Monday, January 27, 2014

The Lucey Disease

My associate has recently come down with a new syndrome related to extensive interaction with the Electronic Health Record.The symptoms are an overwhelming desire to shout expletives, when distracted the data he is inputting is now located in the wrong place!

When reviewing the condition, it is characterized by calm demeanor that explodes into frustration, anxiety, stress and the use of inappropriate language in the clinical setting.

The individual is confused and frustrated by the less than simplistic navigation, complex interfaces, and inability to remember the last known "work around".

This diagnosis could not be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  It is used or relied upon by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, the legal system and policy makers.

However, treatment has not been well studied but reassurance, back-rubs, and electroshock convulsive therapy seem to ameliorate the symptoms.

Sunday, January 19, 2014

Can a Physician Run a Business???

Physicians have run small businesses for years with varying degrees of success.  Success can be identified multiple ways: 1. Financial; 2. Personal Satisfaction- being a good doctor; 3. Psychologically Rewarding- ego gratification; 4. Etc.; 5. Etc.

Physicians are excellent at providing good medical care and excellent at thinking that this automatically translates into productivity, process improvement, patient satisfaction, financial reward, and efficiency.  They mold their practices, so that everything works reasonably well, according to their personal vision of how it ought to function.

With the continual addition of more rules, the Affordable Care Act, meaningful use, and higher costs of keeping practices open, many offices are closing.  Whereas, the application of some sophisticated guidance from outside consultants could help.

Physicians may consider hiring such consultants, and often their first recommendation is to create a "Business Plan" representative of the physician's, or practice's goals. Such a plan is corporate-speak for an organizational strategy to achieve those goals, and is customarily laid out on paper.  However, many doctors, if they have a structured overall plan, often maintain it solely within in their own minds, if maintained at all.

Decisions always have to be made for that plan, and therefore always evolving to keep up with the ever-changing practice environment.

Examples include:

  1. What Electronic Health Record works for this practice?
  2. Is the meaningful use incentive funds worth it?
  3. What computers to purchase?
  4. How many providers are necessary- physicians, NP, PA, medical assistants, voice activated technology?
  5. Do we staff to demand- right number of people at the right time of day?
  6. What malpractice to choose- my bias is the least expensive with the lowest limits of coverage acceptable-?
  7. Should we perform labs and x-rays in-house or partner?
  8. Should we do our own billing?
  9. What about ICD 10?
  10. Do we accept Medicare and/or Medicaid?
  11. How do we get credentialed with payers?
  12. How much do we market or advertise?
  13. Do we rent, lease or purchase space?
  14. Should we sell out to the hospital to eliminate 1-8- what happens after the 2- year honeymoon period?
These are complex questions with no easy answers.  Best decisions in this regard are always made when time is taken to get sufficient data and advice before making adjustments.  But even if decisions are made to change practices, changing behaviors is not so easy, no matter what the facts, or realities of the particular care setting say.

Wisdom is not always easily acquired, and one should carefully listen to those both within and outside of the particular workplace in question.  Optimizing one's practice through small incremental steps with limited investments can be richly rewarding.

Monday, January 13, 2014

Search Engine Optimization

Being technologically impaired according to my offspring, I never understood the mechanics of how Google, Bing, and other search engines know how to deliver advertisements in my mail as well as different web sites I visit.  The term for this process goes by the acronym SEO (search Engine Optimization)

SEO is accomplished through keywords on which searches are initially based.  On the other hand, after the keywords themselves are injected into the mix, there is the rank given to the website, which determines whether it will appear on the search results, and where on the returned links it shows up.  Larry Page, one of Google's founders, first introduced the concept of rank; hence, the first algorithm used for ranking was called Page-rank(though many have mistakenly thought it meant to reference web-page rank).  Rank, in essence, determines the "popularity" of a given site for the keywords submitted.  Popularity is determined through complex formula that analyze not only how many hits a site has, but also how many other webpages link to the site receiveing the ranking.  Industries have appeared over the last decade that promise to increase ranking and improve hits on a website.  Hence search results, in general, must be viewed with a measure of skepticism, as with any advertising.

The following is a description of an optimal EHR having multiple keywords within the content.

The EHR is being used in hospitals, emergency departments, urgent cares, family practice and specialty private offices to fundamentally change work flow and processes.  The EHR contains databases, charting systems for physicians, physician assistants, and nurse practitioners, nurses, and support staff.  CPOE (computerized order entry), patient education, e-prescribing, report generation, and tracking board.   The database has the ability to scan in outside document or attachments in the record, which can be imported to the contemporaneous patient encounter.  The medical record should be voice activated technology and ICD 10 ready.  It should also be able to send secure faxes with reports to the private medical office.

The Practice Management side contains registration, real-time insurance eligibility checks (extremely important with the initiation of the ACA (Affordable care act), scheduling, medical coding assistants (an estimated level of service), billing with revenue cycle management, and multiple efficiency and reimbursement reports.  The data should be backed up redundantly in the cloud to allow instant update.

In the modern world the internet both watches and has a great influence on your potential behaviors.