specific experts to be able to compare software features, technologies and price. Vendors will tend to give a low price for a basic solution but the real solution that the office will need may be multiples higher in final cost. They rope you in with a low price than add on fees dramatically once you are locked in.

o     The doctor or office manager reads a glowing article on a software solution and decides to implement that solution based on the article written.

 

I have been in many situations where I was brought in to help resolve the result of poor decisions that have left practices in chaos with angry physicians, frustrated staff and unhappy patients after months of wasted efforts and at a tremendous cost leaving the practice worse off than they started! So how do you go about ensuring a successful selection of the right software for your medical practice?

 

Steering Committee

o     A steering committee needs to be created that is accountable and is comprised of the best people from all areas of the practice.

o     Each person is a stakeholder and represents a specific area of the business in the practice.

o     The steering committee leadership needs to have deep technical, project management skills as well as a good understanding of the current work flow of the practice. They will rely on each of the stakeholders to properly define the needs and requirements of their areas.

o     There has to be a commitment and practice management must make the team members available and dedicated for the process to work.

 

Defining goals and objectives

The process of selecting a practice software solution at this stage is more based on the business needs and politics than on technology.

o     Indentify immediate and long term practice goals.

o     Clearly outline the business goals and direction. This includes any planed new service offerings, any changes in reporting requirements, changes in office situations and a review of the current systems that are in use.

o     Generate a document with clear goals and objectives, list of major features that are required, any specific technological limitations or requirements, list of systems that the new practice solution must be able to interface with, general timeframe and budget.

 

Performing an audit and mapping out workflows

Most software implementations fail because people throw money at a vendor who intern drops a solution into a practice with little training. This process is doomed to fail since even the best software cannot fix an inefficient or ineffective workflow!

 

Medical practices rely on information from many systems both internally and externally. Just adding technology will not necessarily improve your practice’s productivity. It has been shown that simply introducing new technology usually results in decreased productivity. The staff must maintain the current way they do their work while learning a new system. Adding new technology to an inefficient workflow does not result in efficiency gains.

 

It is amazing how many times people do things but no longer remember why they do those things. In one practice, one staff member was dedicated to filling out and processing certain paperwork that was sent to another department. The other department had changed their policies long time ago, failed to notify the other department and simply threw out the paper work! The best way is to map out the current workflow of all processes in the practice.

 

o     Perform an audit trail of the patient encounter form as it travels throughout the office workflow.

o     Document every system that provides or receives information from the patient encounter and the people involved.

o     Document the workflows.

o     Having a detailed map of each process, the people and systems they involved is critical to properly selecting the right software solution, maximizing efficiencies and ensuring a successful implementation.

 

Defining your system requirements

o     Start by the things you can’t or don’t want to change such as the need to be able to interface with system A, B and C, the need for a multi-office solution or the need to support key business requirements.

o     Reduce the number of vendors by the capabilities outlined in your requirements, by costs and by complexity.

o     Call your colleagues with similar practices and see what they have done.

o     Create an RFP (Request For Proposal) and distribute your request to the top vendors that have passed your initial minimum requirements.

 

System review and selection

o     Start by eliminating any system that does not meet your system requirements. Many vendors will say that is planned in the next release. If it isn’t in the system now, don’t count on it being there any time soon or for free.

o     The software must be able to work with existing systems.

o     Many vendors promise that their system can interface to many systems. What is usually not disclosed is that this sometimes requires special programming and can be very expensive.

o     Request a demonstration of the software once you have the vendor proposals. Make sure what is demonstrated is what you will be buying with all the features you will need and includes all costs. Many vendors show their top fully loaded application then sell you an entry version at a much lower cost to get you in the door. You end up spending so much more just to get to where you thought you had purchased.

o     Each team member needs to review the software from their area’s perspective.

o     A new process map needs to be created with the new system in mind so that each stakeholder can see how this will impact people’s tasks and ultimately show how the new software solution will streamline current workflows and result in new efficiencies.

o     Try to visit an office that is similar in size and scope as yours that has the software you are looking to implement. Interview many people involved in the process and try to get as many lessons learned as possible.

o     The final step is to select 3 top vendors and negotiate on price. Get everything in writing and do not accept any verbal promises.

 

Before signing a contract, closely review the contract with a technologist!!! I don’t know how many times I have reviewed contracts that were full of thousands of dollars in unnecessary line items. For every $100,000 contracts, at least 25% were things added that were not necessary for the success of the project. One client had a $25,000 option for an EMR solution that they had paid for as part of a much larger practice software package. I was doing an audit for the client when I made that discovery. They approached the vendor to implement that option. The vendor stated that since the software was purchased 3 years ago, the hardware and software has changed so much that it is now obsolete. It will cost them an additional $50,000 if they want the EMR option.

 

Conclusion
Selecting and implementing an EMR/Practice Management system is a complex undertaking that requires commitment from everyone that will be using the system. A committed steering committee is critical, clear objectives and goals, a detailed process map, workflows, system requirements are all critical to the proper selections of an EMR system. Keep in mind that more than 50% of EMR implementations fail because of improper technology selection, poor planning, lack of commitment and lack of training. One way to make sure your implementation is a success is to hire an independent third party technology consultant that is not associated with the vendor but is rather your hired technology expert. Their sole job is to make this a success while everyone else in the process has their real job to do as well. They will flush out which solution is best suited for your needs, project manage the implementation and keep the vendor honest. Their keys strengths are business and technology skills, strong project management and people skills. You can always contact us and we will be happy to give you a free consultation and or point you in the right direction!

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How do you justify the cost of implementing an EMR system?

October 9th, 2008

By Pascal Helou

New York, NY - The cost of an EMR system is a function of several factors such as the complexity of the EMR feature sets, whether the system is an in-house solution or rented software as a service solution, the number of doctors and if more than one office is required to access the information.It costs $25,000 to $40,000 in labor costs per year per physician by simply staying in paper and not using an EMR solution. Switching to an EMR solution was demonstrated in a Congressional testimony in 1999 that will save $40,250 per year per physicians. A complex EMR investment should pay for itself in less than 2 years and a simpler solution can return savings instantly.
How do you determine the real costs for your current paper based charting system?
Determine the number of charts pulled and re-filed in a week. A typical week for most doctors is 375 charts per doctor. If it takes on average 8 minutes to file and re-file a chart, then your staff is spending 50 hours per week to pull and re-file charts. If you are paying your staff $15 per hour, this translates into a yearly cost of $39,000 per physician. The costs of $117,000 add up quickly for a 3 physician office. You can reduce those costs by $81,900 per year by implementing an EMR. An EMR solution also scales much easier and costs are further reduced as physicians are added.

 

A basic EMR solution that simply allows the staff to scan your current patient encounters has been very popular among my clients in the NYC area because the system is a fraction of the cost of a full blown EMR solution, is implemented in a few days, requires little training and you use your current forms and documents. The system simply stores all documents electronically. To pull a file simply requires that you type the patient name into the system. The second selling feature in the NYC area is that it saves on all that storage space required to keep all those paper records. That space can be used for another exam room or office. The third selling feature is providing disaster recovery. Since the records are electronic, they can easily be backed up offsite. The forth selling feature is the ability to have access to these records in more than one location. No more having to carry patient records in your car which can be a HIPAA violation.

 

Additional Savings

More savings can be realized in the investment of a more complex EMR solution.

o     Paper storage costs add huge savings. A typical space used to store the paper records is on average 500ft2. The average costs for space in NYC of $65 ft2 leads to savings of $32,500 per year.

o     Transcription costs can either be eliminated or drastically reduced in a well designed template system. This can translate into $36,000 in savings per year per physician. Systems that require you continue hand-writing in the charts will increase costs do to the added steps of the process.

o     Malpractice premium costs may go down as the improved documentation leads to better patient care. New government initiatives, grants and tax incentives are also planed to encourage the deployment of EMR solutions.

o     Storing records electronically also eliminates the need to print expensive microfilm.

o     Increased productivity has also allowed the addition of providers without additional staff.

 

Conclusion

Implementing a basic EMR solution is the cheapest and easiest to get up and running with the lowest risks. Complex EMR solutions have so much more to offer but also are more expensive, complicated, time consuming to implement and carry much more risk. I have implemented many flavors of both and find that a basic EMR solution (electronic document storage) works best for small practices and even some large offices. Implementing a full blown EMR solution is a complex undertaking that requires extensive workflow analysis, project management skills, stake holders, a large budget, a timeframe of 12-18 months and commitment from everyone involved. This solution has worked well in larger offices and has the greatest productivity gains in the long run. You can always contact us and we will be happy to give you a free consultation and or point you in the right direction!

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How do you choose an EMR solution?

September 9th, 2008

By Pascal Helou

New York, NY - The first step to implement an EMR solution is to document the current office workflow that supports the patient encounter. This is a tedious, iterative and time consuming process that is critical to the success of any EMR implementation. Document exactly what happens when a patients sees a doctor. What forms do they fill out? What happens to those forms? Are they sent to other departments? What systems is data entered into? Who are the people involved and what do they do to move the process forward? Every detail, process, form, system, technology and person involved in the process has to be properly documented to fully understand the workflow of a patient encounter. This process involves many iterations and every person that is involved in the process before a complete understanding is gained.

Once this is documented, you can then identify areas that need improvement, steps that are no longer required, and areas in the process that can benefit from technology and interfaces that will be required to work with existing systems.

You start by eliminating any vendor that does not meet your minimum system requirements. The areas of focus will then be on the feature sets and whether they satisfy your current and future needs.

I will begin by the process by focusing on the underlying technology. Is the solution based on a server you keep in house or can you access the application on the Internet? The advantages to an in-house solution is that the system is much faster, is always available even if the Internet goes down and you have better control of your patient information since it stays in your office. The disadvantage is that there is a larger upfront cost and you have to maintain the server. The alternative is to “rent” the solution. You access the application over the Internet. The advantages are that you have access from anywhere. No or low upfront costs. No servers to maintain in-house. The disadvantage is that the system will always be slower than an in-house solution and will have higher monthly costs. Your data is out of your control and resides off-site. If the Internet goes down, your staff will have little to do till service is restored. Another thing to remember is when a doctor decides to change service; it is much easier to do it on your own terms with an in-house based server than with a hosted solution where you have no control.

 

Built in patient schedulers or an interface to your existing patient scheduler is critical to reducing errors. If you already are using a billing software that has a patient scheduler then you will want your EMR system to interface with your billing software. That way the staff can schedule a patient in the billing system as they have always done and that information is transmitted automatically to the EMR system. You don’t want to be in a situation where you have to enter the patient schedule into multiple systems. This greatly increases errors and reduces efficiencies.

 

You also need to consider who uses the patient schedule. The doctors and staff all use that information differently. The staff accesses the patient/doctor schedules from their computers. The doctors may prefer to have that information on their wireless devices. The schedule must also be able to be updated real time wirelessly…These are the types of scenarios that can seriously reduce the success of the project.

 

Patient tracking can help reduce patient waiting times. Tracking patients through your office will help determine where the bottle necks are and help you better plan your resources.

                 

What physicians fear the most is that by switching to an EMR system the new process will slow them down causing them to see less patients in a day. Templates are key to decreasing the time required in the patient encounter. There are several methods of data collection. The first is predefined paragraphs of text. Paragraphs of text are created by the physicians who address a specific diagnosis, procedure or treatment. As the doctor performs their patient review, they select the predefined paragraph that best meets the patient ailment.

  

The flow through the system, how many clicks it takes to get to the information you need is very important to doctors. Reducing the time to do something and customizing the process to work with the doctor is critical to making the new system a hit.

 

EMR systems contain many areas for documentation. They typically include Patient Vitals, Family History, Illness History, Lab Reports, Dictations and Medications.

 

Patient Vitals – Reason for patient visit, chief complaint and patient vitals are recorded in this section.

 

Family History – Past family history, any allergies and current medications. 

 

Illness History – Details for patient illness history.

 

Lab Reports – labs and diagnostic imaging reports. Some even allow you to import the actual test, scan or image for reference. Make sure the system as a HL7 interface if you would like the actual tests, scan or images directly sent from the lab equipment into the EMR system. This usually requires some programming but is worth while having all patient data in one location.

 

Dictations – There are several methods to handle dictations.

o     Directly - Speak directly into a microphone and the system transcribes in real time. My experience is that busy doctors simply do not have the time for this since these systems are not totally accurate and require you to edit the results.

o     Dragon Naturally Speaking - The most accurate and popular voice recognition software is Dragon Naturally Speaking. You dictate into the application and import the results into the EMR. This is more accurate but requires two steps.

o     Templates combined with Dragon Naturally Speaking – You create templates that define in detail a particular problem. You simply select the most appropriate template and dictate the specific details. This is the best tradeoff since it is the fastest (other than dictating into a recorder and sending it out for it to be transcribed) and lowers dictations costs. You need to accept the fact that the end note is not perfect

o     The last method is the fastest but most expensive. Doctors dictate as usual and send it out to be transcribed. The returned report is scanned into the EMR.

 

Medications – History of medications and prescriptions. Some EMR systems that are tied to an electronic prescription service allow you to electronically send the prescription directly to the pharmacist with a few clicks. This reduces costs and errors.

 

Conclusion

Choosing an EMR solution is a daunting task with so much at stake with more than 60% of all EMR projects implemented failing. The role I usually help clients with is project leader/manager. Clients have the most difficult part with selecting the right EMR solution, documenting workflows and implementation. The project can be a major success with the proper structure, planning, commitment and a team with the proper skill sets to deliver the right solution. You can always contact us and we will be happy to give you a free consultation and or point you in the right direction!

 

1 “Electronic Medical Records: Lessons from Small Physician Practices”, prepared by University of

California, San Francisco for the California HealthCare Foundation, October, 2003

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Which is better Electronic Document Storage or EMR?

August 9th, 2008

By Pascal Helou

New York, NY - The process begins by reviewing your system requirements created from your current workflow audit. The question you then must answer to help select the proper solution is whether you want a simple Electronic Document Storage solution or a complete EMR/practice management system?

 

Electronic Document Storage solution
An Electronic Document Storage solution simply replaces your filing cabinets/paper charts with electronic charts. This option is popular in NYC because it is much cheaper (1/20th the cost of a full blown EMR/practice management system) and simpler to implement (can be deployed in a few days).

 

Doctors and staff continue to capture office visit information using the existing paper forms. The office usually hires a bunch of high school students that spend a few weeks scanning the patient paper records into the system. This process can proceed in parallel with the current office operations without any disruptions. Once all paper records are scanned in, the doctors and staff can access all patient records electronically in seconds from any location. The staff simply scans the paper charts after a patient encounter or at the end of the day as a batch process.

 

A basic Document Storage solution requires the following:

o     $1,000 - Medium end scanner (used by staff for general scanning)

o     $3,000-$5,000 - High speed scanner (used for batch scanning)

o     $5,000-$10,000 - Electronic Document Storage software

o     $3,000 – file server to host Electronic Document Storage software

o     $1,000 - training

Total costs $13,000-$20,000 (total costs regardless of number of physicians)

 

If you are a small office then you can reduce the training, remove the file server for total costs of under $10,000. The system can be setup in 1-2 days. Maintenance costs and support are minimal.

 

The EMR/practice management solution
The EMR/practice management system is a powerful solution (integrated EMR and complete practice management solution), much more complicated (requires complete understanding of current workflows, systems and processes) and time-consuming to properly deploy (takes anywhere from 6-18 months to deploy).

 

The typical EMR/practice management system costs $15,000-$50,000 per physician according to a report produced for the California HealthCare Foundation1. The high end EMR implementations that I have worked with have averaged $150,000.

 

Most of the EMR/practice management systems I have implemented were on large offices connected to hospitals. The Electronic Document Storage solutions have been popular with small medical practices.

 

Conclusion
Both the basic EMR and EMR/Practice Management solutions have much to offer. The basic EMR can begin to pay for itself in a few days, is easy to implement, is inexpensive and provides an immediate ROI. The EMR/Practice Management solution is expensive, complex, is riskier to implement but carries the highest efficiency gains. What’s best for you depends on the complexity of your workflows, your budget, timeframe and calculated ROI. You can always contact us and we will be happy to give you a free consultation and or point you in the right direction!

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EMR (Electronic Medical Records) for FREE

July 5th, 2008

By Pascal Helou

New York, NY - There are two types of EMR solutions. The first is a basic EMR which is an electronic filing cabinet. The patient records are scanned and stored electronically thereby eliminating the paper and filing cabinets. The second is a full blown EMR which is much more complex. The focus of this paper is the basic EMR. 

A basic EMR solution has been very popular among my clients in the NYC area because the system is less than 1/20th the cost of a full blown EMR solution, is implemented in a few days, requires little training and you use your current forms and documents. The system begins to pay for itself immediately. All documents are stored electronically. To retrieve a patient file simply requires that you type the patient name into the system. The second selling feature in the NYC area is that it saves on all that storage space required to keep all those paper records. That space can be used for another exam room or office. The third selling feature is providing disaster recovery. Since the records are electronic, they can easily be backed up offsite. The forth selling feature is the ability to have access to these records in more than one location. No more having to carry patient records in your car which can be a HIPAA violation.       

 The following is 11 reasons to implement an EMR:

 

1.      The greatest savings is in labor costs. It is estimated that over 70 percent of the costs associated with pulling and re-filing charts can be eliminated resulting in head count reductions. Determine the number of charts pulled and re-filed in a week. A typical week for most doctors is 375 charts per doctor. If it takes on average 5 minutes to file a chart and 3 minutes to re-file the chart, then your staff is spending 50 hours per week to pull and re-file charts. If you are paying your staff $15 per hour, this translates into a yearly cost of $39,000 per physician. The yearly recurring cost of $117,000 adds up quickly for a 3 physician office.

2.      Paper storage costs add huge savings. A typical space used to store the paper records is on average 500ft2. The average cost for space in NYC of $65 ft2 leads to savings of $32,500 per year.

3.      Transcription costs can either be eliminated or drastically reduced in a well designed template system. This can translate into $36,000 in savings per year per physician.

4.      Malpractice premium costs may go down as the improved documentation leads to better patient care. New government initiatives, grants and tax incentives are also planed to encourage the deployment of EMR solutions.

5.      Storing records electronically also eliminates the need to print expensive microfilm.

6.      Increased productivity also allows for the addition of providers without additional staff.

7.      EMR can help you achieve maximum reimbursement by guiding you through the coding process and ensures you have documented each encounter properly.

8.      EMR records also help protect you in the event of an audit.

9.      EMR can help provide discounts in malpractice insurance premiums. Improved documentation, accountability and tracking helps in reducing medical errors which can result in lower premiums.

10.  Medical Liability Monitor conducted a survey in 2005 that indicated that the four-state average of the highest liability rates for OB/GYN was $230,919. Malpractice insurance companies provided a 2-5% EMR credit which translates into a savings of $4,600 to $11,500 per provider per year.

11.  Stark and anti-kickback laws provide subsidies for hospitals and regional healthcare providers if they purchase an EMR with the following criteria: Data from the EMR can be communicated to other EMR systems, E-prescribing capabilities and interoperate with other provider systems. The state of New York contributed $52.9 million in funding in 2006 to create community RHIOs and increase use of interoperable EMRs. The state handed out $105 million in 2008 to 96 hospitals in order to create a statewide EMR system.

 

More savings can be realized in the investment of a more complex EMR solution but at a much greater cost and risk.

 

Keep in mind that the national average for a successful EMR implementation is 40% meaning that 60% of EMR projects fail! You cannot simply select a vendor and write a check and expect the process to work its way out. The role I usually take is project manager between the practice and vendor keeping everyone on schedule. This role requires strong project planning skills, detailed workflow analysis of the practice, technology, process and people skills.

Conclusion
EMRs can pay for themselves in a short period of time through significant cost savings and increased revenues for your practice. The initial investment can be as little as $10,000 for a simple EMR solution taking a few days to implement to a full blown EMR solution costing $150,000 and taking 16 months to fully implement. The cost savings are very real. Your bottom line will decrease during implementation but should drastically increase as the system is brought on line and the staff begins to work more efficiently. You can always contact us and we will be happy to give you a free consultation and or point you in the right direction!

 

 

 

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What is SEO and what is the process to make a website SEO friendly?

June 9th, 2008

By Pascal Helou 

New York, NY - SEO (Search Engine Optimization) is the process of optimizing your website to gain maximum exposure and achieve high rankings in search engine results. There is no silver bullet to achieve this but rather a complex process that I will describe bellow. The idea is to optimize your website for the search terms that visitors will likely type in a search engine looking for your product or service. The more optimized and focused you are, the higher you will rate in the search results leading to increased traffic.

Step 1 - The first step is to baseline your current rankings by analyzing your current website rankings in all major search engines:

o     Google PR - Google PageRank

o     Google Index - Number of indexed pages

o     Google link - Number of links

o     Google cachedate - Date of current Google cache.

o     Yahoo Index - Number of indexed pages

o     Yahoo link - Number of links, pointing to the current page

o     Yahoo Linkdomain (LD) - Number of links, pointing to the current domain

o     Yahoo Directory - Domain presence in the Yahoo Directory

o     MSN Index - Number of indexed pages

o     MSN link - Number of links, pointing to the current page

o     MSN Linkdomain (LD) - Number of links, pointed to the current domain

o     DMOZ Directory - Domain presence in the Dmoz Directory

o     Alexa Rank - Traffic estimation index

o     Del.icio.us index - Link to del.icio.us history for current url

o     Digg index - Link to Digg history for current url

o     Check robots.txt - Check if robots.txt file exists and if it does show link to it

o     Sitemap – Presence of a sitemap

o     SEOdigger - Detecting search keywords for which a site is ranked high

o     DMOZ – Domain presence in the Dmoz Directory

o     Alexa Rank – Traffic estimation index

o     Internal Links – Internal website links

o     External Links – Links to external websites

 

Step 2 - Perform a complete analysis of your site:

o     Validate the home page and all landing pages’ code and text.

o     Note any changes that are required to make the pages more easily crawled or spidered.

o     Identify all broken links or missing images.

o     Check for any problems or errors on your web server.

 

Step 3 - Develop a list of keywords that people would type in a search engine to find you. These key words should be relevant to your site, your business, your industry and if possible your local area. The targeted keyword phrases list should be at about 20 words or phrases. Narrow the list down to a few based on how relevant they are, how popular and how strong the competition is for those words.  Use the following top tools Trellian Keyword Discovery, Word Tracker, Google Adwords Keyword Tool and SEO Book Keyword Search Tool to create your keywords.

Step 4 - Review your website content and modify your content to include key words from Step 3.

Step 5 – Publishing articles is a great way to drive traffic to your website. I don’t call them press releases because they are not. They are more like short white papers like this paper to address an issue. A great place to release such papers is ezinearticles.com and free-press-release.com. Do your press releases at prweb.com. There are many more release options. I just listed the ones I like. You should publish at least 10 articles on topics that relate to your site. Search Google for the paper titles you published and see how many websites have picked up on your papers.

Step 6 - Optimize the website for the following:

o     Creation of Title Tags based on initial keyword research

o     Description Tags

o     Keyword Tags

o     Alt Tags

o     Comment Tags

o     Robots.txt file

o     Meta tags optimization including title, description and keywords

o     Image Optimization

o     On page Optimization

o     Key phrases Optimization

o     W3c Validations for Home page

o     Comprehensive log file analysis

o     Creation of a search engine friendly sitemap for better crawling of your site

o     Create and optimize landing pages

 

Step 7 – Blogs are a great way to keep search engine spiders visiting frequently. Search engines like fresh and unique content. So keep the blog interesting, with daily updates and watch your ratings increase.

Step 8 - Create a competitive analysis once you have cleaned up your website structure, design and text. Search for your competition by using the search terms you selected in Google and take note the search results. Keep track of their ranking progress, what search words they have optimized for, the amount of traffic they receive and the inbound links.

Step 9 - Submit your website to all major search engines.

Step 10 - Open an account at google.com and upload your sitemap.xml to google.com/webmaster tools.

Step 11 - Get the code from google.com/analytics and imbed that code into your website to be able to track users coming to your site.

Step 12 - Review your website internal and external links. Make sure your internal links point the most to your most relevant page or your landing page. This will tell Google that this is your most important page.

Step 13 - Create a Link Exchange program to try to get as many high ranking links pointing back to your website.

Step 14 - Review your rankings as in Step1, competitive analysis as in Step 8 and review how successful your keyword selection has been based on the generated traffic.

Step 15 - Try different key word combinations to focus on if the current selection is generating very little traffic. Adjust your website text to reflect the new key word combinations.

Summary
Keep refining the process in Step 15 till you achieve the traffic you desire. Just remember, this is a time consuming and iterative process so give yourself plenty of time to get the rankings you are looking for.

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