Thursday, March 27, 2008

Plant City Florida known for great Strawberries!

My two latest EHR prodigies! These two guys have a nice office in Central Florida. They are in an aggressively growing urban area in Central florida. Nearby Plant City is know for its' Strawberries in the Spring and Tomatoes all year long. They are also home to the Strawberry Festival in February. (Check out the Strawberry festival site! Click on the Royalty tab when you get to the site... That's cracking me up with the Royalty tab.. !!)
The city had the parade down our street while we were customizing a few weeks ago. We were shut ins due the the parade going right down our street so we made sure a drug rep brought lunch that day to keep us nourished during the jam session of template production!
the Lead Dr. is no stranger to the Healthmatics EMR from A4. He went through Family practice residency with 3 doctors I took live on Healthmatics 3 years ago in Jacksonville. (Queue the "It's a Small World" music!) This is the fourth client I have had where they all had ties to the Same Residency class from St Vincent's in Jacksonville.
The Dr did the research for the other Dr's and chose Healthmatics. He has been instrumental in securing 3 or 4 customers for us without even owning his own EMR at the time! (He was still a resident at St Vincent's in Jacksonville) The Dr. recently left a large clinic in Central Florida who has been seeing a sudden decrease in their physician staffing due to a rough transition to their EMR. Seems like workflow was not well thought out and customization was not put in place soon enough to allow for a smooth transition. You hate to see that regardless of who the vendor is... Hopefully they get it turned around ... This has been the 4th Physician I have heard who left that clinic to go solo and purchased the EMR I implement.
Both Dr's were quick studies and they have learned to customize and are getting a nice head start while they are building their practice. We already have the LabCorp interface up and going at Go-Live and they just need to set their webpage up to get the Patient portal running. He should have fun over the next few weeks getting all the toys tweaked. The new practice also purchased all the bells and whistles from Midmark with the Spirometer and EKG that can interface to the EMR.
I'm excited for them I always enjoy working for a new start up practice. This is my 4th start up practice to install this year and I have had 10 or 11 start ups in the past year. I have 2 more new start up practices that I was just assigned this week so I'm looking forward to the initial setup of these offices and watching them grow. It's a nice change from the established offices withtheir mountains of patient charts on an intricate chart rack system and years of consistent scanning ahead of you. Nothing better than a new office with no chart rack in site!! Love those offices!!

Wednesday, March 26, 2008

Phreesia Tablets

Wanted to share my experience with the new Phreesia Tablet. I'm doing an EMR go-live this week and the Dr. at this site in Plant City Florida, was contacted via a postcard mailer to try the Phreesia tablets. They are pretty cool Tablets that allow the patient to enter their medical data into a question and answer software. These Tablets are provided free of cost from Phreesia. They are supported by ads that the patient can watch after they are done entering their data. The tablet has a card reader built in. You may be able to see it on the right side of the tablet. They received two identical units that the Dr. configured and set up on his network. They are wireless and come with a wireless router you install in your network and software you place on a PC on your network. That software allows you to review and configure the application on the tablets.

Configuration is setup of the questionnaire which is basic patient history like allergies, past medical, Family History, Demographics, Insurance info, Social History, Medications, Review of systems, and a chief complaint you can pick from a list of most common complaints. Not sure if you can customize any templates or chief complaints. The patient swipes their credit card in the reader and it reads their information and provides a name. (Or they can type the name) Then they are asked for a Date of birth and a pin like the last 4 of your social security number. They are asked gender, demographics, etc. and the interview proceeds with the user touching buttons on the tablet or using a stylus to click through. After the interview the patient is shown an ad from the sponsor of the day. They can skip this ad and then get patient education provided which is linked to the chief complaint they entered earlier. If they had Headaches, it lists patient education on headaches, if they also entered High Blood pressure as an additional complaint, it provides that also. Pretty neat and gives the patient something to do and information to read prior to the visit.

The practice then either prints a PDF of the data or gets a CCR download. This looks like a good first step and is a great idea for practices with no kiosk, patient portal or waiting room kiosk like a Galvanon (which is expensive I hear)

A few draw backs I have noted.
  1. The data is in text format and not "codified" so it's not discreet data yet.
  2. The patients have had some resistance in using this each visit new and follow up.
  3. The patient portion and the MA data entry time is longer than an MA interview while entering data.
  4. The Medications do not contain dosages etc for a script.
  5. They do not read Driver's Licenses yet.
  6. Specific Complaints do not trigger special interviews geared toward those complaints.
  7. The data does not interface to an EMR at this time.
  8. The only data exchange is via a CCR record which has no standards yet.

Some Benefits

  1. It is really cool technology to have!
  2. It gets patients in the mode of using a wireless device to enter their own data
  3. Easy to use and large buttons are easy on the eyes and on the Grandparents.
  4. Lots of data ports on the tablet.
  5. Prints off a nice PDF that you can scan in or use for data entry.
  6. Second visit is easier since data is retained from each visit.
  7. Prompts patients to provide information that they might not feel comfortable writing on a piece of paper.
  8. Reduces spelling errors by patients.
  9. Reduces reliance on poor penmanship by the patient.
  10. Can prompt the patient for specific data needed.
  11. Places the burden of data entry on the patient.
  12. provides a PDF or CCR that can be loaded into an EMR at some point.
  13. Can be used to collect co-pays and payment in a few months.
  14. Does not feel guilty asking the patient to pay their portion of the bill or a bill in full.

It's a great first step and I think this company has a great idea they just need to codify it quickly and get it interfaced to an EMR where you can import the ROS, P/E and HPI sections of the note along with History, Demographics and Insurance data to match the power of a Kiosk or patient portal.

All in all it's a neat device and with a few modifications and additions in the software will make a great addition to any waiting room.

LINKS about Phreesia:

Monday, March 24, 2008

Common Ground Health Clinic Gets An EMR!

It is with great pride and pleasure that I'm able to fill you in on the fact that Common Ground Health Clinic is now Live on an EMR. HIMSS helped in getting a donated EMR to this free clinic to help provide better care for their patients. They completed go live the week of February 18th. I was able to provide training and go-live support and attend Mardi Gras... At least I have my priorities straight right?

What a great experience this has been personally for me to take this client live. Great thanks to everyone at my company for allowing me to participate in this client’s project. I’m really humbled at how hard these volunteers work to provide FREE healthcare to the people of New Orleans.

When I was assigned this account in late December I was told we need to get them live prior to HIMSS the last week of February. I heard they were a free clinic staffed by volunteers and was a little worried about this project. They have a great staff and once I met everyone and saw how dedicated they were I knew they would do a fantastic job!

Common Ground Health Clinic was founded a few days after Hurricane Katrina hit the Gulf Coast. This free clinic started as a street clinic and eventually moved into a local Mosque for a few months before moving across the street to a vacant store located in the Algiers section of New Orleans. Their reach is felt over a 20 mile radius. Healthcare and medications are dispensed from MD’s, NP’s and Nurses who are all Volunteers at the clinic.

Post Katrina many of the normal healthcare channels that provided free or low cost care to the people of New Orleans were closed due to the closing of many local hospitals and clinics. This clinic was started on September 9th by street medics who were basically EMT’s Nurses and Healthcare clinicians that decided to provide free care to people in need.

Since this is a free clinic, this was a radical change from the standard install we do every week. First of all they do not bill the patient. As an Implementer that has implemented EMR’s for over 10 years I’m programmed to naturally seek the best path for our client to seek maximum reimbursement from the insurance company. Everything in our daily life is geared towards coding, and I mean everything. At his clinic there is a completely different approach, everything is provided free of charge and donations are accepted but not necessary. All staff are volunteers which means new people every day. They are staffed with 5 Volunteer MD’s one Full time Nurse Practitioner and 5 volunteer nurses as well as volunteer front desk and office staff, 18 staff in all. The client’s website is located here.

Also a You Tube Video that provides insight into the process of how the clinic started. And the feelings in New Orleans that prompted volunteers to do something for their fellow neighbors. Their Slogan is “Solidarity not charity”. The little clinic that could video shows the Narrator Anne who is the Nurse practitioner. Ed is the Man in the video that works at the front desk now. Both are great people to work with!

The clinic opens at 8:30 AM and is a Walk-in clinic where healthcare and medications are provided on a first come first served basis. Walk-in charts are assigned a number 1 to 30, etc depending on how many people show up and they are seen in sign up order.

The patient is taken through “Intake” where a nurse triages the patient and uses our intake FastTrack to guide them from screen to screen to capture vitals, chief complaint, Allergies, Social History and provide basic labs of a glucose check, if Diabetes is in their Family history, or provide basic immunizations or other in office labs. The patient is then placed back in the waiting area until the MD or NP can see the patient. The MD takes over the chart and provides the additional care. They utilize the Wal-Mart $4 prescription list as their “Formulary” for medications. They also dispense free meds from supplies attained from Drug companies and other health clinics that send in their overstock of free samples. If you are affiliated with a drug company make sure you contact the clinic to see how you may contribute to their project.

The Volunteer doctors are thrilled to be using E-prescribe. They all work in other clinics for their Day job and many use EMR’s but none had e-prescribed before.

Thanks to the Assisting Dr. who mentored the Staff during go live. The Dr. was on site a few days and saw abut 10 patients each day himself in the EMR, and provided a tremendous amount of education and advice to the clinic from his 10 years of using an EMR. David Collins from HIMMS was onsite also and was responsible for gathering donations from my employer and other vendors like Dell, HP, and Fujitsu etc for all the donated equipments to the clinic.

McKesson donated $20,000 in cash. Great Job Big Mc! They have since received a grant to provide health services and with that grant of course comes the need to provide information.

I’m very proud of my company for their role in this project. It was a great day to wear RED when this client went live on our donated EMR system. From the server to the software to the desktop PC’s, Hand Held Fuji tablets, Fuji scanner, HP Laser printer, Cisco Access point etc… All were donated by my company and individual vendors to get this project going. HIMSS took this clinic under their wings and mentored them through to the finish. This is a great example of how my company is giving back to the community.

I was onsite for staff training last week and trained 5 MD’s, 6 Nurses, and 7 office personnel, for a total of 18 volunteers. We started seeing a few patients in the EMR last week and then saw all patients Monday and Tuesday of this week in the EMR. Totals were 18 patients for Labs Monday morning, 20 patients Monday afternoon, 28 patients Tuesday in the clinic. All notes were completed in the EMR 100%!!

The office is doing great and I’m so proud of all the staff and how hard they worked to get this accomplished. This clinic has done a fantastic job of getting ready for the EMR tidal wave that hit them this week. It’s great to work with people who are excited and LOVE what they do every day and are doing it out of compassion rather than for a paycheck.

The clinic is so thrilled to be using a top notch EMR! They marvel every day at just how far they have come from a street clinic on a sidewalk to a full fledged clinic with 5 exam rooms 4 intake areas and even Herbalists on site to provide Alternative medicine.

We are waiting to hear from LabCorp to see if they will supply a Lab Interface… If you have contacts with LabCorp in New Orleans ... Please drop a note and let them know how great a result interface will be for this group. OR better yet a donated LabCorp Phlebotomist and a Bi-directional interface.

If you have other stories similar to this please post them to comments so we can share how EMR companies are giving back to help those clinics who are not able to afford an EMR.

I return the end of April and first of May to complete their project. This just happens to coincide with the Jazz and Blues Festival. Let the good times roll!!

Sunday, March 23, 2008

Comparing Oysters in Nawlins

Acme Oyster House in the French Quarter is where these beauties came from!. I sat on the corner of the oyster bar next to the front door and ate a half dozen raw. Man were they sweet! I also had the Grilled oysters which were great. They are comparable to the Famous Drago's grilled oysters. I had Drago's grilled the night before. Loved the multiple Tabasco Sauces. The smoked one was new for me and it was just right on one of the oysters. I also love the Trio Oyster Sampler at Bourbon House Seafood and Oyster Bar. The Fonseca is the best for me. The BBQ oysters at Redfish Grill on Bourbon street are very unique and surprising ly not as hot as I thought they wuld be very good appitizer.

Friday, March 21, 2008

Allscripts- Misys Merger

Having spent the past 25 years in Healthcare IT. I have seen a lot of companies come and go.
The past 19 years of my career have been spent at +Medic (Misys) and A4 Healthsystems (Allscripts). I have to admit I had an inkling this merger would occur for the past year. I went through the +Medic – Misys merger and the A4 – Allscripts merger and have seen great benefits from both.

Announcement day I did feel a little like Luke Skywalker when he found out Darth Vader was his father! The dark side had now become one with the force.
Reflecting on this merger for the past week has lead me to believe that it is a very important first step towards a more effective approach to solving the Healthcare EHR adoption rate in this country while fast forwarding the “interopability” rates of the current EMR’s/EHR’s.

Yes there are a ton of products and yes there will be some sun setting of current EHR’s take a look around HIMSS and see how many little companies are doing the exact same thing with little or minimal differences in their software. I think we tie ourselves to a product or brand name and derive our sense of personality and who we are from a piece of software. We should step back and analyze more from the stand point are we helping or harming the Physician and how they practice medicine. I also realized how many of my friends are still at Misys and how many family members we will now have at Allscripts, once this merger completes. I think Dr Morrow summed it up well in his article. Free registration gets you the article.

I think we need to re-evaluate our emphasis on what we are really trying to achieve here. We should have less focus on my software can kick your softwares ass... and more focus on what service are we really providing for our providers. Are we first seeking to do no harm?

Much has been said here about workflow and how we can’t change an offices workflow and have the software adapt to the provider and not vice versa.

Let’s take a look at a few examples of where workflow should change. Option A (antiquated) vs option E (EHR) I can list 20 or 30 of these off the top of my head but lets start with this simple one.

A. Patient calls to speak to the Dr to get results on a lab test. If you are lucky enough to talk to the Dr you get your results on that one call. (We all know this rarely if ever happens) What usually happens is the phone operator without an EMR writes a hand written message then passes that to a medical records clerk who pulls the chart and paper clips the message to the chart and places the chart on the provider’s desk. The provider who is busy with patients may see the chart and make a call back at Lunch (if there is no drug rep chatting them up at lunch) or after the day is done, which usually means a message on a cell phone or answering machine. The patient meanwhile sits and waits and worries for hours or days until contacted. Once contacted, and usually by an MA or front desk person, who may not have the results in front of them or know how to interpret the results, they are told they are WNL (Within Normal limits). The patient then asks for a copy of the results (so they can Google them to get some answers for a change) and are told they can not be faxed to your home since it is not a secure fax but you can pick up a copy at the office. You pick up a copy the next day or whenever you can get by the office and notice a few lab values at the upper limits of normal. You call again to ask about these values and you now start this whole process over again. Now if you are happy with that work flow continue to seek out an office with no EMR. If you prefer a more modern approach try this.

E. Your results come back via a lab results interface and the physician signs off on the results within minutes of receiving them and publishes these results to their patient portal. The patient receives an email that they have results posted to their portal and can access their secure login to the portal from home or office and receive the physician’s message as well as the results. The results can then be printed on their home computer or exported to their personal health record. You reply to the physician about the top end normal’s via a secure direct email to your physician. Your physician replies within minutes to your concerns. This is all completed in less than an afternoon. So take your pick which workflow works best for you versus works best for the Doctor? Why preserve the paper version?
I was providing follow up training at an OB/GYN practice this past week in rural Georgia. We are talking a tiny, tiny town here people way up in the mountains. This practice is 100% EMR after being on the EMR for 2 months. I’m talking GYN patient and OB patients. (If you are not familiar with this specialty and the trials of going on an EMR then let me tell you that’s a remarkable feat!) They get how this product can change their ability to provide service to the community. The Hospital meanwhile maintains a paper chart.

While I was training a provider on a template design tool on how we can process their Hospital Short Stay report from our EMR and fax to the hospital while in the Hospital rather than complete it by hand in the hospital…. The Caregiver received a call from Labor and Delivery in regards to an OB patient who was in the ER and the nurse had a few questions. The Caregiver without getting up from her chair… Pulled the patients chart, accessed her pregnancy record, (ACOG form) reviewed a few items, reviewed the online fetal monitor Real time, and was also able to have her discharged in a few mins. She even e-prescribed an antibiotic to the pharmacy which would be ready for the patient once she arrived. This all took about 3-5 minutes, if that. Most was taken up by conversation to the Nurse.

When she hung up I asked how long that transaction would have taken on paper. She replied, “Hours.. and that’s if I could find her chart… I also would have had to drive over to L&D and review her monitor tapes and her chart there.” Again, which workflow do you want to preserve? Keep the mother in the ER for hours needlessly on a fetal monitor and IV etc., or let her go home and pick up her script while on the way home and be done in 15 minutes??? How much was actually saved in ER time and valuable Nursing time not to mention supplies etc with the new workflow? We may never know but you can guess hundreds or thousands of dollars a day.

I routinely contact every client I take Live on our EMR one year and two years after their go-live and ask how things are going and would they go back to paper. Every client has answered no way. Now if you ask this question at 2 weeks or 6 months they may say heck yes take me back! But once they make the move to a total electronic record they rarely if ever want to go back to paper. You have to put in the effort and the results will come … some immediately like e-prescribe, lab interfaces, completing charts notes in the same day, no more lost charts, and faxing consult letters at the end of the visit etc…. Others benefits take a few months or years.

I think this is a bold first step towards a much needed consolidation of the EHR Market place. Many more will soon follow and I can’t wait to see how 10 years from now this will be reflected back on as the starting point of a great expansion in beneficial Healthcare technology. Working toward a common benefit rather than erecting competing fiefdoms that do little to advance EHR adoption.

Allscripts and Misys need to remember that a company is made up of people. Those people provide the companies reputation. People enjoy working for a company where quality of life and a fun factor are present. How the company treats its employees and how much of a fun factor they maintain will go a long way in determining their future and their reputation. Which will also lead to more clients and higher revenue.

Saturday, March 15, 2008

The US is taking a beating

OK ok... I have to admit . When I saw this article in Forbes it shocked me. I have to tip my hat to you guys from India and Russia. You are rocking it when it comes to new Millionaires and total Millionaires / Billionaires. Keep up the good work and share the wealth.

Cadiz and everyone who commented on my blog. Smile for a few minutes and then go make friends with a new Indian or Pakistani or Russian who is new to your company, neighborhood or church. We are all American and that's all that matters.

Here is the impressive chart from Forbes.

First the Article.

And secondly the entire list.

8 out of the top 24 are from the US.
4 of the top 24 are from India

Wednesday, March 5, 2008

BNA Bound

Headed to BNA today (Nashville) I'm providing Follow up training to a Family practice that is a new office in Murfreesboro, TN. I have a ton of great stories to tell and will blog my butt off when I get to the hotel in Murfreesboro Tonight. The flight leaves at 6:50am. So another 4:00am wake up call to catch the first flight up. The kids have games this weekend first day of Spring baseball and softball. Michael and Katie are doing well and they are standouts on their respective teams. I met with the Oncologist today for my 3 month follow up they drew blood and I'll know results in a day or two. Going in for another MRI Friday AM. Hoping to find no difference in the spleen. Looking forward to getting back to NOLA later in the spring. Common Ground is doing well and I checked on their server last night and it looks like they are maintaining their ability to enter progress notes. I had to add this Picture of the Tennessee Scrubs. My Wife Went to UT in Knoxville and when you are in Tennessee you can't escape the big orange or the power T. Go Vols! The Medical Assistant at Genesys Family, Valerie, had to show them off.