In a previous post, I made a plea for replacing paper charts with cheap ($300) tablet PCs.

Recently, the New York Times predicted that thin and inexpensive ($50) netbooks will reshape the way we compute.

Netbooks become the logical hardware choice as more software applications are accessed from a web browser and more data is stored on servers in the cloud.

In these lean economic times, physician practices could implement web-based electronic records with a netbook at a fraction of the cost of a traditional EMR. Traditional EMRs require large cash outlays for hardware, IT infrastructure and support.

    

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ATM
Fandango
Airline boarding passes
Hotel reservations
Online retail orders
Computerized phone help
Online help

Information technology has provided cost savings in the examples above by enlisting the help of the customer. Somehow, healthcare has not caught on to this. When I make an appointment to see the doctor, a live person researches the doctor’s availability, then tries to accommodate my schedule. When I arrive for my appointment, the front desk photocopies my insurance card while I hand write demographic and health information on paper forms. People are accustomed to entering their demographic data and payment information, navigating through lists, schedules and options, pressing buttons on their phone. In fact, according to a study by Deloitte, they would welcome the opportunity to enter this data for their healthcare provider.

Here are some ways to harness patients' willingness to do the work:

1.  Appointments

Use an online appointment scheduling program like Eppointments.

2.  Demographics

Let patients enter their current demographic and insurance information with Medfusion.

3.  Medical History

Allow patients to enter their own history of present illness with Instant Medical History. This program uses branching logic and decision trees to gather information about Chief Complaint, History of Present Illness and Past Medical History. The doctor only needs to add Physical Exam, Assessment and Plan details to the office note.

4.  Payment

Collect patients' credit card information when they make their appointment and ensure that a co-pay is collected for every patient. You could even enforce payment for no-shows; but be sure that this is spelled out clearly on your website.

    

 

Adam Bosworth spoke at the TEPR Conference today about how President Obama can best spend the $50 billion that will be available when the stimulus package is signed. Mr. Bosworth, one of the founders of Google Health, left Google in 2007 to create his own health IT company, Keas. 

Even though he has a long history as a techie (he worked at Microsoft before Google), he believes money could be better spent, not on IT, but on providing incentives for patients and doctors to work together to create health plans for healthy lifestyles. He believes that the U.S. has become sicker over the last 20 years due to unhealthy lifestyles which contribute to skyrocketing rates of obesity and the long list of illnesses that go along with that. 

However, not surprisingly, my three favorite points of Mr. Bosworth's talk had to do with IT:

1.    Information Technology Saves Money 

In every industry that has adopted IT, most have realized cost savings by shifting business activities to the consumer.

For instance, banks save money when customers get money from an ATM instead of a bank teller. Airlines save money when travelers print boarding passes at home instead of using a gate agent.

Physician practices can see the same benefits by enlisting patients to do some of the work now done by their overworked staff. Allow patients to register with your patient management system online and allow them to update it when their insurance or demographic information changes. In fact, studies show that patients would like to be more involved electronically. Read more about that in my post about what patients want.


 

2.  Do not spend government money on developing “standards”

Standards are not developed by government fiat, but by financial motivation. The best standards are easy; if standards are difficult to use then they will be harder to implement because fewer people will be able to implement them. For example, html was widely adopted as a standard because it is so easy that even non-programmers can use it. In healthcare, the CCR (Continuity of Care Record) is quite sufficient for interoperability, because it is so straightforward and easy.

3.  Doctors should not run IT departments

The only hardware a physician office needs is a monitor that can run a web browser. Systems that are accessed through the internet have a distinct advantage over those that are housed on-site in terms of back-up and new releases. One doctor at the conference related a story where his paperless office had a server crash and he was not able to recover any data for six weeks. Horror stories like this are far less likely to happen if you are using a browser based system.

    

Next week I will be attending the 2009 TEPR (Toward an Electronic Patient Record) Conference, blogging and tweeting from sunny Palm Springs. Here are some of the sessions that I look forward to:

1.  Web based e-tools
            Patient Portals
            Start e-Visits in Your Practice
            Life in the eMail Age: A Case Study
            How the Internet Has Changed the Classical Doctor-Patient Relationship
            Implementing On-Line Patient Education 

2.  Health 2.0
            Health 2.0: What it is and Example Projects, Matthew Holt , Co-Founder, Health 2.0

3.  Physicians and Hospitals
            How Patient Portals are Linking Physicians to Hospitals
            Creating a Patient-Centric Care Process
            Linking Offices to Hospitals - What Works and What Doesn't

4.  Mobile Health Applications
            Cell Phone as the Key to EPR: A Substitute for a Health Insurance Card 
            Lessons Learned in Piloting Text Messaging for Patient Notification
            The iPhone EMR, Technology and Practical Use
            iPhone and iTouch Applications for Use in the Clinical Setting
            Payers Offering PHR Information on the Cell Phone
            Mobile Health ROI: Improving Outcomes and Reducing Costs
            The Cell Phone Culture and Healthcare
            Mobile Solution Boosts Medical Practice's Revenues 20% While Enhancing Care


5.  EMRs
            Navigating the Waters of Hybrid Medical Record Management
            Improving Quality with an EMR: Working Smarter, not Harder to Provide Better Care
            Using IT Solutions to Attract and Keep Patients
            Opportunities Lost in EMR Implementation Interoperability – It’s Not Just About IT


6.  Emerging New Practice Models, David C. Kibbe, MD, MBA, Senior Advisor, AAFP
  

    

 

The new stimulus bill is huge in terms of dollars, winners and losers.
Once again, big corporations are the winners and the little guys can't get in the game.  I take this personally, because I work for a small start-up that provides IT solutions to small physician practices at low to moderate pricing.

Frankly, I do not see how this bill will encourage us to spend tax dollars wisely.

One provision of the bill mandates that federal funds only be used for health information technology that is certified by the Certification Commission for Healthcare Information Technology, or CCHIT. Mandating that physicians use bloated CCHIT certified emrs will only aid large vendors who have the deep pockets to fund CCHIT certification. 

Certification does nothing to encourage innovation. Instead, it erects roadblocks to fresh and frugal ways for small physician practices to adopt software systems. Members of Congress, before signing this bill, please ponder these questions:

1. What happens when large corporations influence decisions where they have a conflict of interest?

(Have we forgotten the subprime mortgage lending crisis already?)
CCHIT's board includes stakeholders from GE (NextGen), Siemens, McKesson, BlueCross Blue Shield – all big players in healthcare or healthcare IT. 

2. What value does the CCHIT certification process provide to providers or patients?

Why not just mandate standards that are already in place, such as HL7?

3. Are physicians so feeble-minded that they cannot make IT decisions without CCHIT’s help?

(I mean, they did make it through med school)

Mark Leavitt, MD, PhD, CCHIT chair,  has been quoted  as saying the benefit of CCHIT certification to physicians is that it will “simplify the decision-making process…for physicians starting from scratch, this will be a tremendous help because they know that those products (on the Web site) meet the certification standards.”

4. Do barriers to entry in the marketplace enhance competition?

With an initial price tag of about $36,000 just to participate in the certification process, competition is limited to large corporations with deep pockets. Less competition does not promote lower prices, but somehow Leavitt thinks it does:

"Our goal at CCHIT is to see the market, and the value of the EMR, accelerate with certification in place. When this happens, vendors can sell at a lower price and invest more in research and development or attract more capital."

5. Will large corporations offer affordable healthcare IT solutions?

As Clayton Christensen from Harvard Business School says, "Direct competition among U.S. automakers did not give us more affordable, quality cars - disruption by Japanese (and now Korean) companies did. Breaking up AT&T to induce competition among the Baby Bells did not bring more affordable telephone service - disruptive technologies like Voice Over IP (VOIP) did."


6.  Is certification in anything necessary in a Web 2.0 world?

Give me user reviews any day over a rating by a quasi-private organization. What are the real users of the product saying? Is it useful? Is it expensive? Is it worth it? Recommendations by trusted sources, even if those sources are online, are invaluable in making IT decisions.

7.  $36000 just for the first year of certification, really?

 

    

 



If you are sick, one way to get better care is to consult the internet.

Not by typing your symptoms into Google for self-diagnosis, but by tapping into social networks to find the best doctor and health care facility. Researching symptoms online can make you feel like you are doing due diligence, but your time is far better spent finding a person who has the education and training to properly diagnose your illness and provide you with the best care for your condition.

Social networks like Facebook, Twitter, and Linkedin are perfectly suited for doing this type of research because they are based on relationships, reputation and trust.

The best ways to utilize social networks to get better care are:

1. Ask for recommendations from friends

Whether you are job-hunting, electronics shopping or considering the latest movie, there is nothing like a recommendation from a friend to propel you into action. Admittedly, a healthcare decision is more weighty than your next flick-pick, but a trusted source will not risk their reputation by steering you in the wrong direction. As my online mentor, Seth Godin says, "We are almost always in search of recommendations, especially from people who don’t seem to have an ulterior motive."

2. Even better, ask friends who are doctors

This works even if you know a doctor in a distant city. One of the greatest benefits surrounding social networks is the ability to connect people who are otherwise separated by time and distance.

Ask any doctor friend, regardless of where they live, if they know a doctor in your city.
They will know someone, either from medical school, internship, residency or other training that lives in your city or region. The next step is to contact the local doctor to suggest a doctor trained in treating your condition.

 

3. Confirm that the physician is board certified

A doctor's profile on any of the social network sites will list credentials such as board certification. It is a good idea to verify this information by visiting the granting board's website. For example, your internist should be certified by The American Board of Internal Medicine. Board certified physicians must undergo approved training at credentialed institutions, pass rigorous written and oral exams, participate in continuing education and recertify after a period of time (varies according to specialty).

4. Verify fellowship or other specialized training

Again, this information will be listed on a doctor's profile.
In orthopedics, for instance, there are fellowships in sports, joint replacements, hand surgery and trauma. If you are about to undergo surgery, it makes sense to find a doctor who has specialized training in the procedure.

5. Research your hospital

Even hospitals have embraced social media. If you require a hospital stay, research your medical center on Twitter or Facebook. There are roughly 35 hospitals currently on Twitter. The Mayo clinic has a Facebook page that boasts over 4,000 members. These 4,000 individuals, as friends to that organization, may be able to answer questions that cannot be gleaned from the hospital's website.

Social media is all about who you know (and trust) - and who they know (and trust)- and so on and so on. What better way to get better care than by enlisting those whom you trust?

 

    

In this post I noted that patients want more online access to their doctors. Most of the suggestions << MORE >>

TechCrunch recently posted about their prototype Crunchpad, a bare-bones tablet for web-surfing. << MORE >>

I love this post by Joshua Schwimmer, M.D. where he lists his predictions for iphone applications that will be developed and rolled out in the future. While we wait for those,<< MORE >>